Monkeypox: Here’s How Colleges Are Preparing For Possible Outbreaks As Students Return

Universities and colleges across the U.S. are preparing for potential outbreaks of monkeypox this fall as students begin returning to campus amid an upswing in cases nationally, marking another public health challenge for schools to manage after years of grappling with Covid-19.

Dr. Ina Park, a professor at the University of California San Francisco School of Medicine, told Forbes that while monkeypox “does pose a risk to students,” the risk is different from that posed by Covid-19 and there is not a concern about catching the virus through everyday activity or passing someone in a corridor.

The main issue is that students live together in close quarters and gather to socialize, including hookups where close contact like kissing, skin-to-skin contact and sex might happen, Park explained, adding that the virus could also potentially be transmitted through sharing clothing or sleeping in someone else’s bed.

Numerous universities told Forbes they are in contact with local and federal health authorities to plan their responses and some schools, such as Texas A&M University, said clinicians at student health services have taken part in CDC training related to the disease.

Other universities, including Georgetown University and NYU, said student health services are able to carry out the specific testing needed to diagnose monkeypox.

Disinfecting desks or public toilets—surfaces the monkeypox virus can live on—could be one way of minimizing the risk to students, Park said, as would vaccinating students who are men or transgender people who have sex with men and expanding access to all college students when supplies permit.

Evidence-based education—especially alerting people to “the fact that monkeypox is transmitted through intimate contact”—will be crucial, Dr. Marina Klein, a professor of medicine at McGill University, told Forbes, as well as training campus health services to be on the lookout for potential monkeypox cases.

Monkeypox primarily spreads through close physical contact, as well as contact with contaminated objects and surfaces like bedding or clothing. While infections are clustered among men who have sex with men—data suggests the outbreak is largely driven by sexual activity—there have also been cases in women and children and experts told Forbes there is a risk the disease could spill over into other groups and obviously these communities are not self contained and members also attend university.

Experts stress the importance of balancing the provision of accurate information about the risks of monkeypox and how it is spreading and avoiding stigmatizing the groups most affected. Campuses also face a number of unique challenges when managing disease outbreaks, the American College Health Association (ACHA), told Forbes, such as how to isolate people with limited housing available and managing the disruption a two-to-four week isolation period can cause to students. The organization said it is working to develop tailored guidance for campus settings.

What To Watch For

How universities communicate about monkeypox. Several universities told Forbes they are following guidance from local health departments and the CDC, though this advice does not specifically address university settings. Many universities have set up informational websites providing resources and guidance on the virus, while some like NYU, the University of Texas at Austin, Texas A&M University and the University of Michigan told Forbes they have also emailed staff and students about the outbreak and will provide updates as the situation evolves.

Other universities have gone, or plan to go, further in communication efforts: the University of Florida told Forbes it is increasingly promoting safe sex messaging and Texas A&M University said the school is pushing out information on the disease via social media and flyers in residence halls and high-traffic areas. Guidance and protocols are sure to evolve as the outbreak does; NYU spokesperson John Beckman told Forbes the university is “closely following developments” and staff at the student health center are on “heightened alert” to respond.

There are also broader impacts of monkeypox to be considered, Cornell’s director of media relations Rebecca Valli told Forbes, adding that the school is considering “the potential academic impacts and accommodations which may arise” should a student come down with monkeypox.

There have been 10,768 confirmed cases of monkeypox in the U.S., according to numbers from the Centers for Disease Control and Prevention. The overwhelming majority of cases have been among men who identify as gay, bisexual or who have sex with men and transmission is suspected to have occurred through sexual activity in most of those infected.

The World Health Organization , the White House and a number of local jurisdictions have declared the outbreak a public health emergency and a vaccination campaign is underway to target groups most at risk of the virus. Supplies of Jynneos, the only vaccine licensed against monkeypox in the U.S., do not come close to meeting demand for the shot and U.S. officials have greenlit a dose-saving strategy to stretch the stockpile.

Though the outbreak is largely, though not exclusively, limited to men who have sex with men and spread through sexual activity, concern has grown among officials that the disease could spread more widely. The close-contact campus environment, notably dorms, contact sports and sex, have flagged colleges as more likely to experience outbreaks. At least five schools—Georgetown University, George Washington University, the University of Texas at Austin, Bucknell University and West Chester University—have already reported monkeypox cases, according to STAT News.

McGill’s Klein said it is “inevitable” that monkeypox will spillover into populations other than men who have sex with men, which could happen more easily in situations where people are living in close quarters. “There is no need for panic,” Klein stressed, urging strong and sensible messaging on how monkeypox is transmitted and reinforcing “messages about how to be safe when having sex,” especially with casual contacts. “Making vaccines easily available in safe spaces for those at risk would also go a long way to helping stem any potential outbreaks on campus,” Klein added.

I am a senior reporter for the Forbes breaking news team, covering health and science from the London office. Previously I worked as a reporter for a trade publication

Source: Monkeypox: Here’s How Colleges Are Preparing For Possible Outbreaks As Students Return

Critics by: Nicole Karlis

One of the first public health measures triggered by the onset of the COVID-19 pandemic was mass closure of daycares and schools. Indeed, the proximity with which students and teachers congregate in close quarters means that viruses are more apt to spread in such conditions, which made school closures a sensible means of slowing the spread of COVID-19.

Then, last week, news broke that an Illinois daycare worker tested positive for monkeypox. While the worker is isolating, it remains unclear how many children — if any — were exposed to the virus while the infected person was at work. The news raises questions over whether schools, daycares, and the like are safe — from monkeypox — for both workers and their charges.

“An adult at a day-care center in the Rantoul area has tested positive for a case of monkeypox,” Dr. Sameer Vohra, director of the Illinois Department of Public Health, said at a news briefing. “Screening of children and other staff is taking place now.” As parents gear up to send their children back to school, should they expect monkeypox outbreaks to occur in school and daycare settings?

The answer to that requires understanding the way that monkeypox spreads, and how it differs from COVID-19.  Monkeypox symptoms start within two to three weeks after exposure to the virus. The primary mode of transmission for monkeypox is skin-on-skin contact or contact with contaminated items.

Currently, there are more than 7,500 confirmed cases in the United States, according to the US Centers for Disease Control and Prevention, which is nearly double the number of cases since late July. Last week, the Biden administration declared the monkeypox a public health emergency. While transmission is mostly occurring in adult men, in the United States there have been at least five reported pediatric cases.


Yet experts are optimistic about the safety of schools. Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California–Davis, told Salon he doesn’t anticipate K-12 schools to be particularly rife with outbreaks this school year.“Since transmission is primarily via prolonged skin to skin contact,” Blumberg said. “So of course children horse around and they might have skin to skin contact, but usually it’s not prolonged during most activities.”

Blumberg added that another way monkeypox could be transmitted in a school setting is via contaminated linens or bedding. Unlike COVID-19, which is more transmissible but usually less severe for children, monkeypox is less transmissible but can pose a higher risk of severe disease for children under the age of 8.

“I suppose during nap time if kids are sharing bedding or linens, it’s possible that there might be transmission,” Blumberg said. “But most schools and daycares, for now, have their own dedicated area, their own dedicated space, for nap time.”

Dr. Katrine Wallace, an epidemiologist University of Illinois–Chicago, told Salon via email that monkeypox could potentially spread at school “by touching someone’s rash/lesions, exchanging body fluids via kissing or prolonged face to face contact, hugging, etc.”

“So, it’s best (for [monkeypox virus] and for COVID-19 reasons) to emphasize giving each other space in the classroom and not touching one another,” Wallace said. According to the CDC, monkeypox spreads through direct contact with body fluids or sores on the body of someone who has monkeypox. It can also spread through sores that have been in contact with someone who is infected, or materials that have touched body fluids — for example, clothing or bedsheets.

Monkeypox may also spread through respiratory droplets when people have close face-to-face contact. However, experts say this is not the main mode of transmission. According to data from the World Health Organization, 91.4 percent of cases have been linked to sexual contact.

Wallace agreed it is possible for a monkeypox outbreak to occur in communities like college campuses. Understandably, this raises questions about college students in a university setting. “If students are having prolonged skin to skin contact with many others, such as having sex with multiple partners, that will be a risk factor for transmission,” Blumberg said. “And in that case, it’s easy to prevent transmission — if somebody has a rash, then they shouldn’t have prolonged skin to skin contact with others until they get that rash diagnosed and make sure it’s non-infectious.”

Wallace agreed it is possible for a monkeypox outbreak to occur in communities like college campuses.”It is important that colleges and universities are prepared to provide public health education/information about monkeypox to students, have testing/medical resources available to if students develop symptoms, and have an isolation protocol ready,” Wallace said.

Still, there are reasons to protect younger children from any exposure to monkeypox. Unlike COVID-19, which is more transmissible but usually less severe for children, monkeypox is less transmissible but can pose a higher risk of severe disease for children under the age of 8, as noted by the CDC based on limited pediatric data on infection.

“Children who have monkeypox are at higher risk for severe disease and higher fatality rates have been reported in children less than eight years of age,” Blumberg said. “There’s a variety of complications that may occur, including inflammation of different organs, myocarditis, meningitis” — hence the concern about young children being infected.

Notably,  there are vaccines for monkeypox, although supply is limited. As Salon previously reported, the U.S. has released the Jynneos vaccine against monkeypox from the Strategic National Stockpile. Meanwhile, those who received the smallpox vaccine before it stopped being regularly given in the 1970s will likely have protection against monkeypox. While the Jynneos vaccine isn’t being publicly offered to kids nor is it licensed for children, those who have been exposed to it can be vaccinated if it is recommended by the local health departments.

As noted by CDC, Jynneos has been used in studies as part of vaccines against other diseases including tuberculosis, measles, and Ebola. These studies included children as young as five months old, and were found to have no adverse health effects or safety concerns. For worried parents, Blumberg said it is a good idea to make sure that daycares and schools and policies are in place to prohibit potentially infectious staff and students.

“Most schools and daycares do have policies in place so that if somebody is suspected to be infectious to others, they are excluded — and for monkeypox, the key would be an undiagnosed rash,” Blumberg said. “There are many different infections that may cause rashes that may be transmitted to others — so schools and daycares should be pretty experienced with screening for rashes.”

Wallace emphasized how different monkeypox is from SARS-CoV-2, stating bluntly: “this is not COVID-19.””It spreads very differently and is nowhere near as contagious,” Wallace said. “If your child develops symptoms, definitely see a health care provider before sending the child back to school.”

Related contents:

California monkeypox response is bumpy, but builds on some lessons from COVID Jefferson Public Radio

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How To Avoid The Most Common Workout Injuries, According To Experts

A good rule of thumb: Don’t increase your workout volume more than 10% per week. And every four to eight weeks, give your body a rest by significantly reducing the volume and intensity of your workouts. “This ‘three steps forward, one step back’ approach requires discipline and isn’t always fun,” Matthews said, “but it’s the best way to make your body more resilient and durable.”Cross-training is another good idea, which the American Academy of Orthopaedic Surgeons endorses. Since your body’s soft tissues are working in different ways or even resting when you bike versus swim or play tennis, it’s an easy preventive measure.

Diet, stress, sleep may increase risk, too

Avoiding soft tissue injuries isn’t necessarily all about training, however. Research suggests major changes in your environment may affect your risk of injury, too, Cheatham said, such as poor nutrition, stress and lack of sleep. Cheatham is also a member of the National Academy of Sports Medicine Scientific Advisory Board. If you get less than seven hours of sleep at night for more than two weeks, your risk of musculoskeletal injury rises 1.7 times, found a 2021 study published in the journal Current Sports Medicine Reports. So eat well, get plenty of sleep and perhaps skip tough workouts when your stress levels are high.

And what about stretching? Stretching, warm-ups, a post-workout meal and other practices have long been touted to help avoid injury, yet there is no evidence to support these moves, Matthews said. Still, developing a strong core is always helpful, said physical therapist Aime Maranan, owner of Skillz Physical Therapy in Evanston, Illinois.”If the muscles in your core aren’t strong enough to withstand hours of training, their strength will go down, then the stability of the spine will go down, and then your nerves and soft tissues will be irritated,” she said. “It’s a domino effect.”

Core exercises such as the plank are good, she said, or holding the tabletop position, where you lie on your back with your hips and knees at a 90-degree angle. The quadruped is valuable, too. This exercise involves getting onto your hands and knees, contracting your core, then alternating an extension of your right arm and left leg with an extension of your left arm and right leg. Yet these exercises have to be performed properly, or ironically, they could cause a soft issue injury. So consult with a professional before doing them on your own to ensure proper form. This could be your physical therapist, chiropractor, personal trainer or fitness instructor.

Take any injuries seriously

If you do get injured despite your best precautions, take it seriously. “Even when people realize they have a soft tissue injury, they often carry on with their program and whistle past the graveyard, hoping it gets better with time,” Matthews said. “More often than not, it just gets worse and worse until it hurts badly enough that the person simply can’t train due to the pain.”Instead of ignoring that muscle or ligament strain, see a qualified health care provider and expect to spend a few weeks to a month or more recovering, depending on the severity of the injury, your age and other factors. Most importantly, complete your entire rehabilitation process so another injury doesn’t occur, Cheatham said. No stopping the minute you start feeling a little better.

A positive mindset is also key to a speedy recovery. “If you think you will not get any better, you will not get any better. If you think you will get injured again, you will get injured again,” Maranan said. “It starts with your mindset, then religiously doing your home exercises and your post-exercise recovery routine.” And remember, stay mindful to stay true to form.

By: Melanie Radzicki McManus

Source: How to avoid the most common workout injuries, according to experts – CNN

Critics:

Nearly two million people every year suffer sports-related injuries and receive treatment in emergency departments. Fatigue is a large contributing factor that results in many sport injuries. There are times where an athlete may participate on low energy leading to the deterioration in technique or form, resulting in a slower reaction time, loss in stability of muscle joints, and allowing an injury to occur.

For both sexes the most common areas injured are the knee and ankle, with sprains/strains being the most common areas for injury. Injuries involving the patellofemoral articulation are significantly more frequent among females. The sport with the highest injury rate in the United States is American football, with greater than 12 times the number of injuries seen in the next most common sport.

Soft tissue injuries

When soft tissue experiences trauma the dead and damaged cells release chemicals, which initiate an inflammatory response. The small blood vessels that are damaged become dilated which produce bleeding within the tissue. The body’s normal response includes forming a small blood clot in order to stop the bleeding and allows a clot of special cells, called fibroblasts, to form. This begins the healing process by laying down scar tissue.

Therefore, the inflammatory stage is the first phase of healing. However, too much of an inflammatory response in the early stage can indicate that the healing process takes longer and a return to activity is delayed. Sports injury treatments are intended to minimize the inflammatory phase of an injury, so that the overall healing process is accelerated. Intrinsic and extrinsic factors are determinant for the healing process.

Soft tissue injuries can be generally grouped into three categories: contusions, abrasions and lacerations. Contusions or bruises are the simplest and most common soft tissue injury and is usually a result of blunt force trauma. Severe contusions may involve deeper structures and can include nerve or vascular injury. Abrasions are superficial injuries to the skin no deeper than the epidermis tissue layer, and bleeding, if present, is minimal.

Minor abrasions generally do not scar, but deeper abrasions generally bleed and may scar. Lastly, sports-related lacerations are caused by blunt trauma and result in burst-type open wounds, often with jagged irregular edges. Facial lacerations are the most variable of the soft tissue injuries that athletes can sustain. They can occur intraorally and extraorally, vary from a superficial skin nick to a through and through lip laceration, or involve significant vascular disruption or injury to collateral vital structures.

Hard tissue injuries

Types of hard tissue injuries can include dental and bone injuries and are less frequent than soft tissue injuries in sport, but are often more serious.Hard tissue injuries to teeth and bones can occur with contusions, such as Battle sign, which indicates basilar skull fracture, and so-called raccoon eyes, which indicate mid-face fractures. However, tooth fractures are the most common type of tooth injury, and can be categorized as crown infractions, enamel-only fracture, enamel-dentin fractures, and fractures that extend through the enamel and dentin into the pulp which are defined below.

  • Crown infractions are characterized by a disruption of the enamel prisms from a traumatic force, these injuries typically present as small cracks that affect only the enamel.
  • Enamel-only fractures are mild and often appear as roughness along the edge of the tooth crown. These injuries typically can go unnoticed by the athlete as they are usually not sensitive to the touch or to temperature changes. Enamel-only fractures are not considered dental emergencies and immediate care is not needed.
  • Enamel-Dentin crown fractures typically present as a tooth fracture confined to enamel and dentin with loss of tooth structure, but not exposing the pulp. The athlete often will report sensitivity to air, cold or touch, but the athlete can return to play as tolerated and referral can be delayed up to 24 hours.
  • Enamel-Dentin-Pulp fractures extend through the enamel and dentin and into the pulp. If the pulp is vital, a focal spot of hemorrhage will be noticeable within the yellow dentin layer and the athlete may report acute pain. Referral to a trauma-ready dentist should occur as soon as possible.

In addition to tooth fractures, there are several types of bone fractures as well. These types being closed or simple, open or compound, greenstick, hairline, complicated, comminuted, avulsion, and compression. A complicated fracture is when the structures surrounding the fracture are injured, such as blood vessels, organs, nerves, etc.

Overuse injuries

Overuse injuries can be defined as injuries that result from a mechanism of repetitive and cumulative micro-trauma, without a specific onset incident.Rapid changes in physical growth can make children vulnerable to overuse injuries, and these types of injuries are increasing among youth populations. Overuse injuries can usually be classified into 4 types/stages, these include:

  • Pain in the affected area during activity (which does not affect performance)
  • Pain in the affected area during activity (which does restrict performance)
  • Pain in the affected area after activity
  • Chronic pain in the affected area, even after resting

Predictive Indicators of Overuse Injuries in Adolescent Endurance Athletes, runners seem to account for the majority of injuries (up to 80 percent) with the majority of these injuries (more than two-thirds), occurring in the lower extremity and being of an overuse nature.Although incidence rates in senior athletics has been reported as 3.9 injuries/1000 hours of practice, specific injury incidence in youth track and field varies among disciplines; whereas an overall incidence of 0.89 injuries/1000 hours has been reported for high school track and field athletes. In addition, long-distance runners have showed a 19 times higher incidence (17 injuries/1000 hours) than other disciplines.

Head and neck injuries

Head and neck injuries can include a variety of pathologies from sprains, strains and fractures to traumatic brain injuries and spinal cord injuries. Sprains and strains can occur from an abrupt rotation or whipping motion, such as whiplash.Stress injuries (stress fractures and stress reactions) of the lumbosacral region are one of the causes of sports-related lower back pain in young individuals. The onset of the observed cervical fractures in sports injury were likely due to continued momentum that transferred loads superiorly through the neck, which likely exacerbated the injuries to the occipital condyles and the upper cervical vertebrae.

Researchers have reported that 3-25% of cervical spine injuries actually occur after the initial traumatic event and are caused or exacerbated by improper handling during early stages of management or patient transport.One of the more common head or neck injuries that occurs in sports is a concussion. A concussion is a type of mild traumatic brain injury resulting in a chemical change in the brain and has potential to cause damage to brain tissue.

This can occur when a person sustains a hit or blow that cause the head and brain to move quickly, causing the brain to bounce in the skull. According to an epidemiological study published in the Journal of Athletic Training, the incidence of concussions from 27 high school sports was 3.89 sports-related concussions per 10,000 athlete exposures.

Related contents:

Shields vs. Marshall: Claressa Shields Miami/ft. Lauderdale Workout Quotes BoxingNews24.com

09:51
09:50
How to avoid the most common workout injuries, according to experts CNN

16:03 Wed, 10 Aug
“Overuse Injuries – Treatment and Prevention”. SportNova UK. 2017-01-14. Retrieved 2019-08-07.
“Predictive Indicators of Overuse Injuries in Adolescent Endurance Athletes”. International Journal of Sports Physiology and Performance. 12 (Suppl 2): S2-153–S2-156. doi:10.1123/ijspp.2016-0316. ISSN 1555-0265. PMID 27918673.

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Why Has The Misleading Chemical Imbalance Theory of Mental Illness Persisted For So Long

Recently, one of my friends messaged frantically, asking if I had seen the big serotonin study that had been published by scientists at University College London. The study, an umbrella review critically evaluating pre-existing research, concluded that there was little support for the idea that depression was related to abnormally low levels of serotonin. As a philosopher of medicine and psychiatry, I had to confess that I had seen the study and was utterly unsurprised at the results.

It’s true that the authors of the study are controversial figures, vocal to sometimes vituperative critics of the mental health status quo, leaving heated debates in their wake with each new publication. But the authors’ conclusion has been an open secret within mental health circles for at least a decade. The very public dispelling of this “serotonin model” has also removed a key plank in the widely believed but oversimplified myth of mental illness being caused by a “chemical imbalance.” My friend was devastated.

The chemical imbalance myth has its roots in the late ’70s and ’80s when psychiatry was dominated by the desire to understand mental illness in primarily biological terms—as deviations in brain structure, neurochemistry, and genetics. When the first generation of selective serotonin reuptake inhibitors (or SSRI) antidepressants such as Prozac was introduced in the late ’70s, a key part of their marketing claimed that they targeted specific neurochemical imbalances.

Psychiatry is now interested in a wider range of factors contributing to mental illness—including genetics, gut microbiome, environmental influences, socioeconomic factors, and interpersonal stressors—and the marketing of psychiatric drugs is more tightly regulated.

However, as the authors of the new study point out, this initial starting point has already crept into everything from public health messaging to popular websites. For instance, though the American Psychological Association takes no stance on the serotonin model when describing SSRIs, Australia’s Department of Health, describes antidepressants in terms of the chemical imbalance model.

In the past year, 8.3 million people in the U.K. (about 12 percent of the population) took antidepressants. The most recent figures from the United States, collected between April and May by the National Center for Health Statistics, show that approximately 23 percent of adults took prescription medication for their mental health.

The vast majority of these prescriptions, including the one taken by my friend, are for SSRIs. And it’s no surprise that many people who have been prescribed an SSRI believe that they work by increasing the availability of serotonin, thereby correcting the abnormally low levels of serotonin responsible for her depression. Finding out that this story of how SSRIs work was unsubstantiated made her question whether she should be taking them in the first place.

This is a common reaction. As I write this, my social media channels are full of patients who say they now want to stop taking SSRIs. The response by concerned mental health professionals and skeptical commentators has been twofold: First, they are poking holes in the study—usually an important part of scientific method. But in this case I suspect it is sort of pointless, given that many experts already thought the serotonin model to be a nonstarter, and this is a review of existing work rather than new research. Second, they are correctly noting that though we are unsure how SSRIs and other psychiatric drugs work, we have reason to believe that they do—an important distinction.

Medical treatments, including psychiatric drugs, are primarily tested for efficacy, usually via randomized controlled trials rather than more primary research into how or why they work. In many ways, this makes sense: When there is a problem, especially with one’s health, the priority is fixing the problem rather than working out why this particular fix works. Indeed, there are many common medicines and treatments where we are not entirely sure how they work, despite being fairly certain that they do—including acetaminophen (or, as we call it in the U.K., paracetamol).

There are many people who swear SSRIs have improved their lives, and pooled reviews and meta-analyses point toward their efficacy. Based on such reviews,  they are recommended treatments for depression (and a host of other mental illnesses) via the U.K.’s National Health Service and the American Psychological Association. On the other side, critics point to a number of deep issues with this research such as the failure to publish negative results, the fact that trials tend to be funded by pharmaceutical companies, and the exclusion of severely depressed patients from the trials.

And then there is the perennial problem of taking experimental results about a broader population or group and applying them to a particular individual. I am inclined to think the debate over the efficacy has distracted from the main point of the study—in the case of mental health, how and whether something works both matter.

In many ways my friend and I are very similar: prone to severe depression, from the same ethnic background, of similar ages, both philosophers. We have both spent the vast majority of our adult lives in precarious environments that incentivized a certain kind of relentless pursuit of achievements. But unlike my friend, I made the choice, not just once but at many critical junctures in my life, not to take antidepressants. Because I knew that depression doesn’t necessarily come from a chemical imbalance, I knew that SSRIs would hardly be a silver bullet or the only thing that would help.

I also thought about what side effects they would have. One of the primary reasons I avoided antidepressants is because a common side effect of SSRIs is disruption to sleep. My mood is very responsive to sleep, and I worried that I would just be creating a whole new set of problems for myself; a number of people end up with prescriptions for both sleeping pills and SSRIs. The possibility of sleep disruptions, the fact that my mood was very responsive to other interventions, and other potential side-effects led me to my decision.

I do not think there is a correct answer to the question of whether any particular individual should take SSRIs. I can imagine someone in my shoes whose symptoms were more severe and had tried other options making a different decision. But the persistence of the chemical myth of depression obfuscates this kind of decision-making. Though mental health professionals and academic researchers understand the distinction between whether and how a treatment works, these two things come hand in hand for patients, and it has been disingenuous to pretend otherwise.

One of the main reasons my friend was so upset about the serotonin study was because she was now left with a great many questions. If she wasn’t depressed because of serotonin levels, how was she to understand her propensity to depression? Was something else wrong with brain? Her genetics? Most heartbreakingly, she wondered whether it was that she was simply weak. The serotonin model of depression had not only played a part in her decision to take antidepressants; it shaped how she thought about herself.

I have spent a great many years biting my tongue when friends or acquaintances described their depression in terms of chemical imbalances. I hesitated in part because I was fearful of affecting their treatment, something I did not feel professionally qualified to weigh in on. But my biggest fear was intruding on the way in which they understood themselves and their lives.

Because I have seen myself and my tendency toward depression in different terms, the results of the study have not disrupted my understanding of myself. Though I have sometimes wondered why I seem more inclined to low mood than other people and idly wonder whether it some variation in my particular neurochemistry or genetics, for the most part, when I am going through a depressive period, I recognize its relationship to something that is happening in my life which needs resolving or the fact that I work in a particularly demanding field.

I am not suggesting that SSRIs prevent people from considering what might underlie their depression, or that in all cases depression is situational. But when such a compelling story is put forward by authoritative sources, one that explains so tidily why someone feels the way they do and what can be done about it, people tend not to look elsewhere for explanations or solutions. Just as the chemical imbalance myth has clouded making choices about treatment, it has altered how people understand themselves and their lives.

It is a platitude to say that different treatments work for different people, but I find it interesting that both me and my friend have ended up in similar contented places. One of the reasons the study has been so painful for so many people is the sheer variety of experiences. Those who, like me, have refrained from taking SSRIs feel faintly resentful for the many years that they have been made to feel irrational about their choice.

More tragic are the people like my friend who are now questioning their choices and their understanding of themselves. More tragic still are those patients who had an adverse reaction to SSRIs and have spent many years trying to make the psychiatric establishment acknowledge the myth and the way in which it has hidden the trade-offs associated with SSRIs and other psychiatric drugs. Then there are the many patients for whom SSRIs have been beneficial and continue to advocate for their use in the fear that others will miss out on life changing treatment.

On the other side of the fence, I have colleagues I trust and respect with a wide spectrum of views. What is striking is that once you put the bruised egos and the usual financial vested interests aside, the debates, vicious as they are, seem mostly conducted in utter good faith. Both sides convinced that the other is not only mistaken but in danger of harming vulnerable patients either by peddling dangerous, ill-evidenced treatments or through vilifying treatments that many had found helpful. Though it has been upsetting, I cannot help but find it moving that for most parties involved, the priority is the patient and their well-being.

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

By Sahanika Ratnayake

Source: Why has the misleading chemical imbalance theory of mental illness persisted for so long?

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The Surprising Benefits of Training in the Heat

One of the highest sweat rates ever recorded was that of marathon runner Alberto Salazar at the 1984 Olympics in Los Angeles. In the months leading up to the games, which were expected to be oppressively hot, the marathoner was put through a regimen of temperature acclimation training with the goal of helping him adapt to running in the heat.

While Salazar placed only 15th overall, the program was deemed a success, physiologically speaking—vitals taken after the race found that Salazar’s hormonal and thermoregulatory systems were completely normal. His body had compensated by causing him to sweat at an incredibly high rate—about three liters per hour, compared to the roughly one liter per hour for an average human.

Researchers have been looking at the effects of heat on athletic performance for decades, and their results have been consistently surprising. Studies have found that, in addition to an increased rate of perspiration, training in the heat can increase an athlete’s blood plasma volume (which leads to better cardiovascular fitness), reduce overall core temperature, reduce blood lactate, increase skeletal muscle force, and, counterintuitively, make a person train better in cold temperatures.

In fact, heat acclimation may actually be more beneficial than altitude training in eliciting positive physiological adaptations, says Santiago Lorenzo, a professor of physiology at Lake Erie College of Osteopathic Medicine and a former decathlete at the University of Oregon. “Heat acclimation provides more substantial environmental specific improvements in aerobic performance than altitude acclimation,” he says.

And in contrast to the live low, train high philosophy, we more quickly adapt to heat stress than we do to hypoxia. In other words, heat training not only does a better job at increasing V02 max than altitude, but it also makes athletes better at withstanding a wider range of temperatures.

Athletes can adapt to heat in one of two ways. The first is through incremental improvements in tolerance over time—work out in the heat a little bit every day, and eventually your body will dissipate heat more effectively. The second way is through thermotolerance, which is a cellular adaptation to an extreme heat experience, like suffering such severe dehydration after a run that you need an IV.

Essentially, if you shock your system, your body will be able to withstand greater temperature stresses later on. But successful heat adaptation is difficult—and clearly dangerous—to achieve outside of controlled settings. Lorenzo explains that performance gains are possible only when athletes elevate their core body temperature, and without careful monitoring, it’s possible to elevate your core temperature to lethal levels.

When performed safely, however, heat training can have extraordinary effects. This phenomena fascinates Chris Minson, a professor of human physiology at the University of Oregon, who studies heat acclimation responses in athletes. According to his research, heat training can expand blood plasma volume, but Minson says there also seem to be inexplicable changes to the heart’s left ventricle, which helps to increase oxygen delivery to the muscles.

In addition, he says that athletes who train in warm temperatures generally get better at regulating heat by sweating earlier, as Salazar did, or developing a colder resting body temperature.  A 2011 study by a group of researchers in New Zealand also found that overall volume of blood plasma increased at a greater rate when athletes did not drink water during exercise. While some coaches are carefully experimenting with dehydration, Minson and Lorenzo are not because it adds too much additional stress.

However, they do say that this type of training can be beneficial because it produces a higher number of “heat shock” protein cells. Ahead of Western States this June, ultrarunning coach Jason Koop worked on heat training with Amanda Basham and eventual winner Kaci Leckteig. Koop believes this type of acclimating is a good example of blending an academic concept with real-world training. But, says Koop, “at a certain level, you have to compromise training quality for the heat acclimation.

Acclimating to the heat is additional stress [on the body], just like more miles or intervals, so you can’t simply pile it on. Something on the training side has to give.” One method of heat acclimation that Minson uses with his athletes is to do hard workouts on colder days or earlier in the morning, and then start training in hotter conditions with less intensity. He is also looking into adding heat in ways that wouldn’t require an athlete to train in high temperatures at all—using hot tubs, for instance. 

All this being said, not everyone responds to heat at the same rate or with the same physiological gains, which makes it similar to altitude training in that it might make a high-performing age grouper, college athlete, or elite a little better, but it won’t compensate for intelligent, consistent training.

How to Incorporate Heat Acclimation into Your Training Schedule

When acclimating to heat, you’ll be forced to compromise training quality, says Koop. While he understands the benefits of heat acclimation, he still prioritizes smart, solid training. But if you want to incorporate heat into your workouts, here’s how he recommends doing it safely.

1. First, pick a protocol (sauna, hot bath, or exercising in the heat) that minimizes the impact on training, both physically and logistically.

2. Koop most commonly recommends that his athletes use a dry sauna immediately after running. “It doesn’t impact training nearly as much as running in the heat, and the effects are similarly positive,” he says. He often tells his athletes to not drink water during these sessions to enhance the effect. Koop recommends spending 20-to-30-minutes in the sauna, depending on tolerance.

3. Koop says that when he has his athletes exercise in the heat—either naturally or by wearing extra clothing to simulate the experience—it will be on a long, slow day for 60 to 90 minutes. The time completely depends on the athlete’s tolerance and previous experience. But he stresses to not do this on a recovery day, because heat training is an added stress on the body. Koop recommends drinking 30 to 40 ounces of an electrolyte drink per hour during these sessions  And for safety, he advises using low-traffic sidewalks and bike paths—not trails.

4. Despite the benefits of heat training, Koop reminds his athletes that running in the heat is extremely difficult and usually replaces a hard day. “You are substituting one potential gain for another one,” he says. In other words, use it carefully.

Source: The Surprising Benefits of Training in the Heat – Outside Online

Critics by issaonline

Although training in the heat offers some benefits, it does have drawbacks too.

The Mayo Clinic reports exercising in a high temperature environment can sometimes result in heat-related illness. The most common illnesses include:

Heat cramps – These are painful muscle contractions. Though caused by excessive heat, they can also occur when body temperature is normal.

Heat syncope – If the client feels lightheaded or faints due to high heat exposure, heat syncope may exist.

Heat exhaustion – This occurs when the body’s core temperature approaches 104 degrees Fahrenheit. Symptoms of heat exhaustion include nausea, vomiting, headache, and clammy skin.

Heat stroke – If the core body temperature exceeds 104 degrees, heat stroke can occur. This results in feelings of confusion, heart rhythm issues, and vision problems. Immediate medical attention is necessary to help preserve the brain and organs. If untreated, death can result.

Heat stress and heat-related illness are a major concern. Reduce this concern by helping clients acclimate to the heat and humidity common in summer training sessions. Research reveals that the human body goes through certain changes when exercising in a hot environment. Our core body temperature increases, first rapidly then at a slower rate. Metabolic rate increases as well, especially in heat stress conditions. Blood flow is altered to transfer the heat from our internal body to our skin, where it is released via our sweat. These changes are necessary to help prevent the body from overheating.

Though the human body is good at adapting to warmer climates, heat acclimation training improves this response. This enables clients to exercise more safely in hot environments. It also improves their performance. What does an effective acclimation program look like? A study on endurance athletes found that, for those not acclimated to the heat, high intensity exercise increased fatigue and weakened performance. Therefore, a lower-intensity workout regimen is recommended. At least until the client becomes used to the heat and humidity.

Another piece of research noted that 6-7 high-heat exposures are needed to improve adaptation. Each one should be at least 30 minutes in length. If you live in an area that is not particularly hot or it isn’t summer, there are a few ways to add heat to an exercise session. These include using a sauna or working out in heated water. Wearing multiple layers of clothing will also raise the body’s internal temp.

Some gyms and fitness facilities have an athletic chamber. This is a room that enables you to raise the heat and humidity to specific levels. You might also find these rooms at universities and colleges.

Yes, heat acclimation helps boost performance. But its number one goal is to help clients avoid heat illness, heat exhaustion, or heat stroke. Here are a few more safety tips that will help too:

Drink lots of water. Dehydration occurs faster in hot environments because heat increases sweat rate. This makes hydration critical when exercising in hot weather. Harvard University suggests consuming 2-3 cups of water per hour if you’re sweating a lot.

But don’t overdo your water consumption. It’s also important to note that you can drink too much water. This is called water intoxication and reduces the sodium in the bloodstream. This can cause headache, nausea, and vomiting. In severe cases, blood pressure rises, it’s harder to breathe, and the client feels confused.

Consume sports drinks for lengthy trainings. During longer workout sessions, water may not be enough. Because your sweat contains many chemicals and salts, these need replacing. In this case, sports drinks can replenish the electrolytes lost via excessive sweat. Sports drinks also supply a limited level of carbohydrates. This gives your body the energy it needs to continue to work out.

Avoid exercise during extremely high temperatures. If you live in a place where extreme heat is common, exercise when it’s a bit cooler outside. This limits the likelihood that you’ll suffer a heat illness. What’s the best time of day to exercise in this type of environment? Either early in the morning or later in the day.

Pay attention to the humidity. When it is both hot and humid outside, the body responds differently than in dry conditions. Specifically, humidity increases your sweat rate, which impacts your hydration. The Cleveland Clinic suggest not exercising if the humidity is over 80 percent and it’s 80 degrees or higher.

Wear the right clothing. Your body must be able to sweat to better control its internal temperature. Lightweight clothing assists with this. Wearing clothing in lighter colors is preferred as well since they don’t absorb as much heat as dark colors.

Monitor your heart rate. Heart rate increases 10 beats per minute for every degree the body temperature rises. So, wearing a heart rate monitor helps clients better identify whether their cardiovascular system is experiencing heat stress. Heart rate monitors can also signal if dehydration exists.

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What Is Naloxone? Where To Get Narcan And How To Reverse Overdoses

The overdose crisis continues to worsen in the U.S., and overdose deaths reached an all-time high in 2021. Experts say that a simple drug — naloxone — is a key tool in preventing more deaths. But not enough people know about it, have access to it or actually carry it with them.

“Naloxone is a miracle drug,” Dr. Kimberly Sue, medical director for the National Harm Reduction Coalition and associate professor of medicine at Yale School of Medicine, told TODAY. “It’s literally a Lazarus drug that prevents people from dying of an opioid overdose.”

And in the midst of the overdose crisis, which claimed nearly 108,000 lives just last year, getting naloxone to those who need it is vitally important. Here, experts discuss what naloxone is, how to get it and how it can save lives.

How does naloxone work?

Naloxone, also referred to by the brand name Narcan, is what experts call an opioid antagonist, Dr. Sarah Wakeman, medical director for the Massachusetts General Hospital Substance Use Disorder Initiative, told TODAY. Narcan is not the only branded naloxone product; a high-dose nasal spray called Kloxxado works similarly, according to the FDA.

That means it “binds to the opioid receptors in the brain — the same receptors that opioid drugs or medications like oxycodone or heroin or fentanyl bind to — and then blocks those receptors,” Wakeman explained. In the event of an opioid overdose, naloxone “can actually kick off the opioid from the receptor, reverse the acute effects of an opioid overdose and save someone’s life.”

A standard dose of naloxone is effective against even fentanyl, Wakeman said. If they’ve taken an opioid and something else, or if they took something like cocaine that was tainted with illicit fentanyl, naloxone will still work against the opioid in their system.

“And naloxone won’t be harmful to someone who doesn’t have an opioid in their body,” Wakeman said. “So if there’s a possibility that you think someone is having an overdose … then it is always a good idea to give naloxone.”

When should naloxone be given?

Before using naloxone, check to see if someone has the telltale signs of an overdose, Dr. Ayana Jordan, an addiction expert and associate professor of psychiatry at NYU Grossman School of Medicine, told TODAY. She pointed to the Center for Disease Control and Prevention‘s tips to learn about the signs of an overdose.

According to the CDC, someone having an overdose may have:

  • Loss of consciousness.
  • Weak, slow or no breathing.
  • Small or constricted pupils.
  • Choking or gurgling sounds.
  • Limp body.
  • Clammy or cold skin.
  • Blue or discolored skin, especially around the lips. (However, Jordan notes that this may not apply to people with darker skin.)

In general, someone who is in the midst of an overdose will “have slowed and very shallow breathing to the point that, ultimately, they’ll stop breathing,” Wakeman said. “So they may look blue or cold and not be responsive.”

Giving someone naloxone

Once you’ve identified that someone might be having an overdose, you should call 911, the CDC says. Even if you’re able to reverse the overdose, they will likely still need emergency services. (Some states, but not all, have Good Samaritan laws, which protect people calling for medical help from some drug-related charges, Sue explained.)

From there, the right way to use naloxone depends on the specific formulation you’re using. For most people, that will likely be the nasal spray called Narcan, Wakeman said. In the hospital, naloxone may be given through an IV or as an injection into the muscle, she added.

After administering naloxone, the person should wake up within seconds to minutes, Wakeman said. And you should always start with as low a dose as possible. If someone is a regular opioid user and you give them a massive dose of naloxone all at once, “they’re going to immediately go into withdrawal,” Wakeman explained. While that isn’t necessarily harmful, it is pretty unpleasant and uncomfortable.

After giving someone naloxone, you should stay with them if you can until emergency medical help arrives. “Naloxone works very quickly, but it also wears off very quickly,” Wakeman said. In fact, the effects of naloxone can wear off within 30 minutes. And if someone still has the other opioid in their system, they may fall back into an overdose after the naloxone has worn off.

Where to get naloxone

If you use drugs, your doctor may give you a naloxone prescription as a regular part of their practice. “I make sure that everyone that sees me gets prescribed naloxone and that they understand how to use it,” Jordan said.

Depending on the state, you may be able to get naloxone at a local pharmacy without a prescription through the use of a standing order, Wakeman noted. (Standing orders allow pharmacies to give out prescription medications, like the annual flu vaccine, without requiring each individual person to have their own prescription.)

Another option is to connect with local harm reduction groups in your area, which frequently hand out naloxone kits, Wakeman said. These community-based organizations may also offer in-person or virtual trainings on how to use naloxone. Jordan noted that her research group also does large virtual naloxone training sessions for people who participate in their studies looking at drug use.

If you live in a state without a standing order and want to get naloxone to use on someone else, you can likely get a third-party prescription through a doctor, Sue said. She recommended looking at the local health department’s website for more information about where to get naloxone in your area.

It’s most important for people who use drugs to have access to naloxone. But if you know someone who uses drugs, you should consider carrying naloxone, too, the experts said. “Carrying naloxone is no different than carrying an epi-pen,” Jordan said.

And even though there are several ways to get naloxone now, there are still barriers to actually accessing and using it, Sue explained. She recalled a story of pharmacy staff being simply unaware of the standing order for naloxone, for instance, and noted that harm reduction groups are experiencing an ongoing naloxone shortage.

Additionally, naloxone is something that, by definition, people can’t use on themselves in the event of an overdose, Sue said. (If you are going to use by yourself, Sue recommended calling the Never Use Alone hotline so there is someone who can notify emergency services if you lose consciousness.)

Naloxone is a crucial tool in reducing overdose deaths, experts say

“Really, no one should die from an opioid overdose,” Wakeman said. “Not only do we know how to prevent overdoses and how to treat people who have an opioid use disorder, but we also have this life-saving, immediately-acting medication that will quickly reverse the effects of an opioid overdose.” 

The challenge for experts now is to make naloxone more accessible to those who need it. “There’s no moral or medical reason to keep this life-saving medication behind the counter,” Dr. Bobby Mikkamula, chair of the American Medicine Association’s Substance Use and Pain Care Task Force, told TODAY.

Earlier this year, AMA urged the Biden administration to remove naloxone’s prescription status, which would make it available over-the-counter. “It’s not the kind of thing that needs to be protected or that people need to be protected from,” Mikkamula said. “This saves their lives, and the fewer barriers we have to getting this into their hands and into their medicine cabinets, the better.”

For Jordan, the importance of naloxone comes down to one simple truth: “I can’t help people who are dead,” she said.

By

Source: What Is Naloxone? Where To Get Narcan And How To Reverse Overdoses

Related links:

Overdose Deaths Behind Bars Rise as Drug Crisis Swells The Good Men Project

Report details Alaska demographics hurt most by 2021 spike in drugoverdose deaths Alaska Public Media

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13:02 Fri, 29 JulOpioid Crisis Fentanyl
15:34 Mon, 25 JulNative Americans Pandemic Racism
01:14 Thu, 21 JulNative Americans CDC Alaska
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