In this video I show you three vagus nerve exercises to rewire your brain from anxiety. I also share what anxiety actually is (and the surprising reason why it’s good for you) as well as what to do when anxiety hits. Note: this content is for informational purposes only and is not intended as medical advice, or as a substitute for the medical advice of a physician.
While investigators have known that maternal and fetal outcomes of pregnancy among women with systemic lupus erythematosus (SLE) have improved over time, it is unknown whether the improved outcomes are shared equally among different racial and ethnic groups. Lupus has been shown to disproportionately affect minorities of childbearing age. A new study that includes researchers from Hospital for Special Surgery (HSS) presented today at the American College of Rheumatology (ACR) annual meeting shows that pregnancy outcomes in women with lupus have improved in all racial and ethnic groups over the past decade, but disparities still exist.
“We’re happy to see pregnancy outcomes improved over time in all of the groups studied, however improvements were more evident in some groups than others,” said lead study author Bella Mehta, MBBS, MS, MD, a rheumatologist at HSS. “African Americans and Hispanics continue to have poor pregnancy outcomes. Further study is warranted to determine where resources are needed to improve access and care for these patients.”
In the new study, researchers used the National Inpatient Sample (NIS) to conduct a retrospective cross-sectional analysis of lupus and pregnancy related hospital admissions from 2008 to 2017. The NIS is the largest publicly available all-payer healthcare database designed to produce US regional and national estimates of inpatient utilization, access, cost, quality and outcomes. Patients with lupus were identified by using ICD-9/10 codes. The researchers evaluated the pregnancy outcomes of four groups: Caucasians, African Americans, Hispanics and Asians/Native Americans/Others. Outcomes included in-hospital maternal mortality, fetal mortality, non-delivery related admissions and Cesarean section (C-section).
The investigators found that from 2008 to 2017, there were a total of 61,012 SLE pregnancy related hospitalizations. The median age of pregnant women in the sample was 29 for African American and Hispanic women, 30 for Caucasians, and 31 for Asians/Native Americans/Others. African Americans and Hispanics were more likely to be on Medicaid (51% and 49% respectively) versus Caucasians (30%) and Asians/Native Americans/Others (33%).
During the 10-year study period, fetal mortality and non-delivery related admissions and C-section rates improved in all racial/ethnic groups. Maternal mortality rates were very low throughout the study period, with none observed among Caucasians. Overall fetal mortality declined in all racial/ethnic groups, with a numerically greater reduction in Hispanic (from 291 in 2008-2009 to 101 in 2016-2017 per 10,000 admissions) and Asian/Native American/Other (from 267 in 2008-2009 to no observations in 2016-2017 per 10,000 admissions) versus Caucasian (from 136 in 2008-2009 to 108 in 2016-2017 per 10,000 admissions) and African American (from 385 in 2008-2009 to 308 in 2016-2017 per 10,000 admissions). In the latest data from 2017, African Americans continued to have worse fetal mortality than Hispanic or Caucasian patients, and Asians/Native Americans/Others had the least fetal mortality. In data from 2017, African Americans had the most non-delivery admissions, followed by Hispanics, Asians/Native Americans/Others and Caucasians. In 2017, C-section rates were highest in African Americans, followed by Caucasians, Asians/Native Americans/Others, and Hispanics.
“We have learned over the years that patients with lupus can become pregnant but need to do so in a certain way. That is, they should have quiet disease activity at conception and they shouldn’t become pregnant if they have serious internal organ damage such as renal failure,” said study co-author Lisa R. Sammaritano, MD, a rheumatologist at HSS. “What this study shows is there is still a persistent disparity between non-Caucasian ethnic groups and Caucasians in terms of pregnancy outcomes in women with lupus, but both groups have had improvement over 10 years.
“It’s good to see that improvements have been across racial and ethnic groups, but we need to continue to work toward identifying the reasons disparities still exist,” she continued. “This kind of large database study is very useful in looking at this type of problem across the country as a whole, rather than a study focused on a single hospital system, as most other studies do.”
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Neuroscientists link autism to reduced activity of key neurotransmitter in human brain
Caption:(Left to right) Caroline Robertson and Nancy Kanwisher.Credits:Photo: Sham Sthankiya
MIT and Harvard University neuroscientists have found a link between a behavioral symptom of autism and reduced activity of a neurotransmitter whose job is to dampen neuron excitation. The findings suggest that drugs that boost the action of this neurotransmitter, known as GABA, may improve some of the symptoms of autism, the researchers say.
Brain activity is controlled by a constant interplay of inhibition and excitation, which is mediated by different neurotransmitters. GABA is one of the most important inhibitory neurotransmitters, and studies of animals with autism-like symptoms have found reduced GABA activity in the brain. However, until now, there has been no direct evidence for such a link in humans.
“This is the first connection in humans between a neurotransmitter in the brain and an autistic behavioral symptom,” says Caroline Robertson, a postdoc at MIT’s McGovern Institute for Brain Research and a junior fellow of the Harvard Society of Fellows. “It’s possible that increasing GABA would help to ameliorate some of the symptoms of autism, but more work needs to be done.”
Robertson is the lead author of the study, which appears in the Dec. 17 online edition of Current Biology. The paper’s senior author is Nancy Kanwisher, the Walter A. Rosenblith Professor of Brain and Cognitive Sciences and a member of the McGovern Institute. Eva-Maria Ratai, an assistant professor of radiology at Massachusetts General Hospital, also contributed to the research.
Too little inhibition
Many symptoms of autism arise from hypersensitivity to sensory input. For example, children with autism are often very sensitive to things that wouldn’t bother other children as much, such as someone talking elsewhere in the room, or a scratchy sweater. Scientists have speculated that reduced brain inhibition might underlie this hypersensitivity by making it harder to tune out distracting sensations.
In this study, the researchers explored a visual task known as binocular rivalry, which requires brain inhibition and has been shown to be more difficult for people with autism. During the task, researchers show each participant two different images, one to each eye. To see the images, the brain must switch back and forth between input from the right and left eyes.
For the participant, it looks as though the two images are fading in and out, as input from each eye takes its turn inhibiting the input coming in from the other eye.
“Everybody has a different rate at which the brain naturally oscillates between these two images, and that rate is thought to map onto the strength of the inhibitory circuitry between these two populations of cells,” Robertson says.
She found that nonautistic adults switched back and forth between the images nine times per minute, on average, and one of the images fully suppressed the other about 70 percent of the time. However, autistic adults switched back and forth only half as often as nonautistic subjects, and one of the images fully suppressed the other only about 50 percent of the time.
Performance on this task was also linked to patients’ scores on a clinical evaluation of communication and social interaction used to diagnose autism: Worse symptoms correlated with weaker inhibition during the visual task.
The researchers then measured GABA activity using a technique known as magnetic resonance spectroscopy, as autistic and typical subjects performed the binocular rivalry task. In nonautistic participants, higher levels of GABA correlated with a better ability to suppress the nondominant image. But in autistic subjects, there was no relationship between performance and GABA levels. This suggests that GABA is present in the brain but is not performing its usual function in autistic individuals, Robertson says.
“GABA is not reduced in the autistic brain, but the action of this inhibitory pathway is reduced,” she says. “The next step is figuring out which part of the pathway is disrupted.”
“This is a really great piece of work,” says Richard Edden, an associate professor of radiology at the Johns Hopkins University School of Medicine. “The role of inhibitory dysfunction in autism is strongly debated, with different camps arguing for elevated and reduced inhibition. This kind of study, which seeks to relate measures of inhibition directly to quantitative measures of function, is what we really to need to tease things out.”
Early diagnosis
In addition to offering a possible new drug target, the new finding may also help researchers develop better diagnostic tools for autism, which is now diagnosed by evaluating children’s social interactions. To that end, Robertson is investigating the possibility of using EEG scans to measure brain responses during the binocular rivalry task.
“If autism does trace back on some level to circuitry differences that affect the visual cortex, you can measure those things in a kid who’s even nonverbal, as long as he can see,” she says. “We’d like it to move toward being useful for early diagnostic screenings.”