John C Kim and International Adoption Video

Tuesday, June 30, 2009

A brief history of American Parenting as an enterprise in the US in New Yorker Magazine; Is there a demand for experts or by virtue of rite of passage of birthing or adopting enough to make us good parents, or at least good enough parents.

BABY TALK

The fuss about parenthood.

by Jill LeporeJUNE 29, 2009
 

Middle-class parents are an insecure, easily gulled consumer group.

Middle-class parents are an insecure, easily gulled consumer group.

Am a Failure as a Mother,” a talk given on NBC radio in 1932 by Clara Savage Littledale, mother of two, has a lot to answer for, including a couple of new memoirs by grownups determined to profess their parental ineptitude: “Home Game: An Accidental Guide to Fatherhood” (Norton; $23.95), by Michael Lewis, father of three; and “Bad Mother: A Chronicle of Maternal Crimes, Minor Calamities, and Occasional Moments of Grace” (Doubleday; $24.95), by Ayelet Waldman, mother of four. Littledale was the founding editor of Parents’ Magazine; in the nineteen-thirties, her radio program—a column broadcast over the wireless—filled Emily Post’s noontime slot on Wednesdays, Miss Manners’s day off. Lewis and Waldman are columnists, too. “Home Game” started as a series on Slate, episodes in which Lewis, tenderhearted and befuddled, tries to figure out the unwritten rules of the “new fatherhood”; “Bad Mother” revisits essays first written for Salon, in which Waldman uses stories about her family to argue that there’s no such thing as a good mother. If you’ve ever read a parenting blog, and I don’t say you ought to, you have a good idea what lies at the heart of these books: ersatz confession. Lewis finds newborns hard to love; Waldman hires a maid to clean up after her maid. Lewis tells all—all!—about his vasectomy; Waldman provides her sexual history. Waldman insists that how any woman rears her kids is nobody’s never-you-mind. “Let’s all commit ourselves to the basic civility of minding our own business,” she writes. This puts a reader in a tight spot: can I or can I not skip the chapter in “Bad Mother” wherein our author confides her regret over her breasts’ lost buoyancy?

Lots of people find this kind of thing winsome, I guess, and I did like it when Lewis admitted to sneaking out during his wife’s ten-hour labor to score Ring Dings from a hospital vending machine. But as long as we’re trafficking in unsought revelation, reading these books made me think of nothing so much as traipsing to the playground with a twelve-month-old who merrily toddles off to the sandbox while I, despite hiding behind a newspaper and attempting to appear exactly as approachable as Napoleon Bonaparte, find myself cornered by a stranger: “You have a baby? I have a baby! Doesn’t parenthood beat all?” I’ve been that stranger, too (I confess! I confess!), which must be why I’m such an easy mark; the sandbox, my Waterloo. I used to like that conversation. Lately, though, it’s been getting old: all the mothers want forgiveness; all the fathers want applause. A few years back, in “Confessions of a Slacker Mom,” Muffy Mead-Ferro admitted that during her pregnancy she did not actually buy a gizmo that was supposed to pipe Mozart into her belly; in “Dinner with Dad,” Cameron Stracher offered an account of his valiant year of getting home in time for supper. Frankly, I’d just as soon stipulate that most baby gear is worthless, stupid junk and that eating dinner with your kids is really important. Then I’d like to get back to reading the paper. But, hey, sure, amnesty, ovation, whatever gets you through the long, sleepless night.

I blame, as I say, Clara Savage Littledale, whose job it was to help invent American parenthood. Stages of life are artifacts. Adolescence is a useful contrivance, midlife is a moving target, senior citizens are an interest group, and tweenhood is just plain made up. Parenthood seems, at first, different. There have always been parents, and parents have always been besotted with their children, awestruck by their impossible beauty, dopey high jinks, and strange little minds. But “parenthood,” the word, dates only to the middle of the nineteenth century, and the notion that parenthood is a distinct stage of life, shared by men and women, is historically in its infancy. An ordinary life used to look something like this: born into a growing family, you help rear your siblings, have the first of your own half-dozen or even dozen children soon after you’re grown, and die before your youngest has left home. In the early eighteen-hundreds, the fertility rate among American women was between seven and eight children; adults couldn’t expect to live past sixty. To be an adult was to be a parent—nearly everyone lived in households with children—except that people didn’t usually think of themselves as “parents”; they were mothers or fathers, and everyone knew that there was a world of difference between the two.

In Littledale’s day, all that had begun to change. People were living longer, having fewer children, and starting families later in life. Littledale, who was born in 1891, didn’t have a baby until she was thirty-one. By 1920, women bore, on average, just over three children. Child rearing no longer circumscribed every woman’s life; motherhood and fatherhood, though not the same, had more in common than they used to. The slice of the population that consisted of adults who did not have children at home—people who would never have children, hadn’t had them yet, or had already had them and now had an empty nest—was sizable, and growing. In 1880, seventy per cent of American adults lived in households with children under the age of fifteen; by 1920, that number had fallen to fifty-five per cent. All these changes, aggregated, made parenthood into something different, something big, something planned.

By 1922, when Littledale became a mother, parenting had also begun to look especially mystifying to the increasing numbers of people, generally wealthier people, who had not grown up caring for their siblings, neighbors, cousins, and nieces and nephews, and who, it turned out, had no idea how to bathe or dress or soothe a baby. Looking after babies and little kids is skilled labor, but, as the number of children dwindled, so did the number of adults who had any real skill. The growing uprootedness of American life meant that many first-time parents couldn’t count on grandparents, or, really, on anyone. In stepped experts, who argued that taking care of children was not just a skill; it was a science. In the eighteen-nineties, the psychologist G. Stanley Hall established an American foothold for the academic discipline of child study (imported from Europe, along with kindergarten), just as pediatrics was becoming a specialty. The U.S. Children’s Bureau was established in 1912. As Littledale explained in 1930, the year the American Academy of Pediatrics was founded:

Once it was believed that the very physical fact of parenthood brought with it an instinctive wisdom that enabled one to rear children wisely and well. Parents knew best. Today fathers and mothers are unwilling to struggle under such a load of self-imposed omniscience. Even if they were, the facts would be against them. For in this country various studies made in the last ten years present incontrovertible data to prove that devoted but unenlightened parenthood is a dangerous factor in the lives of children.

This almost passes for a definition: parenthood is being so inept that you’re a danger to your own children. That, at least, was the premise of Littledale’s magazine, and its price.

Littledale was the editor, but Parents’ Magazine was the brainchild of a philanthropist and publisher named George Joseph Hecht. Hecht, who was born in New York in 1895, had served in the government’s office of public information during the First World War, where he helped found the Bureau of Cartoons. In 1919, he published an amazing collection, “The War in Cartoons”—a history of the war in a hundred cartoons—and, the following year, began publishing Better Times, “the Smallest Newspaper in the World.” (It measured less than four by five inches.) For a while, Hecht wrote the entire paper, which was a weekly, and pretty good. Hecht liked to tell this story: In the early nineteen-twenties, while sailing back from a trip to Europe, he met a well-heeled woman who confided to him, “I have failed where every woman wants to succeed—as a mother.” Moved, and curious, Hecht began reading child-rearing manuals. “They were all great big thick books,” he noticed. He liked little books; he liked pictures. He began raising money for a magazine that would teach a de-skilled middle class how to be parents. (Hecht did not, at this point, have children.) For the editor, he wanted a woman, and required “that she be a college graduate, that she should have had an editorial position preferably with a woman’s magazine, that she should be able to write if dire necessity ever required it of her, that she be married and that she should be a mother.” In 1926, he hired Clara Savage Littledale.

Littledale, talented and driven, had written features for the New York Timeswhile still a student at Smith; after graduating, she became only the second woman reporter to be hired by the Evening Post. But at the Post, as elsewhere, women were almost never allowed into the newsroom; she was named editor of the paper’s woman’s page. (Joseph Pulitzer had started a woman’s page in 1886, in the New York World. Woman’s pages lasted for about a century. In 1969, the Washington Post renamed its “For and About Women” page the Style section; other newspapers followed suit. Parenting blogs like the Times’ Motherlode are basically a throwback.) In 1914, Savage left the Post to become press chairperson of the National American Woman Suffrage Association; and the next year she took a job as associate editor at Good Housekeeping, though she mainly reported on policy matters, from Washington. In 1918, she went to Europe, to cover the war. When peace came, Savage quit Good Housekeeping, stayed in Europe, and, in 1920, married a journalist named Harold Littledale; two years later, she gave birth to a daughter. In 1924, Littledale wrote a short, bitter piece for The New Republic about sharing a maternity room with a woman whose baby had been stillborn. We never learn the woman’s name; Littledale calls her 41A. Weirdly, the story, much of which is conversation overheard during a visit from 41A’s husband, has a lot in common with “Hills Like White Elephants,” which Hemingway published in 1927, in “Men Without Women.” The couple never mention the dead baby, but everything they say is about the dead baby:

“Is my aunt cookin’ your meals?” she asked.
“Yep, and, say, we had a pie.”
“What kind of a pie?” the girl demanded fiercely.
“Apple pie.”
“Did she use up those apples I was savin’?” The face of 41A was white and set.

ith Littledale at the helm, the first issue of Children, The Magazine for Parents appeared in 1926 (a year after Harold Ross started The New Yorker). It was full of expert advice, offered by leading psychologists, doctors, educators, and scholars. There had been advice literature before, of course—not only great, thick books but also magazines, including Babyhood (1884-92) andAmerican Motherhood (1903-19)—but Hecht and Littledale came up with a formula for explaining the new science of parenting. “The staff sits up nights throwing scientific words out of the articles submitted by college professors,” Littledale wrote. She also domesticated her experts. If the magazine “publishes an article by a Ph.D.,” she wrote, “it hastens to explain that said Ph.D. has a baby or if the Ph.D. is a man that he is the uncle of a dear little tot.” More important, Littledale solicited contributions from people who had no academic expertise—“Mammas and papas are encouraged to contribute articles and they do”—chiefly to point out what rank amateurs they were. In 1927, the year Littledale worked through her second pregnancy, she ran articles like “Can a Tired Business Man Be a Good Father?,” an argument for what later came to be called “quality time” (“An hour can be made more significant than a day”) and “Confessions of an Amateur Mother,” the lament of a wealthy, well-educated woman who hasn’t the slightest idea how to care for her newborn: “Why is it that for the women of my type—professional women—motherhood, as a rule, comes so hard?” (She complains, too, that she isn’t eligible for social services; there are “motherhood clinics and baby stations aplenty in the districts of the ‘poor’ women: why not for me?”)

Within two years of Children’s first issue, Hecht and Littledale had changed the magazine’s name, a decision that made a lot of sense, since all this business about parenthood, then as now, has very little to do with kids. By 1931, ParentsMagazine boasted two hundred thousand subscribers. Middle-class mothers and fathers turned out to be a very well-defined consumer group, easily gulled into buying almost anything that might remedy their parental deficiencies. In 1938,Parents’ peddled a correspondence course: “Add Science to Love and Be a ‘Perfect Mother.’ ” The magazine’s success carried Littledale into broadcasting; she was heard on NBC radio beginning in 1932, where she administered advice by the anecdote. “A child needs two parents” was her answer to a letter from a listener who wished that he knew his children better. “I’m afraid I’m a failure as a mother,” a woman fretted, and Littledale wisely counselled her, “One way to be a failure as a mother is to overplay the role.” Littledale’s advice was usually perfectly sensible. She didn’t much like punishment; she thought kids needed to learn to do things for themselves. On more particular matters, such as how to handle a crying baby, Littledale’s advice, like her magazine, followed parenting fashion, which changes with the hemlines. Urgent social issues that affected the way many Americans reared their children—segregation and poverty, for instance—had no place on Littledale’s list of parenting problems. In 1946, the year Benjamin Spock published “Baby and Child Care,” Parents’ reached four hundred thousand subscribers; it came to be known as the Family Bible. Today, it claims fifteen million readers, nearly all of them women. The magazine lost its apostrophe somewhere along the way, as well as its purchase on American life, but confessions of amateur mothers—“Parents is for every woman who lives and parents in her own authentic way”—and a column called Fatherhood 101 can still be read at its Web site, parents.com, where you can also find out about a lot of worthless, stupid baby gear and learn that eating dinner with your kids is really important.

In the United States today, people raising children are, statistically, a minority. With the notable exception of the baby boom, the percentage of American adults living in households with children younger than fifteen has been falling for more than a century; by 1990, it was down to about a third. The fertility rate is now just slightly more than two. The average American can expect to live into his or her seventies; the population, as everyone knows, is aging, fast. Forty per cent of American babies born in 2006 were their mother’s first. We are more inexperienced and unskilled at caring for them than ever, something Anne Lamott wrote about in her wry and smart memoir, “Operating Instructions: A Journal of My Son’s First Year.” Small families make for few economies of scale; a father finally figures out how to swaddle his baby, and, damn it, the age of swaddling is over. A not uncommon experience is a mother who, upon first holding her newborn, realizes that it is the first baby she has ever held.

One of the stranger things about the success of a magazine whose premise was that parents are a danger to their own children is that, by the time Hecht began publishing Parents’, children were safer than ever. In 1850, more than one baby in every five died before its first year. By 1920, infant mortality in the United States had dropped to one in twenty. By the Second World War, accidents had replaced disease as the leading cause of childhood death. Today, infant mortality is at one in two hundred. Historians once assumed that when childhood mortality was high people must not have loved their children very much; it would have been too painful. Research has since proved that assumption wrong. Now that children are very likely to survive to adulthood, you might think parents wouldn’t worry so much. This is wrong, too. We love even when that spells grief, and we worry even when that means worrying about nothing. Or, at least, that’s the best explanation I’ve got for why I once bought one of those little mirrors you Velcro to the back seat of your car so that, when your baby has to ride facing backward, you can keep an eye on him. I could tell that story, I guess, but only two things about it are worth knowing: (1) those little mirrors, while in all other respects useless, make a pretty good ice-skating rink for Lego people and (2) it’s more important to mind the road.

Meanwhile, the changes of the past two centuries have created actual problems, structural problems that affect everyone, not just the demographic that reads Parents, problems that can be very hard to see when you’re driving while looking in a baby-view mirror. Most jobs are made for people who aren’t taking care of children. The sharper the division between parenthood and adulthood, the worse those jobs fit, and the less well people who aren’t rearing children understand the hardships of people who are. Employers are seldom asked to accommodate family life in any meaningful way; employees do all the accommodating, which mainly involves, especially for women, pretending that we don’t actually have families. Everyone has a story about how painful that is. It’s also crazy, and maddening, and unfair. We’ve all got stories to tell, but stories aren’t going to rewrite employment law.

Neither are cute books about parenthood as an exclusive club whose initiation rites include confessions of ineptitude, though it’s easy to see why people write them. The average age of a woman at the birth of her first child is now twenty-five, an all-time high, and the fastest-growing cohort of first-time mothers is women over thirty-five. Most Americans become parents only after having been fully grown for a goodish while, which means that we share an experience—a set piece in every parenting memoir—that can feel as if it binds us to one another and alienates us from everyone else, the experience of crossing a great divide between Life Before Children and Life, the Much Sloppier, Sweeter, and More Ridiculous 3-D Sequel. I love that sequel. I laugh! I cry! I also really like the part where I get to read the newspaper.

wasn’t prepared for how ill suited and poorly trained I was for the job of full-time mother,” Ayelet Waldman writes in “Bad Mother,” unintentionally echoing “Confessions of an Amateur Mother,” even though Waldman, a former public defender, is explicitly arguing against the idea that she, or any woman, needs Littledale-style parental education. As Waldman sees it, expert advice about how to be a “good mother” is the problem; a “bad mother” movement is her solution. (Hey, sure, absolution, three cheers, but I’m with Littledale here: don’t overplay the role.) If only more mothers were willing to be more honest about how far we fall short of an ill-conceived ideal—June Cleaver is Waldman’s straw woman—we’d all be better off. That’s why Waldman confesses, and confesses, and confesses: she’s taking a hit for the rest of us. Paid parental leave? Better day care? Nah. More memoir is what we need. Michael Lewis isn’t trying to start a movement; mostly, he’s trying to make fun of the new fatherhood. “This book is a snapshot of what I assume will one day be looked back upon as a kind of Dark Age of Fatherhood,” he writes, archly. “Obviously, we’re in the midst of some long unhappy transition between the model of fatherhood as practiced by my father and some ideal model, approved by all, to be practiced with ease by the perfect fathers of the future.”

The thing is, we are in the midst of a long transition. But it’s no happier for these books. You have a baby? I have a baby! Doesn’t parenthood beat all? Well, yes, it does. But I still miss adulthood. ♦

ILLUSTRATION: PHILIPPE PETIT-ROULET

Wednesday, June 24, 2009

For ankle injuries, cold is best.

The Claim: Heat Should Be Applied to a Sprained Ankle

Article Tools Sponsored By 

By ANAHAD O’CONNOR

Published: June 22, 2009

THE FACTS

Leif Parsons

 

Health Guide: Ankle Pain | Sprains

 Ankle sprains are one of the most common sports injuries; they send about a million Americans to clinics every year and cause chronic problems for many.

The problem is clear, but the first-aid treatment is not: heat or cold?

Many people swear by heat, saying it soothes the pain and promotes healing by stimulating blood flow. Others advocate ice, precisely because it does the reverse, slowing blood flow and minimizing inflammation.

According to research, ice wins every time.

In multiple studies, scientists have compared heat and ice by randomly assigning people who showed up at sports clinics with sprains to receive one treatment or the other, in combination with a pain reliever like ibuprofen. One prominent study found that immediate ice therapy “resulted in earlier return to activity, as defined by ability to walk, climb stairs, run and jump without pain.”

In people with the most severe injuries — including torn ligaments — treatment with ice resulted in a 13-day recovery, compared with 30 days for those treated with heat.

For the best results, experts recommend the Price method: protection, rest, ice, compression and elevation. They caution that ice should be applied only 20 minutes at a time.

THE BOTTOM LINE

Ice is far better than heat for ankle sprains.

Tuesday, June 23, 2009

Review of Kessler’s book on food and over eating, sounds like dummy proofing ourselves from an fat inducing environment is a crucial step toward freedom. But catch the last few paragraph, ah when the chips are down, and we are tired, the chips come up.

How the Food Makers Captured Our Brains

Stuart Bradford

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By TARA PARKER-POPE

Published: June 22, 2009

As head of the Food and Drug Administration, Dr. David A. Kessler served two presidents and battled Congress and Big Tobacco. But the Harvard-educated pediatrician discovered he was helpless against the forces of a chocolate chip cookie.

 

 

In an experiment of one, Dr. Kessler tested his willpower by buying two gooey chocolate chip cookies that he didn’t plan to eat. At home, he found himself staring at the cookies, and even distracted by memories of the chocolate chunks and doughy peaks as he left the room. He left the house, and the cookies remained uneaten. Feeling triumphant, he stopped for coffee, saw cookies on the counter and gobbled one down.

“Why does that chocolate chip cookie have such power over me?” Dr. Kessler asked in an interview. “Is it the cookie, the representation of the cookie in my brain? I spent seven years trying to figure out the answer.”

The result of Dr. Kessler’s quest is a fascinating new book, “The End of Overeating: Taking Control of the Insatiable American Appetite” (Rodale).

During his time at the Food and Drug Administration, Dr. Kessler maintained a high profile, streamlining the agency, pushing for faster approval of drugs and overseeing the creation of the standardized nutrition label on food packaging. But Dr. Kessler is perhaps best known for his efforts to investigate and regulate the tobacco industry, and his accusation that cigarette makers intentionally manipulated nicotine content to make their products more addictive.

In “The End of Overeating,” Dr. Kessler finds some similarities in the food industry, which has combined and created foods in a way that taps into our brain circuitry and stimulates our desire for more.

When it comes to stimulating our brains, Dr. Kessler noted, individual ingredients aren’t particularly potent. But by combining fats, sugar and salt in innumerable ways, food makers have essentially tapped into the brain’s reward system, creating a feedback loop that stimulates our desire to eat and leaves us wanting more and more even when we’re full.

Dr. Kessler isn’t convinced that food makers fully understand the neuroscience of the forces they have unleashed, but food companies certainly understand human behavior, taste preferences and desire. In fact, he offers descriptions of how restaurants and food makers manipulate ingredients to reach the aptly named “bliss point.” Foods that contain too little or too much sugar, fat or salt are either bland or overwhelming. But food scientists work hard to reach the precise point at which we derive the greatest pleasure from fat, sugar and salt.

The result is that chain restaurants like Chili’s cook up “hyper-palatable food that requires little chewing and goes down easily,” he notes. And Dr. Kessler reports that the Snickers bar, for instance, is “extraordinarily well engineered.” As we chew it, the sugar dissolves, the fat melts and the caramel traps the peanuts so the entire combination of flavors is blissfully experienced in the mouth at the same time.

Foods rich in sugar and fat are relatively recent arrivals on the food landscape, Dr. Kessler noted. But today, foods are more than just a combination of ingredients. They are highly complex creations, loaded up with layer upon layer of stimulating tastes that result in a multisensory experience for the brain. Food companies “design food for irresistibility,” Dr. Kessler noted. “It’s been part of their business plans.”

But this book is less an exposé about the food industry and more an exploration of us. “My real goal is, How do you explain to people what’s going on with them?” Dr. Kessler said. “Nobody has ever explained to people how their brains have been captured.”

The book, a New York Times best seller, includes Dr. Kessler’s own candid admission that he struggles with overeating.

“I wouldn’t have been as interested in the question of why we can’t resist food if I didn’t have it myself,” he said. “I gained and lost my body weight several times over. I have suits in every size.”

This is not a diet book, but Dr. Kessler devotes a sizable section to “food rehab,” offering practical advice for using the science of overeating to our advantage, so that we begin to think differently about food and take back control of our eating habits.

One of his main messages is that overeating is not due to an absence of willpower, but a biological challenge made more difficult by the overstimulating food environment that surrounds us. “Conditioned hypereating” is a chronic problem that is made worse by dieting and needs to be managed rather than cured, he said. And while lapses are inevitable, Dr. Kessler outlines several strategies that address the behavioral, cognitive and nutritional factors that fuel overeating.

Planned and structured eating and understanding your personal food triggers are essential. In addition, educating yourself about food can help alter your perceptions about what types of food are desirable. Just as many of us now findcigarettes repulsive, Dr. Kessler argues that we can also undergo similar “perceptual shifts” about large portion sizes and processed foods. For instance, he notes that when people who once loved to eat steak become vegetarians, they typically begin to view animal protein as disgusting.

The advice is certainly not a quick fix or a guarantee, but Dr. Kessler said that educating himself in the course of writing the book had helped him gain control over his eating.

For the first time in my life, I can keep my weight relatively stable,” he said. “Now, if you stress me and fatigue me and put me in an airport and the plane is seven hours late — I’m still going to grab those chocolate-covered pretzels. The old circuitry will still show its head.”

Mother’s guilt magnified and recycled. serious problem. Mom’s depression affects infant development, and may have longer lasting affects, insidious as some parents are not well aware of themselves, or just in plain denial.

Postpartum Depression Epidemic Affects More than Just Mom

A deep despair mars the first year of motherhood for as many as one in five women. Without treatment, postpartum depression can weaken critical bonds between a mother and her child

By Katja Gaschler

The psychologist smiles at Manuela, a new mother in her late thirties. “Please play with your baby for two minutes,” the therapist instructs her and then leaves the room. Two video cameras film Manuela (which is not her real name) and her three-month-old daughter. In the next room, a split-screen monitor shows the mother’s profile on the left and her infant in a baby chair on the right.

At first, Manuela appears to be at a loss for what to do. Then, her face noticeably stiff, she begins to talk softly to her baby. Her baby fidgets, briefly makes eye contact and then turns away. Manuela eventually stops talking and stares into the distance, unsure again how to act. She absentmindedly strokes her baby’s foot with one hand. The psychologist knocks on the door; the videotaping is over. The new mother is now on the verge of tears.

Manuela is undergoing therapy at the Clinic for General Psychiatry in Heidelberg, Germany, for postpartum depression, an ailment that has strained her relationship with her baby. Although the vast majority of mothers experience periods of crying and irritability along with concen tration lapses and exhaustion, these so-called baby blues disappear within a few hours or days of delivery. But 10 to 20 percent of women in the U.S. develop, in the first year after childbirth, the more disabling despair that afflicts Manuela. These mothers succumb to a deep sadness that, if untreated, may persist for months to years.

Manuela frequently feels exhausted and emotionally empty. When her baby cries, she sometimes wants to flee or hide. She is wracked with guilt because she cannot show love to her daughter. Mothers with symptoms of postpartum depression [see box on page 70] are often overwhelmed by the feeling that they might harm their babies. Although they rarely cause any outright harm, depressed mothers may have difficulty caring for their infants—and that fact can heighten their distress.

These emotional problems plague women worldwide. A 2006 review of 143 studies in 40 countries documents that postpartum depression is especially common in Brazil, Guyana, Costa Rica, Italy, Chile, South Africa, Taiwan and Korea, with prevalence rates as high as 60 percent in some countries.

The causes of the disorder are not fully known, but the dramatic hormonal fluctuations that occur after delivery may contribute to it in sus ceptible women. A bout of previous depression is a huge risk factor for the postpartum variety, new research shows. Whatever its cause, depression can weaken the nascent bond between a mother and her child, studies suggest, and thereby make a toddler more passive, insecure and socially inhibited—although a child’s intellectual development usually remains unimpaired.

Thus, in addition to treating the mother’s depression, psychologists and psychiatrists increasingly focus on strengthening the relationship between the mother and her child—for example, by using a video camera to record and analyze their interactions. “We need to change the unfavorable behavioral patterns that develop between mother and child during depression,” says University of Heidelberg psychologist Corinna Reck.

Hormonal Havoc
Women seem to be particularly vulnerable to depression during their reproductive years: rates of the disorder are highest in females between the ages of 25 and 45. New data indicate that the incidence of depression in females rises, albeit modestly, after giving birth. In the October 2007 American Journal of Psychiatry, epidemiologist Patricia Dietz of the U.S. Centers for Disease Control and Prevention and her colleagues reported that 10.4 percent of 4,398 mothers had been depressed in the nine months following childbirth, compared with 8.7 percent in the nine months before pregnancy and 6.9 percent during pregnancy. More than half of the women with postpartum depression had also been depressed during or before pregnancy, suggesting that a previous occurrence of depression may be the biggest risk factor for acquiring the illness postpartum.

But the hormonal changes that occur in a new mother’s body are also thought to contribute to postpartum depression in some cases. During pregnancy, a woman experiences a surge in blood levels of estrogen and progesterone. Then, in the first 48 hours after childbirth, the amount of these two hormones plummets almost 50-fold back to normal levels. This chemical seesaw could contribute to depression just as smaller hormonal changes before a woman’s menstrual period may affect her moods.

Of course, hormonal flux does not fully explain postpartum depression. After all, this biochemical oscillation occurs in all new mothers, and yet only a small proportion of them become depressed. In addition, studies have shown that pregnancy hormone levels in a woman do not predict her risk of depression.

Nevertheless, the rapid rise and fall of female sex hormones may buffet the emotions of a subset of women who are predisposed to depression and thus may be acutely sensitive to the hormones’ effects. In 2000 endocrinologist David R. Rubinow, then at the National Institute of Mental Health, and his colleagues reported that simulating the hormonal ebb and flow that occurs during pregnancy and childbirth in 16 women precipitated depressive symptoms in five of the eight women with a history of postpartum depression but not in subjects who had no such history.

The demands of motherhood very likely play a role as well. Many women feel exhausted from a baby’s broken sleep and become overwhelmed by new child care duties. Some may lament the loss of the life they led before having the baby or of their former figure. Women who must endure such stresses on top of marital problems, a complicated birth, job loss or lack of support from family and friends are more likely to succumb to depression.

Broken Bonds
The consequences of depression inevitably reach beyond the mother. In a fog of sadness, a mother often lacks the emotional energy to relate appropriately to her baby. Overwhelming grief prevents her from properly perceiving a child’s smiles, cries, gestures and other attempts to communicate with her. Getting no response from mom, the child quits trying to relate to her. Thus, three-month-old infants of depressed mothers look at their mothers less often and show fewer signs of positive emotion than do babies of mentally healthy moms.

In fact, infants of depressed mothers display something akin to learned helplessness, a phenomenon University of Pennsylvania psychologist Martin E. P. Seligman and his colleagues described in the 1960s. In Seligman’s experiments, an animal would conclude that a situation was hopeless after repeatedly failing to overcome it—and then remain passive even when it could effect change. A similar passivity characterizes depression. “Sometimes the infants mirror their mother’s depressive behavior,” Reck says.

Such reciprocal withdrawal can start to fray the critical emotional bond between mother and child, especially if the depression occurs early in the baby’s life. Other work has shown that infants develop essential social skills in months two through six, building relationships with their mothers as well as other people. In a 2006 study of 101 new mothers, psychiatrist Eva Moeh ler, Reck and their Heidelberg colleagues found that maternal depression strongly diminished the quality of a mother’s bond with her child at two weeks, six weeks and four months postpartum—but not at 14 months. Thus, depression during the first few months after birth may be particularly perilous for a child’s social development.

A child of a depressed mother may even become more introverted and face a greater risk for social phobia, an extreme fear of social situations, among other emotional difficulties. In 2007 Reck, Moehler and their colleagues reported that in the same 101 mother-infant pairs, postpartum depression at six weeks, four months and 14 months after birth tended to make a 14-month-old toddler more fearful and inhibited as compared with same-age toddlers of healthy moms. Other work suggests that postpartum depression may produce behavioral problems and negativity in children.

Postpartum gloom usually does not have a long-lasting impact on children’s cognitive development, however. In a 2001 study psychologists Sophie Kurstjens and Dieter Wolke of the University of Munich tested the intellectual skills of 1,329 children (92 of them born to mothers who had depression) at various ages from 20 months to eight years. The researchers generally found no cognitive deficits among the children of depressed mothers as compared with those of healthy mothers. They did find cognitive problems, however, in boys of low socioeconomic status who had chronically depressed mothers as compared with children whose mothers had less severe depression.

Nursing Mom
Despite the devastating fallout from postpartum depression, many mothers shy away from getting help—in some cases, out of shame for emotions they cannot justify. Manuela, for example, was initially afraid to talk about her feelings and fears.
She felt no one would understand why she was sad after the birth of a healthy, beautiful baby. Eventually, however, at her breaking point, she sought treatment at the Heidelberg clinic.

Many new mothers require medication to take the sting out of their sadness. A doctor may prescribe an antidepressant such as Prozac and, in some cases, may recommend taking a hormone such as estrogen as well. In addition, a small 2007 study by Yale University psychiatrists Ariadna Forray and Robert B. Ostroff suggests that electroconvulsive therapy can ameliorate postpartum depression and its more severe cousin, postpartum psycho sis, in women who do not respond to drug therapy.

Psychotherapy for the mother’s depression may also be beneficial. One proven approach is cognitive-behavior therapy, in which a therapist tries to correct distorted and negative ways of thinking either by discussing them openly or by asking the patient to practice more adaptive behaviors.

But treating the mother in isolation is often not enough to prevent her illness from affecting her child. In a study published last year psychologist David Forman of Concordia University in Quebec and his colleagues compared 60 mothers who received psychotherapy for depression with a group of 60 untreated depressed mothers and 56 healthy mothers. Six months of therapy did lower parenting stress in depressed women as compared with untreated depressed women, but the treated women still viewed their infants more negatively than did mothers who had not been depressed. Perhaps as a result, after 18 months of therapy the affected mothers reported more behavior problems, a lower level of attachment security and a more negative temperament in their children as compared with moms who had not been depressed.

Now these and many other researchers believe that therapy for postpartum depression should also involve the child. Psychologist George Downing of Pitié-Salpêtrière Hospital in Paris developed video intervention therapy, for example, to improve mother-infant interaction. The technique helps mothers to correctly perceive their infants’ behavior by recording and analyzing it—and to feel better about their own actions as mothers. “The goal of therapy is to reactivate the intuitive maternal behavioral repertoire that was covered over by the depression,” explains Heidelberg clinic psychiatrist Thomas Fuchs.

Baby Talk
Tabea, a mother in her early thirties whose depression was severe enough to warrant hospitalization for several weeks after she gave birth, is still having difficulty interacting with her four-month-old son. At the Heidelberg clinic, a psychologist asks Tabea (which is not her real name) to sit in front of a video camera with her baby. Tabea speaks loudly to him. She raises her eyebrows and laughs. Her infant makes eye contact, and a smile flits across his face. His mother feels reinforced. But then the infant turns his head away. And Tabea says, “Well, what’s the matter now? Sulking again, are we? Did mommy leave you by yourself too long?” Tabea feels guilty for having had to leave her baby to be treated for depression.

But it is normal for infants to turn away after a social interaction. That is how they regulate stimuli. It is not, as Tabea sees it, a personal affront or a sign that she is a bad mother. Nevertheless, Tabea’s misinterpretation of her baby’s actions can prompt a vicious cycle in which the child’s apparent rejection hurts Tabea, making her feel insecure and sad, which in turn has a negative effect on the baby.

The therapist’s job is to break that cycle, large ly by correcting a mother’s misimpressions and emphasizing what she has done well. Tabea’s wide-open eyes, for example, signaled that she was paying attention to her child. The psychologist points out that Tabea’s expressive face and melodious speech are similarly appropriate and helpful. Then she encourages Tabea to wait for her child to take the initiative, which will be her signal to respond.

Some hospitals have mother-infant treatment centers for postpartum depression so that the mother can remain with her infant during treatment. There hospital personnel help the mother feed, diaper and bathe her child while also providing behavior therapy. Fathers can play an important part, too. Assuming he is not depressed, a father can significantly ameliorate the effects of a mother’s depression by building a close relationship with his son or daughter.

Meanwhile a mother can take steps to ease her emotional burden by asking for help from family and friends, sleeping more, spending time with her spouse, getting out of the house and putting less pressure on herself. In the end, most mothers who receive adequate treatment—often a combination of psychotherapy, medication and self-help—usually recover completely within about two months of starting treatment, according to psychiatrist Ricardo J. Fernandez of Prince ton Family Care Associates in New Jersey. Some mothers even emerge from their cloud of sadness with a new sense of clarity. As one mother said of her depression, “It gave me the impetus to change my life.”

Further Reading

via scientificamerican.com

Sleep deprivation clearly linked to hypertension, using varied methodology. They don't seem to account for obstructive sleep apnea which may be vastly under diagnosed

Medical News Today

Insufficient Sleep Linked To High Blood Pressure
10 Jun 2009   
Not getting enough sleep could increase a person's risk of developing high blood pressure, said US researchers who monitored over 500 middle aged people for 5 years. They hope that the discovery of this new risk factor will help prevent more people developing high blood pressure and suggest more research is done to see if improving sleep patterns reduces the risk.
The study was the work of lead author Dr Kristen L Knutson of the University of Chicago, and colleagues, and is published in the 8 June issue of the Archives of Internal Medicine.
High blood pressure accounts for 7 million deaths worldwide and affects about one third of Americans, wrote the authors in their background information.
Researchers already know of a possible link between self-reported hours of sleep and high blood pressure but this appears to be the first study to look at both cross-sectional (taking a snapshop of a group of people showing different patterns of the same variables) and longitudinal (following a group of people over time) measurements of sleep and blood pressure.
The study was part of a larger investigation called Coronary Artery Risk Development in Young Adults (CARDIA) which took blood pressure measurements in 2000 and 2001 and in 2005 and 2006. For this study, the participants were 578 African Americans and whites aged from 33 to 45 years at the start.
Sleep was also measured using a sensor worn on the wrist that measures movement patterns characteristic of sleep and wakefulness (actigraphy). The sensor was worn on three consecutive days between 2003 and 2005 and gave measures of sleep duration and sleep maintenance (a measure of sleep quality).
The results showed that on average, participants slept for about 6 hours a night and only 1 per cent averaged 8 or more hours a night.
After excluding those participants who were on blood pressure medication, and adjusting for age, race and sex, the results also showed that:
  • Participants who had less sleep and lower quality sleep were significantly more likely to have higher systolic and diastolic blood pressure readings (ie from the cross-sectional point of view less and poorer sleep predicted higher blood pressure across the group).
  • Less and lower quality sleep was also significantly more likely to be linked to adverse changes in systolic and diastolic blood pressure over a 5 year period (ie from the longitudinal view the lower sleep figures predicted the increases in blood pressure figures over time, all P<.05).
  • After 5 years, each hour less of sleep was linked to a 37 per cent higher chance of developing high blood pressure.
  • African Americans tended to sleep less than whites and also tended to have higher blood pressure.
The authors concluded that:
"Reduced sleep duration and consolidation predicted higher BP [blood pressure] levels and adverse changes in BP, suggesting the need for studies to investigate whether interventions to optimize sleep may reduce BP."
They said that identifying a new lifestyle risk factor for high blood pressure could help develop new ways to prevent or reduce it.
Speculating on what the underlying mechanism might be, they suggested that insufficient sleep affects the way the body responds to stress and this might lead to raised blood pressure.
"Association Between Sleep and Blood Pressure in Midlife: The CARDIA Sleep Study."

Kristen L. Knutson; Eve Van Cauter; Paul J. Rathouz; Lijing L. Yan; Stephen B. Hulley; Kiang Liu; Diane S. Lauderdale.
Arch Intern Med, 2009;169(11):1055- 1061.
Vol. 169 No. 11, June 8, 2009
Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Article URL: http://www.medicalnewstoday.com/articles/153242.php

Main News Category: Sleep / Sleep Disorders / Insomnia

Also Appears In:  Hypertension, 

Friday, June 19, 2009

this constitutes a huge even epic social engineering/experimentation because of the rapidity of change in family dynamics

Yahoo! News

Surging Internet Use Cutting Into Family Time

By Amanda Gardner
HealthDay Reporter
Thu Jun 18, 11:49 pm ET

THURSDAY, June 18 (HealthDay News) -- American kids and their parents are now spending more hours huddled alone around computer screens and cell phone displays, seriously eroding the amount of time families spend together.

That's according to a new report that found the time per week that families interact as group has fallen by nearly a third between 2005 and 2008. ( this Incredibly dramatic  Change In a very short period of time. Functions as a wide scale societal intervention.)

"Family face-to-face time has decreased in a substantial way. There's been a fairly abrupt drop in family time, a process which is usually glacial," said Michael Gilbert, a senior fellow at the Center for the Digital Future at the University of Southern California's Annenberg School for Communication. "Families are the social building blocks of virtually every society, and this can't be a good thing."

In a new survey from the center, researchers found that in 2008, 28 percent of people said that being wired has resulted in them spending less time with family members, a threefold increase from the 11 percent reported just two years ago, in 2006.

"We wanted to put a little alert out about this," Gilbert said. "Technology isn't all good."

This is certainly not the first time researchers have sounded an alarm about Internet use and even "Internet addiction." Other studies have suggested that online usage has significantly disrupted the lives of millions of Americans.

"In the last two decades, there has been an erosion in family dinners together that take place without gadgets," Gilbert said. "There's reduced cohesion, reduced communication."

And the Internet is vastly different from television, which drew (and still draws) people together -- watching, say, Johnny Carson, the 1969 moon landing, or American Idol.

In contrast, "the Internet is one-to-one and so demanding. The key distinction of the Internet is interactivity," Gilbert said. "You have to sit and respond."

The annual survey, part of the Center's Digital Future Project, involved contacts with 2,000 American households. In 2005, the survey found that the amount of time family members spent together averaged about 26 hours a month.

That shared time had dropped precipitously to just under 18 hours per month by 2008, slashing overall time spent together by 30 percent. (then there is the multitasking time that is spent, where the family is present, but engaging any electronic activity like texting. This probably erodes meaningful social times as well )

Women seem to be bearing the brunt of this Web-linked isolation, with more than 49 percent reporting feeling "sometimes" or "often" ignored by other family members, compared with only about 39 percent of men reporting the same.

Meanwhile, in 2000, 11 percent of people surveyed said younger people (under 18) were spending "too much time" online, vs. 28 percent in 2008.

This trend toward decreased family time dovetails with the emergence and rapid growth of online social communities, the researchers noted.

"Social networks such as Twitter and Facebook exploded in 2007. At that time, more than half of people online said this online community was as important as their offline community," Gilbert said. "Many technology issues are pulling on the family which, in the modern world, has enough pressures."

Where might all this lead?

"Certainly a lack of collective experience and face-to-face time will lead to a breakdown in communication, decreased opportunities to experience the world together, increased alienation of children," Gilbert said. "Family breakdown leads to destructive behavior."

In response, some families are beginning to budget time for Internet use, setting curfews or proclaiming no Internet on weekends.

"There are ways we can put little fences around our involvement with the Internet," Gilbert said. "We need to remember how valuable it is to spend time together and experience the world together. Nothing can substitute for face-to-face time."

For all the potential damage involved in Internet usage, there are also numerous benefits, said Dr. Harold Koplewicz, director of the Child Study Center at New York University Langone Medical Center.

"Kids have the opportunity to learn, play, socialize and participate in social life. It's communication besides pleasure," he said. "It may look as though they're wasting time, but spending time online is essential. Kids can participate in culture and connect with others with similar interests."

But, Koplewicz added, "Parents need to counter the trend towards decreased family time. While there are benefits to Internet usage, it doesn't mean you can let the machine take over."

Parents need to consciously plan family time, which can include playing computer games together, doing online projects together, having regular family meal times and participating in regular outings. They also need to monitor their children's use of the Internet, including having access to a history of sites visited, he said.

"The more involved parents are in their teen's life, the more valued teens feel. It's a myth that teens do not want their parents in their life," Koplewicz said.

More information

Find out more at the Center for the Digital Future.

On postpartum depression take away message its common almost 10% in the first 9 months, it last longer than the first few weeks after delivery, it affects mom child bonding, and has vicious cycle effects on mom's feeling of adequacy as a parent. What may be underestimated is low levels of depression not quite reaching clinical depression and anxiety overlay , which think is substantially more common.

SciAm.com logo

Scientific American Mind -  March 20, 2008

Postpartum Depression Epidemic Affects More than Just Mom

A deep despair mars the first year of motherhood for as many as one in five women. Without treatment, postpartum depression can weaken critical bonds between a mother and her child

By Katja Gaschler

The psychologist smiles at Manuela, a new mother in her late thirties. “Please play with your baby for two minutes,” the therapist instructs her and then leaves the room. Two video cameras film Manuela (which is not her real name) and her three-month-old daughter. In the next room, a split-screen monitor shows the mother’s profile on the left and her infant in a baby chair on the right.

At first, Manuela appears to be at a loss for what to do. Then, her face noticeably stiff, she begins to talk softly to her baby. Her baby fidgets, briefly makes eye contact and then turns away. Manuela eventually stops talking and stares into the distance, unsure again how to act. She absentmindedly strokes her baby’s foot with one hand. The psychologist knocks on the door; the videotaping is over. The new mother is now on the verge of tears.

Manuela is undergoing therapy at the Clinic for General Psychiatry in Heidelberg, Germany, for postpartum depression, an ailment that has strained her relationship with her baby. Although the vast majority of mothers experience periods of crying and irritability along with concen tration lapses and exhaustion, these so-called baby blues disappear within a few hours or days of delivery. But 10 to 20 percent of women in the U.S. develop, in the first year after childbirth, the more disabling despair that afflicts Manuela. These mothers succumb to a deep sadness that, if untreated, may persist for months to years.

Manuela frequently feels exhausted and emotionally empty. When her baby cries, she sometimes wants to flee or hide. She is wracked with guilt because she cannot show love to her daughter. Mothers with symptoms of postpartum depression [see box on page 70] are often overwhelmed by the feeling that they might harm their babies. Although they rarely cause any outright harm, depressed mothers may have difficulty caring for their infants—and that fact can heighten their distress.

These emotional problems plague women worldwide. A 2006 review of 143 studies in 40 countries documents that postpartum depression is especially common in Brazil, Guyana, Costa Rica, Italy, Chile, South Africa, Taiwan and Korea, with prevalence rates as high as 60 percent in some countries.

The causes of the disorder are not fully known, but the dramatic hormonal fluctuations that occur after delivery may contribute to it in sus ceptible women. A bout of previous depression is a huge risk factor for the postpartum variety, new research shows. Whatever its cause, depression can weaken the nascent bond between a mother and her child, studies suggest, and thereby make a toddler more passive, insecure and socially inhibited—although a child’s intellectual development usually remains unimpaired.

Thus, in addition to treating the mother’s depression, psychologists and psychiatrists increasingly focus on strengthening the relationship between the mother and her child—for example, by using a video camera to record and analyze their interactions. “We need to change the unfavorable behavioral patterns that develop between mother and child during depression,” says University of Heidelberg psychologist Corinna Reck.

Hormonal Havoc
Women seem to be particularly vulnerable to depression during their reproductive years: rates of the disorder are highest in females between the ages of 25 and 45. New data indicate that the incidence of depression in females rises, albeit modestly, after giving birth. In the October 2007 American Journal of Psychiatry, epidemiologist Patricia Dietz of the U.S. Centers for Disease Control and Prevention and her colleagues reported that 10.4 percent of 4,398 mothers had been depressed in the nine months following childbirth, compared with 8.7 percent in the nine months before pregnancy and 6.9 percent during pregnancy. More than half of the women with postpartum depression had also been depressed during or before pregnancy, suggesting that a previous occurrence of depression may be the biggest risk factor for acquiring the illness postpartum.

But the hormonal changes that occur in a new mother’s body are also thought to contribute to postpartum depression in some cases. During pregnancy, a woman experiences a surge in blood levels of estrogen and progesterone. Then, in the first 48 hours after childbirth, the amount of these two hormones plummets almost 50-fold back to normal levels. This chemical seesaw could contribute to depression just as smaller hormonal changes before a woman’s menstrual period may affect her moods.

Of course, hormonal flux does not fully explain postpartum depression. After all, this biochemical oscillation occurs in all new mothers, and yet only a small proportion of them become depressed. In addition, studies have shown that pregnancy hormone levels in a woman do not predict her risk of depression.

Nevertheless, the rapid rise and fall of female sex hormones may buffet the emotions of a subset of women who are predisposed to depression and thus may be acutely sensitive to the hormones’ effects. In 2000 endocrinologist David R. Rubinow, then at the National Institute of Mental Health, and his colleagues reported that simulating the hormonal ebb and flow that occurs during pregnancy and childbirth in 16 women precipitated depressive symptoms in five of the eight women with a history of postpartum depression but not in subjects who had no such history.

The demands of motherhood very likely play a role as well. Many women feel exhausted from a baby’s broken sleep and become overwhelmed by new child care duties. Some may lament the loss of the life they led before having the baby or of their former figure. Women who must endure such stresses on top of marital problems, a complicated birth, job loss or lack of support from family and friends are more likely to succumb to depression.

Broken Bonds
The consequences of depression inevitably reach beyond the mother. In a fog of sadness, a mother often lacks the emotional energy to relate appropriately to her baby. Overwhelming grief prevents her from properly perceiving a child’s smiles, cries, gestures and other attempts to communicate with her. Getting no response from mom, the child quits trying to relate to her. Thus, three-month-old infants of depressed mothers look at their mothers less often and show fewer signs of positive emotion than do babies of mentally healthy moms.

In fact, infants of depressed mothers display something akin to learned helplessness, a phenomenon University of Pennsylvania psychologist Martin E. P. Seligman and his colleagues described in the 1960s. In Seligman’s experiments, an animal would conclude that a situation was hopeless after repeatedly failing to overcome it—and then remain passive even when it could effect change. A similar passivity characterizes depression. “Sometimes the infants mirror their mother’s depressive behavior,” Reck says.

Such reciprocal withdrawal can start to fray the critical emotional bond between mother and child, especially if the depression occurs early in the baby’s life. Other work has shown that infants develop essential social skills in months two through six, building relationships with their mothers as well as other people. In a 2006 study of 101 new mothers, psychiatrist Eva Moeh ler, Reck and their Heidelberg colleagues found that maternal depression strongly diminished the quality of a mother’s bond with her child at two weeks, six weeks and four months postpartum—but not at 14 months. Thus, depression during the first few months after birth may be particularly perilous for a child’s social development.

A child of a depressed mother may even become more introverted and face a greater risk for social phobia, an extreme fear of social situations, among other emotional difficulties. In 2007 Reck, Moehler and their colleagues reported that in the same 101 mother-infant pairs, postpartum depression at six weeks, four months and 14 months after birth tended to make a 14-month-old toddler more fearful and inhibited as compared with same-age toddlers of healthy moms. Other work suggests that postpartum depression may produce behavioral problems and negativity in children.

Postpartum gloom usually does not have a long-lasting impact on children’s cognitive development, however. In a 2001 study psychologists Sophie Kurstjens and Dieter Wolke of the University of Munich tested the intellectual skills of 1,329 children (92 of them born to mothers who had depression) at various ages from 20 months to eight years. The researchers generally found no cognitive deficits among the children of depressed mothers as compared with those of healthy mothers. They did find cognitive problems, however, in boys of low socioeconomic status who had chronically depressed mothers as compared with children whose mothers had less severe depression.

Nursing Mom
Despite the devastating fallout from postpartum depression, many mothers shy away from getting help—in some cases, out of shame for emotions they cannot justify
. Manuela, for example, was initially afraid to talk about her feelings and fears. She felt no one would understand why she was sad after the birth of a healthy, beautiful baby. Eventually, however, at her breaking point, she sought treatment at the Heidelberg clinic.

Many new mothers require medication to take the sting out of their sadness. A doctor may prescribe an antidepressant such as Prozac and, in some cases, may recommend taking a hormone such as estrogen as well. In addition, a small 2007 study by Yale University psychiatrists Ariadna Forray and Robert B. Ostroff suggests that electroconvulsive therapy can ameliorate postpartum depression and its more severe cousin, postpartum psycho sis, in women who do not respond to drug therapy.

Psychotherapy for the mother’s depression may also be beneficial. One proven approach is cognitive-behavior therapy, in which a therapist tries to correct distorted and negative ways of thinking either by discussing them openly or by asking the patient to practice more adaptive behaviors.

But treating the mother in isolation is often not enough to prevent her illness from affecting her child. In a study published last year psychologist David Forman of Concordia University in Quebec and his colleagues compared 60 mothers who received psychotherapy for depression with a group of 60 untreated depressed mothers and 56 healthy mothers. Six months of therapy did lower parenting stress in depressed women as compared with untreated depressed women, but the treated women still viewed their infants more negatively than did mothers who had not been depressed. Perhaps as a result, after 18 months of therapy the affected mothers reported more behavior problems, a lower level of attachment security and a more negative temperament in their children as compared with moms who had not been depressed.

Now these and many other researchers believe that therapy for postpartum depression should also involve the child. Psychologist George Downing of Pitié-Salpêtrière Hospital in Paris developed video intervention therapy, for example, to improve mother-infant interaction. The technique helps mothers to correctly perceive their infants’ behavior by recording and analyzing it—and to feel better about their own actions as mothers. “The goal of therapy is to reactivate the intuitive maternal behavioral repertoire that was covered over by the depression,” explains Heidelberg clinic psychiatrist Thomas Fuchs.

Baby Talk
Tabea, a mother in her early thirties whose depression was severe enough to warrant hospitalization for several weeks after she gave birth, is still having difficulty interacting with her four-month-old son. At the Heidelberg clinic, a psychologist asks Tabea (which is not her real name) to sit in front of a video camera with her baby. Tabea speaks loudly to him. She raises her eyebrows and laughs. Her infant makes eye contact, and a smile flits across his face. His mother feels reinforced. But then the infant turns his head away. And Tabea says, “Well, what’s the matter now? Sulking again, are we? Did mommy leave you by yourself too long?” Tabea feels guilty for having had to leave her baby to be treated for depression.

But it is normal for infants to turn away after a social interaction. That is how they regulate stimuli. It is not, as Tabea sees it, a personal affront or a sign that she is a bad mother. Nevertheless, Tabea’s misinterpretation of her baby’s actions can prompt a vicious cycle in which the child’s apparent rejection hurts Tabea, making her feel insecure and sad, which in turn has a negative effect on the baby.

The therapist’s job is to break that cycle, large ly by correcting a mother’s misimpressions and emphasizing what she has done well. Tabea’s wide-open eyes, for example, signaled that she was paying attention to her child. The psychologist points out that Tabea’s expressive face and melodious speech are similarly appropriate and helpful. Then she encourages Tabea to wait for her child to take the initiative, which will be her signal to respond.

Some hospitals have mother-infant treatment centers for postpartum depression so that the mother can remain with her infant during treatment. There hospital personnel help the mother feed, diaper and bathe her child while also providing behavior therapy. Fathers can play an important part, too. Assuming he is not depressed, a father can significantly ameliorate the effects of a mother’s depression by building a close relationship with his son or daughter.

Meanwhile a mother can take steps to ease her emotional burden by asking for help from family and friends, sleeping more, spending time with her spouse, getting out of the house and putting less pressure on herself. In the end, most mothers who receive adequate treatment—often a combination of psychotherapy, medication and self-help—usually recover completely within about two months of starting treatment, according to psychiatrist Ricardo J. Fernandez of Prince ton Family Care Associates in New Jersey. Some mothers even emerge from their cloud of sadness with a new sense of clarity. As one mother said of her depression, “It gave me the impetus to change my life.”

 

Monday, June 15, 2009

summary of relenza data from package FDA

Relenza notes 10 mg PO PID for five days treatment.

Can get first dose and second should get first two doses within the first day at least two hours apart.

Side effects fairly minimal, about   3 to 6% about the same as placebo G.I. 
FDA approved over seven years of age for treatment over five for prophylaxis  the reason for this seems to be the difficulty in getting adequate medication deposition in the lungs and children under seven years of age they can't suck in hard enough.
 

Bronchospasm 1/13 with mild or moderate asthma 
in a phase 3 study with acute influenza like illness superimposed on underlying asthma or COPD 10% experienced greater than 20% declining a 51 following treatment for five days. Interestingly 9% on placebo also experienced this 

The nearest psychiatric events occurred both with and without encephalitis. They had abrupt onset and rapid resolution.

Relenza not known whether it is excreted in milk. ie what to do with lactating women.
 
half-life is very fast essentially undetectable after 1 1/2 hours

Interestingly no consistent treatment effect was demonstrated in patients with underlying medical problems. No consistent differences in rate of development of complications. 
In terms of prophylaxis, the attack rate  seem to go from 20% to 4% for group receiving Relenza; so strong role for prophylaxis, weaker role for treatment

 

re fda warning re stims, more controversy, the hard and sad thing about this kind of study is that many young children who would benefit will likely be pulled off meds, and who can count increase in accidents from untreated impulsivity, etc

re fda warning re stims, more controversy, the hard and sad thing about this kind of study is that many young children who would benefit will likely be pulled off meds, and who can count increase in accidents from untreated impulsivity, etc

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166667.htm

Stimulant Medications used in Children with Attention-Deficit/Hyperactivity Disorder - Communication about an Ongoing Safety Review

Products involved include: Focalin, Focalin XR (dexmethylphenidate HCl ); Dexedrine, Dexedrine Spansules, Dextroamphetamine ER, Dextrostat (dextroamphetamine sulfate); Vyvanse (lisdexamfetamine dimesylate); Desoxyn (methamphetamine); Concerta, Daytrana, Metadate CD, Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin-LA, Ritalin-SR (methylphenidate); Adderall, Adderall XR (mixed salts amphetamine); Cylert (pemoline) and generics.

Audience: Pediatricians, Neuropsychiatric healthcare professionals

[Posted 06/15/2009] FDA notified healthcare professionals that it is providing its perspective on study data published in the American Journal of Psychiatry on the potential risks of stimulant medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in children. This study, funded by the FDA and the National Institute of Mental Health (NIMH), compared the use of stimulant medications in 564 healthy children from across the United States who died suddenly to the use of stimulant medications in 564 children who died as passengers in a motor vehicle accident.The study authors concluded that there may be an association between the use of stimulant medications and sudden death in healthy children. Given the limitations of this study’s methodology, the FDA is unable to conclude that these data affect the overall risk and benefit profile of stimulant medications used to treat ADHD in children. FDA believes that this study should not serve as a basis for parents to stop a child’s stimulant medication. Parents should discuss concerns about the use of these medicines with the prescribing healthcare professional. Any child who develops cardiovascular symptoms (such as chest pain, shortness of breath or fainting) during stimulant medication treatment should immediately be seen by a doctor.

FDA is continuing its review of the strengths and limitations of this and other epidemiological studies that evaluate the risks of stimulant medications used to treat ADHD in children. FDA and the Agency for Healthcare Research and Quality are sponsoring a large epidemiological study that will provide further information about the potential risks associated with stimulant medication use in children. The data collection for this study will be complete later in 2009.

Sunday, June 14, 2009

A great article on a reporter’s journey into insidious sleep disorder. This is the tip of the iceberg.

When Sleep Leaves You Tired

  • By MELINDA BECK

Columnist's name

Ask readers of this newspaper if they're getting adequate sleep, and many would probably say "Ha!"

Twenty percent of Americans sleep less than six hours a night, and nearly one-third have lost sleep worrying about financial concerns, according to the National Sleep Foundation, which recommends that adults get seven to nine hours. "Our society thinks sleep is for slackers," says Darrel Drobnich, the organization's chief program officer.

But all that lost sleep is taking an insidious toll. Chronic, inadequate sleep raises the risk of cardiovascular disease, depression, diabetes and obesity. It impairs cognitive function, memory and the immune system and causes more than 100,000 motor-vehicle accidents a year. Sleep deprivation also changes the body's metabolism, making people eat more and feel less satisfied.

Studies presented at the American Association of Sleep Medicine's annual meeting in Seattle this week also found that inadequate sleep is associated with lower GPAs among college students and with elevated levels of visfatin, a hormone secreted by belly fat that is associated with insulin resistance.

What many people don't realize is that even if they log respectable time in bed (known as TIB among sleep researchers), they may be getting poor-quality sleep, with not enough of the restorative phases. REM, the Rapid Eye Movement phase in which dreaming occurs, is crucial for consolidating memories, learning, creativity, problem-solving and emotional balance. Deep, or slow-wave sleep, when the body secretes human growth hormone, is critical for development and physical repair. Both REM and deep sleep decline with age and are highly vulnerable to disruptions, from caffeine and alcohol to anxiety and a variety of sleep disorders.

One tip-off that you haven't gotten enough restorative sleep is trouble waking up and excessive daytime sleepiness (a condition known as EDS). "People say, 'Oh, I don't have a sleep problem. I can fall asleep anywhere, anytime' -- but that means you are excessively sleepy," says Charles Czeisler, a professor of sleep medicine at Harvard Medical School.

Other symptoms of sleep deprivation include mood changes, difficulty focusing or remembering and a chronic need for caffeine, which can then create a vicious circle of dependence and disruption. That would be me.

Finding out what's going on in your sleep generally requires spending the night in a professional sleep lab hooked up to lots of wires and monitors. But I've been testing a new home-sleep monitor called the Zeo Personal Sleep Coach that lets people track their sleep patterns nightly in their own bedrooms.

You sleep wearing a soft headband with sensors that monitor your brain waves and send signals wirelessly to a device that looks like a sleek clock radio. It displays whether you are awake or in light sleep, deep sleep, or REM sleep, in real time, all through the night.

"If you can measure it, you can manage it," says Stephan Fabregas, one of two recent Brown University graduates who invented the Zeo because they were looking for a way to wake up feeling less groggy after late nights.

Of course, not everyone needs a fancy gadget to tell them whether they are sleeping properly. But I was stunned by my results: The Zeo showed that I woke up numerous times and was awake for long stretches of the night, without having any recollection. (Perception of time is often distorted at night -- many people with insomnia actually sleep more than they think they do.) Even though I was in bed for six or seven hours each night, I was averaging only about four hours of real sleep and very little REM or deep sleep. No wonder I feel so tired!

The Zeo stores the information on a memory card you can upload to a Web site, which helps track your sleep patterns and sends daily coaching tips for getting better sleep. The $399 device comes with six months of daily email coaching, which can be extended at a cost of $99 for each additional six months. (Currently, it's available only online at www.myzeo.com.)

To help you keep track of your sleep, the Zeo also gives you a "ZQ" score every morning, based on the quantity and quality of your sleep the night before. There's no ideal ZQ -- you're comparing your own score from night to night. But the average for people in their 20s is 86; for those in their 40s, it is 74; and for those in their 50s, it is 67, since sleep quality declines with age.

My ZQs bounced from the 40s to a dismal 15 the first week. Switching to decaf after 3 p.m. and making an effort to get to bed earlier helped me bring my score into the 50s the second week. ("Having caffeine even first thing in the morning can induce changes in brain activity during sleep," says Kenneth Wright, director of the Sleep and Chronobiology Lab at the University of Colorado at Boulder and one of Zeo's scientific advisers.) I also noticed that the nights when I had the longest stretches of wakefulness were those when my column was due -- probably a sign that I was still thinking about it long after turning in.

Everybody's sleep and sleep disruptors are different. Todd Johnson, a 40-year-old border-patrol agent in Caribou, Maine, and one of ZEO's early testers, found that reading before he went to bed helped reduce his wake time and bring his ZQ from the 20s into the 60s. "You can try something that night and see the results in the morning," he says. Another early tester, Tim Guirl, who teaches at a community college in Seattle, found that he had more restorative sleep if he didn't exercise too close to bedtime and eliminated a large late-night snack.

Other recommendations from Zeo include reducing noise, light and disruptive influences like pets in the bedroom; having a "power-down" hour before bedtime with no email, no Internet use, no cellphones and no BlackBerrys; and keeping a consistent sleep schedule. And if you find yourself awake and worrying, Zeo recommends getting out of bed and writing down what you're thinking about in a "worry journal."

Zeo says its brain-wave results are similar to those from professional sleep labs -- but only about 140 people have tested it so far. And the Zeo isn't designed to diagnose actual sleep disorders, which plague an estimated 70 million Americans -- you need to see a doctor for that.

To see if something besides drinking coffee and thinking great thoughts was affecting my sleep, I underwent a sleep study at the Sleep Health Center connected with Brigham and Women's Hospital in Brighton, Mass. A polysomnography, as such tests are called, measures brain waves like the Zeo, but also heart rate, respiratory rate, oxygen saturation, body positions and movements. It took about 45 minutes to have all of the sensors and wires attached -- and then a little longer to get comfortable enough to sleep.

To my surprise, the study found that I had a fairly severe case of Periodic Limb Movements, episodes of involuntary muscle movements in the night. About 10% of adults have PLMs. Many don't even notice; sleep partners are often bothered more than the sleepers themselves. But PLMs can be very disruptive if they are accompanied by arousals from sleep. I was averaging 42 arousals per hour. According to David White, another Harvard sleep physician who prescribed the study for me, PLMs can be due to an iron deficiency or medication side effects, and they are often related to "restless-leg syndrome," which causes an irresistible urge to move the legs, day or night. Medications like Requip can minimize the movements; I'm going to give them a try.

The study also showed I had some obstructive sleep apnea, in which the airway narrows, especially when the muscles relax in sleep. People with OSA stop breathing momentarily until a lack of oxygen alerts the brain, which wakes them up with a gasp. These mini arousals can occur as often as 70 times an hour, leaving the sufferer exhausted and at risk for heart disease, stroke and atherosclerosis. An estimated 4% of men and 2% of women have OSA. One telltale sign is having a shirt-collar size larger than 17 inches. Another sign is loud snoring, although I certainly don't do that. ("Women never snore -- they all deny it," says Dr. White.)

The most effective treatment is a Continuous Positive Airway Pressure machine, which blows air through the nose to keep the airway open. My OSA isn't that bad -- yet. Other remedies include a dental appliance that helps prop the airway open and losing weight, which helps reduce the airway blockage.

Dr. White is also chief medical officer for Philips Home Healthcare, which makes a watch-like monitor, called an Actiwatch, that tracks whether the wearer is moving or still, roughly corresponding with sleep. The Actiwatch doesn't show sleep phases; it generally diagnoses problems with jet lag and body clocks. I wore one for a week, and although I'm still a night owl, it showed nothing amiss in that area.

All in all, "there are plenty of ways you can improve your sleep," Jason Donahue, another Zeo founder, tells me cheerily. This week, I'm starting in on Zeo's tips on keeping disturbances in the bedroom to a minimum. The dog may have to find a new place to sleep.

http://online.wsj.com/article/SB124451280076496767.html?mg=com-wsj#project%3DSLEEPQUIZ0906%26articleTabs%3Darticle

Screening tools for sleep disorder; the Epworth Sleepiness Scale

A good interactive using the most widely utilized clinical sleep scale. This is well validated and good screening tool

http://online.wsj.com/article/SB124451280076496767.html?mg=com-wsj#project%3DSLEEPQUIZ0906%26articleTabs%3Dinteractive

Personal Web site for John C Kim: KIDDOC.ORG

I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.