Sleepless Nights and Restless Legs: New Study Offers Hope for RSL Patients.

John Hopkins researchers may have discovered why insomnia persists in patients with restless leg syndrome (RLS), despite successful treatment of the condition.

An estimated 5 per cent of the U.S. population has Restless Leg Syndrome, also known as "jimmy legs" - a common condition affecting the nervous system causing an uncontrollable urge to move the legs.  The condition varies in severity and can be painful, distressing and interrupt daily activities as well as disturb sleep.

RLS patients commonly suffer from poor sleep as the actual activity of lying down and relaxing in preparation for sleep can activate RLS symptoms - relieved only by rising and moving.

The disruption of neurochemical signals has been identified as a key factor in causing the involuntary movements in RLS, often characteristic of Parkinson's disease. Neurologists have previously based treatment on the understanding that Dopamine is the main culprit in Restless Legs Syndrome.

However, despite drugs that increase the levels of dopamine levels being used in the treatment for RLS, studies have shown that they do not improve sleep outcomes and only treat the restless legs.
A research team led by associate professor of neurology Richard P. Allen, Ph.D from John Hopkins University School of Medicine has looked into solving the sleep anomaly, using MRI to image the brain in a group of 28 RLS patients and 20 non RLS patients.

Glutamate, the neurotransmitter involved in arousal, was found in abnormally high levels in the RLS group. The higher the level of glutamate recorded in the brain of those with RLS, the worse the patient’s sleep.

The research team recorded MRI images and glutamate activity in the thalamus - the part of the brain involved with the regulation of consciousness, sleep and alertness.
RLS patients included in the study had severe symptoms which exhibited:

• six to seven nights a week
• persisting for at least six months
• an average of 20 involuntary movements a night or more.

The second stage of the study involved a two day sleep study on the RLS and non RLS group.  RLS patients were reported to have received 5.5 hours sleep on average.  A direct link between glutamate levels in the thalamus and the number of hours sleep received was identified. There was no such association within the non RLS control group.

Richard P. Allen, Ph.D., is hopeful that the team may have discovered the reason why Restless Legs Syndrome also affects sleep in RSL sufferers -

 “We may have solved the mystery of why getting rid of patients’ urge to move their legs doesn’t improve their sleep,” Allen says. “We may have been looking at the wrong thing all along, or we may find that both dopamine and glutamate pathways play a role in RLS.”

The results of the study could change the way RLS is treated and could potentially eradicate sleepless nights for patients with Restless Legs Syndrome.

Dopamine-related drugs which are currently used in the treatment of RLS do currently work, yet many patients lose the drug benefit and require ever higher doses. If  the dose is too high, the medication can aggravate RLS symptoms to a state worse than prior to treatment.

Allen points out that despite drugs already on the market being available which can reduce glutamate levels in the brain, such as the anticonvulsive gabapentin enacarbil, they have not been given as a first-line treatment for RLS patients.

As more is understood about this neurobiology, the findings may not only apply to RLS, he says, but also to some forms of insomnia.

“It’s exciting to see something totally new in the field — something that really makes sense for the biology of arousal and sleep,” Allen says.

Notes:
The study was funded in part by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke (R01 NS075184 and NS044862), the National Institute on Aging (P10-AG21190) and the National Center for Research Resources (M01RR02719).

Other Johns Hopkins researchers involved in the study include Peter B. Barker, D.Phil.; Alena Horska, Ph.D.; and Christopher J. Earley, M.D., Ph.D.

http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/restless-legs-syndrome/
Image: credit to xymonau at RGB Free Stock http://www.rgbstock.com/images/sleep

A Day in the Life of Shelley and Kev's 1066 Cake Stand. What's it like to run a vegan cake shop?

I am guest posting and guest sitting in Shelley and Kev's 1066 Cake Stand shop. It’s a real eye opener to the hard graft of working for yourself and running a shop. My hat off to you all. 

Shelley and Kev have a shop – The 1066 Cake Stand in Queen’s Road in Hastings and sells vegan cakes and savories and has been since 2012.


I normally work in an office so it is a right old treat to have the day off and be part of the comings and goings of a real live local shoppe.

I’ve been here since 11.30am and so much has happened today and yet it’s not even the book end of the day. We’ve had regulars coming in all morning for their weekly supplies of gluten free goodies, a lady who drove all the way from Crowhurst to pick up a giant vegan wedding cake for her daughter and a man from the council talking in dulcet tones about all the complexities of extending a license to include alcohol. Not any ole boozy woozy mind, but a select vegan and local beer and ale that is coming along soon. Hastings Vegan Brewery – very exciting and a marriage I approve of.



In my office, you don’t need to expect the unexpected but you DO it seems when you work on your todd in a shop. Shelley is like a skilled ninja of conversation and can talk to anybody who appears on her shop stop. At this very moment she is outside and touting her fresh bread to passers by. Ooh someone has just stopped to have a little crunch – a nice young chap having a nibble looking well chuffed; I can hear him promise to come back with his girlfriend to try some cake. Next there is a handsome man outside with, oh boo girlfriend/wife, and they’re sharing a nibble of gluten free bread on their way past. Cor you have to be brave to run a business. I do talk to people at work, but not in the way where I need to jolly them along into a purchase, more in a “pass the stapler” way. It’s a different world.

2.00pm - It’s all gone a little quiet. I think people are too weak from the heat to buy, eat, etc. Shelley said that the heat is like a slap in the face. Poignant.

2.45pm - how the landscape changes! A gaggle of 10 people are clamoring in the shop. What a surprise! A big group of workers on an away day from a Brighton nursery have popped out of nowhere and they seem well chuffed to find a vegan yum shop. You couldn’t predict that you would have a bale of hay one minute followed by a mass of people the next. Now the shop is teeming, everyone else wants a slice (ho ho) of the action and are all about the door and it feels all exciting like Christmas, except it’s boiling and not like Christmas at all.

3.00pm Shelley is all a busy bee now with doing business stuff on her computer  -  emails, invoices and oooh most exciting of all is the news that 1066 Cake Stand has been shortlisted for the 1066 “Eatery of the Year” award. So a posh black tie event is on the cards for next Friday and maybe a shiney award will be glinting in the window from next week. You will have to keep an eye out to see. Shelley reckons she will do a “Gwynth” if she wins and has to do a speech. Can’t wait to see her blub. Not really

1066 Business Award category –
Eatery (Restaurant / Pub / Cafe) of the Year
Sponsored by: Bannatynes Spa Hotel, Hastings
Award for a local restaurant, café, pub that can demonstrate outstanding creativity,
customer service and top quality dining / food in the Hastings and Rother area.

The till is running through. Not sure if it is polite to ask how much is chugging through but it sounds like a healthy noise.

4.11pm Shop is shut. Shelley has just put some gluten free bread in front of me and I am going to have some. Yum.

4.00pm – nearly shutty up shop time. It’s all quiet now and Shelley is washing up and putting things away and getting ready for tomorrow with all the efficiency an cuteness of a little Disney character bird.

4.15pm I didn’t travel in a time machine! I got my times mixed up. I think it is time for me to go home. Bit pooped strangely and in awe of how many skills you need to work for yourself – a right old melee of conversationalism, friendliness, business acumen and not to mention being able to master the craft of bakery too.

Thanks for having me Shelley and Kev. I am going back to the office though where it is safe. Good luck on Friday, 26th of July. I hope you win.

You’ve got my vote, super woman!

UK Gov: "Obesity can not be prevented by individual action alone."

Obesity is no longer a problem that just threatens the future of the US. A research paper published by Foresite of the Government Office for Science warns that 61.3% of adults and a third of children in the UK are now clinically overweight or obese.

Incidents of obesity have increased since 2001 with alarming speed. Figures published by the National Office of Statistics report that 11,736 children and adults were admitted to hospital with a primary diagnosis of obesity in 2011/12 - a ten fold increase in just ten years.

Stomach stapling, gastric bypass and sleeve gastroectomy have seen a year on year increase in the number of procedures recorded. 261 procedures were carried out in 2000/01, and according to the NHS this figure has risen to 6,723 in 20011/12. Gastric bands alone reportedly cost the UK health service £85 million a year.

Obesity is life limiting,  life threatening and leads to premature death. Obese patients can suffer heart disease, strokes, obesity related cancers, hypertension, arthritis and asthma as well as serious physical injuries resulting from falls. According to the UK Government research, obesity can also cause feelings of low self worth, mental health problems and difficulties in gaining and sustaining employment.

Three major findings of the Foresite report are -

• Modern living ensures every generation is heavier than the last
• The obesity epidemic cannot be prevented by individual action alone
• Preventing obesity is a societal challenge, similar to climate change
  

Costs are high to health and to society. Using Department of Health data, the projected price tag to the NHS could double to £10bn a year by 2050. The wider cost to employers and the economy will be much greater - higher rates of obesity are associated with absence from work, early retirement and an increase in disability pensions.

In response to the Foresite report, the government has set out a target for a "downward trend in obese adults and a sustained downward trend in excess weight in children." Tame rhetoric for a health crisis that is as pressing to health as climate change is to the environment.

The US and the UK are hit with an obesity epidemic which is only set to worsen. Marketing of "junk" - high fat and zero nutrient convenience foods, are a major factor in damaging public health. Yet, despite the role that the food industry plays in the health of future generations the guidelines for business set by the US and the UK are voluntary and self-regulatory.

The US drafted "Voluntary Guidelines for the Marketing of Food to Children" while the UK has similarly set out a tentative business 'Pledge' - companies volunteer to commit to a pledge to meet salt and fat targets and remove trans fats. Both are 'opt in' recommendations that businesses are free to adopt,or ignore. According to Small Business only 11% of UK companies have signed up for the scheme.

Critics claim that the Foresite report should push governments to react with more gumption. The British Heart Foundation said in response to the obesity report that if it was was setting off alarm bells, the government's response was "met only by repeated pushes of the government's snooze button."

Professor Rob Moodie of the University of Melbourne recently researched multinationals, their impact on health and government policy and expressed similar disappointment. Commenting on the "nudge theory" and reliance on voluntary self-regulation, he told The Independent;

"You can't expect self-regulation to work. It is like having the burglars install your locks. You think it might work and you are safe but you are not," he said.


Notes:

Foresight Report - Tackling Obesities - Future Choices (2007)
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity/DH_079713

National Office of Statistics -
https://catalogue.ic.nhs.uk/publications/public-health/obesity/obes-phys-acti-diet-eng-2013/obes-phys-acti-diet-eng-2013-rep.pdf

Food Pledges - UK Gov voluntary agreement for food companies
https://responsibilitydeal.dh.gov.uk/food-pledges
Image: RGB Freestock: nazreth (Michael Lorenzo)

"Mappiness" App Proves the Secret to Happiness is Outside

One of the world’s top social science universities, The London School of Economics and Social Policy (LSE), has joined the digital scientific community in harnessing the power of mobile apps to study human behaviour. The "Mappiness" app, created by Dr George MacKerrona of Sussex University and Dr Susana Mourato of the LSE, mapped the top habitats for optimum wellbeing using iPhone technology.

21,947 people downloaded the iPhone app which not unlike a digital mum, prompted participants for answers to their whereabouts, the company they were keeping and what they were doing. In addition, the app asked for a rating on how they felt; tired, happy or anxious.

Twice a day at random and over a 6 month period, participants were beeped to plot the following:

• location users coordinates were recorded via satellite positioning

• habitat users reported whether they were inside, outside,
  in a park, a barren landscape or an office.

• feeling users scored their subjective wellbeing from
  1 (not at all) to 100 (extremely) for happy, awake and tired

Robust as it was regular, the app was primed to ensure that the happy scores generated by green spaces were not confused with the pleasures derived from friends and family by accounting for activity, company and whether the activity was work related or recreational.

With 1,138,481 responses, there was plenty of data to play to whittle down the component happiness.

Whatever people were doing, they were happier outside. Although perhaps not surprising in itself, Professor George MacKerrona points out that quantifying happiness is the really exciting aspect of the Mappiness app project, "there really aren't a lot of surprises: it's all very intuitive, so the exciting thing is to be able to use quantitative evidence to (a) prove that these effects are real and (b) compare how big they are."

The belief that being outside improves our wellbeing has been long held, but before now there has been limited quantitative research until now to prove this. The sample size of 1,138,481 responses from 21,947 participants is believed to be the largest ever achieved by an Experience Sampling Method (ESM).

Three factors were identified to pinpoint why outdoor habitats improve our physical and mental health:

• 1. Pathways
  The existence of direct pathways known as "biolphilia" bring about stress reduction to the nervous system. Biolphilia has its roots in evolution; an affinity with nature and living organisms in general is an adaption to our historic reliance on natural environments.

• 2. Environment “bads”A natural environment is less likely to house environmental "bads" such as noise and air pollution than urban environments. This freedom to enjoy optimal health directly creates a cause for increased happiness and reported wellbeing.

• 3. Recreation
  Outside spaces naturally encourage recreational activities that are good for physical and mental well being. Sports, games, walking and socialising with others are all relaxing recreational pursuits that contribute to optimum health.

When outdoors, every habitat type except inland bare ground is associated with higher happiness levels than the inside, urban type. Marine and coastal areas are the happiest locations, with responses approximately 6 points higher than continuous urban environments on the 0 – 100 scale. The difference between the happiness in being inside or outside is equal to the difference between the happiness of attending an exhibition or doing housework.

All other green or natural environment types — ‘mountains, moors, and heathland’, ‘freshwater, wetlands and flood plains’, woodland, grasslands, and farmland — are between 2.7 and 1.8 points happier than continuous urban environments. Suburban or rural developed environments are a little under one point happier.

To take part in the research, participants needed an iPhone to download the Mappiness app. The principle that iPhone ownership was required restricted participation to wealthy households with an income of £48,000. The age of participants was young too with over 66% under 35 years and nearly 80% of the participants employed and 13% in education.


Interesting excerpts taken from the Mappiness study:

Tuesday is the unhappiest day of the week

Saturday is the happiest day of the week

Higher happiness reported in Scotland and Dorset

Lower happiness in Slough and parts of London

People are happier at home than at work

Higher temperatures and lower wind speeds make us happier

Rain, wind or fog make us less happy

People are more happy outdoors than indoors or in a vehicle

Physical activities running, hiking, birdwatching make us happy


Happiness is greater in natural environments is published in Global Environmental Change. Surprises or no surprises, the quantitative and substantial evidence reaped to prove that outside space is good for physical and mental health can be used for the first time to inform policy makers in decision making.

George MacKerrona, Economics Professor at the University of Sussex is reassured by the lack of surprise in the data,"the lack of surprises is also reassuring. If I told you people were happiest with the flu in Slough on a Monday, you'd probably think I'd made a mistake somewhere!"




Notes:

Mappiness, the happiness mapping app www.mappiness.org.uk

Happiness is greater in natural environments in press in Global Environmental Change:
http://dx.doi.org/10.1016/j.gloenvcha.2013.03.010

Happiness Map of the UK:
http://www.mappiness.org.uk/maps

1920’s Factory Experiment Leads to App for Mental Health

In an American factory in 1920, factory workers were involved in a psychology experiment conducted by Harvard university students to investigate the effects of environmental changes on productivity. The experiment was a simple one; turn the lights up and see if the factory workers were more productive, turn the lights down and see if they were less productive. What happened instead was the Hawthorne effect – a phenomenon that led to the factory workers productivity increasing which had nothing to do with the lighting and everything to do with being paid attention to. The workers were stimulated by the interest that was being shown in them and became more productive when they knew they were being observed.

The Hawthorn affect, discovered nearly 100 years ago is the psychology behind the new MoodScope app; a free web app to help people manage their moods. The app, like many others, asks members to monitor their mood every day. The difference is that if the mood recorded is low enough, a trusted “buddy” will be notified by email and be made aware that the user is in need of support. What the buddy does next is up to them; call their pal, email or text. It doesn’t matter. The basic principle of someone being involved is good enough.

How does it work?

Everyday a user rates their mood. It’s not a box ticking exercise, quite the opposite. A user is dealt a set of mood cards from ‘anxiety’ to ‘angry’ and clicks to flip the cards over or turn the card upside down to rate whether they are ‘a little’ anxious or ‘extremely’, for example. The results are tallied up and added to a graph where the user can pinpoint high or low periods and add a note to explain the blip. Nominated buddies are alerted if the user appears to be on a down trend.

The app has had mixed results. The buddy option has caused users to worry about changing the dynamic of a friendship; turning friends into carers. The graph however has proved a useful aid to show users that they can be happy, even in the midst of depression when they feel this to be impossible – the proof is the positive tips in the graph.

Of the focus group, 7.2 found it was useful to monitor mood over time. Some users however struggled in differentiating between similar mood words such as “jittery” or “nervous.” Others commented that judging a mood was tricky in just one space in time and their mood was liable to change over the day and difficult to pinpoint. Motivation was key, with one participant commenting that completing the mood test was “like going to the gym.” Certainly, towards the end of the pilot run there appeared to be a drop of usage as motivation tailed off.

The Buddy system

The Buddy system had mixed results. General concern and encouraging feedback from friends had the best results, humour the least with users with very low mood dips. The majority of users found it helpful to have a friend involved and one user commented that they felt essentially, less alone;

“A big part of depression is feeling alone and even if they’re just getting an email that says ‘so and so’ is having a crap day, then at least someone else there knows.” MoodScope Focus Group User

The World Foundation for Mental Health predicted on World Mental Health day that depression will be the largest global health burden facing the modern world in 2030. With over a 3rd of current depression sufferers reporting that they are resistant to anti-depressant treatment, the new MoodScope app will come as a welcome addition to help people manage their moods, or as a tool to manage patients while they are on waiting lists for treatment such as Cognitive Behavioural Treatment or, as one patient pointed out, to get help in the first place;

“I think for a lot of guys I know who wouldn’t want to say ‘I’m struggling doctor’ I think that would be a great use to them. I think if people know about it in the privacy of their own homes they can try and help themselves … to identify what’s bothering them and maybe give them the confidence to then go a step further and see the doctors. That’s where I see its use as being.”

Notes:

Moodscope https://www.moodscope.com

Moodscope IAP research downloadable from https://www.moodscope.com/about/how-it-works/demo

via WordPress http://sallyburr.wordpress.com/2013/07/01/1920s-factory-experiment-leads-to-app-for-mental-health/