Symbicort price with insurance

65 Click here symbicort price with insurance to view the webinar Recorded May 6, 2016 Download the Powerpoint here. Download the DAB Household Size calculator chart here. Focus on Disabled/Age 65+/ Blind [“DAB”] Medicaid- Part 2.

Applications and procedures Click here to view the webinar - How and Where to Apply for Medicaid Tips for Requesting “Retroactive” eligibility to cover bills in 3 months preceding application Tips for people how people seeking Managed Long Term Care apply for Medicaid Download the Powerpoint here and the Sample Medicaid application here Recorded May 6, 2016 Medicare and Medicaid for People Age 65, symbicort price with insurance Blind or Disabled and Access to Long Term Care) Services in the Community Click here to view the webinar Brief 1-hour overview Recorded July 6, 2016 Pooled Trusts and Medicaid in NYS Conducted by David Silva, former Asst. Director, Evelyn Frank Legal Resources Program Recorded July 16, 2013 (not part of the Borchard series) Download info on pooled trusts here WEBINARS &. FACT SHEETS - Since 2016 Fact Sheets and Webinars on Managed Long Term Care and FIDA LUMP SUMS -- Using SNTs to Protect Medicaid and Other Strategies when Receiving A Lump Sum - View recordings of Parts 1 and 2 Nov.

2019 Part 1 • Basics – What is a Supplemental Needs Trust symbicort price with insurance. Types of SNTs (pooled trusts vs. Individual trusts, 3rd party trusts vs.

Self-settled trusts) • Using SNTs to eliminate the Medicaid Spend-down – Basics of Pooled Income Trusts (NOT a detailed explanation of all of the steps to get trust approved by Medicaid - for more on that see this Step by Step guide • What expenses may be paid by an SNT?. Different rules for Medicaid, SSI, and other benefits • ABLE accounts – how are they different than SNTs?. Part 2 -- Options when you receive a Lump Sum vary with different benefits.

Learn rules on impact of “transferring” the lump sum, spending it or depositing it into an SNT for. €¢ MEDICAID – differences between “MAGI” and “Non-MAGI” Medicaid • SSI • Veteran’s Benefits (new penalties on transfers of assets since 10/2018) • SNAP/Food Stamps • Housing Subsidies (Section 8) Lookback and Home Care Changes Enacted in 2020 Budget NYLAG Evelyn Frank program conducted a webinar on September 9, 2020. Please note that the webinar says the lookback will start Jan.

1, 2021. That has since changed to April 1, 2021. NYLAG Is Grateful to the Borchard Foundation Center on Law &.

Which is better advair or symbicort

Latest MedicineNet News MONDAY, Dec which is better advair or symbicort. 21, 2020 (HealthDay News)As scientists have labored to understand anti inflammatory drugs and develop a treatment to combat it, interest in infectious disease careers seems to be growing.Academic leaders from the United States and Israel have noted the increased interest among medical students."We just went through an applications season for fellows, and we had more applicants than in recent years," said Richard D'Aquila, director of the Clinical and Translational Sciences Institute at Northwestern University, in Chicago.D'Aquila spoke at a recent which is better advair or symbicort webinar — "In the Aftermath of anti inflammatory drugs. The Impact on Science and Research" — sponsored by the Israel Innovation Project.Itai Benhar, director of the Center for Combating symbicorts at Tel Aviv University, said, "We had registration for undergraduate studies in life and biomedical sciences almost double from last year to this year."Benhar said students in Israel haven't been able to take their usual gap year due to travel restrictions and the disappearance of temporary jobs during the economic crisis. Many entered the university directly instead, which could be driving those high numbers.He added that he expects a long-term increase in science, medicine and symbicort-related research in Israel, as well as increased interest in certain scientific fields."Virology had been considered which is better advair or symbicort a profession of the past. This has which is better advair or symbicort changed," Benhar said.

"The same is true with immunology. Epidemiology also came to the forefront of the medical professions, because statistics based on large sample sizes are now becoming which is better advair or symbicort more and more important."One positive that has come from these changes is a boost in international collaboration, D'Aquila said."A lot of long-distance collaborations are actually working much better," he said in a university news release. "I think we're going to stick with some hybrid scientific workplace, partly remote which is better advair or symbicort and partly in-person."But, D'Aquila added, there is a tendency to be nationalistic about the treatments that could become a problem."We're all in this together," he said. "To me, knowledge is global and we have to take advantage of every brilliant person in the world."Though laboratory work was reduced early on due to symbicort lockdowns, experiments are almost back to normal levels now, D'Aquila and Benhar said.Neither saw regular research areas face funding cuts. Support for anti inflammatory drugs-related research which is better advair or symbicort has come from additional sources, according to Benhar.

D'Aquila added which is better advair or symbicort that many HIV researchers pivoted to anti inflammatory drugs work and have made major contributions.More informationThe U.S. Centers for Disease Control and Prevention has more about anti inflammatory drugs research.SOURCE. Northwestern University, news release, which is better advair or symbicort Dec. 14, 2020Cara MurezCopyright © 2020 HealthDay. All rights which is better advair or symbicort reserved.

SLIDESHOW which is better advair or symbicort Bacterial s 101. Types, Symptoms, and Treatments See SlideshowLatest Healthy Kids News MONDAY, Dec. 21, 2020 which is better advair or symbicort (HealthDay News)Dads matter. New research shows how attentive, involved fathers can really boost which is better advair or symbicort the mental well-being and behavior of teens from low-income families.The study looked at 5,000 U.S. Children born between 1998 and 2000, and their fathers' involvement with them between ages 5 and 15.That included activities such as feeding, playing, reading, helping with homework and providing non-cash items, such as clothes, toys, food and other necessities.The researchers also assessed behavioral and emotional problems among the children, including crying, worrying, fighting, bullying and skipping school.Teens whose fathers paid more attention to them had fewer behavioral and emotional problems, according to the Rutgers University-New Brunswick study published recently in the journal Social Service Review.The findings suggest that more engagement by fathers in low-income families could help boost their kids' mental well-being to levels similar to those of kids from wealthier families."On average, children in lower socioeconomic status families tend to have more behavior problems and their fathers have lower levels of overall involvement than those in higher socioeconomic status families," said study lead author Lenna Nepomnyaschy, associate professor of social work.Fathers with lower levels of education, less-skilled jobs and lower wages may find it difficult to play a significant role in their children's lives due to social and economic changes over recent decades, she said in a university news release.Those changes have led to the loss of manufacturing jobs, a decline in union power and criminal justice policies associated with higher rates of imprisonment, particularly among men of color, the study authors noted.Policymakers, researchers and the public need to push for wage, employment and criminal justice policies that give low-income men more opportunities to spend time with their children and improve their well-being, the team concluded.More informationThe American Academy of Pediatrics offers parenting tips.SOURCE.

Rutgers University-New Brunswick, news release, which is better advair or symbicort Dec. 9, 2020Robert PreidtCopyright © 2020 which is better advair or symbicort HealthDay. All rights reserved. QUESTION Teens need which is better advair or symbicort how many hours of sleep per night?. See AnswerLatest Cancer News By Amy Norton HealthDay which is better advair or symbicort ReporterMONDAY, Dec.

21, 2020 (HealthDay News)When the anti inflammatory drugs symbicort hit the United States, many routine cancer screenings were put on hold. Now a new study suggests that lung cancer screenings have yet to rebound.The findings come from one hospital system, but experts said they add to worries about which is better advair or symbicort the symbicort's impact on cancer care.In the spring, when many U.S. Hospitals were overrun with anti inflammatory drugs patients and stay-at-home orders were issued, elective medical care -- including cancer screenings -- was largely delayed.Research since then has pointed to the early consequences. One study found that in March and April, the United States saw a 46% drop in new diagnoses of six common cancers -- a sign that many cases were being missed for lack of screening.When it which is better advair or symbicort comes to lung cancer screening -- which is done via low-dose CT scan -- rates were already low pre-symbicort."Only about 4% of eligible patients were getting screening nationally," said Dr. Robert Van Haren.So any sustained decrease in that figure would be concerning, said Van Haren, the lead researcher on the new study and assistant professor of surgery at the University of Cincinnati College of Medicine.For their study, his team looked at how the situation at their health system has changed during the course of the symbicort.In March, the university which is better advair or symbicort suspended its lung cancer screening program, ultimately canceling more than 800 appointments.

The program began reopening in May, with priority given to patients who needed follow-up scans of previously detected growths.But while screening numbers went up, they remained below pre-symbicort numbers.Between 2017 and February 2020, 15% of screening appointments were "no shows" -- meaning the patient never showed or did not reschedule a canceled appointment. During the symbicort (through the end of July), the no-show rate was 40%.And the number of new patients going in for a first-time scan ticked up only slightly after reopening.The symbicort essentially created "a perfect storm," according to which is better advair or symbicort Dr. William Cance, chief medical and scientific officer for the American Cancer Society.First, he said, it forced shutdowns that later created a backlog of appointments which is better advair or symbicort that had to be rescheduled -- making it hard for patients to get new appointments.Then there's the fear. It's known, Cance noted, that the symbicort made many Americans hesitant to receive even routine medical care in a doctor's office."There's also the economic side," said Cance, who wasn't part of the study. "So many people lost their jobs and health insurance which is better advair or symbicort.

For them, it might have been a matter of, 'Can which is better advair or symbicort I put food on the table, or get my mammogram?. '"The full impact of the symbicort -- its effects on timely cancer diagnoses and people's survival -- will take time to sort out.But Van Haren pointed to a concerning finding in this study. A sharp increase in the proportion of patients with potentially cancerous lung growths -- from 8% in pre-symbicort times, to 29% during the which is better advair or symbicort symbicort.In many cases, those patients were returning for follow-up after a previous scan showed a growth. But in about 40%, Van Haren said, the growths were new.Screening can catch lung tumors when they are small enough to remove by surgery, and research suggests it reduces the risk of dying from lung cancer by 20%, Van Haren said.Right now, annual screening is recommended starting at age 55 for people who have smoked at least 30 "pack-years" over a lifetime, and who either still smoke or have quit in the which is better advair or symbicort past 15 years. That translates to one pack a day for 30 years, or two packs a day for 15 years, for example.Van Haren said medical centers have safety protocols to protect patients who visit for screening.

One measure at his health system, he noted, was to move CT screenings from the hospital to an outpatient center.Cance urged Americans who have missed any cancer screening to talk to their provider about which is better advair or symbicort rescheduling and any safety questions they have.With U.S. anti inflammatory drugs cases now soaring, another question arises. Will screening which is better advair or symbicort programs shut down again?. It's possible, Van Haren said which is better advair or symbicort. And that's yet another reason, he said, that the surge needs to be brought under control.

SLIDESHOW Lung which is better advair or symbicort Cancer. Early Signs, Symptoms, Stages See Slideshow The findings were published which is better advair or symbicort Dec. 17 online in the Journal of the American College of Surgeons.More informationThe American Cancer Society has more on lung cancer screening.SOURCES. Robert Van which is better advair or symbicort Haren, MD, MSPH, assistant professor, surgery, University of Cincinnati College of Medicine, Ohio. William Cance, MD, chief medical and scientific officer, which is better advair or symbicort American Cancer Society, Atlanta.

Journal of the American College of Surgeons, Dec. 17, 2020, onlineCopyright © 2020 HealthDay which is better advair or symbicort. All rights which is better advair or symbicort reserved. From Cancer Resources Featured Centers Health Solutions From Our SponsorsLatest MedicineNet News By Ernie Mundell and Robin Foster HealthDay ReportersTUESDAY, Dec. 22, 2020 (Healthday News)As which is better advair or symbicort Congress passed a $900 billion symbicort relief package on Monday, U.S.

Experts warned that a new, more infectious variant of the anti-inflammatories recently discovered in Britain may already be circulating in this country.The relief bill will authorize direct payments of $600 to any American who made less than $75,000 in the last tax year, the Washington Post reported, with checks arriving as early as next week. Enhanced unemployment benefits will also be extended, and businesses will benefit from $325 billion in economic relief under the bill.Seeking to reassure a troubled nation, President-Elect Joe Biden received the first dose of the which is better advair or symbicort two-dose Pfizer anti inflammatory drugs treatment on Monday. He did so live on television at ChristianaCare Hospital in Newark, Del.Biden said, "I'm doing this to demonstrate that people should be prepared when it's available to take the treatment," the New York Times reported.Meanwhile, health experts worried that a troubling variant of the anti-inflammatories that has cropped up which is better advair or symbicort in Britain may already be in the United States, the Post reported."We don't know that for absolutely certain, but it is reasonable to assume that is going on," Dr. Anthony Fauci, director of the U.S. National Institute of which is better advair or symbicort Allergy and Infectious Diseases, said Monday.

"It very well might be here for all we know."Some which is better advair or symbicort infectious disease experts said Monday the variant may not have even originated in Britain, the Post reported. Instead, it may have been identified there first because the British government has a strong monitoring system that has tracked tens of thousands of genomic sequences of symbicort samples. The United which is better advair or symbicort States does not have nearly the same level of symbicort surveillance, the newspaper said."It may very well be here. It may have even started here which is better advair or symbicort. The sequencing in the U.S.

Is so sporadic," Jeremy Luban, a virologist at the University of Massachusetts Medical School, told the which is better advair or symbicort Post."It makes sense that it was detected first in the U.K. Because they have probably the world's best surveillance program. It would not shock me at all to find out that it also is circulating in the U.S.," said Angela Rasmussen, a virologist at the Georgetown Center for Global Health Science and Security, in Washington, D.C.Even though this variant, officially known as B.1.1.7, will require close monitoring, it is which is better advair or symbicort unlikely to undermine the United States' anti-inflammatories vaccination campaign, said William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health in Boston."The treatment is a pretty thorough thing," which is better advair or symbicort Hanage explained. "Whether or not the existing treatments are less effective against B.1.1.7 is at the moment not known.

I think there is good reason which is better advair or symbicort to think they will not be severely impacted."Some U.S. Governors aren't which is better advair or symbicort waiting to find out.On Monday, New York Gov. Andrew Cuomo asked the three airlines that fly from the U.K. Into New York -- British Airways, Delta and Virgin Atlantic -- to which is better advair or symbicort require all travelers to test negative before boarding. British Airways and Delta agreed and will begin to do so Tuesday, Cuomo said."I believe intuitively [the new variant] is already here, because which is better advair or symbicort if it's been flying around the world, it will be here," Cuomo said.

"We learned this lesson the hard way, and we're not going to go through it again... I believe my intuition is correct that this is another disaster waiting to happen."In California, which is better advair or symbicort Gov. Gavin Newsom which is better advair or symbicort said on Monday that his administration had been in discussion for the past 48 hours with airlines and "stakeholders" in the state about possible new quarantine and testing protocols for travelers arriving from the U.K., the Post reported.Moderna's anti inflammatory drugs treatment gets FDA's blessingModerna's anti-inflammatories treatment has been granted emergency use approval by the U.S. Food and Drug Administration, joining Pfizer's treatment in an unprecedented campaign to inoculate enough Americans to stop the symbicort in its tracks."With the availability of two treatments now for the prevention of anti inflammatory drugs, the FDA has taken another crucial step in the fight against this global symbicort that is causing vast numbers of hospitalizations and deaths in the United States each day," said FDA Commissioner Dr. Stephen Hahn which is better advair or symbicort.

"Through the FDA's open and transparent scientific review process, two anti inflammatory drugs treatments have been authorized in an expedited timeframe while adhering to the rigorous standards for safety, effectiveness, and manufacturing quality needed to support emergency use authorization that the American people have come to expect from the FDA." QUESTION What percentage of the human body is water?. See Answer "To get another very important treatment into play is just, yet again, another which is better advair or symbicort step toward what the ultimate goal is. To get enough people vaccinated so you could essentially end the epidemic as we know it in this country," Fauci told which is better advair or symbicort the Post. "I believe that's possible."The authorization of a second treatment will double to roughly 20 million the number of Americans who will get a first shot before the end of the year, the Post reported.Gen. Gustave Perna, who is overseeing the federal effort to distribute treatments, said the government was preparing to ship almost 6 million doses of the Moderna treatment to 3,285 locations in the first week after approval."It will be a very similar cadence that was executed this week with Pfizer, where we're hitting initial sites on Monday, [followed] on Tuesday and Wednesday," Perna said, the Post reported.The Moderna treatment was developed in which is better advair or symbicort partnership with the U.S.

National Institute of Allergy and which is better advair or symbicort Infectious Diseases. The federal government invested in the research and development of the treatment and bought 200 million doses in advance, bringing the government outlay to $4.1 billion, the Post reported.Moderna's treatment was shown to be 94 percent effective in its large clinical trial. Pfizer's treatment was 95 percent effective which is better advair or symbicort. The efficacy was similar across age, gender and racial groups.Poll shows 70% will get anti inflammatory drugs treatmentAs the first doses of anti-inflammatories treatments which is better advair or symbicort made their way to the arms of health care workers around the United States, a new survey from the Kaiser Family Foundation shows that 71% of Americans say they will "definitely or probably" get a anti inflammatory drugs treatment.That's up from 63% in September, and it's a sign that a growing number of Americans are starting to trust the science behind the treatments as they become more comfortable with the speed in which the treatments are being developed.Still, just over a quarter of Americans are hesitant to get a treatment, saying they probably or definitely would not get a anti inflammatory drugs treatment even if it were free and deemed safe by scientists. The greatest reluctance was seen among Black Americans, people living in rural areas and Republicans.And not everyone wants a shot right away.

A third of those which is better advair or symbicort surveyed said they want to get a treatment "as soon as possible," while 39% of those surveyed said they would "wait and see" how initial vaccination efforts go before getting a treatment themselves. Kaiser polled 1,676 adults for which is better advair or symbicort the survey.U.S. Officials said they are on track to meet initial treatment delivery targets, the Post reported.An additional 2 million Pfizer doses are scheduled for delivery this week, and 5.9 million Moderna doses will be sent out in the coming days, the Post reported.Most of the first round of injections were given to high-risk health care workers, The New York Times said. Because the which is better advair or symbicort treatments can cause side effects including fevers and aches, hospitals have said they will stagger vaccinations among their workers.Residents of nursing homes, who have suffered a disproportionate share of anti inflammatory drugs deaths, will begin to get shots this week, the Times reported. A vast majority of Americans will not be eligible for vaccinations until the spring or later.Azar said the plan is to have 20 million people vaccinated by the end of December, up to 50 million by the end of January and 100 million by the end of February, the Post reported.A global scourgeBy Tuesday, the U.S.

anti-inflammatories case count passed 18 million while which is better advair or symbicort the death toll neared 320,000, according to a Times tally. By Tuesday, the top five states for anti-inflammatories s were California with over 1.9 million cases, Texas with more than 1.6 million cases, Florida which is better advair or symbicort with over 1.2 million cases. Illinois with nearly 907,000 cases and New York with almost 861,000 cases.Curbing the spread of the anti-inflammatories in the rest of the world remains challenging.In India, the anti-inflammatories case count was over 10 million on Tuesday, a Johns Hopkins University tally showed. More than 146,000 anti-inflammatories patients have died in India, according to the Hopkins which is better advair or symbicort tally, but when measured as a proportion of the population, the country has had far fewer deaths than many others. Doctors say this reflects India's younger which is better advair or symbicort and leaner population.

Still, the country's public health system is severely strained, and some sick patients cannot find hospital beds, the Times said. Only the United States has more anti-inflammatories cases.Meanwhile, Brazil had over 7.2 million cases and over 187,000 deaths as of Tuesday, the Hopkins which is better advair or symbicort tally showed.Worldwide, the number of reported s passed 77 million on Tuesday, with over 1.7 million deaths recorded, according to the Hopkins tally.More informationThe U.S. Centers for Disease Control and Prevention which is better advair or symbicort has more on the new anti-inflammatories.SOURCES. Washington Post. The New York TimesCopyright which is better advair or symbicort © 2020 HealthDay.

All rights which is better advair or symbicort reserved. From Healthy Resources Featured Centers Health Solutions From Our SponsorsLatest anti-inflammatories News By Ernie Mundell HealthDay ReporterTUESDAY, Dec. 22, 2020 (HealthDay News)Despite more Americans saying they know someone who's been sickened or even died from anti inflammatory drugs, there's been a decline in the percentage who say they always wear a mask which is better advair or symbicort when they leave their home.Two-thirds (66%) of U.S. Adults surveyed in a new HealthDay/Harris Poll said they "always" donned a mask when leaving their home and weren't able to socially distance, compared with 72% in a poll conducted in October. The proportion of Americans who now say they wear a mask outside the home is edging closer to the 61% reported in an August survey conducted by The Harris Poll.The new poll of 2,027 adults aged 18 which is better advair or symbicort and older was conducted online from Dec.

8 to 10 by The Harris which is better advair or symbicort Poll.The decline in mask wearing is surprising, given that the same poll finds the proportion of Americans with a direct connection to anti inflammatory drugs is on the rise.Close to two-thirds of U.S. Adults (63%) said they or someone they know (including acquaintances) had been hospitalized due to, or passed away from, anti inflammatory drugs, and half (50%) said they had direct experience with anti inflammatory drugs. That includes:Having personally had (9%) or been hospitalized (5%) due to anti inflammatory drugs.Residing in a household with someone who had it (8%).Having a close friend/family member/loved one outside of their household who had it which is better advair or symbicort (42%), was hospitalized (23%), or passed away (16%).Overall, more than two in five U.S. Adults (43%) now know someone who has been hospitalized which is better advair or symbicort or passed away due to anti inflammatory drugs."As anti inflammatory drugs cases and deaths in the U.S. Continue to rise, our current survey data put this harrowing reality into further perspective," said Kathy Steinberg, vice president of research for public release at The Harris Poll."The majority of Americans have close connection to the serious impacts of the symbicort, as 43% know someone who has been hospitalized or passed away from anti inflammatory drugs, which is up from 36% just two months ago in October," she noted."Despite these frightening and shared experiences, the proportion of Americans who frequently wear a mask is declining, especially for men and younger adults," Steinberg said.

"It will be crucial to reinforce the continued importance of masks and social distancing even as treatment distribution begins."As seen in prior polls, partisanship is closely tied with decisions which is better advair or symbicort around mask use. In the new poll, 71% of Democrats said they "always" wear a mask when leaving their home, versus 61% of Republicans.Still, consistent mask wearing has declined among all parties since October, when a which is better advair or symbicort poll pegged rates at 82% among Democrats, 66% among Republicans and 69% among Independents.Age and gender seemed to matter in decisions around mask use, too. According to the December poll, while 80% of people aged 65 and over said they always wore a mask outside of the home, that number dropped to 77% for those aged 55 to 64. 62% for those aged 45 to which is better advair or symbicort 54. 64% for those aged 35 to 44 which is better advair or symbicort.

And just 53% for people 18 to 34.Women (72%) were more likely than men (59%) to say they "always" wore a mask, while men were more likely to say "rarely/never" (11% versus 5%).One expert had some theories about why mask wearing is declining as more people are affected by the symbicort."Although it is not clear why there is a disconnect between less stringent mask wearing and increased exposure to loved ones sick or dying of anti inflammatory drugs, some theories are being considered," said Dr. Teresa Murray Amato, chair of emergency medicine at Long Island which is better advair or symbicort Jewish Forest Hills, in New York City."The symbicort has been active in the United States for several months and people have had to undergo quarantining, social isolation and disruption in normal routines," she said."Wearing a mask for some means having to acknowledge that we are still in a symbicort and that life has not returned to what it was. For others, it may be that hearing about the treatment rolling out represents hope and the feeling that we are no longer going to need to wear masks," Amato added."This finding is troubling for those of us in health care, as we know that wearing a mask will significantly reduce the chance of both transmitting and acquiring the ," she said. "And although we are very hopeful about the treatments, we do not have enough data to know if vaccination will stop the transmission of the symbicort."Another expert stressed that mask wearing is more which is better advair or symbicort important than ever."Now that much more is known about how to treat the disease early, the fact that there are therapeutics now that help with the early disease management, and the treatment is here and is beginning to be administered gives us a real hope that there is a way out of this symbicort," said Dr. Theodore Strange, interim chair of medicine at Staten Island University Hospital, in New York which is better advair or symbicort City.

"It will take a few more months, even up to a year. But not individually doing all our parts to curtail which is better advair or symbicort the spread and potentially devastating effects for some is not fair to ourselves, our families, our friends and our community at large as we come to this point of hope to end this scourge," Strange added.More informationThere's more on how you can help prevent transmission of the new anti-inflammatories at the U.S. Centers for Disease Control and which is better advair or symbicort Prevention.SOURCES. HealthDay/Harris Poll, Dec. 8-10, 2020 which is better advair or symbicort.

Kathy Steinberg, which is better advair or symbicort vice president of research for public release, The Harris Poll. Teresa Murray Amato, MD, chair, emergency medicine, Long Island Jewish Forest Hills, New York City. Theodore Strange, MD, interim chair, medicine, Staten Island University Hospital, New York which is better advair or symbicort CityCopyright © 2020 HealthDay. All rights reserved..

Latest MedicineNet symbicort price with insurance over here News MONDAY, Dec. 21, 2020 (HealthDay News)As scientists have labored to understand anti inflammatory drugs and develop a treatment to combat symbicort price with insurance it, interest in infectious disease careers seems to be growing.Academic leaders from the United States and Israel have noted the increased interest among medical students."We just went through an applications season for fellows, and we had more applicants than in recent years," said Richard D'Aquila, director of the Clinical and Translational Sciences Institute at Northwestern University, in Chicago.D'Aquila spoke at a recent webinar — "In the Aftermath of anti inflammatory drugs. The Impact on Science and Research" — sponsored by the Israel Innovation Project.Itai Benhar, director of the Center for Combating symbicorts at Tel Aviv University, said, "We had registration for undergraduate studies in life and biomedical sciences almost double from last year to this year."Benhar said students in Israel haven't been able to take their usual gap year due to travel restrictions and the disappearance of temporary jobs during the economic crisis.

Many entered the university directly instead, which symbicort price with insurance could be driving those high numbers.He added that he expects a long-term increase in science, medicine and symbicort-related research in Israel, as well as increased interest in certain scientific fields."Virology had been considered a profession of the past. This has changed," Benhar symbicort price with insurance said. "The same is true with immunology.

Epidemiology also came to the forefront of the medical professions, because statistics based on large sample sizes are now becoming more and more important."One positive that has come from these changes is a boost in international collaboration, D'Aquila said."A lot of long-distance collaborations are actually working much better," symbicort price with insurance he said in a university news release. "I think we're going to stick with some hybrid scientific workplace, symbicort price with insurance partly remote and partly in-person."But, D'Aquila added, there is a tendency to be nationalistic about the treatments that could become a problem."We're all in this together," he said. "To me, knowledge is global and we have to take advantage of every brilliant person in the world."Though laboratory work was reduced early on due to symbicort lockdowns, experiments are almost back to normal levels now, D'Aquila and Benhar said.Neither saw regular research areas face funding cuts.

Support for anti inflammatory drugs-related symbicort price with insurance research has come from additional sources, according to Benhar. D'Aquila added symbicort price with insurance that many HIV researchers pivoted to anti inflammatory drugs work and have made major contributions.More informationThe U.S. Centers for Disease Control and Prevention has more about anti inflammatory drugs research.SOURCE.

Northwestern University, symbicort price with insurance news release, Dec. 14, 2020Cara MurezCopyright © 2020 HealthDay. All rights reserved symbicort price with insurance.

SLIDESHOW Bacterial symbicort price with insurance s 101. Types, Symptoms, and Treatments See SlideshowLatest Healthy Kids News MONDAY, Dec. 21, 2020 symbicort price with insurance (HealthDay News)Dads matter.

New research shows how attentive, involved fathers can really boost symbicort price with insurance the mental well-being and behavior of teens from low-income families.The study looked at 5,000 U.S. Children born between 1998 and 2000, and their fathers' involvement with them between ages 5 and 15.That included activities such as feeding, playing, reading, helping with homework and providing non-cash items, such as clothes, toys, food and other necessities.The researchers also assessed behavioral and emotional problems among the children, including crying, worrying, fighting, bullying and skipping school.Teens whose fathers paid more attention to them had fewer behavioral and emotional problems, according to the Rutgers University-New Brunswick study published recently in the journal Social Service Review.The findings suggest that more engagement by fathers in low-income families could help boost their kids' mental well-being to levels similar to those of kids from wealthier families."On average, children in lower socioeconomic status families tend to have more behavior problems and their fathers have lower levels of overall involvement than those in higher socioeconomic status families," said study lead author Lenna Nepomnyaschy, associate professor of social work.Fathers with lower levels of education, less-skilled jobs and lower wages may find it difficult to play a significant role in their children's lives due to social and economic changes over recent decades, she said in a university news release.Those changes have led to the loss of manufacturing jobs, a decline in union power and criminal justice policies associated with higher rates of imprisonment, particularly among men of color, the study authors noted.Policymakers, researchers and the public need to push for wage, employment and criminal justice policies that give low-income men more opportunities to spend time with their children and improve their well-being, the team concluded.More informationThe American Academy of Pediatrics offers parenting tips.SOURCE. Rutgers University-New symbicort price with insurance Brunswick, news release, Dec.

9, 2020Robert PreidtCopyright symbicort price with insurance © 2020 HealthDay. All rights reserved. QUESTION Teens need how many hours of symbicort price with insurance sleep per night?.

See AnswerLatest Cancer News By Amy symbicort price with insurance Norton HealthDay ReporterMONDAY, Dec. 21, 2020 (HealthDay News)When the anti inflammatory drugs symbicort hit the United States, many routine cancer screenings were put on hold. Now a new study suggests that lung cancer screenings have yet to rebound.The findings come from one hospital system, but experts said they add to worries about the symbicort's impact on cancer care.In the symbicort price with insurance spring, when many U.S.

Hospitals were overrun with anti inflammatory drugs patients and stay-at-home orders were issued, elective medical care -- including cancer screenings -- was largely delayed.Research since then has pointed to the early consequences. One study found that in March and April, the United States saw a 46% drop in new diagnoses of six common cancers -- a symbicort price with insurance sign that many cases were being missed for lack of screening.When it comes to lung cancer screening -- which is done via low-dose CT scan -- rates were already low pre-symbicort."Only about 4% of eligible patients were getting screening nationally," said Dr. Robert Van Haren.So any sustained decrease in that symbicort price with insurance figure would be concerning, said Van Haren, the lead researcher on the new study and assistant professor of surgery at the University of Cincinnati College of Medicine.For their study, his team looked at how the situation at their health system has changed during the course of the symbicort.In March, the university suspended its lung cancer screening program, ultimately canceling more than 800 appointments.

The program began reopening in May, with priority given to patients who needed follow-up scans of previously detected growths.But while screening numbers went up, they remained below pre-symbicort numbers.Between 2017 and February 2020, 15% of screening appointments were "no shows" -- meaning the patient never showed or did not reschedule a canceled appointment. During the symbicort (through the end of July), the no-show rate was symbicort price with insurance 40%.And the number of new patients going in for a first-time scan ticked up only slightly after reopening.The symbicort essentially created "a perfect storm," according to Dr. William Cance, chief medical and scientific officer for the American Cancer Society.First, he said, it forced shutdowns that later created a backlog of appointments that had to be rescheduled -- making symbicort price with insurance it hard for patients to get new appointments.Then there's the fear.

It's known, Cance noted, that the symbicort made many Americans hesitant to receive even routine medical care in a doctor's office."There's also the economic side," said Cance, who wasn't part of the study. "So many people lost their jobs and health insurance symbicort price with insurance. For them, it might have been a matter of, 'Can I put food on the symbicort price with insurance table, or get my mammogram?.

'"The full impact of the symbicort -- its effects on timely cancer diagnoses and people's survival -- will take time to sort out.But Van Haren pointed to a concerning finding in this study. A sharp increase in the proportion symbicort price with insurance of patients with potentially cancerous lung growths -- from 8% in pre-symbicort times, to 29% during the symbicort.In many cases, those patients were returning for follow-up after a previous scan showed a growth. But in about 40%, Van Haren said, the growths were new.Screening can catch lung tumors when they are small enough to remove by surgery, and research suggests it reduces the risk of dying from lung cancer by 20%, Van Haren said.Right now, annual screening is recommended symbicort price with insurance starting at age 55 for people who have smoked at least 30 "pack-years" over a lifetime, and who either still smoke or have quit in the past 15 years.

That translates to one pack a day for 30 years, or two packs a day for 15 years, for example.Van Haren said medical centers have safety protocols to protect patients who visit for screening. One measure at his health system, he noted, was to move symbicort price with insurance CT screenings from the hospital to an outpatient center.Cance urged Americans who have missed any cancer screening to talk to their provider about rescheduling and any safety questions they have.With U.S. anti inflammatory drugs cases now soaring, another question arises.

Will screening programs shut down symbicort price with insurance again?. It's possible, Van Haren symbicort price with insurance said. And that's yet another reason, he said, that the surge needs to be brought under control.

SLIDESHOW Lung symbicort price with insurance Cancer. Early Signs, Symptoms, Stages See Slideshow The symbicort price with insurance findings were published Dec. 17 online in the Journal of the American College of Surgeons.More informationThe American Cancer Society has more on lung cancer screening.SOURCES.

Robert Van Haren, MD, MSPH, assistant professor, surgery, symbicort price with insurance University of Cincinnati College of Medicine, Ohio. William Cance, MD, chief medical and scientific officer, symbicort price with insurance American Cancer Society, Atlanta. Journal of the American College of Surgeons, Dec.

17, 2020, onlineCopyright © 2020 HealthDay symbicort price with insurance. All rights symbicort price with insurance reserved. From Cancer Resources Featured Centers Health Solutions From Our SponsorsLatest MedicineNet News By Ernie Mundell and Robin Foster HealthDay ReportersTUESDAY, Dec.

22, 2020 (Healthday News)As Congress passed a $900 billion symbicort price with insurance symbicort relief package on Monday, U.S. Experts warned that a new, more infectious variant of the anti-inflammatories recently discovered in Britain may already be circulating in this country.The relief bill will authorize direct payments of $600 to any American who made less than $75,000 in the last tax year, the Washington Post reported, with checks arriving as early as next week. Enhanced unemployment benefits will symbicort price with insurance also be extended, and businesses will benefit from $325 billion in economic relief under the bill.Seeking to reassure a troubled nation, President-Elect Joe Biden received the first dose of the two-dose Pfizer anti inflammatory drugs treatment on Monday.

He did so live on television at ChristianaCare Hospital in Newark, Del.Biden said, "I'm doing this to demonstrate that people should be prepared when it's available to take the treatment," the New York Times reported.Meanwhile, health experts worried that a troubling variant of the anti-inflammatories that has cropped up in Britain may already be in the United States, the Post reported."We don't know that symbicort price with insurance for absolutely certain, but it is reasonable to assume that is going on," Dr. Anthony Fauci, director of the U.S. National Institute of symbicort price with insurance Allergy and Infectious Diseases, said Monday.

"It very well might be here for all we know."Some infectious disease experts said Monday the variant may not have even originated in symbicort price with insurance Britain, the Post reported. Instead, it may have been identified there first because the British government has a strong monitoring system that has tracked tens of thousands of genomic sequences of symbicort samples. The United States does not have nearly the same level of symbicort symbicort price with insurance surveillance, the newspaper said."It may very well be here.

It may have even started symbicort price with insurance here. The sequencing in the U.S. Is so sporadic," Jeremy Luban, a virologist at the University of symbicort price with insurance Massachusetts Medical School, told the Post."It makes sense that it was detected first in the U.K.

Because they have probably the world's best surveillance program. It would not shock me at all to find out that it also is circulating in the U.S.," said Angela Rasmussen, a virologist at the Georgetown Center for Global Health symbicort price with insurance Science and Security, in Washington, D.C.Even though this variant, officially known as B.1.1.7, will require close monitoring, it is unlikely to undermine the United States' http://thepeoplesadjustmentfirm.com/?page_id=321 anti-inflammatories vaccination campaign, said William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health in Boston."The treatment symbicort price with insurance is a pretty thorough thing," Hanage explained.

"Whether or not the existing treatments are less effective against B.1.1.7 is at the moment not known. I think there is good reason to think they will not be severely impacted."Some U.S symbicort price with insurance. Governors aren't waiting to find out.On Monday, symbicort price with insurance New York Gov.

Andrew Cuomo asked the three airlines that fly from the U.K. Into New York -- British Airways, Delta and Virgin Atlantic -- to require symbicort price with insurance all travelers to test negative before boarding. British Airways and Delta agreed and will begin to do so Tuesday, Cuomo said."I believe intuitively [the new variant] is already here, because if it's been flying symbicort price with insurance around the world, it will be here," Cuomo said.

"We learned this lesson the hard way, and we're not going to go through it again... I believe my intuition is correct that this is another disaster waiting to happen."In California, Gov symbicort price with insurance. Gavin Newsom said on Monday that his administration had been in discussion for the symbicort price with insurance past 48 hours with airlines and "stakeholders" in the state about possible new quarantine and testing protocols for travelers arriving from the U.K., the Post reported.Moderna's anti inflammatory drugs treatment gets FDA's blessingModerna's anti-inflammatories treatment has been granted emergency use approval by the U.S.

Food and Drug Administration, joining Pfizer's treatment in an unprecedented campaign to inoculate enough Americans to stop the symbicort in its tracks."With the availability of two treatments now for the prevention of anti inflammatory drugs, the FDA has taken another crucial step in the fight against this global symbicort that is causing vast numbers of hospitalizations and deaths in the United States each day," said FDA Commissioner Dr. Stephen Hahn symbicort price with insurance. "Through the FDA's open and transparent scientific review process, two anti inflammatory drugs treatments have been authorized in an expedited timeframe while adhering to the rigorous standards for safety, effectiveness, and manufacturing quality needed to support emergency use authorization that the American people have come to expect from the FDA." QUESTION What percentage of the human body is water?.

See Answer "To get another very symbicort price with insurance important treatment into play is just, yet again, another step toward what the ultimate goal is. To get enough people vaccinated so you could essentially end the epidemic symbicort price with insurance as we know it in this country," Fauci told the Post. "I believe that's possible."The authorization of a second treatment will double to roughly 20 million the number of Americans who will get a first shot before the end of the year, the Post reported.Gen.

Gustave Perna, who is overseeing the federal effort to distribute treatments, said the government was preparing to ship almost 6 million doses of the Moderna treatment to 3,285 locations in the first week after approval."It will be a very similar cadence that was executed this week with Pfizer, where we're symbicort price with insurance hitting initial sites on Monday, [followed] on Tuesday and Wednesday," Perna said, the Post reported.The Moderna treatment was developed in partnership with the U.S. National Institute of Allergy symbicort price with insurance and Infectious Diseases. The federal government invested in the research and development of the treatment and bought 200 million doses in advance, bringing the government outlay to $4.1 billion, the Post reported.Moderna's treatment was shown to be 94 percent effective in its large clinical trial.

Pfizer's treatment symbicort price with insurance was 95 percent effective. The efficacy was similar across age, gender and racial groups.Poll shows 70% will get anti inflammatory drugs treatmentAs the first doses of anti-inflammatories treatments made their way to the arms of health care workers around the United States, a new survey symbicort price with insurance from the Kaiser Family Foundation shows that 71% of Americans say they will "definitely or probably" get a anti inflammatory drugs treatment.That's up from 63% in September, and it's a sign that a growing number of Americans are starting to trust the science behind the treatments as they become more comfortable with the speed in which the treatments are being developed.Still, just over a quarter of Americans are hesitant to get a treatment, saying they probably or definitely would not get a anti inflammatory drugs treatment even if it were free and deemed safe by scientists. The greatest reluctance was seen among Black Americans, people living in rural areas and Republicans.And not everyone wants a shot right away.

A third of those surveyed said they symbicort price with insurance want to get a treatment "as soon as possible," while 39% of those surveyed said they would "wait and see" how initial vaccination efforts go before getting a treatment themselves. Kaiser polled 1,676 adults for the symbicort price with insurance survey.U.S. Officials said they are on track to meet initial treatment delivery targets, the Post reported.An additional 2 million Pfizer doses are scheduled for delivery this week, and 5.9 million Moderna doses will be sent out in the coming days, the Post reported.Most of the first round of injections were given to high-risk health care workers, The New York Times said.

Because the treatments can cause side effects including fevers and aches, hospitals have said they will stagger vaccinations among their symbicort price with insurance workers.Residents of nursing homes, who have suffered a disproportionate share of anti inflammatory drugs deaths, will begin to get shots this week, the Times reported. A vast majority of Americans will not be eligible for vaccinations until the spring or later.Azar said the plan is to have 20 million people vaccinated by the end of December, up to 50 million by the end of January and 100 million by the end of February, the Post reported.A global scourgeBy Tuesday, the U.S. anti-inflammatories case count passed 18 million while the death toll neared 320,000, according to symbicort price with insurance a Times tally.

By Tuesday, the top five states for anti-inflammatories s were symbicort price with insurance California with over 1.9 million cases, Texas with more than 1.6 million cases, Florida with over 1.2 million cases. Illinois with nearly 907,000 cases and New York with almost 861,000 cases.Curbing the spread of the anti-inflammatories in the rest of the world remains challenging.In India, the anti-inflammatories case count was over 10 million on Tuesday, a Johns Hopkins University tally showed. More than 146,000 anti-inflammatories symbicort price with insurance patients have died in India, according to the Hopkins tally, but when measured as a proportion of the population, the country has had far fewer deaths than many others.

Doctors say this reflects India's younger and symbicort price with insurance leaner population. Still, the country's public health system is severely strained, and some sick patients cannot find hospital beds, the Times said. Only the United States has more anti-inflammatories cases.Meanwhile, Brazil had over 7.2 million cases and over 187,000 deaths as of Tuesday, the Hopkins tally showed.Worldwide, the number of reported s passed 77 million on Tuesday, with over 1.7 million deaths recorded, according symbicort price with insurance to the Hopkins tally.More informationThe U.S.

Centers for Disease Control and Prevention has more on symbicort price with insurance the new anti-inflammatories.SOURCES. Washington Post. The New York TimesCopyright © 2020 symbicort price with insurance HealthDay.

All rights reserved symbicort price with insurance. From Healthy Resources Featured Centers Health Solutions From Our SponsorsLatest anti-inflammatories News By Ernie Mundell HealthDay ReporterTUESDAY, Dec. 22, 2020 (HealthDay News)Despite more Americans saying they know someone who's been sickened or even died from anti inflammatory drugs, there's been a decline in the percentage who say they always wear a mask when they leave their home.Two-thirds (66%) of U.S symbicort price with insurance.

Adults surveyed in a new HealthDay/Harris Poll said they "always" donned a mask when leaving their home and weren't able to socially distance, compared with 72% in a poll conducted in October. The proportion of Americans who now say they wear a mask outside the home is edging closer to the 61% reported in an August survey conducted by The Harris Poll.The new symbicort price with insurance poll of 2,027 adults aged 18 and older was conducted online from Dec. 8 to 10 by The Harris Poll.The decline symbicort price with insurance in mask wearing is surprising, given that the same poll finds the proportion of Americans with a direct connection to anti inflammatory drugs is on the rise.Close to two-thirds of U.S.

Adults (63%) said they or someone they know (including acquaintances) had been hospitalized due to, or passed away from, anti inflammatory drugs, and half (50%) said they had direct experience with anti inflammatory drugs. That includes:Having personally had (9%) or been hospitalized (5%) due to anti inflammatory drugs.Residing in a household with someone who had it (8%).Having a close friend/family member/loved one outside of their household who had it (42%), was hospitalized symbicort price with insurance (23%), or passed away (16%).Overall, more than two in five U.S. Adults (43%) symbicort price with insurance now know someone who has been hospitalized or passed away due to anti inflammatory drugs."As anti inflammatory drugs cases and deaths in the U.S.

Continue to rise, our current survey data put this harrowing reality into further perspective," said Kathy Steinberg, vice president of research for public release at The Harris Poll."The majority of Americans have close connection to the serious impacts of the symbicort, as 43% know someone who has been hospitalized or passed away from anti inflammatory drugs, which is up from 36% just two months ago in October," she noted."Despite these frightening and shared experiences, the proportion of Americans who frequently wear a mask is declining, especially for men and younger adults," Steinberg said. "It will be crucial to reinforce the continued importance of masks and social distancing even as treatment distribution begins."As seen in symbicort price with insurance prior polls, partisanship is closely tied with decisions around mask use. In the new poll, 71% of Democrats said they "always" wear a mask when leaving symbicort price with insurance their home, versus 61% of Republicans.Still, consistent mask wearing has declined among all parties since October, when a poll pegged rates at 82% among Democrats, 66% among Republicans and 69% among Independents.Age and gender seemed to matter in decisions around mask use, too.

According to the December poll, while 80% of people aged 65 and over said they always wore a mask outside of the home, that number dropped to 77% for those aged 55 to 64. 62% for symbicort price with insurance those aged 45 to 54. 64% for those symbicort price with insurance aged 35 to 44.

And just 53% for people 18 to 34.Women (72%) were more likely than men (59%) to say they "always" wore a mask, while men were more likely to say "rarely/never" (11% versus 5%).One expert had some theories about why mask wearing is declining as more people are affected by the symbicort."Although it is not clear why there is a disconnect between less stringent mask wearing and increased exposure to loved ones sick or dying of anti inflammatory drugs, some theories are being considered," said Dr. Teresa Murray Amato, chair of emergency medicine at Long Island Jewish Forest Hills, in New York City."The symbicort has been active in the United States for several months and people have had to undergo quarantining, social isolation and disruption in normal routines," she said."Wearing a mask for some means having to acknowledge that we are still in a symbicort and that life symbicort price with insurance has not returned to what it was. For others, it may be that hearing about the treatment rolling out represents hope and the feeling that we are no longer going to need to wear masks," Amato added."This finding is troubling for those of us in health care, as we know that wearing a mask will significantly reduce the chance of both transmitting and acquiring the ," she said.

"And although we are very hopeful about the treatments, we do not have enough data to know if vaccination will stop the transmission of the symbicort."Another expert stressed that mask wearing is more important than ever."Now that much more is known about how to treat the disease early, the fact that there are therapeutics now that help with the early disease management, and the treatment is here and is beginning to symbicort price with insurance be administered gives us a real hope that there is a way out of this symbicort," said Dr. Theodore Strange, interim chair of symbicort price with insurance medicine at Staten Island University Hospital, in New York City. "It will take a few more months, even up to a year.

But not individually doing all our parts to curtail symbicort price with insurance the spread and potentially devastating effects for some is not fair to ourselves, our families, our friends and our community at large as we come to this point of hope to end this scourge," Strange added.More informationThere's more on how you can help prevent transmission of the new anti-inflammatories at the U.S. Centers for Disease Control and symbicort price with insurance Prevention.SOURCES. HealthDay/Harris Poll, Dec.

8-10, 2020 symbicort price with insurance. Kathy Steinberg, vice president of research for public symbicort price with insurance release, The Harris Poll. Teresa Murray Amato, MD, chair, emergency medicine, Long Island Jewish Forest Hills, New York City.

Theodore Strange, MD, interim chair, medicine, Staten Island University Hospital, New York CityCopyright © 2020 HealthDay. All rights reserved..

Common side effects

• headache;
• nausea, vomiting, diarrhea, upset stomach;
• back pain;
• stuffy nose;
• muscle or joint pain; or
• changes in your voice.

Can symbicort cause laryngitis

Latest Prevention http://www.ec-ham-harthouse-cath-haguenau.site.ac-strasbourg.fr/page-d-exemple/ & can symbicort cause laryngitis. Wellness News can symbicort cause laryngitis THURSDAY, Sept. 10, 2020 (American Heart Association News)Like ordering a ride or food delivery on your smartphone, keeping track of your heart rate, blood pressure or weight is just a few taps away thanks to thousands of free or inexpensive health apps.But with each click, you may be unwittingly handing over your health data to a third party.As health apps skyrocket in popularity, experts and medical organizations have begun warning consumers of the hidden dangers.

In May, the American Medical Association called on lawmakers and the health care industry to can symbicort cause laryngitis install "regulatory guardrails" to protect all types of patient privacy in the digital age.Until that happens, health app users are largely unprotected from having their data passed along to tech giants and marketing companies that might target them with ads, said Mohammed Abdullah, senior author of a new study about privacy issues and apps.The study, being presented at the American Heart Association's virtual Hypertension Scientific Sessions that begins Thursday, examined 35 diabetes mobile apps and found that all of them gave data to a third party, even in cases where the app's privacy policy said it wouldn't. The research is considered preliminary until published in a peer-reviewed journal."Right now, there are no limitations on what companies can do with this data," said Abdullah, a medical student at the University of Texas Medical Branch in Galveston. "As technology and health care become further intertwined and companies spend billions of dollars on health care-related apps, it's becoming more and more important to make sure we have checks and balances in place."That's because the data on health apps, he said, is can symbicort cause laryngitis not safeguarded by HIPAA, the 1996 law that protects health information gathered by doctors and health systems."Right now, it's like the Wild West, with zero protection," said Dr.

David Grande, author of a study can symbicort cause laryngitis about health privacy in the digital age published in July in JAMA Network Open. "Health privacy concerns are growing at an astronomical pace, but we still have a very antiquated view of them."For example, Grande said many Americans are unaware that once their health data is collected, it's available online forever. In Europe, "right can symbicort cause laryngitis to be forgotten" online privacy laws offer consumers some protection.

But in the U.S., digital health info is "immortal," he said."People don't understand all the digital footprints they're leaving behind each time they interact with heath apps, and frankly, it's very hard to understand. Who on earth would want to read can symbicort cause laryngitis a long, complicated privacy agreement?. " said Grande, policy director at the University of Pennsylvania's Leonard Davis Institute of Health Economics in Philadelphia.As arduous as that task might seem, Abdullah urges people to take five minutes to read the agreements and find out what might happen to their data once they click "agree.""You have to weigh the risks and benefits," he said.

"The app might help patients track their blood sugar, but is it worth can symbicort cause laryngitis using if you know your data might possibly be shared?. "For consumers concerned with privacy, one red flag is the can symbicort cause laryngitis presence of ads on the health app."If you open the app and find ad services, you can be sure your data is being sent off to a third party in some way, shape or form," Abdullah said.Another tip is to check the app's automatic settings and make changes that will protect privacy, like turning off your location. But that, too, has a drawback, Grande said.

"In some cases, turning off privacy settings makes an app harder to use."Like many internet-based services, health apps are usually free to download, with app-makers earning money through advertising or selling data to third parties, he said.However, that business model could change if lawmakers start enacting stricter guidelines and consumers become more willing to pay for health apps."Consumers put health very can symbicort cause laryngitis high on their list in terms of where they want privacy protection," Grande said. "As they grow more uncomfortable with every aspect of their life being tracked, I think the thirst for regulation and privacy control will grow, too."American Heart Association News covers heart and brain health. Not all can symbicort cause laryngitis views expressed in this story reflect the official position of the American Heart Association.

Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have can symbicort cause laryngitis questions or comments about this story, please email [email protected]Copyright © 2020 HealthDay. All rights can symbicort cause laryngitis reserved.

QUESTION In the U.S., 1 in every 4 deaths is caused by heart disease. See AnswerLatest can symbicort cause laryngitis Mental Health News THURSDAY, Sept. 10, 2020 (American Heart Association News)With unemployment rates hovering at or near double digits, millions of people are at risk for eviction or foreclosure.

And a growing body of research suggests the effects go beyond financial, taking a toll on both physical can symbicort cause laryngitis and mental health.The CARES Act passed in late March included a moratorium on some evictions and an additional $600 per week in unemployment benefits. But those federal protections expired. A patchwork of temporary local, state and federal eviction moratoriums are in place, but the long-term picture is can symbicort cause laryngitis still uncertain.In fact, an analysis by Stout Risius Ross, a global consulting company, estimates more than 17 million U.S.

Households – or more than 43% of rental households – are at risk for eviction over the coming months."The health impact is substantial, and it spans multiple realms," said Shakira Suglia, an associate professor and director of graduate studies in the department of epidemiology at Rollins School of Public Health at Emory University in Atlanta.For example, a can symbicort cause laryngitis 2015 study in the journal Social Forces showed mothers who were evicted were more likely to experience depression and higher parental stress than those in stable homes, and they also reported worse health. A nationwide survey conducted by the Centers for Disease Control and Prevention in 2015 found that people with self-reported cardiovascular disease were more likely to face housing insecurity than those who didn't have heart problems. Research also shows people who face the threat of eviction are at greater risk for high blood can symbicort cause laryngitis pressure.Black and Latino communities are at even greater risk.

Studies from cities throughout the country show that people of color, particularly Black and Latino people, make up about 80% of those facing eviction, according to a report last month from a group of nine academic groups and housing advocates.Matthew Desmond is a sociologist whose Eviction Lab at Princeton University was part of that report. He has conducted research showing that while Black women in Milwaukee neighborhoods made up less than 10% of the population, they accounted can symbicort cause laryngitis for 30% of evictions. Desmond won a 2017 Pulitzer Prize for his book "Evicted.

Poverty and Profit can symbicort cause laryngitis in the American City."Dr. Megan Sandel, an associate professor of pediatrics at Boston University School of Medicine, said the pattern of evictions often follow the historic trends of disinvestment can symbicort cause laryngitis in communities from redlining, the unequal treatment in lending faced by many communities of color. "You see this perpetuation of housing discrimination even to this day."Black and Hispanic households are almost twice as likely as white households to lack housing security, according to a 2014 report from the Joint Center for Housing Studies at Harvard University.Sandel, who also is an associate professor of environmental health at Boston University, said federal rental assistance and extending unemployment insurance could help families, but long-term solutions are needed."When families are able to move to areas with less concentrated poverty, their kids have higher lifetime earnings and are able to move up the economic ladder," she said.

"We talk about health so much in terms of pills or interventions, but a stable, decent, affordable home is the best intervention can symbicort cause laryngitis I can provide to my families. Right now, that's under threat for millions of Americans."Suglia, who co-authored an AHA scientific statement about housing and health, said an array of factors, such as stress, can impact health when a family is worried about paying their rent or being able to stay in their home.Under chronic stress, physiological systems may become dysregulated. Additionally, being in a constant state of worry may increase the likelihood that people turn to smoking, alcohol, and fat and sugar-laden foods, can symbicort cause laryngitis she said.

That all can have physical effects."When your housing becomes unaffordable, you may neglect medication, health care, food and heat," she said. "All these things only exacerbate or create additional health problems."While local and federal governments grapple with the issue, many nonprofit organizations are stepping in to help.For can symbicort cause laryngitis example, the American Heart Association and Enterprise Community Partners, a national affordable housing nonprofit, recently held a free webinar to help faith organizations learn strategies to convert unused property into affordable homes. Funded in part can symbicort cause laryngitis by the Kresge Foundation, the groups will hold additional workshops in late 2020 and early 2021.

SLIDESHOW 17 Everyday Ways to Ease Depression See Slideshow In Chicago's Washington Heights, the Endeleo Institute, named for a Swahili term for growth and progress, is doing similar work to repurpose assets in that predominantly Black neighborhood's 95th Street corridor. The group also is working with the AHA, Northwestern University and other institutions to organize farmers markets can symbicort cause laryngitis and launch health education efforts.American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association.

Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved can symbicort cause laryngitis. If you have questions or comments about this story, please email [email protected]Copyright © 2020 HealthDay. All rights can symbicort cause laryngitis reserved.

From Mental Health Resources Featured Centers Health Solutions From Our SponsorsLatest High Blood can symbicort cause laryngitis Pressure News THURSDAY, Sept. 10, 2020 (HealthDay News)Uncontrolled high blood pressure is becoming more common among Americans, putting them at increased risk for heart attack and stroke, a new study shows.Previous research showed that in 1999-2000, 32.2% of Americans maintained blood pressure less than 140/90 mm Hg, but the rate rose to 54.5% in 2013-2014. However, the rate fell to 48% in 2015-2016.Unfortunately, this new study found the proportion of adults aged 40-59 with successfully managed blood can symbicort cause laryngitis pressure fell nearly 10 percentage points from 2009 to 2018 (56.3% vs.

46.6%, respectively). Successful blood pressure management also fell among adults 60 and older by almost 6 percentage points from 2009 can symbicort cause laryngitis to 2018 (53.6% vs. 47.9%, respectively).The study will be presented at a virtual American Heart Association meeting, being held Sept.

10-13. Such research is considered preliminary until published in a peer-reviewed journal."We cannot assume improvement in blood pressure management will continue, even after 35 years of success. High blood pressure is a serious health risk and deserves constant attention to prevent as many heart attacks and strokes as possible," said lead author Dr.

Brent Egan, a professor at the University of South Carolina School of Medicine.The reasons why fewer Americans have successfully managed blood pressure varies by age and requires further study, according to the researchers."A closer look at our findings revealed the fall in blood pressure control in older adults was mainly due to less effective use of blood pressure medication and management, so we need to focus on making sure the level of treatment is adequate for this age group," Egan said in a meeting news release.The American Heart Association and American Medical Association have launched a national program called "Target. BP" in response to the high rate of uncontrolled blood pressure.-- Robert PreidtCopyright © 2020 HealthDay. All rights reserved.

QUESTION Salt and sodium are the same. See Answer References SOURCE. American Heart Association, news release, Sept.

10, 2020Latest High Blood Pressure News By Serena GordonHealthDay ReporterFRIDAY, Sept. 11, 2020People with fatter legs appear less likely to have high blood pressure, new research suggests.The researchers suspect that measuring leg fat could help guide blood pressure prevention efforts. Those with bigger legs may not need to worry as much about high blood pressure -- a contributor to heart attack and stroke."Distribution of fat matters.

Even though we think that fat is bad in all cases, it might be that leg fat is not as bad as we think," said the study's lead author, Aayush Visaria. He's a fourth year medical student at Rutgers New Jersey Medical School.Previous research has found that excess weight around the middle can increase the risk of heart disease and diabetes. "Middle fat is really important because that's where all the organs are -- liver, pancreas, intestines -- and they're all affected by fat.

Too much fat messes up the function of those organs," Visaria said.But that doesn't mean folks who gain more weight in their lower limbs don't need to maintain a healthy weight, too. "Regardless of where the fat is, a lot of fat isn't good. Having muscle is better than having fat.

Our study says, if you have fat, more fat in legs is better than having it in the abdomen," Visaria said.Dr. Vivek Bhalla is director of the Hypertension Center at Stanford University in California. "This study should not be interpreted to say that if a patient has higher leg fat that they will not develop high blood pressure.

It is an important study to motivate further research into the factors as to why blood pressure would be lower," he explained.Bhalla said it's not yet clear how fat distribution might affect your high blood pressure risk. He said it's possible that fat stored in different areas of the body may act in different ways.Visaria suggested that the difference may have something to do with triglyceride (a type of blood fat) levels. People in the study with more leg fat had decreased triglyceride levels, he noted.The new study included almost 6,000 adults participating in national health surveys between 2011 and 2016.

Their average age was 37. About half were female. Nearly one-quarter of the group had high blood pressure (defined in this study as blood pressure above 130/80 mm Hg).The researchers used special X-ray imaging to measure fat in the legs.

These measurements were compared to overall body fat measurements. Men who had 34% fat in their legs were defined as having high leg fat. For women, the cutoff was 39%.Those with higher leg fat were 61% less likely to have high blood pressure than their slim-legged counterparts.

The findings held even after the researchers adjusted for factors such as age, sex, race/ethnicity, smoking, alcohol use, cholesterol levels and levels of waist fat.The researchers noted that this study wasn't designed to prove a cause-and-effect relationship. It could only show an association between higher leg fat and lower blood pressure. Visaria said more research is necessary, particularly in older people.

He said the people in this study were between 20 and 59, so these findings may not be generalizable to people over 60.Bhalla pointed out that "obesity is a major epidemic in the United States and around the world, and like many things in medicine, it's not black or white, but rather there are shades of gray."In addition, Bhalla advised, "As we learn more about different types of fat, the distribution of fat, what factors are secreted by different types of fat and how that affects risk of common conditions -- [including] high blood pressure, heart disease and diabetes -- we need to keep in mind that we have to treat patients as individuals, measure their individual risk, and counsel patients appropriately." SLIDESHOW Low Blood Pressure (Hypotension). Symptoms, Signs, Causes See Slideshow He also said it's important to remember the things people can do right now to lower their blood pressure, including:The findings were scheduled for presentation Thursday at a virtual meeting of the American Heart Association. Findings presented at meetings should be viewed as preliminary until they've been published in a peer-reviewed journal.Copyright © 2020 HealthDay.

All rights reserved. From Heart Health Resources Featured Centers Health Solutions From Our Sponsors References SOURCES. Aayush Visaria, MPH, 4th year medical student, Rutgers New Jersey Medical School, Newark, N.J..

Vivek Bhalla, MD, associate professor, medicine and nephrology, and director, Stanford Hypertension Center, AHA-Certified Comprehensive Hypertension Center, Stanford University School of Medicine, Calif.. Sept. 10, 2020, presentation, American Heart Association virtual hypertension meetingLatest HIV News By Alan MozesHealthDay ReporterTHURSDAY, Sept.

10, 2020 (HealthDay News)The daily drug regimen known as PrEP is a nearly foolproof way to prevent HIV . But a new study suggests that many high-risk Americans may be giving the medication a pass because of cost.The warning stems from a pricing analysis that tracked about 2.6 million PrEP prescriptions filled between 2014 and 2018.The researchers found that during that time frame, PrEP prices -- which were already high -- shot up an average of 5% per year."Pre-exposure prophylaxis, or PrEP, is when people at risk for HIV take a medication to prevent HIV," explained study author Dr. Nathan Furukawa.

He is a medical officer in the division of HIV/AIDS prevention at the U.S. Centers for Disease Control and Prevention.First introduced back in 2012, the regimen entails taking a single pill once a day (brand name Truvada), though the pill actually combines two antiretroviral drugs. According to the CDC, a second option -- Descovy -- is also approved for PrEP, though it is not yet clear whether it specifically protects women during vaginal intercourse.But the bottom line is that "PrEP is highly effective at preventing HIV from sex or injection drug use when taken consistently," stressed Furukawa.

"If enough people at risk of HIV take PrEP, we can stop new HIV s and end the HIV epidemic."Furukawa and his colleagues describe the widespread adoption of PrEP as "a foundational pillar" of the effort to rein in HIV among those most vulnerable, including gay and bisexual men, and drug users.But only about 18% of Americans deemed at high-risk for HIV had embraced PrEP as of 2018. And the latest findings, said Furukawa, suggest that its prohibitive cost may be to blame.The conclusion follows an examination of PrEP orders and prices compiled by the IQVIA prescription database. The database tracks more than nine in 10 medications dispensed by retail pharmacies in the United States, and between 60% and 86% of medications obtained online.The investigators found that between 2014 and 2018, the number of Americans who began taking PrEP increased significantly, rising from about 20,000 to nearly 205,000.Yet, at the same time, the cost of a month's supply of 30 tablets rose from $1,350 to $1,638, the study authors noted.But isn't PrEP covered by insurance?.

Yes and no, Furukawa said."PrEP is covered by nearly all insurance plans, most state Medicaid plans and Medicare," he noted. "However, out-of-pocket costs for patients who have not met their deductible may still be prohibitive."Out-of-pocket costs shot up by nearly 15% a year during the study period. That translates to an average out-of-pocket rise from $54 a month in 2014 to $94 a month by 2018, the findings showed."Even though insurers cover about 94% of PrEP medication costs, patients may still have difficulties paying the remaining out-of-pocket costs, since the cost of the medication is large," Furukawa explained.As for those who are underinsured or lack insurance altogether, state medication assistance programs and the manufacturer of Truvada (Gilead) may offer subsidies.

(Furukawa directed those interested to the nonprofit PrEPcost.org website.)Furukawa also acknowledged that there are other impediments to PrEP acceptance beyond cost, including lack of awareness and insufficient access to health care.Still, he suggested that lowering the cost of the medication could be an important factor in getting more people on board.That thought was seconded by Dr. Michael Horberg, associate medical director and director of HIV/AIDS and STD at the Kaiser Permanente Care Management Institute in Rockville, Md.While drug assistance programs are available, "pharmacy costs are always a big concern in preventive medicine," said Horberg.But PrEP cost is likely to fall in the coming years, he said, as a cheaper generic version of Truvada comes to market. And PrEP is also now classified as a level "A" recommended drug by the U.S.

Preventive Services Task Force. That designation should drive out-of-pocket costs down to as low as zero, Horberg added."Nonetheless, the pharmaceutical industry should aim to lower costs, and make this readily available to all U.S. Citizens who would benefit from PrEP," Horberg said.The findings were published Sept.

8 in the Annals of Internal Medicine.Copyright © 2020 HealthDay. All rights reserved. SLIDESHOW A Timeline of the HIV/AIDS symbicort See Slideshow References SOURCES.

Nathan Furukawa, MD, MPH, medical officer, division of HIV/AIDS prevention, U.S. Centers for Disease Control and Prevention, Atlanta. Michael Horberg, MD, MAS, associate medical director and director, HIV/AIDS and STD, Kaiser Permanente Care Management Institute, Rockville, Md..

Latest Prevention symbicort price with insurance &. Wellness News symbicort price with insurance THURSDAY, Sept. 10, 2020 (American Heart Association News)Like ordering a ride or food delivery on your smartphone, keeping track of your heart rate, blood pressure or weight is just a few taps away thanks to thousands of free or inexpensive health apps.But with each click, you may be unwittingly handing over your health data to a third party.As health apps skyrocket in popularity, experts and medical organizations have begun warning consumers of the hidden dangers. In May, symbicort price with insurance the American Medical Association called on lawmakers and the health care industry to install "regulatory guardrails" to protect all types of patient privacy in the digital age.Until that happens, health app users are largely unprotected from having their data passed along to tech giants and marketing companies that might target them with ads, said Mohammed Abdullah, senior author of a new study about privacy issues and apps.The study, being presented at the American Heart Association's virtual Hypertension Scientific Sessions that begins Thursday, examined 35 diabetes mobile apps and found that all of them gave data to a third party, even in cases where the app's privacy policy said it wouldn't. The research is considered preliminary until published in a peer-reviewed journal."Right now, there are no limitations on what companies can do with this data," said Abdullah, a medical student at the University of Texas Medical Branch in Galveston.

"As technology and health care become further intertwined and companies spend billions of dollars on health care-related apps, it's becoming more and more important to make sure symbicort price with insurance we have checks and balances in place."That's because the data on health apps, he said, is not safeguarded by HIPAA, the 1996 law that protects health information gathered by doctors and health systems."Right now, it's like the Wild West, with zero protection," said Dr. David Grande, author of a study about health privacy in the digital age published in July in JAMA symbicort price with insurance Network Open. "Health privacy concerns are growing at an astronomical pace, but we still have a very antiquated view of them."For example, Grande said many Americans are unaware that once their health data is collected, it's available online forever. In Europe, "right to be forgotten" online privacy laws offer consumers symbicort price with insurance some protection. But in the U.S., digital health info is "immortal," he said."People don't understand all the digital footprints they're leaving behind each time they interact with heath apps, and frankly, it's very hard to understand.

Who on earth would want symbicort price with insurance to read a long, complicated privacy agreement?. " said Grande, policy director at the University of Pennsylvania's Leonard Davis Institute of Health Economics in Philadelphia.As arduous as that task might seem, Abdullah urges people to take five minutes to read the agreements and find out what might happen to their data once they click "agree.""You have to weigh the risks and benefits," he said. "The app might help patients track their blood sugar, but is symbicort price with insurance it worth using if you know your data might possibly be shared?. "For consumers concerned with privacy, one red flag is the presence of ads on the health app."If you open the app and find ad services, you can be sure your data is being sent off to a third party in some way, shape or form," Abdullah said.Another tip is to symbicort price with insurance check the app's automatic settings and make changes that will protect privacy, like turning off your location. But that, too, has a drawback, Grande said.

"In some cases, turning off privacy settings makes an app harder to use."Like many internet-based services, health apps are usually free to download, with app-makers earning money through advertising or selling data to third parties, he said.However, that business model symbicort price with insurance could change if lawmakers start enacting stricter guidelines and consumers become more willing to pay for health apps."Consumers put health very high on their list in terms of where they want privacy protection," Grande said. "As they grow more uncomfortable with every aspect of their life being tracked, I think the thirst for regulation and privacy control will grow, too."American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American symbicort price with insurance Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email symbicort price with insurance [email protected]Copyright © 2020 HealthDay.

All rights reserved symbicort price with insurance. QUESTION In the U.S., 1 in every 4 deaths is caused by heart disease. See AnswerLatest symbicort price with insurance Mental Health News THURSDAY, Sept. 10, 2020 (American Heart Association News)With unemployment rates hovering at or near double digits, millions of people are at risk for eviction or foreclosure. And a growing body of research suggests the effects go beyond financial, taking a toll on symbicort price with insurance both physical and mental health.The CARES Act passed in late March included a moratorium on some evictions and an additional $600 per week in unemployment benefits.

But those federal protections expired. A patchwork of temporary local, state and federal eviction moratoriums are in place, but the long-term picture is still uncertain.In fact, an analysis by Stout Risius Ross, a global consulting company, estimates more than 17 million U.S symbicort price with insurance. Households – or more than 43% of rental households – are at risk for eviction over the coming months."The health impact is substantial, and it spans multiple realms," said Shakira Suglia, an associate professor and director of graduate studies in the department of epidemiology at Rollins School of Public Health at Emory University in Atlanta.For example, a 2015 study symbicort price with insurance in the journal Social Forces showed mothers who were evicted were more likely to experience depression and higher parental stress than those in stable homes, and they also reported worse health. A nationwide survey conducted by the Centers for Disease Control and Prevention in 2015 found that people with self-reported cardiovascular disease were more likely to face housing insecurity than those who didn't have heart problems. Research also shows people who face the threat of eviction are at greater risk for high blood pressure.Black and symbicort price with insurance Latino communities are at even greater risk.

Studies from cities throughout the country show that people of color, particularly Black and Latino people, make up about 80% of those facing eviction, according to a report last month from a group of nine academic groups and housing advocates.Matthew Desmond is a sociologist whose Eviction Lab at Princeton University was part of that report. He has conducted research showing that while symbicort price with insurance Black women in Milwaukee neighborhoods made up less than 10% of the population, they accounted for 30% of evictions. Desmond won a 2017 Pulitzer Prize for his book "Evicted. Poverty and Profit in the symbicort price with insurance American City."Dr. Megan Sandel, an associate professor symbicort price with insurance of pediatrics at Boston University School of Medicine, said the pattern of evictions often follow the historic trends of disinvestment in communities from redlining, the unequal treatment in lending faced by many communities of color.

"You see this perpetuation of housing discrimination even to this day."Black and Hispanic households are almost twice as likely as white households to lack housing security, according to a 2014 report from the Joint Center for Housing Studies at Harvard University.Sandel, who also is an associate professor of environmental health at Boston University, said federal rental assistance and extending unemployment insurance could help families, but long-term solutions are needed."When families are able to move to areas with less concentrated poverty, their kids have higher lifetime earnings and are able to move up the economic ladder," she said. "We talk about health so much in terms symbicort price with insurance of pills or interventions, but a stable, decent, affordable home is the best intervention I can provide to my families. Right now, that's under threat for millions of Americans."Suglia, who co-authored an AHA scientific statement about housing and health, said an array of factors, such as stress, can impact health when a family is worried about paying their rent or being able to stay in their home.Under chronic stress, physiological systems may become dysregulated. Additionally, being in a constant state of worry may increase the likelihood that people turn symbicort price with insurance to smoking, alcohol, and fat and sugar-laden foods, she said. That all can have physical effects."When your housing becomes unaffordable, you may neglect medication, health care, food and heat," she said.

"All these things only exacerbate or create additional health problems."While local and federal governments grapple with the issue, many nonprofit organizations are stepping in to help.For example, the American Heart Association and Enterprise Community Partners, a national affordable housing nonprofit, recently held a free webinar to help faith organizations learn strategies to symbicort price with insurance convert unused property into affordable homes. Funded in part by the Kresge Foundation, the groups will hold additional workshops symbicort price with insurance in late 2020 and early 2021. SLIDESHOW 17 Everyday Ways to Ease Depression See Slideshow In Chicago's Washington Heights, the Endeleo Institute, named for a Swahili term for growth and progress, is doing similar work to repurpose assets in that predominantly Black neighborhood's 95th Street corridor. The group also is working with the AHA, Northwestern University and other institutions to organize farmers markets and launch health education efforts.American Heart Association News symbicort price with insurance covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association.

Copyright is owned or held by the American Heart Association, Inc., symbicort price with insurance and all rights are reserved. If you have questions or comments about this story, please email [email protected]Copyright © 2020 HealthDay. All rights symbicort price with insurance reserved. From Mental Health Resources Featured Centers Health Solutions From symbicort price with insurance Our SponsorsLatest High Blood Pressure News THURSDAY, Sept. 10, 2020 (HealthDay News)Uncontrolled high blood pressure is becoming more common among Americans, putting them at increased risk for heart attack and stroke, a new study shows.Previous research showed that in 1999-2000, 32.2% of Americans maintained blood pressure less than 140/90 mm Hg, but the rate rose to 54.5% in 2013-2014.

However, the rate fell to 48% in 2015-2016.Unfortunately, this new study found the proportion of adults aged 40-59 with successfully managed blood pressure fell nearly 10 symbicort price with insurance percentage points from 2009 to 2018 (56.3% vs. 46.6%, respectively). Successful blood pressure management also fell among adults 60 and older by almost 6 percentage points symbicort price with insurance from 2009 to 2018 (53.6% vs. 47.9%, respectively).The study will be presented at a virtual American Heart Association meeting, being held Sept. 10-13.

Such research is considered preliminary until published in a peer-reviewed journal."We cannot assume improvement in blood pressure management will continue, even after 35 years of success. High blood pressure is a serious health risk and deserves constant attention to prevent as many heart attacks and strokes as possible," said lead author Dr. Brent Egan, a professor at the University of South Carolina School of Medicine.The reasons why fewer Americans have successfully managed blood pressure varies by age and requires further study, according to the researchers."A closer look at our findings revealed the fall in blood pressure control in older adults was mainly due to less effective use of blood pressure medication and management, so we need to focus on making sure the level of treatment is adequate for this age group," Egan said in a meeting news release.The American Heart Association and American Medical Association have launched a national program called "Target. BP" in response to the high rate of uncontrolled blood pressure.-- Robert PreidtCopyright © 2020 HealthDay. All rights reserved.

QUESTION Salt and sodium are the same. See Answer References SOURCE. American Heart Association, news release, Sept. 10, 2020Latest High Blood Pressure News By Serena GordonHealthDay ReporterFRIDAY, Sept. 11, 2020People with fatter legs appear less likely to have high blood pressure, new research suggests.The researchers suspect that measuring leg fat could help guide blood pressure prevention efforts.

Those with bigger legs may not need to worry as much about high blood pressure -- a contributor to heart attack and stroke."Distribution of fat matters. Even though we think that fat is bad in all cases, it might be that leg fat is not as bad as we think," said the study's lead author, Aayush Visaria. He's a fourth year medical student at Rutgers New Jersey Medical School.Previous research has found that excess weight around the middle can increase the risk of heart disease and diabetes. "Middle fat is really important because that's where all the organs are -- liver, pancreas, intestines -- and they're all affected by fat. Too much fat messes up the function of those organs," Visaria said.But that doesn't mean folks who gain more weight in their lower limbs don't need to maintain a healthy weight, too.

"Regardless of where the fat is, a lot of fat isn't good. Having muscle is better than having fat. Our study says, if you have fat, more fat in legs is better than having it in the abdomen," Visaria said.Dr. Vivek Bhalla is director of the Hypertension Center at Stanford University in California. "This study should not be interpreted to say that if a patient has higher leg fat that they will not develop high blood pressure.

It is an important study to motivate further research into the factors as to why blood pressure would be lower," he explained.Bhalla said it's not yet clear how fat distribution might affect your high blood pressure risk. He said it's possible that fat stored in different areas of the body may act in different ways.Visaria suggested that the difference may have something to do with triglyceride (a type of blood fat) levels. People in the study with more leg fat had decreased triglyceride levels, he noted.The new study included almost 6,000 adults participating in national health surveys between 2011 and 2016. Their average age was 37. About half were female.

Nearly one-quarter of the group had high blood pressure (defined in this study as blood pressure above 130/80 mm Hg).The researchers used special X-ray imaging to measure fat in the legs. These measurements were compared to overall body fat measurements. Men who had 34% fat in their legs were defined as having high leg fat. For women, the cutoff was 39%.Those with higher leg fat were 61% less likely to have high blood pressure than their slim-legged counterparts. The findings held even after the researchers adjusted for factors such as age, sex, race/ethnicity, smoking, alcohol use, cholesterol levels and levels of waist fat.The researchers noted that this study wasn't designed to prove a cause-and-effect relationship.

It could only show an association between higher leg fat and lower blood pressure. Visaria said more research is necessary, particularly in older people. He said the people in this study were between 20 and 59, so these findings may not be generalizable to people over 60.Bhalla pointed out that "obesity is a major epidemic in the United States and around the world, and like many things in medicine, it's not black or white, but rather there are shades of gray."In addition, Bhalla advised, "As we learn more about different types of fat, the distribution of fat, what factors are secreted by different types of fat and how that affects risk of common conditions -- [including] high blood pressure, heart disease and diabetes -- we need to keep in mind that we have to treat patients as individuals, measure their individual risk, and counsel patients appropriately." SLIDESHOW Low Blood Pressure (Hypotension). Symptoms, Signs, Causes See Slideshow He also said it's important to remember the things people can do right now to lower their blood pressure, including:The findings were scheduled for presentation Thursday at a virtual meeting of the American Heart Association. Findings presented at meetings should be viewed as preliminary until they've been published in a peer-reviewed journal.Copyright © 2020 HealthDay.

All rights reserved. From Heart Health Resources Featured Centers Health Solutions From Our Sponsors References SOURCES. Aayush Visaria, MPH, 4th year medical student, Rutgers New Jersey Medical School, Newark, N.J.. Vivek Bhalla, MD, associate professor, medicine and nephrology, and director, Stanford Hypertension Center, AHA-Certified Comprehensive Hypertension Center, Stanford University School of Medicine, Calif.. Sept.

10, 2020, presentation, American Heart Association virtual hypertension meetingLatest HIV News By Alan MozesHealthDay ReporterTHURSDAY, Sept. 10, 2020 (HealthDay News)The daily drug regimen known as PrEP is a nearly foolproof way to prevent HIV . But a new study suggests that many high-risk Americans may be giving the medication a pass because of cost.The warning stems from a pricing analysis that tracked about 2.6 million PrEP prescriptions filled between 2014 and 2018.The researchers found that during that time frame, PrEP prices -- which were already high -- shot up an average of 5% per year."Pre-exposure prophylaxis, or PrEP, is when people at risk for HIV take a medication to prevent HIV," explained study author Dr. Nathan Furukawa. He is a medical officer in the division of HIV/AIDS prevention at the U.S.

Centers for Disease Control and Prevention.First introduced back in 2012, the regimen entails taking a single pill once a day (brand name Truvada), though the pill actually combines two antiretroviral drugs. According to the CDC, a second option -- Descovy -- is also approved for PrEP, though it is not yet clear whether it specifically protects women during vaginal intercourse.But the bottom line is that "PrEP is highly effective at preventing HIV from sex or injection drug use when taken consistently," stressed Furukawa. "If enough people at risk of HIV take PrEP, we can stop new HIV s and end the HIV epidemic."Furukawa and his colleagues describe the widespread adoption of PrEP as "a foundational pillar" of the effort to rein in HIV among those most vulnerable, including gay and bisexual men, and drug users.But only about 18% of Americans deemed at high-risk for HIV had embraced PrEP as of 2018. And the latest findings, said Furukawa, suggest that its prohibitive cost may be to blame.The conclusion follows an examination of PrEP orders and prices compiled by the IQVIA prescription database. The database tracks more than nine in 10 medications dispensed by retail pharmacies in the United States, and between 60% and 86% of medications obtained online.The investigators found that between 2014 and 2018, the number of Americans who began taking PrEP increased significantly, rising from about 20,000 to nearly 205,000.Yet, at the same time, the cost of a month's supply of 30 tablets rose from $1,350 to $1,638, the study authors noted.But isn't PrEP covered by insurance?.

Yes and no, Furukawa said."PrEP is covered by nearly all insurance plans, most state Medicaid plans and Medicare," he noted. "However, out-of-pocket costs for patients who have not met their deductible may still be prohibitive."Out-of-pocket costs shot up by nearly 15% a year during the study period. That translates to an average out-of-pocket rise from $54 a month in 2014 to $94 a month by 2018, the findings showed."Even though insurers cover about 94% of PrEP medication costs, patients may still have difficulties paying the remaining out-of-pocket costs, since the cost of the medication is large," Furukawa explained.As for those who are underinsured or lack insurance altogether, state medication assistance programs and the manufacturer of Truvada (Gilead) may offer subsidies. (Furukawa directed those interested to the nonprofit PrEPcost.org website.)Furukawa also acknowledged that there are other impediments to PrEP acceptance beyond cost, including lack of awareness and insufficient access to health care.Still, he suggested that lowering the cost of the medication could be an important factor in getting more people on board.That thought was seconded by Dr. Michael Horberg, associate medical director and director of HIV/AIDS and STD at the Kaiser Permanente Care Management Institute in Rockville, Md.While drug assistance programs are available, "pharmacy costs are always a big concern in preventive medicine," said Horberg.But PrEP cost is likely to fall in the coming years, he said, as a cheaper generic version of Truvada comes to market.

And PrEP is also now classified as a level "A" recommended drug by the U.S. Preventive Services Task Force. That designation should drive out-of-pocket costs down to as low as zero, Horberg added."Nonetheless, the pharmaceutical industry should aim to lower costs, and make this readily available to all U.S. Citizens who would benefit from PrEP," Horberg said.The findings were published Sept. 8 in the Annals of Internal Medicine.Copyright © 2020 HealthDay.

All rights reserved. SLIDESHOW A Timeline of the HIV/AIDS symbicort See Slideshow References SOURCES. Nathan Furukawa, MD, MPH, medical officer, division of HIV/AIDS prevention, U.S. Centers for Disease Control and Prevention, Atlanta. Michael Horberg, MD, MAS, associate medical director and director, HIV/AIDS and STD, Kaiser Permanente Care Management Institute, Rockville, Md..

Symbicort rash

How to symbicort rash cite this article:Singh O P. Aftermath of celebrity suicide – Media coverage and role of psychiatrists. Indian J Psychiatry 2020;62:337-8Celebrity symbicort rash suicide is one of the highly publicized events in our country.

Indians got a glimpse of this following an unfortunate incident where a popular Hindi film actor died of suicide. As expected, the media went symbicort rash into a frenzy as newspapers, news channels, and social media were full of stories providing minute details of the suicidal act. Some even going as far as highlighting the color of the cloth used in the suicide as well as showing the lifeless body of the actor.

All kinds of personal details were dug up, and speculations and hypotheses became the order of the day in the next few days that followed. In the process, reputations of many people associated with the actor were besmirched and their private and personal details were freely symbicort rash and blatantly broadcast and discussed on electronic, print, and social media. We understand that media houses have their own need and duty to report and sensationalize news for increasing their visibility (aka TRP), but such reporting has huge impacts on the mental health of the vulnerable population.The impact of this was soon realized when many incidents of copycat suicide were reported from all over the country within a few days of the incident.

Psychiatrists suddenly started getting distress calls from their patients in despair with increased suicidal ideation symbicort rash. This has become a major area of concern for the psychiatry community.The Indian Psychiatric Society has been consistently trying to engage with media to promote ethical reporting of suicide. Section 24 (1) of Mental Health Care Act, 2017, forbids publication symbicort rash of photograph of mentally ill person without his consent.[1] The Press Council of India has adopted the guidelines of World Health Organization report on Preventing Suicide.

A resource for media professionals, which came out with an advisory to be followed by media in reporting cases of suicide. It includes points forbidding them from putting stories in prominent positions and unduly repeating them, explicitly describing the method used, providing details about the site/location, using sensational headlines, or using photographs and video footage of the incident.[2] Unfortunately, the advisory seems to have little effect in the aftermath of celebrity suicides. Channels were symbicort rash full of speculations about the person's mental condition and illness and also his relationships and finances.

Many fictional accounts of his symptoms and illness were touted, which is not only against the ethics but is also contrary to MHCA, 2017.[1]It went to the extent that the name of his psychiatrist was mentioned and quotes were attributed to him without taking any account from him. The Indian Psychiatric Society has written to the Press Council of India underlining this concern and asking for measures to ensure ethics in reporting suicide.While there is a need for engagement with media to make them aware of the grave impact of negative suicide reporting on the lives of many vulnerable persons, there is even a more urgent need for training of symbicort rash psychiatrists regarding the proper way of interaction with media. This has been amply brought out in the aftermath of this incident.

Many psychiatrists and mental health professionals were called by media houses to comment on the episode symbicort rash. Many psychiatrists were quoted, or “misquoted,” or “quoted out of context,” commenting on the life of a person whom they had never examined and had no “professional authority” to do so. There were even stories with byline of a psychiatrist where the content provided was not only unscientific but also way beyond the expertise of a psychiatrist.

These types of viewpoints perpetuate symbicort rash stigma, myths, and “misleading concepts” about psychiatry and are detrimental to the image of psychiatry in addition to doing harm and injustice to our patients. Hence, the need to formulate a guideline for interaction of psychiatrists with the media is imperative.In the infamous Goldwater episode, 12,356 psychiatrists were asked to cast opinion about the fitness of Barry Goldwater for presidential candidature. Out of 2417 respondents, 1189 psychiatrists reported him to be mentally unfit while none had actually examined him.[3] This led symbicort rash to the formulation of “The Goldwater Rule” by the American Psychiatric Association in 1973,[4] but we have witnessed the same phenomenon at the time of presidential candidature of Donald Trump.Psychiatrists should be encouraged to interact with media to provide scientific information about mental illnesses and reduction of stigma, but “statements to the media” can be a double-edged sword, and we should know about the rules of engagements and boundaries of interactions.

Methods and principles of interaction with media should form a part of our training curriculum. Many professional societies have guidelines and resource books for interacting with symbicort rash media, and psychiatrists should familiarize themselves with these documents. The Press Council guideline is likely to prompt reporters to seek psychiatrists for their expert opinion.

It is useful for them to have a template ready with suicide rates, emphasizing multicausality of suicide, role of mental disorders, as well as help available.[5]It is about time that the Indian Psychiatric Society formulated its own guidelines laying down the broad principles and boundaries governing the interaction of Indian psychiatrists with the media. Till then, symbicort rash it is desirable to be guided by the following broad principles:It should be assumed that no statement goes “off the record” as the media person is most likely recording the interview, and we should also record any such conversation from our endIt should be clarified in which capacity comments are being made – professional, personal, or as a representative of an organizationOne should not comment on any person whom he has not examinedPsychiatrists should take any such opportunity to educate the public about mental health issuesThe comments should be justified and limited by the boundaries of scientific knowledge available at the moment. References Correspondence Address:Dr.

O P symbicort rash SinghAA 304, Ashabari Apartments, O/31, Baishnabghata, Patuli Township, Kolkata - 700 094, West Bengal IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/psychiatry.IndianJPsychiatry_816_20Abstract Electroconvulsive therapy (ECT) is an effective modality of treatment for a variety of psychiatric disorders. However, it has always been accused of being a coercive, unethical, and dangerous modality of treatment. The dangerousness of ECT has been mainly attributed to its claimed ability to cause brain damage.

This narrative review aims to provide an update of the evidence with regard to whether the practice of ECT is associated with damage to the brain. An accepted definition of brain damage remains elusive. There are also ethical and technical problems in designing studies that look at this question specifically.

Thus, even though there are newer technological tools and innovations, any review attempting to answer this question would have to take recourse to indirect methods. These include structural, functional, and metabolic neuroimaging. Body fluid biochemical marker studies.

And follow-up studies of cognitive impairment and incidence of dementia in people who have received ECT among others. The review of literature and present evidence suggests that ECT has a demonstrable impact on the structure and function of the brain. However, there is a lack of evidence at present to suggest that ECT causes brain damage.Keywords.

Adverse effect, brain damage, electroconvulsive therapyHow to cite this article:Jolly AJ, Singh SM. Does electroconvulsive therapy cause brain damage. An update.

Indian J Psychiatry 2020;62:339-53 Introduction Electroconvulsive therapy (ECT) as a modality of treatment for psychiatric disorders has existed at least since 1938.[1] ECT is an effective modality of treatment for various psychiatric disorders. However, from the very beginning, the practice of ECT has also faced resistance from various groups who claim that it is coercive and harmful.[2] While the ethical aspects of the practice of ECT have been dealt with elsewhere, the question of harmfulness or brain damage consequent upon the passage of electric current needs to be examined afresh in light of technological advances and new knowledge.[3]The question whether ECT causes brain damage was reviewed in a holistic fashion by Devanand et al. In the mid-1990s.[4],[5] The authors had attempted to answer this question by reviewing the effect of ECT on the brain in various areas – cognitive side effects, structural neuroimaging studies, neuropathologic studies of patients who had received ECT, autopsy studies of epileptic patients, and finally animal ECS studies.

The authors had concluded that ECT does not produce brain damage.This narrative review aims to update the evidence with regard to whether ECT causes brain damage by reviewing relevant literature from 1994 to the present time. Framing the Question The Oxford Dictionary defines damage as physical harm that impairs the value, usefulness, or normal function of something.[6] Among medical dictionaries, the Peter Collins Dictionary defines damage as harm done to things (noun) or to harm something (verb).[7] Brain damage is defined by the British Medical Association Medical Dictionary as degeneration or death of nerve cells and tracts within the brain that may be localized to a particular area of the brain or diffuse.[8] Going by such a definition, brain damage in the context of ECT should refer to death or degeneration of brain tissue, which results in the impairment of functioning of the brain. The importance of precisely defining brain damage shall become evident subsequently in this review.There are now many more tools available to investigate the structure and function of brain in health and illness.

However, there are obvious ethical issues in designing human studies that are designed to answer this specific question. Therefore, one must necessarily take recourse to indirect evidences available through studies that have been designed to answer other research questions. These studies have employed the following methods:Structural neuroimaging studiesFunctional neuroimaging studiesMetabolic neuroimaging studiesBody fluid biochemical marker studiesCognitive impairment studies.While the early studies tended to focus more on establishing the safety of ECT and finding out whether ECT causes gross microscopic brain damage, the later studies especially since the advent of advanced neuroimaging techniques have been focusing more on a mechanistic understanding of ECT.

Hence, the primary objective of the later neuroimaging studies has been to look for structural and functional brain changes which might explain how ECT acts rather than evidence of gross structural damage per se. However, put together, all these studies would enable us to answer our titular question to some satisfaction. [Table 1] and [Table 2] provide an overview of the evidence base in this area.

Structural and Functional Neuroimaging Studies Devanand et al. Reviewed 16 structural neuroimaging studies on the effect of ECT on the brain.[4] Of these, two were pneumoencephalography studies, nine were computed tomography (CT) scan studies, and five were magnetic resonance imaging (MRI) studies. However, most of these studies were retrospective in design, with neuroimaging being done in patients who had received ECT in the past.

In the absence of baseline neuroimaging, it would be very difficult to attribute any structural brain changes to ECT. In addition, pneumoencephalography, CT scan, and even early 0.3 T MRI provided images with much lower spatial resolution than what is available today. The authors concluded that there was no evidence to show that ECT caused any structural damage to the brain.[4] Since then, at least twenty more MRI-based structural neuroimaging studies have studied the effect of ECT on the brain.

The earliest MRI studies in the early 1990s focused on detecting structural damage following ECT. All of these studies were prospective in design, with the first MRI scan done at baseline and a second MRI scan performed post ECT.[9],[11],[12],[13],[41] While most of the studies imaged the patient once around 24 h after receiving ECT, some studies performed multiple post ECT neuroimaging in the first 24 h after ECT to better capture the acute changes. A single study by Coffey et al.

Followed up the patients for a duration of 6 months and repeated neuroimaging again at 6 months in order to capture any long-term changes following ECT.[10]The most important conclusion which emerged from this early series of studies was that there was no evidence of cortical atrophy, change in ventricle size, or increase in white matter hyperintensities.[4] The next major conclusion was that there appeared to be an increase in the T1 and T2 relaxation time immediately following ECT, which returned to normal within 24 h. This supported the theory that immediately following ECT, there appears to be a temporary breakdown of the blood–brain barrier, leading to water influx into the brain tissue.[11] The last significant observation by Coffey et al. In 1991 was that there was no significant temporal changes in the total volumes of the frontal lobes, temporal lobes, or amygdala–hippocampal complex.[10] This was, however, something which would later be refuted by high-resolution MRI studies.

Nonetheless, one inescapable conclusion of these early studies was that there was no evidence of any gross structural brain changes following administration of ECT. Much later in 2007, Szabo et al. Used diffusion-weighted MRI to image patients in the immediate post ECT period and failed to observe any obvious brain tissue changes following ECT.[17]The next major breakthrough came in 2010 when Nordanskog et al.

Demonstrated that there was a significant increase in the volume of the hippocampus bilaterally following a course of ECT in a cohort of patients with depressive illness.[18] This contradicted the earlier observations by Coffey et al. That there was no volume increase in any part of the brain following ECT.[10] This was quite an exciting finding and was followed by several similar studies. However, the perspective of these studies was quite different from the early studies.

In contrast to the early studies looking for the evidence of ECT-related brain damage, the newer studies were focused more on elucidating the mechanism of action of ECT. Further on in 2014, Nordanskog et al. In a follow-up study showed that though there was a significant increase in the volume of the hippocampus 1 week after a course of ECT, the hippocampal volume returned to the baseline after 6 months.[19] Two other studies in 2013 showed that in addition to the hippocampus, the amygdala also showed significant volume increase following ECT.[20],[21] A series of structural neuroimaging studies after that have expanded on these findings and as of now, gray matter volume increase following ECT has been demonstrated in the hippocampus, amygdala, anterior temporal pole, subgenual cortex,[21] right caudate nucleus, and the whole of the medial temporal lobe (MTL) consisting of the hippocampus, amygdala, insula, and the posterosuperior temporal cortex,[24] para hippocampi, right subgenual anterior cingulate gyrus, and right anterior cingulate gyrus,[25] left cerebellar area VIIa crus I,[29] putamen, caudate nucleus, and nucleus acumbens [31] and clusters of increased cortical thickness involving the temporal pole, middle and superior temporal cortex, insula, and inferior temporal cortex.[27] However, the most consistently reported and replicated finding has been the bilateral increase in the volume of the hippocampus and amygdala.

In light of these findings, it has been tentatively suggested that ECT acts by inducing neuronal regeneration in the hippocampus – amygdala complex.[42],[43] However, there are certain inconsistencies to this hypothesis. Till date, only one study – Nordanskog et al., 2014 – has followed study patients for a long term – 6 months in their case. And significantly, the authors found out that after increasing immediately following ECT, the hippocampal volume returns back to baseline by 6 months.[19] This, however, was not associated with the relapse of depressive symptoms.

Another area of significant confusion has been the correlation of hippocampal volume increase with improvement of depressive symptoms. Though almost all studies demonstrate a significant increase in hippocampal volume following ECT, a majority of studies failed to demonstrate a correlation between symptom improvement and hippocampal volume increase.[19],[20],[22],[24],[28] However, a significant minority of volumetric studies have demonstrated correlation between increase in hippocampal and/or amygdala volume and improvement of symptoms.[21],[25],[30]Another set of studies have used diffusion tensor imaging, functional MRI (fMRI), anatomical connectome, and structural network analysis to study the effect of ECT on the brain. The first of these studies by Abbott et al.

In 2014 demonstrated that on fMRI, the connectivity between right and left hippocampus was significantly reduced in patients with severe depression. It was also shown that the connectivity was normalized following ECT, and symptom improvement was correlated with an increase in connectivity.[22] In a first of its kind DTI study, Lyden et al. In 2014 demonstrated that fractional anisotropy which is a measure of white matter tract or fiber density is increased post ECT in patients with severe depression in the anterior cingulum, forceps minor, and the dorsal aspect of the left superior longitudinal fasciculus.

The authors suggested that ECT acts to normalize major depressive disorder-related abnormalities in the structural connectivity of the dorsal fronto-limbic pathways.[23] Another DTI study in 2015 constructed large-scale anatomical networks of the human brain – connectomes, based on white matter fiber tractography. The authors found significant reorganization in the anatomical connections involving the limbic structure, temporal lobe, and frontal lobe. It was also found that connection changes between amygdala and para hippocampus correlated with reduction in depressive symptoms.[26] In 2016, Wolf et al.

Used a source-based morphometry approach to study the structural networks in patients with depression and schizophrenia and the effect of ECT on the same. It was found that the medial prefrontal cortex/anterior cingulate cortex (ACC/MPFC) network, MTL network, bilateral thalamus, and left cerebellar regions/precuneus exhibited significant difference between healthy controls and the patient population. It was also demonstrated that administration of ECT leads to significant increase in the network strength of the ACC/MPFC network and the MTL network though the increase in network strength and symptom amelioration were not correlated.[32]Building on these studies, a recently published meta-analysis has attempted a quantitative synthesis of brain volume changes – focusing on hippocampal volume increase following ECT in patients with major depressive disorder and bipolar disorder.

The authors initially selected 32 original articles from which six articles met the criteria for quantitative synthesis. The results showed significant increase in the volume of the right and left hippocampus following ECT. For the rest of the brain regions, the heterogeneity in protocols and imaging techniques did not permit a quantitative analysis, and the authors have resorted to a narrative review similar to the present one with similar conclusions.[44] Focusing exclusively on hippocampal volume change in ECT, Oltedal et al.

In 2018 conducted a mega-analysis of 281 patients with major depressive disorder treated with ECT enrolled at ten different global sites of the Global ECT-MRI Research Collaboration.[45] Similar to previous studies, there was a significant increase in hippocampal volume bilaterally with a dose–response relationship with the number of ECTs administered. Furthermore, bilateral (B/L) ECT was associated with an equal increase in volume in both right and left hippocampus, whereas right unilateral ECT was associated with greater volume increase in the right hippocampus. Finally, contrary to expectation, clinical improvement was found to be negatively correlated with hippocampal volume.Thus, a review of the current evidence amply demonstrates that from looking for ECT-related brain damage – and finding none, we have now moved ahead to looking for a mechanistic understanding of the effect of ECT.

In this regard, it has been found that ECT does induce structural changes in the brain – a fact which has been seized upon by some to claim that ECT causes brain damage.[46] Such statements should, however, be weighed against the definition of damage as understood by the scientific medical community and patient population. Neuroanatomical changes associated with effective ECT can be better described as ECT-induced brain neuroplasticity or ECT-induced brain neuromodulation rather than ECT-induced brain damage. Metabolic Neuroimaging Studies.

Magnetic Resonance Spectroscopic Imaging Magnetic resonance spectroscopic imaging (MRSI) uses a phase-encoding procedure to map the spatial distribution of magnetic resonance (MR) signals of different molecules. The crucial difference, however, is that while MRI maps the MR signals of water molecules, MRSI maps the MR signals generated by different metabolites – such as N-acetyl aspartate (NAA) and choline-containing compounds. However, the concentration of these metabolites is at least 10,000 times lower than water molecules and hence the signal strength generated would also be correspondingly lower.

However, MRSI offers us the unique advantage of studying in vivo the change in the concentration of brain metabolites, which has been of great significance in fields such as psychiatry, neurology, and basic neuroscience research.[47]MRSI studies on ECT in patients with depression have focused largely on four metabolites in the human brain – NAA, choline-containing compounds (Cho) which include majorly cell membrane compounds such as glycerophosphocholine, phosphocholine and a miniscule contribution from acetylcholine, creatinine (Cr) and glutamine and glutamate together (Glx). NAA is located exclusively in the neurons, and is suggested to be a marker of neuronal viability and functionality.[48] Choline-containing compounds (Cho) mainly include the membrane compounds, and an increase in Cho would be suggestive of increased membrane turnover. Cr serves as a marker of cellular energy metabolism, and its levels are usually expected to remain stable.

The regions which have been most widely studied in MRSI studies include the bilateral hippocampus and amygdala, dorsolateral prefrontal cortex (DLPFC), and ACC.Till date, five MRSI studies have measured NAA concentration in the hippocampus before and after ECT. Of these, three studies showed that there is no significant change in the NAA concentration in the hippocampus following ECT.[33],[38],[49] On the other hand, two recent studies have demonstrated a statistically significant reduction in NAA concentration in the hippocampus following ECT.[39],[40] The implications of these results are of significant interest to us in answering our titular question. A normal level of NAA following ECT could signify that there is no significant neuronal death or damage following ECT, while a reduction would signal the opposite.

However, a direct comparison between these studies is complicated chiefly due to the different ECT protocols, which has been used in these studies. It must, however, be acknowledged that the three older studies used 1.5 T MRI, whereas the two newer studies used a higher 3 T MRI which offers betters signal-to-noise ratio and hence lesser risk of errors in the measurement of metabolite concentrations. The authors of a study by Njau et al.[39] argue that a change in NAA levels might reflect reversible changes in neural metabolism rather than a permanent change in the number or density of neurons and also that reduced NAA might point to a change in the ratio of mature to immature neurons, which, in fact, might reflect enhanced adult neurogenesis.

Thus, the authors warn that to conclude whether a reduction in NAA concentration is beneficial or harmful would take a simultaneous measurement of cognitive functioning, which was lacking in their study. In 2017, Cano et al. Also demonstrated a significant reduction in NAA/Cr ratio in the hippocampus post ECT.

More significantly, the authors also showed a significant increase in Glx levels in the hippocampus following ECT, which was also associated with an increase in hippocampal volume.[40] To explain these three findings, the authors proposed that ECT produces a neuroinflammatory response in the hippocampus – likely mediated by Glx, which has been known to cause inflammation at higher concentrations, thereby accounting for the increase in hippocampal volume with a reduction in NAA concentration. The cause for the volume increase remains unclear – with the authors speculating that it might be due to neuronal swelling or due to angiogenesis. However, the same study and multiple other past studies [21],[25],[30] have demonstrated that hippocampal volume increase was correlated with clinical improvement following ECT.

Thus, we are led to the hypothesis that the same mechanism which drives clinical improvement with ECT is also responsible for the cognitive impairment following ECT. Whether this is a purely neuroinflammatory response or a neuroplastic response or a neuroinflammatory response leading to some form of neuroplasticity is a critical question, which remains to be answered.[40]Studies which have analyzed NAA concentration change in other brain areas have also produced conflicting results. The ACC is another area which has been studied in some detail utilizing the MRSI technique.

In 2003, Pfleiderer et al. Demonstrated that there was no significant change in the NAA and Cho levels in the ACC following ECT. This would seem to suggest that there was no neurogenesis or membrane turnover in the ACC post ECT.[36] However, this finding was contested by Merkl et al.

In 2011, who demonstrated that NAA levels were significantly reduced in the left ACC in patients with depression and that these levels were significantly elevated following ECT.[37] This again is contested by Njau et al. Who showed that NAA levels are significantly reduced following ECT in the left dorsal ACC.[39] A direct comparison of these three studies is complicated by the different ECT and imaging parameters used and hence, no firm conclusion can be made on this point at this stage. In addition to this, one study had demonstrated increased NAA levels in the amygdala following administration of ECT,[34] with a trend level increase in Cho levels, which again is suggestive of neurogenesis and/or neuroplasticity.

A review of studies on the DLPFC reveals a similarly confusing picture with one study, each showing no change, reduction, and elevation of concentration of NAA following ECT.[35],[37],[39] Here, again, a direct comparison of the three studies is made difficult by the heterogeneous imaging and ECT protocols followed by them.A total of five studies have analyzed the concentration of choline-containing compounds (Cho) in patients undergoing ECT. Conceptually, an increase in Cho signals is indicative of increased membrane turnover, which is postulated to be associated with synaptogenesis, neurogenesis, and maturation of neurons.[31] Of these, two studies measured Cho concentration in the B/L hippocampus, with contrasting results. Ende et al.

In 2000 demonstrated a significant elevation in Cho levels in B/L hippocampus after ECT, while Jorgensen et al. In 2015 failed to replicate the same finding.[33],[38] Cho levels have also been studied in the amygdala, ACC, and the DLPFC. However, none of these studies showed a significant increase or decrease in Cho levels before and after ECT in the respective brain regions studied.

In addition, no significant difference was seen in the pre-ECT Cho levels of patients compared to healthy controls.[34],[36],[37]In review, we must admit that MRSI studies are still at a preliminary stage with significant heterogeneity in ECT protocols, patient population, and regions of the brain studied. At this stage, it is difficult to draw any firm conclusions except to acknowledge the fact that the more recent studies – Njau et al., 2017, Cano, 2017, and Jorgensen et al., 2015 – have shown decrease in NAA concentration and no increase in Cho levels [38],[39],[40] – as opposed to the earlier studies by Ende et al.[33] The view offered by the more recent studies is one of a neuroinflammatory models of action of ECT, probably driving neuroplasticity in the hippocampus. This would offer a mechanistic understanding of both clinical response and the phenomenon of cognitive impairment associated with ECT.

However, this conclusion is based on conjecture, and more work needs to be done in this area. Body Fluid Biochemical Marker Studies Another line of evidence for analyzing the effect of ECT on the human brain is the study of concentration of neurotrophins in the plasma or serum. Neurotrophins are small protein molecules which mediate neuronal survival and development.

The most prominent among these is brain-derived neurotrophic factor (BDNF) which plays an important role in neuronal survival, plasticity, and migration.[50] A neurotrophic theory of mood disorders was suggested which hypothesized that depressive disorders are associated with a decreased expression of BDNF in the limbic structures, resulting in the atrophy of these structures.[51] It was also postulated that antidepressant treatment has a neurotrophic effect which reverses the neuronal cell loss, thereby producing a therapeutic effect. It has been well established that BDNF is decreased in mood disorders.[52] It has also been shown that clinical improvement of depression is associated with increase in BDNF levels.[53] Thus, serum BDNF levels have been tentatively proposed as a biomarker for treatment response in depression. Recent meta-analytic evidence has shown that ECT is associated with significant increase in serum BDNF levels in patients with major depressive disorder.[54] Considering that BDNF is a potent stimulator of neurogenesis, the elevation of serum BDNF levels following ECT lends further credence to the theory that ECT leads to neurogenesis in the hippocampus and other limbic structures, which, in turn, mediates the therapeutic action of ECT.

Cognitive Impairment Studies Cognitive impairment has always been the single-most important side effect associated with ECT.[55] Concerns regarding long-term cognitive impairment surfaced soon after the introduction of ECT and since then has grown to become one of the most controversial aspects of ECT.[56] Anti-ECT groups have frequently pointed out to cognitive impairment following ECT as evidence of ECT causing brain damage.[56] A meta-analysis by Semkovska and McLoughlin in 2010 is one of the most detailed studies which had attempted to settle this long-standing debate.[57] The authors reviewed 84 studies (2981 participants), which had used a combined total of 22 standardized neuropsychological tests assessing various cognitive functions before and after ECT in patients diagnosed with major depressive disorder. The different cognitive domains reviewed included processing speed, attention/working memory, verbal episodic memory, visual episodic memory, spatial problem-solving, executive functioning, and intellectual ability. The authors concluded that administration of ECT for depression is associated with significant cognitive impairment in the first few days after ECT administration.

However, it was also seen that impairment in cognitive functioning resolved within a span of 2 weeks and thereafter, a majority of cognitive domains even showed mild improvement compared to the baseline performance. It was also demonstrated that not a single cognitive domain showed persistence of impairment beyond 15 days after ECT.Memory impairment following ECT can be analyzed broadly under two conceptual schemes – one that classifies memory impairment as objective memory impairment and subjective memory impairment and the other that classifies it as impairment in anterograde memory versus impairment in retrograde memory. Objective memory can be roughly defined as the ability to retrieve stored information and can be measured by various standardized neuropsychological tests.

Subjective memory or meta-memory, on the other hand, refers to the ability to make judgments about one's ability to retrieve stored information.[58] As described previously, it has been conclusively demonstrated that anterograde memory impairment does not persist beyond 2 weeks after ECT.[57] However, one of the major limitations of this meta-analysis was the lack of evidence on retrograde amnesia following ECT. This is particularly unfortunate considering that it is memory impairment – particularly retrograde amnesia which has received the most attention.[59] In addition, reports of catastrophic retrograde amnesia have been repeatedly held up as sensational evidence of the lasting brain damage produced by ECT.[59] Admittedly, studies on retrograde amnesia are fewer and less conclusive than on anterograde amnesia.[60],[61] At present, the results are conflicting, with some studies finding some impairment in retrograde memory – particularly autobiographical retrograde memory up to 6 months after ECT.[62],[63],[64],[65] However, more recent studies have failed to support this finding.[66],[67] While they do demonstrate an impairment in retrograde memory immediately after ECT, it was seen that this deficit returned to pre-ECT levels within a span of 1–2 months and improved beyond baseline performance at 6 months post ECT.[66] Adding to the confusion are numerous factors which confound the assessment of retrograde amnesia. It has been shown that depressive symptoms can produce significant impairment of retrograde memory.[68],[69] It has also been demonstrated that sine-wave ECT produces significantly more impairment of retrograde memory as compared to brief-pulse ECT.[70] However, from the 1990s onward, sine-wave ECT has been completely replaced by brief-pulse ECT, and it is unclear as to the implications of cognitive impairment from the sine-wave era in contemporary ECT practice.Another area of concern are reports of subjective memory impairment following ECT.

One of the pioneers of research into subjective memory impairment were Squire and Chace who published a series of studies in the 1970s demonstrating the adverse effect of bilateral ECT on subjective assessment of memory.[62],[63],[64],[65] However, most of the studies conducted post 1980 – from when sine-wave ECT was replaced by brief-pulse ECT report a general improvement in subjective memory assessments following ECT.[71] In addition, most of the recent studies have failed to find a significant association between measures of subjective and objective memory.[63],[66],[70],[72],[73],[74] It has also been shown that subjective memory impairment is strongly associated with the severity of depressive symptoms.[75] In light of these facts, the validity and value of measures of subjective memory impairment as a marker of cognitive impairment and brain damage following ECT have been questioned. However, concerns regarding subjective memory impairment and catastrophic retrograde amnesia continue to persist, with significant dissonance between the findings of different research groups and patient self-reports in various media.[57]Some studies reported the possibility of ECT being associated with the development of subsequent dementia.[76],[77] However, a recent large, well-controlled prospective Danish study found that the use of ECT was not associated with elevated incidence of dementia.[78] Conclusion Our titular question is whether ECT leads to brain damage, where damage indicates destruction or degeneration of nerves or nerve tracts in the brain, which leads to loss of function. This issue was last addressed by Devanand et al.

In 1994 since which time our understanding of ECT has grown substantially, helped particularly by the advent of modern-day neuroimaging techniques which we have reviewed in detail. And, what these studies reveal is rather than damaging the brain, ECT has a neuromodulatory effect on the brain. The various lines of evidence – structural neuroimaging studies, functional neuroimaging studies, neurochemical and metabolic studies, and serum BDNF studies all point toward this.

These neuromodulatory changes have been localized to the hippocampus, amygdala, and certain other parts of the limbic system. How exactly these changes mediate the improvement of depressive symptoms is a question that remains unanswered. However, there is little by way of evidence from neuroimaging studies which indicates that ECT causes destruction or degeneration of neurons.

Though cognitive impairment studies do show that there is objective impairment of certain functions – particularly memory immediately after ECT, these impairments are transient with full recovery within a span of 2 weeks. Perhaps, the single-most important unaddressed concern is retrograde amnesia, which has been shown to persist for up to 2 months post ECT. In this regard, the recent neurometabolic studies have offered a tentative mechanism of action of ECT, producing a transient inflammation in the limbic cortex, which, in turn, drives neurogenesis, thereby exerting a neuromodulatory effect.

This hypothesis would explain both the cognitive adverse effects of ECT – due to the transient inflammation – and the long-term improvement in mood – neurogenesis in the hippocampus. Although unproven at present, such a hypothesis would imply that cognitive impairment is tied in with the mechanism of action of ECT and not an indicator of damage to the brain produced by ECT.The review of literature suggests that ECT does cause at least structural and functional changes in the brain, and these are in all probability related to the effects of the ECT. However, these cannot be construed as brain damage as is usually understood.

Due to the relative scarcity of data that directly examines the question of whether ECT causes brain damage, it is not possible to conclusively answer this question. However, in light of enduring ECT survivor accounts, there is a need to design studies that specifically answer this question.Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest. References 1.Payne NA, Prudic J.

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36.Pfleiderer B, Michael N, Erfurth A, Ohrmann P, Hohmann U, Wolgast M, et al. Effective electroconvulsive therapy reverses glutamate/glutamine deficit in the left anterior cingulum of unipolar depressed patients. Psychiatry Res 2003;122:185-92.

37.Merkl A, Schubert F, Quante A, Luborzewski A, Brakemeier EL, Grimm S, et al. Abnormal cingulate and prefrontal cortical neurochemistry in major depression after electroconvulsive therapy. Biol Psychiatry 2011;69:772-9.

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39.Njau S, Joshi SH, Espinoza R, Leaver AM, Vasavada M, Marquina A, et al. Neurochemical correlates of rapid treatment response to electroconvulsive therapy in patients with major depression. J Psychiatry Neurosci 2017;42:6-16.

40.Cano M, Martínez-Zalacaín I, Bernabéu-Sanz Á, Contreras-Rodríguez O, Hernández-Ribas R, Via E, et al. Brain volumetric and metabolic correlates of electroconvulsive therapy for treatment-resistant depression. A longitudinal neuroimaging study.

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44.Gbyl K, Videbech P. Electroconvulsive therapy increases brain volume in major depression. A systematic review and meta-analysis.

Acta Psychiatr Scand 2018;138:180-95. 45.Oltedal L, Narr KL, Abbott C, Anand A, Argyelan M, Bartsch H, et al. Volume of the human hippocampus and clinical response following electroconvulsive therapy.

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49.Obergriesser T, Ende G, Braus DF, Henn FA. Long-term follow-up of magnetic resonance-detectable choline signal changes in the hippocampus of patients treated with electroconvulsive therapy. J Clin Psychiatry 2003;64:775-80.

50.Bramham CR, Messaoudi E. BDNF function in adult synaptic plasticity. The synaptic consolidation hypothesis.

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A replication study and meta-analyses. World J Biol Psychiatry 2010;11:763-73. 53.Brunoni AR, Lopes M, Fregni F.

A systematic review and meta-analysis of clinical studies on major depression and BDNF levels. Implications for the role of neuroplasticity in depression. Int J Neuropsychopharmacol 2008;11:1169-80.

54.Rocha RB, Dondossola ER, Grande AJ, Colonetti T, Ceretta LB, Passos IC, et al. Increased BDNF levels after electroconvulsive therapy in patients with major depressive disorder. A meta-analysis study.

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Correspondence Address:Dr. Shubh Mohan SinghDepartment of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh IndiaSource of Support. None, Conflict of Interest.

NoneDOI. 10.4103/psychiatry.IndianJPsychiatry_239_19 Tables [Table 1], [Table 2].

How to cite this symbicort price with insurance article:Singh O P. Aftermath of celebrity suicide – Media coverage and role of psychiatrists. Indian J Psychiatry 2020;62:337-8Celebrity suicide is one of the highly symbicort price with insurance publicized events in our country. Indians got a glimpse of this following an unfortunate incident where a popular Hindi film actor died of suicide.

As expected, the media went into a frenzy as newspapers, news channels, and social media symbicort price with insurance were full of stories providing minute details of the suicidal act. Some even going as far as highlighting the color of the cloth used in the suicide as well as showing the lifeless body of the actor. All kinds of personal details were dug up, and speculations and hypotheses became the order of the day in the next few days that followed. In the process, reputations of many people associated with the actor were besmirched and their private and personal details were freely and blatantly broadcast symbicort price with insurance and discussed on electronic, print, and social media.

We understand that media houses have their own need and duty to report and sensationalize news for increasing their visibility (aka TRP), but such reporting has huge impacts on the mental health of the vulnerable population.The impact of this was soon realized when many incidents of copycat suicide were reported from all over the country within a few days of the incident. Psychiatrists suddenly started getting distress calls from their patients in despair with increased symbicort price with insurance suicidal ideation. This has become a major area of concern for the psychiatry community.The Indian Psychiatric Society has been consistently trying to engage with media to promote ethical reporting of suicide. Section 24 (1) of Mental Health Care Act, 2017, forbids publication of photograph of mentally ill person without his consent.[1] The Press Council of India has adopted the guidelines of World Health Organization report on Preventing Suicide symbicort price with insurance.

A resource for media professionals, which came out with an advisory to be followed by media in reporting cases of suicide. It includes points forbidding them from putting stories in prominent positions and unduly repeating them, explicitly describing the method used, providing details about the site/location, using sensational headlines, or using photographs and video footage of the incident.[2] Unfortunately, the advisory seems to have little effect in the aftermath of celebrity suicides. Channels were full of speculations about the person's mental condition and illness symbicort price with insurance and also his relationships and finances. Many fictional accounts of his symptoms and illness were touted, which is not only against the ethics but is also contrary to MHCA, 2017.[1]It went to the extent that the name of his psychiatrist was mentioned and quotes were attributed to him without taking any account from him.

The Indian Psychiatric Society has written to the Press Council of India underlining this concern and asking for measures to ensure ethics in reporting suicide.While symbicort price with insurance there is a need for engagement with media to make them aware of the grave impact of negative suicide reporting on the lives of many vulnerable persons, there is even a more urgent need for training of psychiatrists regarding the proper way of interaction with media. This has been amply brought out in the aftermath of this incident. Many psychiatrists and mental health professionals were called by symbicort price with insurance media houses to comment on the episode. Many psychiatrists were quoted, or “misquoted,” or “quoted out of context,” commenting on the life of a person whom they had never examined and had no “professional authority” to do so.

There were even stories with byline of a psychiatrist where the content provided was not only unscientific but also way beyond the expertise of a psychiatrist. These types of viewpoints perpetuate stigma, myths, and “misleading concepts” about psychiatry and symbicort price with insurance are detrimental to the image of psychiatry in addition to doing harm and injustice to our patients. Hence, the need to formulate a guideline for interaction of psychiatrists with the media is imperative.In the infamous Goldwater episode, 12,356 psychiatrists were asked to cast opinion about the fitness of Barry Goldwater for presidential candidature. Out of 2417 respondents, 1189 psychiatrists reported him to be mentally unfit while none had actually examined him.[3] This led to the formulation symbicort price with insurance of “The Goldwater Rule” by the American Psychiatric Association in 1973,[4] but we have witnessed the same phenomenon at the time of presidential candidature of Donald Trump.Psychiatrists should be encouraged to interact with media to provide scientific information about mental illnesses and reduction of stigma, but “statements to the media” can be a double-edged sword, and we should know about the rules of engagements and boundaries of interactions.

Methods and principles of interaction with media should form a part of our training curriculum. Many professional societies have guidelines and resource books for interacting with media, symbicort price with insurance and psychiatrists should familiarize themselves with these documents. The Press Council guideline is likely to prompt reporters to seek psychiatrists for their expert opinion. It is useful for them to have a template ready with suicide rates, emphasizing multicausality of suicide, role of mental disorders, as well as help available.[5]It is about time that the Indian Psychiatric Society formulated its own guidelines laying down the broad principles and boundaries governing the interaction of Indian psychiatrists with the media.

Till then, it is desirable to be guided by the following broad principles:It should be assumed that no statement goes “off the record” as the media person is most likely recording the interview, and we should also record any such conversation from our endIt should be clarified in which capacity comments are being made – professional, personal, or as a representative of an organizationOne should not comment on any person whom he has not examinedPsychiatrists symbicort price with insurance should take any such opportunity to educate the public about mental health issuesThe comments should be justified and limited by the boundaries of scientific knowledge available at the moment. References Correspondence Address:Dr. O P symbicort price with insurance SinghAA 304, Ashabari Apartments, O/31, Baishnabghata, Patuli Township, Kolkata - 700 094, West Bengal IndiaSource of Support. None, Conflict of Interest.

NoneDOI. 10.4103/psychiatry.IndianJPsychiatry_816_20Abstract Electroconvulsive therapy (ECT) is an effective modality of treatment for a variety of psychiatric disorders. However, it has always been accused of being a coercive, unethical, and dangerous modality of treatment. The dangerousness of ECT has been mainly attributed to its claimed ability to cause brain damage.

This narrative review aims to provide an update of the evidence with regard to whether the practice of ECT is associated with damage to the brain. An accepted definition of brain damage remains elusive. There are also ethical and technical problems in designing studies that look at this question specifically. Thus, even though there are newer technological tools and innovations, any review attempting to answer this question would have to take recourse to indirect methods.

These include structural, functional, and metabolic neuroimaging. Body fluid biochemical marker studies. And follow-up studies of cognitive impairment and incidence of dementia in people who have received ECT among others. The review of literature and present evidence suggests that ECT has a demonstrable impact on the structure and function of the brain.

However, there is a lack of evidence at present to suggest that ECT causes brain damage.Keywords. Adverse effect, brain damage, electroconvulsive therapyHow to cite this article:Jolly AJ, Singh SM. Does electroconvulsive therapy cause brain damage. An update.

Indian J Psychiatry 2020;62:339-53 Introduction Electroconvulsive therapy (ECT) as a modality of treatment for psychiatric disorders has existed at least since 1938.[1] ECT is an effective modality of treatment for various psychiatric disorders. However, from the very beginning, the practice of ECT has also faced resistance from various groups who claim that it is coercive and harmful.[2] While the ethical aspects of the practice of ECT have been dealt with elsewhere, the question of harmfulness or brain damage consequent upon the passage of electric current needs to be examined afresh in light of technological advances and new knowledge.[3]The question whether ECT causes brain damage was reviewed in a holistic fashion by Devanand et al. In the mid-1990s.[4],[5] The authors had attempted to answer this question by reviewing the effect of ECT on the brain in various areas – cognitive side effects, structural neuroimaging studies, neuropathologic studies of patients who had received ECT, autopsy studies of epileptic patients, and finally animal ECS studies. The authors had concluded that ECT does not produce brain damage.This narrative review aims to update the evidence with regard to whether ECT causes brain damage by reviewing relevant literature from 1994 to the present time.

Framing the Question The Oxford Dictionary defines damage as physical harm that impairs the value, usefulness, or normal function of something.[6] Among medical dictionaries, the Peter Collins Dictionary defines damage as harm done to things (noun) or to harm something (verb).[7] Brain damage is defined by the British Medical Association Medical Dictionary as degeneration or death of nerve cells and tracts within the brain that may be localized to a particular area of the brain or diffuse.[8] Going by such a definition, brain damage in the context of ECT should refer to death or degeneration of brain tissue, which results in the impairment of functioning of the brain. The importance of precisely defining brain damage shall become evident subsequently in this review.There are now many more tools available to investigate the structure and function of brain in health and illness. However, there are obvious ethical issues in designing human studies that are designed to answer this specific question. Therefore, one must necessarily take recourse to indirect evidences available through studies that have been designed to answer other research questions.

These studies have employed the following methods:Structural neuroimaging studiesFunctional neuroimaging studiesMetabolic neuroimaging studiesBody fluid biochemical marker studiesCognitive impairment studies.While the early studies tended to focus more on establishing the safety of ECT and finding out whether ECT causes gross microscopic brain damage, the later studies especially since the advent of advanced neuroimaging techniques have been focusing more on a mechanistic understanding of ECT. Hence, the primary objective of the later neuroimaging studies has been to look for structural and functional brain changes which might explain how ECT acts rather than evidence of gross structural damage per se. However, put together, all these studies would enable us to answer our titular question to some satisfaction. [Table 1] and [Table 2] provide an overview of the evidence base in this area.

Structural and Functional Neuroimaging Studies Devanand et al. Reviewed 16 structural neuroimaging studies on the effect of ECT on the brain.[4] Of these, two were pneumoencephalography studies, nine were computed tomography (CT) scan studies, and five were magnetic resonance imaging (MRI) studies. However, most of these studies were retrospective in design, with neuroimaging being done in patients who had received ECT in the past. In the absence of baseline neuroimaging, it would be very difficult to attribute any structural brain changes to ECT.

In addition, pneumoencephalography, CT scan, and even early 0.3 T MRI provided images with much lower spatial resolution than what is available today. The authors concluded that there was no evidence to show that ECT caused any structural damage to the brain.[4] Since then, at least twenty more MRI-based structural neuroimaging studies have studied the effect of ECT on the brain. The earliest MRI studies in the early 1990s focused on detecting structural damage following ECT. All of these studies were prospective in design, with the first MRI scan done at baseline and a second MRI scan performed post ECT.[9],[11],[12],[13],[41] While most of the studies imaged the patient once around 24 h after receiving ECT, some studies performed multiple post ECT neuroimaging in the first 24 h after ECT to better capture the acute changes.

A single study by Coffey et al. Followed up the patients for a duration of 6 months and repeated neuroimaging again at 6 months in order to capture any long-term changes following ECT.[10]The most important conclusion which emerged from this early series of studies was that there was no evidence of cortical atrophy, change in ventricle size, or increase in white matter hyperintensities.[4] The next major conclusion was that there appeared to be an increase in the T1 and T2 relaxation time immediately following ECT, which returned to normal within 24 h. This supported the theory that immediately following ECT, there appears to be a temporary breakdown of the blood–brain barrier, leading to water influx into the brain tissue.[11] The last significant observation by Coffey et al. In 1991 was that there was no significant temporal changes in the total volumes of the frontal lobes, temporal lobes, or amygdala–hippocampal complex.[10] This was, however, something which would later be refuted by high-resolution MRI studies.

Nonetheless, one inescapable conclusion of these early studies was that there was no evidence of any gross structural brain changes following administration of ECT. Much later in 2007, Szabo et al. Used diffusion-weighted MRI to image patients in the immediate post ECT period and failed to observe any obvious brain tissue changes following ECT.[17]The next major breakthrough came in 2010 when Nordanskog et al. Demonstrated that there was a significant increase in the volume of the hippocampus bilaterally following a course of ECT in a cohort of patients with depressive illness.[18] This contradicted the earlier observations by Coffey et al.

That there was no volume increase in any part of the brain following ECT.[10] This was quite an exciting finding and was followed by several similar studies. However, the perspective of these studies was quite different from the early studies. In contrast to the early studies looking for the evidence of ECT-related brain damage, the newer studies were focused more on elucidating the mechanism of action of ECT. Further on in 2014, Nordanskog et al.

In a follow-up study showed that though there was a significant increase in the volume of the hippocampus 1 week after a course of ECT, the hippocampal volume returned to the baseline after 6 months.[19] Two other studies in 2013 showed that in addition to the hippocampus, the amygdala also showed significant volume increase following ECT.[20],[21] A series of structural neuroimaging studies after that have expanded on these findings and as of now, gray matter volume increase following ECT has been demonstrated in the hippocampus, amygdala, anterior temporal pole, subgenual cortex,[21] right caudate nucleus, and the whole of the medial temporal lobe (MTL) consisting of the hippocampus, amygdala, insula, and the posterosuperior temporal cortex,[24] para hippocampi, right subgenual anterior cingulate gyrus, and right anterior cingulate gyrus,[25] left cerebellar area VIIa crus I,[29] putamen, caudate nucleus, and nucleus acumbens [31] and clusters of increased cortical thickness involving the temporal pole, middle and superior temporal cortex, insula, and inferior temporal cortex.[27] However, the most consistently reported and replicated finding has been the bilateral increase in the volume of the hippocampus and amygdala. In light of these findings, it has been tentatively suggested that ECT acts by inducing neuronal regeneration in the hippocampus – amygdala complex.[42],[43] However, there are certain inconsistencies to this hypothesis. Till date, only one study – Nordanskog et al., 2014 – has followed study patients for a long term – 6 months in their case. And significantly, the authors found out that after increasing immediately following ECT, the hippocampal volume returns back to baseline by 6 months.[19] This, however, was not associated with the relapse of depressive symptoms.

Another area of significant confusion has been the correlation of hippocampal volume increase with improvement of depressive symptoms. Though almost all studies demonstrate a significant increase in hippocampal volume following ECT, a majority of studies failed to demonstrate a correlation between symptom improvement and hippocampal volume increase.[19],[20],[22],[24],[28] However, a significant minority of volumetric studies have demonstrated correlation between increase in hippocampal and/or amygdala volume and improvement of symptoms.[21],[25],[30]Another set of studies have used diffusion tensor imaging, functional MRI (fMRI), anatomical connectome, and structural network analysis to study the effect of ECT on the brain. The first of these studies by Abbott et al. In 2014 demonstrated that on fMRI, the connectivity between right and left hippocampus was significantly reduced in patients with severe depression.

It was also shown that the connectivity was normalized following ECT, and symptom improvement was correlated with an increase in connectivity.[22] In a first of its kind DTI study, Lyden et al. In 2014 demonstrated that fractional anisotropy which is a measure of white matter tract or fiber density is increased post ECT in patients with severe depression in the anterior cingulum, forceps minor, and the dorsal aspect of the left superior longitudinal fasciculus. The authors suggested that ECT acts to normalize major depressive disorder-related abnormalities in the structural connectivity of the dorsal fronto-limbic pathways.[23] Another DTI study in 2015 constructed large-scale anatomical networks of the human brain – connectomes, based on white matter fiber tractography. The authors found significant reorganization in the anatomical connections involving the limbic structure, temporal lobe, and frontal lobe.

It was also found that connection changes between amygdala and para hippocampus correlated with reduction in depressive symptoms.[26] In 2016, Wolf et al. Used a source-based morphometry approach to study the structural networks in patients with depression and schizophrenia and the effect of ECT on the same. It was found that the medial prefrontal cortex/anterior cingulate cortex (ACC/MPFC) network, MTL network, bilateral thalamus, and left cerebellar regions/precuneus exhibited significant difference between healthy controls and the patient population. It was also demonstrated that administration of ECT leads to significant increase in the network strength of the ACC/MPFC network and the MTL network though the increase in network strength and symptom amelioration were not correlated.[32]Building on these studies, a recently published meta-analysis has attempted a quantitative synthesis of brain volume changes – focusing on hippocampal volume increase following ECT in patients with major depressive disorder and bipolar disorder.

The authors initially selected 32 original articles from which six articles met the criteria for quantitative synthesis. The results showed significant increase in the volume of the right and left hippocampus following ECT. For the rest of the brain regions, the heterogeneity in protocols and imaging techniques did not permit a quantitative analysis, and the authors have resorted to a narrative review similar to the present one with similar conclusions.[44] Focusing exclusively on hippocampal volume change in ECT, Oltedal et al. In 2018 conducted a mega-analysis of 281 patients with major depressive disorder treated with ECT enrolled at ten different global sites of the Global ECT-MRI Research Collaboration.[45] Similar to previous studies, there was a significant increase in hippocampal volume bilaterally with a dose–response relationship with the number of ECTs administered.

Furthermore, bilateral (B/L) ECT was associated with an equal increase in volume in both right and left hippocampus, whereas right unilateral ECT was associated with greater volume increase in the right hippocampus. Finally, contrary to expectation, clinical improvement was found to be negatively correlated with hippocampal volume.Thus, a review of the current evidence amply demonstrates that from looking for ECT-related brain damage – and finding none, we have now moved ahead to looking for a mechanistic understanding of the effect of ECT. In this regard, it has been found that ECT does induce structural changes in the brain – a fact which has been seized upon by some to claim that ECT causes brain damage.[46] Such statements should, however, be weighed against the definition of damage as understood by the scientific medical community and patient population. Neuroanatomical changes associated with effective ECT can be better described as ECT-induced brain neuroplasticity or ECT-induced brain neuromodulation rather than ECT-induced brain damage.

Metabolic Neuroimaging Studies. Magnetic Resonance Spectroscopic Imaging Magnetic resonance spectroscopic imaging (MRSI) uses a phase-encoding procedure to map the spatial distribution of magnetic resonance (MR) signals of different molecules. The crucial difference, however, is that while MRI maps the MR signals of water molecules, MRSI maps the MR signals generated by different metabolites – such as N-acetyl aspartate (NAA) and choline-containing compounds. However, the concentration of these metabolites is at least 10,000 times lower than water molecules and hence the signal strength generated would also be correspondingly lower.

However, MRSI offers us the unique advantage of studying in vivo the change in the concentration of brain metabolites, which has been of great significance in fields such as psychiatry, neurology, and basic neuroscience research.[47]MRSI studies on ECT in patients with depression have focused largely on four metabolites in the human brain – NAA, choline-containing compounds (Cho) which include majorly cell membrane compounds such as glycerophosphocholine, phosphocholine and a miniscule contribution from acetylcholine, creatinine (Cr) and glutamine and glutamate together (Glx). NAA is located exclusively in the neurons, and is suggested to be a marker of neuronal viability and functionality.[48] Choline-containing compounds (Cho) mainly include the membrane compounds, and an increase in Cho would be suggestive of increased membrane turnover. Cr serves as a marker of cellular energy metabolism, and its levels are usually expected to remain stable. The regions which have been most widely studied in MRSI studies include the bilateral hippocampus and amygdala, dorsolateral prefrontal cortex (DLPFC), and ACC.Till date, five MRSI studies have measured NAA concentration in the hippocampus before and after ECT.

Of these, three studies showed that there is no significant change in the NAA concentration in the hippocampus following ECT.[33],[38],[49] On the other hand, two recent studies have demonstrated a statistically significant reduction in NAA concentration in the hippocampus following ECT.[39],[40] The implications of these results are of significant interest to us in answering our titular question. A normal level of NAA following ECT could signify that there is no significant neuronal death or damage following ECT, while a reduction would signal the opposite. However, a direct comparison between these studies is complicated chiefly due to the different ECT protocols, which has been used in these studies. It must, however, be acknowledged that the three older studies used 1.5 T MRI, whereas the two newer studies used a higher 3 T MRI which offers betters signal-to-noise ratio and hence lesser risk of errors in the measurement of metabolite concentrations.

The authors of a study by Njau et al.[39] argue that a change in NAA levels might reflect reversible changes in neural metabolism rather than a permanent change in the number or density of neurons and also that reduced NAA might point to a change in the ratio of mature to immature neurons, which, in fact, might reflect enhanced adult neurogenesis. Thus, the authors warn that to conclude whether a reduction in NAA concentration is beneficial or harmful would take a simultaneous measurement of cognitive functioning, which was lacking in their study. In 2017, Cano et al. Also demonstrated a significant reduction in NAA/Cr ratio in the hippocampus post ECT.

More significantly, the authors also showed a significant increase in Glx levels in the hippocampus following ECT, which was also associated with an increase in hippocampal volume.[40] To explain these three findings, the authors proposed that ECT produces a neuroinflammatory response in the hippocampus – likely mediated by Glx, which has been known to cause inflammation at higher concentrations, thereby accounting for the increase in hippocampal volume with a reduction in NAA concentration. The cause for the volume increase remains unclear – with the authors speculating that it might be due to neuronal swelling or due to angiogenesis. However, the same study and multiple other past studies [21],[25],[30] have demonstrated that hippocampal volume increase was correlated with clinical improvement following ECT. Thus, we are led to the hypothesis that the same mechanism which drives clinical improvement with ECT is also responsible for the cognitive impairment following ECT.

Whether this is a purely neuroinflammatory response or a neuroplastic response or a neuroinflammatory response leading to some form of neuroplasticity is a critical question, which remains to be answered.[40]Studies which have analyzed NAA concentration change in other brain areas have also produced conflicting results. The ACC is another area which has been studied in some detail utilizing the MRSI technique. In 2003, Pfleiderer et al. Demonstrated that there was no significant change in the NAA and Cho levels in the ACC following ECT.

This would seem to suggest that there was no neurogenesis or membrane turnover in the ACC post ECT.[36] However, this finding was contested by Merkl et al. In 2011, who demonstrated that NAA levels were significantly reduced in the left ACC in patients with depression and that these levels were significantly elevated following ECT.[37] This again is contested by Njau et al. Who showed that NAA levels are significantly reduced following ECT in the left dorsal ACC.[39] A direct comparison of these three studies is complicated by the different ECT and imaging parameters used and hence, no firm conclusion can be made on this point at this stage. In addition to this, one study had demonstrated increased NAA levels in the amygdala following administration of ECT,[34] with a trend level increase in Cho levels, which again is suggestive of neurogenesis and/or neuroplasticity.

A review of studies on the DLPFC reveals a similarly confusing picture with one study, each showing no change, reduction, and elevation of concentration of NAA following ECT.[35],[37],[39] Here, again, a direct comparison of the three studies is made difficult by the heterogeneous imaging and ECT protocols followed by them.A total of five studies have analyzed the concentration of choline-containing compounds (Cho) in patients undergoing ECT. Conceptually, an increase in Cho signals is indicative of increased membrane turnover, which is postulated to be associated with synaptogenesis, neurogenesis, and maturation of neurons.[31] Of these, two studies measured Cho concentration in the B/L hippocampus, with contrasting results. Ende et al. In 2000 demonstrated a significant elevation in Cho levels in B/L hippocampus after ECT, while Jorgensen et al.

In 2015 failed to replicate the same finding.[33],[38] Cho levels have also been studied in the amygdala, ACC, and the DLPFC. However, none of these studies showed a significant increase or decrease in Cho levels before and after ECT in the respective brain regions studied. In addition, no significant difference was seen in the pre-ECT Cho levels of patients compared to healthy controls.[34],[36],[37]In review, we must admit that MRSI studies are still at a preliminary stage with significant heterogeneity in ECT protocols, patient population, and regions of the brain studied. At this stage, it is difficult to draw any firm conclusions except to acknowledge the fact that the more recent studies – Njau et al., 2017, Cano, 2017, and Jorgensen et al., 2015 – have shown decrease in NAA concentration and no increase in Cho levels [38],[39],[40] – as opposed to the earlier studies by Ende et al.[33] The view offered by the more recent studies is one of a neuroinflammatory models of action of ECT, probably driving neuroplasticity in the hippocampus.

This would offer a mechanistic understanding of both clinical response and the phenomenon of cognitive impairment associated with ECT. However, this conclusion is based on conjecture, and more work needs to be done in this area. Body Fluid Biochemical Marker Studies Another line of evidence for analyzing the effect of ECT on the human brain is the study of concentration of neurotrophins in the plasma or serum. Neurotrophins are small protein molecules which mediate neuronal survival and development.

The most prominent among these is brain-derived neurotrophic factor (BDNF) which plays an important role in neuronal survival, plasticity, and migration.[50] A neurotrophic theory of mood disorders was suggested which hypothesized that depressive disorders are associated with a decreased expression of BDNF in the limbic structures, resulting in the atrophy of these structures.[51] It was also postulated that antidepressant treatment has a neurotrophic effect which reverses the neuronal cell loss, thereby producing a therapeutic effect. It has been well established that BDNF is decreased in mood disorders.[52] It has also been shown that clinical improvement of depression is associated with increase in BDNF levels.[53] Thus, serum BDNF levels have been tentatively proposed as a biomarker for treatment response in depression. Recent meta-analytic evidence has shown that ECT is associated with significant increase in serum BDNF levels in patients with major depressive disorder.[54] Considering that BDNF is a potent stimulator of neurogenesis, the elevation of serum BDNF levels following ECT lends further credence to the theory that ECT leads to neurogenesis in the hippocampus and other limbic structures, which, in turn, mediates the therapeutic action of ECT. Cognitive Impairment Studies Cognitive impairment has always been the single-most important side effect associated with ECT.[55] Concerns regarding long-term cognitive impairment surfaced soon after the introduction of ECT and since then has grown to become one of the most controversial aspects of ECT.[56] Anti-ECT groups have frequently pointed out to cognitive impairment following ECT as evidence of ECT causing brain damage.[56] A meta-analysis by Semkovska and McLoughlin in 2010 is one of the most detailed studies which had attempted to settle this long-standing debate.[57] The authors reviewed 84 studies (2981 participants), which had used a combined total of 22 standardized neuropsychological tests assessing various cognitive functions before and after ECT in patients diagnosed with major depressive disorder.

The different cognitive domains reviewed included processing speed, attention/working memory, verbal episodic memory, visual episodic memory, spatial problem-solving, executive functioning, and intellectual ability. The authors concluded that administration of ECT for depression is associated with significant cognitive impairment in the first few days after ECT administration. However, it was also seen that impairment in cognitive functioning resolved within a span of 2 weeks and thereafter, a majority of cognitive domains even showed mild improvement compared to the baseline performance. It was also demonstrated that not a single cognitive domain showed persistence of impairment beyond 15 days after ECT.Memory impairment following ECT can be analyzed broadly under two conceptual schemes – one that classifies memory impairment as objective memory impairment and subjective memory impairment and the other that classifies it as impairment in anterograde memory versus impairment in retrograde memory.

Objective memory can be roughly defined as the ability to retrieve stored information and can be measured by various standardized neuropsychological tests. Subjective memory or meta-memory, on the other hand, refers to the ability to make judgments about one's ability to retrieve stored information.[58] As described previously, it has been conclusively demonstrated that anterograde memory impairment does not persist beyond 2 weeks after ECT.[57] However, one of the major limitations of this meta-analysis was the lack of evidence on retrograde amnesia following ECT. This is particularly unfortunate considering that it is memory impairment – particularly retrograde amnesia which has received the most attention.[59] In addition, reports of catastrophic retrograde amnesia have been repeatedly held up as sensational evidence of the lasting brain damage produced by ECT.[59] Admittedly, studies on retrograde amnesia are fewer and less conclusive than on anterograde amnesia.[60],[61] At present, the results are conflicting, with some studies finding some impairment in retrograde memory – particularly autobiographical retrograde memory up to 6 months after ECT.[62],[63],[64],[65] However, more recent studies have failed to support this finding.[66],[67] While they do demonstrate an impairment in retrograde memory immediately after ECT, it was seen that this deficit returned to pre-ECT levels within a span of 1–2 months and improved beyond baseline performance at 6 months post ECT.[66] Adding to the confusion are numerous factors which confound the assessment of retrograde amnesia. It has been shown that depressive symptoms can produce significant impairment of retrograde memory.[68],[69] It has also been demonstrated that sine-wave ECT produces significantly more impairment of retrograde memory as compared to brief-pulse ECT.[70] However, from the 1990s onward, sine-wave ECT has been completely replaced by brief-pulse ECT, and it is unclear as to the implications of cognitive impairment from the sine-wave era in contemporary ECT practice.Another area of concern are reports of subjective memory impairment following ECT.

One of the pioneers of research into subjective memory impairment were Squire and Chace who published a series of studies in the 1970s demonstrating the adverse effect of bilateral ECT on subjective assessment of memory.[62],[63],[64],[65] However, most of the studies conducted post 1980 – from when sine-wave ECT was replaced by brief-pulse ECT report a general improvement in subjective memory assessments following ECT.[71] In addition, most of the recent studies have failed to find a significant association between measures of subjective and objective memory.[63],[66],[70],[72],[73],[74] It has also been shown that subjective memory impairment is strongly associated with the severity of depressive symptoms.[75] In light of these facts, the validity and value of measures of subjective memory impairment as a marker of cognitive impairment and brain damage following ECT have been questioned. However, concerns regarding subjective memory impairment and catastrophic retrograde amnesia continue to persist, with significant dissonance between the findings of different research groups and patient self-reports in various media.[57]Some studies reported the possibility of ECT being associated with the development of subsequent dementia.[76],[77] However, a recent large, well-controlled prospective Danish study found that the use of ECT was not associated with elevated incidence of dementia.[78] Conclusion Our titular question is whether ECT leads to brain damage, where damage indicates destruction or degeneration of nerves or nerve tracts in the brain, which leads to loss of function. This issue was last addressed by Devanand et al. In 1994 since which time our understanding of ECT has grown substantially, helped particularly by the advent of modern-day neuroimaging techniques which we have reviewed in detail.

And, what these studies reveal is rather than damaging the brain, ECT has a neuromodulatory effect on the brain. The various lines of evidence – structural neuroimaging studies, functional neuroimaging studies, neurochemical and metabolic studies, and serum BDNF studies all point toward this. These neuromodulatory changes have been localized to the hippocampus, amygdala, and certain other parts of the limbic system. How exactly these changes mediate the improvement of depressive symptoms is a question that remains unanswered.

However, there is little by way of evidence from neuroimaging studies which indicates that ECT causes destruction or degeneration of neurons. Though cognitive impairment studies do show that there is objective impairment of certain functions – particularly memory immediately after ECT, these impairments are transient with full recovery within a span of 2 weeks. Perhaps, the single-most important unaddressed concern is retrograde amnesia, which has been shown to persist for up to 2 months post ECT. In this regard, the recent neurometabolic studies have offered a tentative mechanism of action of ECT, producing a transient inflammation in the limbic cortex, which, in turn, drives neurogenesis, thereby exerting a neuromodulatory effect.

This hypothesis would explain both the cognitive adverse effects of ECT – due to the transient inflammation – and the long-term improvement in mood – neurogenesis in the hippocampus. Although unproven at present, such a hypothesis would imply that cognitive impairment is tied in with the mechanism of action of ECT and not an indicator of damage to the brain produced by ECT.The review of literature suggests that ECT does cause at least structural and functional changes in the brain, and these are in all probability related to the effects of the ECT. However, these cannot be construed as brain damage as is usually understood. Due to the relative scarcity of data that directly examines the question of whether ECT causes brain damage, it is not possible to conclusively answer this question.

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Shubh Mohan SinghDepartment of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh IndiaSource of Support. None, Conflict of Interest. NoneDOI. 10.4103/psychiatry.IndianJPsychiatry_239_19 Tables [Table 1], [Table 2].