Care of the Homeless - 2014 review from Am Fam Physician

The impact of the problem

On any given night, more than 610,000 persons
in the United States are homeless; a little more than one-third of these are families.

Homeless persons are more likely to become ill, have greater hospitalization rates, and are more likely to die at a younger age than the general population. The average life span for a homeless person is between 42 and 52 years. Homeless children are much sicker and have more academic and behavioral problems.

What are the causes?

Insufficient personal income and the lack of affordable housing are the major reasons for homelessness.

A complex, unique challenge

Complex, advanced medical problems and psychiatric illnesses, exacerbated by drug and alcohol abuse, in combination with the economic and social issues (such as the lack of housing and proper transportation) make this subset of the population a unique challenge for the health care system, local communities, and the government.

Multidisciplinary approach

An integrated, multidisciplinary health care team with an outreach focus, along with involvement of local and state agencies, seems best suited to address the components needed to ensure quality of care, to help make these patients self-sufficient, and to help them succeed.

Family physicians are well suited to manage the needs of the homeless patient, provide continuity of care, and lead these multidisciplinary teams

References:

Care of the Homeless: An Overview. Maness DL, Khan M. Am Fam Physician. 2014 Apr 15;89(8):634-640.
http://www.ncbi.nlm.nih.gov/pubmed/24784122

How playing an instrument benefits your brain - TED-Ed video

When you listen to music, multiple areas of your brain become engaged and active. But when you actually play an instrument, that activity becomes more like a full-body brain workout. What's going on? Anita Collins explains the fireworks that go off in musicians' brains when they play, and examines some of the long-term positive effects of this mental workout.



View full lesson: http://ed.ted.com/lessons/how-playing-an-instrument-benefits-your-brain-anita-collins

The Science of Depression - moving from neurotransmitters to neurogenesis and synaptogenesis

From ASAP Science: What's going on inside the brain of a depressed person?



Recent thinking suggests that rather than a shortage of serotonin, a lack of synaptogenesis (the growth of new synapses, or nerve contacts) and neurogenesis (the generation and migration of new neurons) could cause depression.

The main group of medications to treat depression, SSRIs, might promote synaptogenesis and neurogenesis by turning on genes that make ITGB3 as well as other proteins that are involved in these processes. ITGB3 stands for integrin beta-3.

If the neurogenesis and synaptogenesis hypothesis holds, a drug that specifically targeted miR-221 or miR-222 could bring sunnier days to those suffering from depression. The miRs are two microRNA molecules.

From DW: What helps relieve depression, according to Professor Malek Bajbouj, Berlin's Charité Hospital:



References:

Unraveling the Mystery of How Antidepression Drugs Work. Scientific American, 2013.

Chronic Daily Headache: What is the cause? (2014 Am Fam Physician review)

What is the definition of chronic daily headache?

Chronic daily headache is defined as the presence of a headache on 15 days or more per month for at least 3 months.

What are the causes?

The most common types of chronic daily headache are chronic migraines and chronic tension-type headaches. If a red flag for a secondary cause of headache is present, magnetic resonance imaging (MRI) of the head should be performed.

All patients should be asked about medication overuse, which can increase the frequency of headaches. Patients who overuse medications for abortive therapy for headache should be encouraged to stop the medications entirely and consider prophylactic treatment.

How to treat it?

Several prophylactic treatments for chronic daily headache can reduce headache frequency and severity, as well as improve overall quality of life.

Nonpharmacologic treatments include relaxation techniques, cognitive behavior therapy, acupuncture, osteopathic manipulation, and cervical exercises.

Pharmacologic therapies include amitriptyline, gabapentin, onabotulinumtoxinA, propranolol, tizanidine, topiramate, and valproate.

References:

Chronic Daily Headache: Diagnosis and Management. Yancey JR1, Sheridan R2, Koren KG1. Am Fam Physician. 2014 Apr 15;89(8):642-648.
http://www.ncbi.nlm.nih.gov/pubmed/24784123

Image source: Openclipart.org, public domain.

Your Brain On Coffee - one cup has 150 mg of caffeine, 70 times that amount may kill you

From ASAP Science video: How does the world's favorite drug actually work? The guys from ASAP Science have achieved an amazing success - with only 99 published videos, they have 2 million subscribers on YouTube.

It's true. The average cup of coffee contains 150 mg of caffeine or less. The lethal dose is 150 mg/kg, which means that for the average person who weighs 70 kg, 70 cups of coffee (or that amount of caffeine in a tablet) taken at one time could be deadly. Don't forge that caffeine (C8H10N4O2) is the natural pesticide of coffee beans, paralyzing and killing insects that try to feed on them.



Coffee is the most complex food known to man. It has 1200 flavor components. The nearest comparison is red wine with 450 chemical compounds in the flavor make-up. In most commercial blends there are 10 to 12 different coffees, from different farms (BBC, http://goo.gl/m2LwD). Americans get more antioxidants from coffee than anywhere else.


Caffeine is structurally similar to adenosine. Image source: Wikipedia, public domain.

References:

Is coffee a "health food" now?
Americans get more antioxidants from coffee than anywhere else
Caffeine (C8H10N4O2) is the natural pesticide of coffee beans, paralyzing and killing insects that try to feed on them
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