Psychological Effects Of Patient Surge In: Fill & Download for Free

I’m 54 and have no children. I never felt a great pull to have them—except in my late 30s when I was shot through with baby-fever for a couple of years, but the feeling disappeared as suddenly as it arrived.After spending most of my life neutral about kids, I’m suddenly kid-crazy. Maybe now that there is no risk of my getting pregnant, my biology has given my psyche a green light to enjoy children like never before.And, lucky me, my husband and I moved to China only a few years after the end of the One Child policy, meaning there are babies everywhere. It’s so fun to fawn over all the cuties. The language barrier becomes a non-issue; everyone loves it when you love on their kids.My maternal instincts are also blooming because of my relationship with our teaching assistant. She was assigned to help us with everything from buying needed items to figuring out how to get around the city. We’ve spent hours with her, constantly amazed at her ability to translate, solve problems, and remain upbeat. Soon we were attending her dance performances and helping her with her homework.A strong feeling coursed through me as she danced on stage or practiced a speech in front us. I realized the feeling was this: I adored her and was proud of her. The feelings seemed a little out of proportion, since we’d known each other only a few months, but they surged every time I saw her.Once she saw me across campus and came running up and threw herself into my arms, and I felt what I can only describe as motherly.After her bike was stolen, we bought her one for her birthday and took her out to lunch. At the restaurant, she launched into what seemed to be a prepared speech about how much we mean to her.She had barely begun when tears started streaming down my face. She thanked us for being friendly and patient. She recounted fun experiences we’ve had and said, “You have taught me things about life.” She recalled when we went to the bank one day and it was so crowded that we decided to leave and come back another time. You said when things are ‘chaos’”—she remembered learning that word from my husband—“that it’s better to go away and do something else.”She also said she has learned from us how to appreciate small things in life. She was especially touched when one day I told someone she was like our daughter in China.Now I understand how parents feel when their kids come home for the holidays. I’m always happy to see her and spend time with her. During the semester break, we are going to travel together.Just when I thought these feelings might be an anomaly, my 17-year-old nephew sent me the manuscript of a novel he wrote. I was only a few pages in, reading it aloud to my husband, when I burst out in tears.His writing is good. Really good. And the narrator is a loving, observant, smart young man whose philosophy of life deeply resonates with me. For instance, after one dicey adventure in the book, the narrator says, “No longer did I fear death; I feared that I wouldn’t truly live.”We’ve messaged back and forth about the book. As a writer, writing coach and aunt, I am thrilled to be having these conversations with him. I still remember once when he was little he’d said to me, “You know what I love? Big fat books.” And now he’s doing what he loves. He’s become the other writer in the family.When people called me “childless,” I used to say, no, I was “child-free.” But now, I’m not so sure. Children, from babies to young adults, are touching my life. And I’m touching theirs.I know it’s not the same as having raised a child, but these kinds of connections are somehow creating a legacy. So perhaps we don't have to worry about negative psychological consequences of not having children when there are children everywhere ready to be part of our lives.

We simply don't have enough time to do our job and teach nutrition; we can't cover every single aspect of the patient's wellbeing on our own.Allow me to clarify:Teaching nutrition isn't a five-minute thing, and even five minutes is about half the time an average doctor is able to spend on a patient on a busy day.Teaching good habits to somebody who has bad habits is even more demanding.Doctors can't cover every aspect of one's wellbeing: Other factors, like one's financial situation or their psychological wellbeing also contribute to their disease status, as much as we'd like to tackle these as well, we can't do everything on our own. Therefore:A modern doctor will need to be more of a manager of your healthcare and refer you to the appropriate specialists that will treat problems secondary to the main issue he'll treat you for. Just like an electrician won't come to your place and unexpectedly spend a bunch of hours soldering that cable box you just surged while other people are waiting further up his journey.The good news:Depending on specialty, most doctors do keep track of nutrition and will refer to nutrition specialists and to a certain extent they will certainly give advice themselves, but nutrition is a day-to-day habit you need to discuss in a certain amount of detail to reach any real result.It's not a black or white thing you can just ask and run through in your ten minute consultation with a chronic patient.A bad habit like smoking or how many drinks one has in a week is something you can tackle instantly with a straightforward address: "You need to stop smoking. You failed? Here's a good counselor." or "Try to drink less. Keep drinking too much? We need to do something about that, here's a book/support group that might help."Bad diet, in contrast, is not something you cannot simply address with a short "eat healty!"Where I work, we have a weight center and a large group of well-qualified dietary consultants that speak to a large amount of patients that will all benefit from this.As we start to realize the benefits of preventive medicine, I trust this aspect will get more and more of the well-deserved attention it needs in a sadly increasingly unhealthy eating society.

Simpler question is what isn't. Gut bacteria influence our entire physiology from the basic such as what and how much we eat to the synthesis of essential vitamins, from our immune function and metabolism to even our mood. The study of microbiota, much of it mouse model data, has exploded over the past decade. Instead, I specifically highlight human data from peer-reviewed scientific studies.Antibiotic usage, diet, hygiene and lifestyle shape our microbiota, particularly gut microbiota. In turn, they shape our immune and metabolic function.From 1Let's start from first principles. Food. How do microbes control our eating behavior?From 2. I highlight human data in purple.They influence our reward pathway. After all, our enteric (gut-associated) nervous system is the major source of dopamine and serotonin (3, 4).They modulate our taste perception (5).They play on our vagus nerve as a musician plays his instrument (6, 7). What's the importance of the vagus nerve? It's the main nerve communication between our gut and brain.Our gut microbiota is exquisitely adapted to our diet.a) One of the most compelling examples is of a gut bacterium found in the Japanese. Bacteroides plebeius has a horizontally transferred gene from the marine bacterium Zobellia galactanivorans that gives it the capacity to digest seaweed polysaccharides (8). In fact, human-associated bacteria have a 25-fold higher rate of gene transfer compared to bacteria in other environments (9), implying host-microbe association imposes stringent selection pressures on our microbiota.b) Obese have altered gut microbiota with reduced diversity and greater variability (10, 11, 12, 13).c) US population microbiome appears adapted for a high-fat, high-protein diet while that of people living in rural Malawi and the Amazonas in Venezuela for breaking down complex carbohydrates (14).Gut microbes influence every aspect of our physiologyWhat about the rest of our body functions? Even surprising ones such as metabolism and behavior are profoundly influenced by our microbiota.From 15Our metabolome refers to the variety of metabolites present in our blood circulation. About a third of our metabolome is estimated to be of microbial origin. Using our circulation system as their communication network, animal model studies show that our microbial products can reach every part of our body (16, 17, 18), and influence the metabolism and physiology of distant organs and each other. For example, people with symptomatic atherosclerosis have altered gut microbiota (19). A potential mechanism by which our gut microbes could jeopardize cardiovascular health is through conversion of dietary phosphatidylcholine into the proatherosclerotic metabolite, trimethylamine (20), a result that needs to be independently verified.Possible Gut-Brain communication mechanismsFrom 21Short-chain fatty acids (SCFA). Colonic gut microbes digest dietary carbohydrates to generate SCFA such as acetate, butyrate and propionate (22). Signaling through G protein coupled receptors such as (GPRs), GPR41 and GPR43, SCFA induce colonic motility, regulate appetite (23) and even suppress colon cancer (24) in human colon cancer cell lines. While colon cells (colonocytes) use butyrate as an energy source, acetate and propionate enter the blood stream and thence to other organs (25, 26). These SCFAs can stimulate the sympathetic nervous system (27).Gut microbiota can also modulate neurotransmitters within the gut. This includes acetylcholine, gamma-aminobutyric acid, histamines, melatonin and serotonin. Gut microbes can express and secrete neuropeptide-like molecules that could influence behavior and emotion (28, 29).Tryptophan is an essential amino acid we only get from our diet (30), and is the precursor of serotonin (31), most of it synthesized by our gut enterochromaffin cells and enteric nerves (32, 33, 34).Gut microbes synthesize vitamins essential for nervous system function. For example, Lactobacillus reuteri is a major source of Vitamin B12 or cobalamin (35), a vitamin important for the development of the nervous system (36).GI diseases and psychiatric comorbiditiesCause and effect or correlation?While that's still debatable, up to 80% of patients with GI diseases (IBS, Irritable Bowel Syndrome; IBD, Inflammatory Bowel Disease) also have psychiatric illnesses such as depression and anxiety (37, 38, 39). Changes in psychological activities are seen both before and after diagnosis of IBD.Serum cortisol, a marker of elevated anxiety, was reduced in patients who consumed probiotics, Lactobacillus helveticus and Bifidobacterium longum (40) while healthy subjects showed significantly less psychological distress compared to the placebo group in a double- blind, placebo-controlled, randomized parallel group clinical trial with the same probiotic mixture for 30 days (41).Treatment with a probiotic- containing milk drink resulted in improved mood and cognition in healthy subjects when compared to the placebo group (42).There are signs of cognitive impairment in IBS patients (43).After 4 weeks of treatment with a fermented milk product with probiotics, healthy women volunteers performed a specific cognition test faster (44). Analysis of their brain function indicated specific uptick in activity in regions innervated by serotonergic nerves.Neuroimaging studies suggest abnormal brain function in GI disorders. This includes thinning of the anterior cingulate and insular cortex, and increased activation of the thalamus, anterior cingulate and prefrontal cortex of IBS patients (45, 46).Lactobacillus and Clostridium species are reduced in stool samples from IBS patients (47, 48).Deconstructing our Gut microbe-Brain connectionHow to infer a connection between our gut microbiota and brain? We could if specifically targeting microbes affected our brain and/or behavior. Antibiotics directly and specifically target microbes. If antibiotic therapy also resulted in any change in brain function and/or behavior, it could be inferred as evidence of microbe-brain connection. As a direct effect, gut microbes synthesize vitamins essential for brain function.Hepatic EncephalopathyIn the first stages of liver disease, cirrhosis, the liver compensates to perform its functions. In later stages, it can no longer compensate. At this stage, there is attendant encephalopathy (degeneration of brain function). Several lines of evidence suggest a link between gut microbiota disturbance (dysbiosis), liver disease and brain function.Oral antibiotics can reverse encephalopathy in decompensated liver disease patients (49, 50, 51)Compared to healthy controls, encephalopathic cirrhosis patients have altered gut microflora (52, 53).In particular, reduced Alcaligenaceae and Porphyromonadaceae and increased Enterococcus, Megasphaera and Burkholderia correlate with poor cognition and increased inflammation in encephalopathic patients with cirrhosis and cognitive dysfunction (54, 55).AutismMost children with Autism often experience a range of GI problems (56).Disease onset usually follows antimicrobial use in a high percentage of late-onset Autism (18–24 mo of age) children having a history of extensive antibiotic use. One study observed a 10-fold increase in certain clusters of Clostridium spp in stool samples from Autistic children compared with healthy controls. The authors speculated that exposure to trimethoprim/ sulfamethoxazole rather than exposure to other antibiotics could be linked to the diagnosis of late-onset Autism since the former are not effective against Clostridium spp, while oral vancomycin specifically targets Gram positive organisms which include Clostridium spp (57). Increased clostridial species in stool samples of Autistic patients was confirmed by another study (58). Indeed, oral vancomycin treatment showed a decrease in Autistic symptoms, while relapse occurred following cessation of treatment (59).Clostridia spores are also implicated in the high rates of Autism seen among siblings (60).Real time qPCR (61) and culture-based microbiota (57) profiling techniques suggest that alteration in microbiota may contribute to disease phenotype.Intestinal biopsy of late-onset Autism spectrum disorder (ASD) patients revealed reductions in Bifidobacterium spp. and the mucolytic bacterium Akkermansia mucini­phila (62).Late-onset Autism patients have marked reduction in Bacteroides and Prevotella species and increase in Sutterella species compared to controls (63, 64, 65, 66).At least one study refutes differences in gut microbiota between Autistic patients and controls (67). Possible reasons for the different result could be they used a different approach for taking samples and used a different technique for microbiome analysis.Altered expression in the ileum of carbohydrate transporters such as hexoses and for enzymes such as disaccharidases suggest a role for carbohydrate malabsorption in Autism (68).Urine and fecal sample metabolites are different in Autism patients (69, 70, 71, 72).Casein- and gluten-free diets are reported to improve behavior of patients with Autism (73, 74, 75).Problems with many Autism-GI disorder association studiesThey study different types of populations (possibly different diseases).Population sizes differ considerably between studies.Different studies use different controls.Do not control for the unique diets of the patients. Diet itself could be a reason for different gut microbe distribution in patients compared to controls.A better controlled and more comprehensive US study (76) examined 589 patients with a history of familial ASD and their unaffected sibling controls. Separating 'Full' from 'Spectrum', they reported constipation (20%) and chronic diarrhea (19%) as the most common symptoms among those with 'Full' Autism. Another study of >140000 ASD patients showed higher prevalence of IBD (0.83% vs 0.54%) and other bowel disorders (11.74% vs 4.5%) compared to hospitalized controls (77).This comprehensive table summarizes findings from various Autism-GI disorder association studiesFrom 78Antibiotic associated behavior changesSometimes antibiotics are associated with behavioral changes spanning insomnia, mood alteration (79, 80), to mania, particularly in elderly patients, ('antibomania') (81).BibliographySommer, Felix, and Fredrik Bäckhed. "The gut microbiota—masters of host development and physiology." 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