Effects of nutritive and non-nutritive sucking on infant heart rate variability during the first 6 months of life

The effects of eating on heart rate variability (HRV) differ between adults and newborns. This may reflect the impact of suckling on the overall psychophysiological and autonomic nervous system maturation. The purpose of the present study was to explore whether the reactions of HRV during feeding change towards the adult pattern during the first 6 months of life. In addition, the effects of non-nutritive and nutritive sucking on heart rate (HR) and HRV were compared. The participants were 23 infants on whom recordings were performed as newborns and at 6, 12 and 24 weeks old. Nutritive sucking caused an increase in HR and a decline in HRV. The results were consistent with previous reports of a decrease in high frequency components of HRV during feeding in newborns, reflecting a decrease in parasympathetic activity. This response was apparent in all four ages studied, and remained similar throughout the 6-month period. However, age as an independent factor seemed to influence both HR and HRV. Pacifier sucking had no significant effects on HRV at any age. The results demonstrate the physical strain that sucking imposes on the baby, with a specific autonomic nervous system response involved. We consider this response an essential part of the overall psychophysiological maturation of infants.     

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.     

The 9th annual INDUS-EM 2013 Emergency Medicine Summit, “Principles,Practices, and Patients,” a level one international meeting,Kerala University of Health Sciences and Jubilee Mission Medical College and Research Institute,Thrissur, Kerala,India, October 23–27, 2013

INDUS-EM is India’s only level one conference imparting and exchanging quality knowledge in acute care. Specifically, in general and specialized emergency care and training in trauma, burns, cardiac, stroke, environmental and disaster medicine. It provides a series of exchanges regarding academic development and implementation of training tools related to developing future academic faculty and residents in Emergency Medicine in India. The INDUS-EM leadership and board of directors invited scholars from multiple institutions to participate in this advanced educational symposium that was held in Thrissur, Kerala in October 2013.     

Visual processing of coherent rotation in the central visual field: an fMRI study

Functional magnetic resonance imaging was used to determine the brain areas that process coherent motion. To reduce the activity related to eye-movement planning and self-motion perception, rotation was used as coherent motion and the stimulus was restricted to the central visual field. Coherent rotation relative to incoherent random-dot motion resulted in consistent activation in the superior parietal lobule (SPL), in the lateral occipital gyrus (presumptive kinetic occipital region, KO), and in the fusiform gyrus (FG). The main novel finding in present study is the bilateral SPL activation, which has not been found in any previous study contrasting coherent and incoherent motion. It is suggested that the SPL activation is related to form-from-motion processing. The stimulus modification that prevented abrupt appearances of dots at the borders of the stimulus field increased the strength of rolling disk-like percept of the coherent stimulus. This perception of form may also be at least partly responsible for the activation in KO and FG. With this explanation, our three consistent activation areas are in line with previous findings. Furthermore, these results demonstrate that even delicate changes in some stimulus aspects can lead to significant changes in the activation of the brain.     

How do People Attribute their Polydrug Use? A Mixed Methods Approach

ABSTRACT

In Finland, polydrug use is generally seen as stigmatized deviant behavior. By means of the mixed methods approach, this article focuses on how people explain their polydrug use and what they attribute it to. Our findings show that these explanations vary according to sociodemography. Moreover, polydrug use is not always presented as planned and goal-oriented behavior, but also something that can occur due to sudden situational factors beyond the control of the person. Our findings implicate that the judgments regarding the deviance of polydrug use are contextual and different sociodemographic groups consider whether it is deviant behavior or not differently.