Posts Tagged ‘World Health Organization’

The Fading American Dream My Be Behind the Rise in US Suicides

July 2, 2018

The title of the post is identical to the title of an article by Andy Coghlan in the News section of the 30 June 2018 issue of the New Scientist. The article begins, “Shrinking life chances plus the lack of a social safety net may have left middle-aged Americans more vulnerable to suicide than peers in the rich nations.” The annual rate of suicide in the US has risen by almost 28% between 1999 and 2016.

A number of explanations have been advanced for this fact, including the 2008 economic crash, the upsurge in addiction to opiod painkillers and the migration of manufacturing jobs to other countries. But this does not explain why the suicide rate is rising so fast in the US as it falls in other rich countries.

Figures from the US Centers for Disease Control (CDC) show that the country’s rate of suicide was 15.6 per 100,000 population in 2016, up from 12.2 in 1999. According to the World Health Organization (WHO) the global average rate is 10.6. The rate for the UK in 2016 was 8.9 per 100,000, down from 9.1 in 2000, according to the latest WHO data.

Although globalization and automation are driving job losses in the US, the same pressures have affected all Western economies without a similar increase in the suicide rate. People who work in mental health and suicide contacted by the New Scientist argued that some distinctive elements of US Culture may help explain the rise, Julie Phillips of Rutgers University says ,”I think the US is unique in a few respects. One of the key drivers could be the American dream itself—the idea that you can work hard and climb out of poverty. A growing mismatch between life expectations this brings and the increasingly bleak reality for many US citizens could lead to hardship.”

“This may be particularly felt by middle-aged white Americans, who have the highest suicide rates and the steepest rises. The American dream is deeply ingrained, but it no longer seems to be true for working class, middle-aged people. I think this disjuncture between norms, expectations and reality is one important factor behind the increase.”

“This group is also more likely to be negatively affected by divorce, lower education levels and economic inequality. Among US adults over 50, the divorce rate has doubled since the 1990s. In 1999 suicide rates for middle-aged people with a high school diploma or less were 1.7 times greater than those with a college degree. By 2013, this difference in risk had risen to 2.4 times greater.”

Deborah Stone of the CDC and lead author of this report said, “It is also likely that recent events such as the 2008 financial crash and the current opiod painkiller crisis, are contributing to the rise in the suicide rate. We know that suicides increase in times of economic turmoil. Data also indicate that opiod prescribing rates are higher in countries where there are higher rates of suicide.”

Coghlan writes, “Strong individuals in the US and the lack of social welfare schemes found in many other rich countries may also play a role.” Evidence for this comes from a 2013 report that showed people in the US die earlier than those in comparable nations, though not necessarily from suicide. The joint report by the US National Research Council and the Institute of Medicine revealed that by almost every measure, people in the US were unhealthier and more likely to die prematurely than those in 16 other rich nations.

Steven Woolf of Virginia Commonwealth University, who headed up the report said, “This problem has deep roots. We believe living conditions are producing a growing sense of desperation that’s causing people to turn to drugs and alcohol and, when all hope is lost, suicide.”

The report also highlights the fact that, unlike the US, governments of rich nations such as Finland, France, and Belgium promote healthcare through non-medical support, including housing, education, and social insurance. “The US spends plenty, but we spend differently,” says Laudan Aron at the Urban Institute in Washington DC.

This rejection of the state and the prioritizing of individual rights, no matter what the potential costs, runs throughout US culture. It explains why people in the US are more likely to indulge in risky behaviors such as overeating and gun-related activity, and tend to defy safety-based but restrictive norms such as wearing seat belts. So, the author asks, “could this attitude also be behind the US suicide rates?

Stone agrees it may have played a part. “but it is possible that the culture around individualism and stigma around seeking help does leave people vulnerable, perhaps more so than in other Western countries, but that needs additional study.”

Others are more convinced. Phillips says says, “The group most affected—less educated, white, middle-aged males—grew up with certain norms surrounding masculinity and self-reliance, and this group doesn’t seem to be seeking help.”

Stone says, “to redress the increasing rates, the CDC issued guidance on preventing suicide. It has recommended social and economic support measures such as providing financial help with paying rent, teaching skills for coping with stressful events and relationship problems, and encouraging a sense of belonging and social connectedness among vulnerable people.”

But Woolf says more radical interventions are needed. “Policymakers need to address widening social inequalities that are placing a vice on the middle class, and releave the distressful living conditions that are driving people to their deaths. Instead they are doing the opposite. Current elected officials are pulling funding out of such programs and enacting new policies which, if anything, will tighten the vice.”

Memories from Infancy and Early Childhood

January 27, 2017

This post is based on Chapter 1, “I Remember Being Born” in “THE MEMORY ILLUSION” a book by the psychologist Julia Shaw, Ph.D.  Many millions of people remember being a baby.  Fewer people, but still in the millions remember being born, and even fewer people, but still in the millions remember being in the womb.  These people are wrong as “research has long established that as adults we cannot accurately retrieve memories from our infancy and early childhood.  To put it simply, the brains of babies are not yet physiologically capable of forming and storing long-term memories.  People have these misconceptions about remembering due to the creative component of memory that strives to make meaning of the world.

The estimated average age at which we can begin to form memories that last into adulthood is 3.5 years of age, but according to some such as Qi Wang of Cornell University this figure is likely to depend on the individual and can be anywhere between 2 and 5 years of age.

The parts of the brain responsible for long-term memory, including part of the frontal lobe and the hippocampus, begin to grow at around eight or nine months.  According to Harvard professor Jerome Kagan, one clue that children start to develop memory at about nine months is that this is typically when they become less willing to leave their parents.  Being able to miss their mothers is taken as a sign that the infants have a memory of their mother having just been present, and notice when she leaves.  “If you’re five months old, it’s out of sight, out of mind.  You’re less likely to cry because you just forgot that you mother was ever there, so it’s not as frightening.”

Long-term memory capabilities develop quickly as we age, both in duration and complexity.  We increasingly understand how the world around us works and what we should consider important.  The basic functions of long-term autobiographical memory are established within the first fews years of life.  But the main structures involved in memory (the hippocampus and related cognitive structures) actually continue to mature well into early adulthood.  This finding has contributed to the notion of an ‘extended adolescence’ that lasts all the way to the age of 25, since the brain continues substantial maturation until at least this age.

The baby brain  at two to four weeks of age is about 36% of the final adult volume, 72% at one year of age, and 83% of the final adult volume by two years.  By the age of 9 the brain reaches about 95% of the adult volume, and it is not until about the age of 13 that our brains reach their full adult size.

While the baby brains undergo rapid growth they also undergo massive neuronal pruning.  That is. individual neurons disappear.  This process begins almost from birth, and finishes by the time we hit puberty.  According to Maja Abitz and her team, adults actually have a whopping 41% fewer neurons than newborn babies in important parts of the brain that play a role in memory and thinking, such as the mediodorsal nucleus of the thalamus.

There is also an overproduction of synaptic connections in infancy followed by persistence of high levels of synaptic density into late childhood or adolescence.  As we enter late childhood, our brains start to become better at knowing what connections we need to keep and which are superfluous.  From there on until mid-adolescence our brains undergo a short of spring-cleaning.  So perhaps “when you were five years old you could list all of the dinosaurs, but did you really need all that information?  Probably not, says your brain and erases the connections and neurons responsible for much of this knowledge.”  “So, due to structural insufficiencies, as well as organizational and linguistic deficits, memories of early childhood events cannot last into childhood.

This research does not suggest that just because we cannot remember them, that early childhood events are unimportant.  According to a 2012 review of the long-term repercussions of adversity experience in early life by medical doctor Jack Shonkoff and his colleagues experiencing adversity, even at an age before we can consciously remember it as adult, can have lasting effects.  “Early experiences and environmental influences can leave a lasting signature of the genetic predisposition that affect emerging brain architecture and long-term health.”

To read more about the negative effects in early childhood read the healthy memory blog post,”Turning on Genes in the Brain.”  The single best predictor of the healthy growth of a baby is to ask its mother, “Did you want this child?”  In 2005 scientists at the University of Wisconsin-Madison designed a study showing what can happen to children whose parents answer “no” to this question.  The researchers studied children who were “reared in extremely aberrant social environments where they were deprived of the kind of caregiving typical for our species.”  This meant that for seven to forty-two months after their birth, the twelve girls and six boys had lived in Russian or Romanian orphanages  that the World Health Organization described as poor to appalling.  These environments were generally void of stimulation and human interaction.  The children seldom experienced the love and caring of adults who recognized and responded to their needs.These children were adopted by American families.  Within a year, most of their medical problems—ear infections and stomach problems, malnutrition and delayed growth—vanished.  Nevertheless, due to their legacy of neglect many of the children were diagnosed with attachment disorders, an inability to form emotional bonds to those closest to them

© Douglas Griffith and healthymemory.wordpress.com, 2016. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.

A Cognitive Safety Net

January 22, 2012

Prospective memory is the memory “to do” list, that is the memory to do things. A number of Healthymemory Blog posts have addressed failures of prospective memory, some which have been personally embarrassing (“An Embarrassing Failure of Prospective Memory, and “Another Embarrassing Failure of Prospective Memory”), and others that are quite tragic (“Prospective Memory and Technology”), such as leaving a child unattended for a day in a car and returning to find that the child has died. Atul Gawande is a surgeon who has addressed the problems of medical errors during surgery. These errors are documented in his book, The Checklist Manifesto: How to Get Things Right. Frightening numbers of surgical errors have been taking place every year without being systematically addressed. Dr. Gawande and his fellow researchers have addressed them and come up with a solution that markedly reduces these errors, but only if it is employed. That is the World Health Organization (WHO) safe surgery checklist.

The solution is the humble checklist. Unfortunately, the checklist is too humble, resulting in it being ignored by highly esteemed professionals, such as surgeons. The checklist encompasses both types of transactive memory. It is an external prompt, which can employ one of the simplest technologies, ink or graphite on paper. It also encompasses the social aspect of transactive memory, the memories of fellow human beings. Although checklists can be used by single individuals, it is also frequently used by duets or teams, with each party being responsible for different items on the checklist. For example, a surgical team will introduce themselves to each other and identify the portions of the checklist for which they are responsible. Gawande also gives a detailed account of how checklists were used by Captain “Sully” Sullenberger and his crew in safely landing their airliner in the East River.

It is clear that I need to get my personal house in order and start using checklists. The Checklist Manifesto: How to Get Things Right is highly recommended. It is both entertaining and informative, although perhaps a bit scary in its documentation of medical errors. But reading this book could save your life if you inquire whether they are going to use the World Health Organization (WHO) safe surgery checklist during your surgery. This checklist can be found at

http://www.who.int/patientsafety/safesurgery/en/

As for checklist applications, searches indicate that a variety are available. If you have any experience with these APPS, please leave comments.