Some COVID-19 patients still have coronavirus up to eight day after symptoms disappear

In a new study, researchers found that half of the patients they treated for mild COVID-19 infection still had coronavirus for up to eight days after symptoms disappeared. The research letter was published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

In "Time Kinetics of Viral Clearance and Resolution of Symptoms in Novel Coronavirus Infection," Lixin Xie, MD, Lokesh Sharma, PhD, and co-authors report on a study of 16 patients with COVID-19, who were treated and released from the Treatment Center of PLA General Hospital in Beijing between January 28 and Feb. 9, 2020. Patients studied had a median age of 35.5 years.

Researchers collected samples from throat swabs taken from all patients on alternate days and analyzed. Patients were discharged after their recovery and confirmation of negative viral status by at least two consecutive polymerase chain reaction (PCR) tests.

"The most significant finding from our study is that half of the patients kept shedding the virus even after resolution of their symptoms," said co-lead author Dr. Sharma, instructor of medicine, Section of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Yale School of Medicine. "More severe infections may have even longer shedding times."

The primary symptoms in these patients included fever, cough, pain in the pharynx (pharyngalgia) and difficult or labored breathing (dyspnea). Patients were treated with a range of medications.

The time from infection to onset of symptoms (incubation period) was five days among all but one patient. The average duration of symptoms was eight days, while the length of time patients remained contagious after the end of their symptoms ranged from one to eight days. Two patients had diabetes and one had tuberculosis, neither of which affected the timing of the course of COVID-19 infection.

"If you had mild respiratory symptoms from COVID-19 and were staying at home so as not to infect people, extend your quarantine for another two weeks after recovery to ensure that you don't infect other people," recommended corresponding author Lixin Xie, MD, professor, College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing.

The authors had a special message for the medical community: "COVID-19 patients can be infectious even after their symptomatic recovery, so treat the asymptomatic/recently recovered patients as carefully as symptomatic patients."

The researchers emphasized that all of these patients had milder infections and recovered from the disease, and that the study looked at a small number of patients. They noted that it is unclear whether similar results would hold true for more vulnerable patients such as the elderly, those with suppressed immune systems and patients on immunosuppressive therapies.

"Further studies are needed to investigate if the real-time PCR-detected virus is capable of transmission in the later stages of COVID-19 infection," Dr. Xie added.

A plant-based diet helps to prevent and manage asthma, according to new review

A plant-based diet can help prevent and manage asthma, while dairy products and high-fat foods raise the risk, according to a new review published in Nutrition Reviews.

Asthma is a common chronic condition in which the airways become narrow and inflamed--sometimes leading to difficulty with breathing, coughing, wheezing, and shortness of breath.

"Asthma is a condition that affects more than 25 million Americans, and unfortunately it can make people more vulnerable in the COVID-19 outbreak," says study author Hana Kahleova, MD, PhD, director of clinical research for the Physicians Committee. "This research offers hope that dietary changes could be helpful."

Researchers with the Physicians Committee for Responsible Medicine examined the evidence related to diet and asthma and found that certain foods--including fruits, vegetables, whole grains, and other high-fiber foods--can be beneficial, while others--such as dairy products and foods high in saturated fat--can be harmful.

The review authors highlight a study finding that when compared to a control group, asthma patients who consumed a plant-based diet for eight weeks experienced a greater reduction in use of asthma medication and less severe, less frequent symptoms. In another study, asthma patients adopted a plant-based diet for a year and saw improvements in vital capacity--a measure of the volume of air patients can expel--and other measures.

The authors suggest that a plant-based diet is beneficial because it has been shown to reduce systemic inflammation, which can exacerbate asthma. Plant-based diets are also high in fiber, which has been positively associated with improvements in lung function. The researchers also highlight the antioxidants and flavonoids found in plant foods, which may have a protective effect.

The review also finds that dairy consumption can raise the risk for asthma and worsen symptoms. One 2015 study found that children who consumed the most dairy had higher odds of developing asthma, compared with the children consuming the least. In another study, children with asthma were placed in either a control group, where they made no dietary changes, or in an experimental group where they eliminated dairy and eggs for eight weeks. After eliminating dairy, the experimental group experienced a 22% improvement in peak expiratory flow rate--a measure of how fast the children were able to exhale--while children in the control group experienced a 0.6% decrease.

High fat intake, consumption of saturated fat, and low fiber intake were also associated with airway inflammation and worsened lung function in asthma patients.

"This groundbreaking research shows that filling our plates with plant-based foods--and avoiding dairy products and other high-fat foods--can be a powerful tool for preventing and managing asthma," says Dr. Kahleova.

During the COVID-19 pandemic, the Centers for Disease Control and Prevention urges those with asthma to have a plan in place--including stocking up on supplies, taking asthma medication as needed, avoiding crowds, and practicing good hygiene.

No evidence for or against the use of non-steroidal anti-inflammatory drugs such as ibuprofen for patients with COVID-19

A recent study has found that there is no evidence for or against the use of non-steroidal anti-inflammatory drugs such as ibuprofen for patients with COVID-19.

The study, led by researchers at King's College London, also found other types of drugs, such as TNF blockers and JAK inhibitors safe to use.

89 existing studies on other coronavirus strains such as MERS and SARS, as well as the limited literature on COVID-19, were analysed to find out if certain pain medications, steroids, and other drugs used in people already suffering from diseases should be avoided if they catch COVID-19.

Some patients, for example those with cancer, are already given immunosuppressive drugs - therapies that can lower the body's immune system - or immunostimulant drugs - therapies that boost it. If these patients then catch COVID-19, doctors need to know what medication to stop.

Dr Mieke Van Hemelrijck, a cancer epidemiologist and an author on the paper, said "This pandemic has led to challenging decision-making about the treatment of COVID-19 patients who were already critically unwell. In parallel, doctors across multiple specialties are making clinical decisions about the appropriate continuation of treatments for patients with chronic illnesses requiring immune suppressive medication."

The article has been published in ecancermedicalscience, an open access oncology journal, and is authored by researchers from King's College London and Guy's and St. Thomas NHS Foundation Trust, London.

There had been some speculation that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen might make things worse for some COVID-19 patients, but the researchers did not find evidence to support this statement.

Other types of drugs such as TNF blockers and JAK inhibitors, used to treat arthritis or other forms of inflammation, were also found to be safe to use. Another class of drug known as anti-interleukin-6 agents is being investigated for helping to fight COVID-19, although there is no conclusive proof yet.

The researchers found that low amounts of prednisolone or tacrolimus therapy may be helpful in treating COVID-19. Co- author, Dr Sophie Papa, a medical oncologist and immunologist said: "Current evidence suggests that low dose prednisolone (a steroid used to treat allergies) and tacrolimus therapy (an immunosuppressive drug given to patients who have had an organ transplant) may have beneficial impact on the course of coronavirus infections. However further investigation is needed."

As more people catch the disease, researchers will continue to investigate how it interacts with commonly used medications and make further guidance recommendations.

Exercise reduces caregiver's burden in dementia care

The research group "geriatric psychiatry in motion" of the German Sport University Cologne and the LVR-Hospital Cologne develop and evaluate exercise programmes for geriatric mental health care. Latest results from a study in acute dementia care indicate a special exercise programme is not only effective for the patients themselves, but also reduces the professional caregiver's burden caused by neuropsychiatric symptoms.

Short-bout exercise sessions of 20 minutes several times per day are key aspects of this 'exercise-carrousel' - a new exercise programme specially tailored for patients suffering from dementia, which has been developed and evaluated at the LVR-Hospital in Cologne. Throughout the day, the exercises are applied in small groups of patients - twice in the morning, twice in the afternoon. "With these recurrent activity and rest periods, we are not only trying to increase physical activity, but also aiming at stabilising their day-night rhythm" highlights Dr. Tim Fleiner, head of the research group. The novel exercise approach is feasible in the clinical setting - more than half of the patients are physically active for over 150 minutes per week, thus even meeting the recommendation for healthy older adults despite suffering from dementia.

With the same level of psychotropic medication, the patients show clinically relevant improvements in neuropsychiatric symptoms compared to a control group - in particular agitated behavior and lability improved.

As a special side effect, recently published findings show important improvements in the patient's environment: participating in the exercise-carrousel reduces the perceived burden of the patient's caregivers. "Reducing the burden of the patient's caregivers and their relatives is a key aspect in dementia care. That we can achieve an improvement for the patient and his/her environment through a special exercise programme is novel and important for the health care of older people" states PD Dr. Peter Haussermann, head physician of the Department of Geriatric Psychiatry at the LVR-Hospital Cologne.

Exercise training better than weight loss for improving heart function in type 2 diabetes

Researchers in Leicester have shown that the function of the heart can be significantly improved in patients with type 2 diabetes through exercise.

The study, which was funded by the National Institute for Health Research (NIHR) and conducted at the NIHR Leicester Biomedical Research Centre (BRC) - a partnership between Leicester's Hospitals, the University of Leicester and Loughborough University - also showed that a low-energy diet did not alter heart function in the same patient group.

Dr Gaurav Gulsin, a BHF Clinical Research Fellow at the University of Leicester, trainee heart doctor, and a lead author of the study, said: "Heart failure is one of the most common complications in people with type 2 diabetes, and younger adults with type 2 diabetes already have changes in their heart structure and function that pose a risk of developing heart failure. We wanted to confirm the abnormalities in the structure and function of the heart in this patient population using the latest scanning techniques, and explore whether it is possible to reverse these through exercise and/or weight loss."

Eighty-seven patients between 18 and 65 years of age with type 2 diabetes were recruited to the study. Participants underwent echocardiography and a magnetic resonance imaging (MRI) scan to confirm early heart dysfunction, and exercise tests to measure cardiovascular fitness. They were then randomised into one of three groups: routine care, supervised aerobic exercise training, or a low-energy meal replacement programme. Each programme had a 12-week duration. Seventy-six patients completed the full 12 weeks. Thirty six healthy volunteers were enrolled as a control group.

The study found that patients who followed the supervised exercise programme had significantly improved heart function compared with the control group, and had also increased their exercise capacity. Whilst the low energy diet did not improve heart function, it did have favourable effects on the structure of the heart, vascular function and led to the reversal of diabetes in 83 per cent of this arm of the study population.

Gerry McCann, NIHR Research Professor and Professor of Cardiac Imaging at the University of Leicester and a consultant cardiologist at Leicester's Hospitals, was senior author on the study. He said: "Through this research we have shown that lifestyle interventions in the form of regular exercise training may be important in limiting and even reversing the damage to heart structure and function seen in younger adults with type 2 diabetes. While losing weight has a beneficial effect on heart structure, our study shows that on its own it does not appear to improve heart function.

"It may seem obvious, but if we can empower patients with type 2 diabetes to make changes to their daily routines through exercise and healthy eating, we may help them reduce the risk of heart failure and even early death. By using imaging techniques such as MRI we can actually show them the benefits their changes are making to their hearts."

The research team recognised the study population was relatively small. In addition, nearly 1 in 5 patients in the exercise arm of the study did not complete all 36 sessions, which may limit its application in future clinical practice.

Consuming extra calories can help exercising women avoid menstrual disorders \

Exercising women who struggle to consume enough calories and have menstrual disorders can simply increase their food intake to recover their menstrual cycle, according to a study accepted for presentation at ENDO 2020, the Endocrine Society's annual meeting, and publication in the Journal of the Endocrine Society.

The study found that exercising women with menstrual disorders can start menstruating again by consuming an additional 300-400 calories a day.

"These findings can impact all exercising women, because many women strive to exercise for competitive and health-related reasons but may not be getting enough calories to support their exercise," said lead researcher Mary Jane De Souza, Ph.D., of Penn State University.

By consuming enough calories, exercising women with menstrual disorders can avoid complications associated with a condition known as the Female Athlete Triad, De Souza said. This is a medical condition that starts with inadequate food intake that fails to meet the body's needs. It leads to menstrual disorders and poor bone health. It is associated with a high incidence of stress fractures.

The study included 62 young, exercising women with infrequent menstrual periods. Thirty-two women increased their calorie intake an average of 300-400 calories a day, and 30 maintained their exercise and eating habits for the 12-month study. Women who consumed the extra calories were twice as likely to have their menstrual period during the study compared with the women who maintained their regular exercise and eating routine.

"This strategy is easy to implement with the help of a nutritionist. It does not require a prescription and avoids complications from drug therapy," De Souza said. "The findings will encourage healthcare providers to try to help exercising women with menstrual disorders who consume too few calories to eat more, and this may help them to be healthier athletes and avoid bone complications."

Infants introduced early to solid foods show gut bacteria changes that may portend future health risks

Infants who were started on solid foods at or before three months of age showed changes in the levels of gut bacteria and bacterial byproducts, called short-chain fatty acids, measured in their stool samples, according to a study from researchers at Johns Hopkins Bloomberg School of Public Health.

Prior studies have linked the early introduction of solid foods to a higher chance of being overweight in childhood. The new study, published in BMC Microbiology, suggests that early solid food introduction may predispose infants to being overweight at least in part by altering the gut bacterial population.

"How the early introduction of solid foods would cause the later development of obesity has been unknown, but our findings suggest that disruptions to gut bacteria may be one explanation," says Noel Mueller, PhD, assistant professor in the Department of Epidemiology at the Bloomberg School.

Pediatricians' associations typically recommend that infants be breastfed exclusively for the first four to six months, after which solid foods should be introduced as a supplement to breastmilk or milk formula. Past research suggests that children who start eating solid foods earlier than six months are more likely to be overweight in childhood. Prior studies also indicate that the timing of solid food introduction may affect the chances of developing eczema, food allergies, asthma, hay fever, and other allergy-related conditions.

To understand better how the timing of solid food introduction, in terms of biological mechanisms, could affect a child's metabolic and/or immune health, Mueller and his colleagues analyzed data from the Nurture study, which tracked infants in a community in Durham, North Carolina, for the first year of life and was set up principally to explore early-life factors that might predispose to obesity.

The scientists conducting the study interviewed the mothers every three months about the infants' diets and other factors and also collected stool samples from the infants. Data from 67 children were included in the new analysis, for which the researchers compared the timing of solid food introduction with the bacterial species and byproducts found in the month-3 and month-12 stool samples.

The team found that the samples from infants who had started on solid foods at or before three months, at the month-3 time point and even at the month-12 time point, contained a significantly higher diversity of bacteria, indicating a more diverse gut bacterial population or "microbiome," compared to samples from infants who had started later on solid foods. This finding is consistent with a 2018 Norwegian-led study, which linked higher gut microbiome diversity at 3 months of age to a greater chance of being overweight later in childhood.

The researchers also measured the stool-sample levels of organic bacterial byproducts called short-chain fatty acids. Prior studies have linked higher stool levels of butyric acid and other short-chain fatty acids in adults to increased risks of obesity, diabetes, and hypertension. Mueller and colleagues found in their study that infants starting on solid foods by three months had significantly higher concentrations of butyric acid, as well as total short-chain fatty acids, at 12 months--but not at 3 months, which could indicate a delayed and sustained impact of early solid-food introduction.

Mueller concludes that, on the whole, the findings are consistent with the emerging evidence that gut microbiome changes are key factors in the development of common metabolic and immune conditions, and suggest that scientists are on the right track in studying these changes. And, the authors say that further research is needed to determine if these measures of microbiome diversity and short-chain fatty acid concentration truly drive the development of obesity and other disorders.

Mueller and colleagues are continuing to conduct studies of diet and the gut microbiome in infants and children, and the associations between these factors and outcomes such as obesity and immune-related disorders.

"Timing of complementary feeding is associated with gut microbiota diversity and composition and short chain fatty acid concentrations over the first year of life" was written by Moira Differding, Sara Benjamin-Neelon, Cathrine Hoyo, Truls Østbye, and Noel Mueller.

Regular consumption of fish oil is likely associated with decreased all-cause and cardiovascular disease risk

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Consumption of fish oil was associated with decreased incidence of cardiovascular events with effects being most pronounced in patients with hypertension.

Lifestyle modification and dietary supplementation have long been recognized as potential avenues of additional therapeutic options to manage and prevent cardiovascular disease (CVD).  Fish oil and omega 3 fatty acid supplementation have previously been recognized as products that could potentially prevent CVD and have widespread usage globally despite follow-up investigations providing inconclusive results. 

To better characterize its suitability for usage in the general population, researchers conducted a large-scale cohort study published in the BMJ consisting of 427,678 participants aged 40 to 69 in the UK investigating the associations between fish oil supplementation with all-cause mortality, CVD mortality, and CVD events, consisting of strokes and myocardial infarction. Median follow up times were 9 years for mortality outcomes and 8.1 years for CVD events. 

Compared to controls, the cohort of 133,438 participants self-reporting habitual use of fish oil supplements had lower hazard ratios for all-cause mortality (0.87; 95% CI 0.83 – 0.90), CVD mortality (0.84; 95% CI, 0.78 – 0.91), and CVD events (0.93; 95% CI, 0.90 – 0.96). The effect of CVD event mitigation was most pronounced with patients with hypertension. Results were independent of possible confounding risk factors such as sex, BMI, physical activity, and diet. 

Findings from the study provide further evidence to suggest a role for fish oil supplementation in providing a marginal benefit for CVD management and the prevention of mortality from all causes and CVD.

Study shows legal marijuana products too strong for pain relief

More than 90% of the legal marijuana products offered in medical dispensaries are much stronger than what clinical studies have shown that doctors recommend for chronic pain relief, according to a study published in the March 26 online edition of the journal PLOS ONE.

To many that may seem like a good thing, but just the opposite is true.

"We know that high-potency products should not have a place in the medical realm because of the high risk of developing cannabis-use disorders, which are related to exposure to high THC-content products," said the study's lead author, Alfonso Edgar Romero-Sandoval, M.D., Ph.D., associate professor of anesthesiology at Wake Forest School of Medicine, part of Wake Forest Baptist Health.

"Several earlier studies showed that levels of up to 5% tetrahydrocannabinol (THC) - the main psychoactive compound in marijuana that provides pain relief as well as intoxication - were sufficient to reduce chronic pain with minimal side effects."

The goal of this study was to evaluate the advertised THC and CBD content of legal cannabis products to determine their suitability for medicinal use, and to compare the potency of the products offered in medical and recreational programs.

The researchers recorded the concentrations of THC and cannabidiol (CBD) - the non-euphoric compound in marijuana - in all plant cannabis products provided by legal dispensary websites and compared them between or within the states in the study: California, Colorado, Maine, Massachusetts, New Hampshire, New Mexico, Rhode Island, Vermont and Washington. A total of 8,505 cannabis products across 653 dispensaries were sampled.

Romero-Sandoval's team found that most of the products offered in the medical dispensaries in the study had more than 10% THC and that many had 15% or more, the same as what is available in products at recreational dispensaries.

This is problematic because between 60% and 80% of people who use medical marijuana use it for pain relief, Romero-Sandoval said. The higher the concentration of THC the greater risk, not only for developing dependency, but also for developing tolerance more quickly, which means higher and higher concentrations might be needed to get the same level of pain relief.

"It can become a vicious cycle," Romero-Sandoval said.

"Better regulation of the potency of medical marijuana products is critical. The FDA regulates the level of over-the-counter pain medications such as ibuprofen that have dose-specific side effects, so why don't we have policies and regulations for cannabis, something that is far more dangerous?"

This study provides the scientific evidence to help policy makers correct mistakes and to create a better framework to protect patients, he said.

Why life can get better as we age -- study

Mindfulness helps wellbeing at all ages

People say life gets better with age. Now research suggests this may be because older people have the wisdom and time to use mindfulness as a means to improve wellbeing.

Healthy ageing researchers at Flinders University say certain characteristics of mindfulness seem more strongly evident in older people compared to younger people - and suggest ways for all ages to benefit.

"This suggests that mindfulness may naturally develop with time and life experience," says behavioural scientist Associate Professor Tim Windsor, who co-authored a recent study based on an online community survey of 623 participants aged between 18 and 86?years.

"The significance of mindfulness for wellbeing may also increase as we get older, in particular the ability to focus on the present moment and to approach experiences in a non-judgmental way.

"These characteristics are helpful in adapting to age-related challenges and in generating positive emotions."

Mindfulness refers to the natural human ability to be aware of one's experiences and to pay attention to the present moment in a purposeful, receptive, and non-judgmental way. Using mindful techniques can be instrumental in reducing stress and promoting positive psychological outcomes.

From middle age to old age, the Flinders University survey highlights the tendency to focus on the present-moment and adopt a non-judgmental orientation may become especially important for well-being with advancing age.

In one of the first age-related studies of its kind, the researchers assessed participants' mindful qualities such as present-moment attention, acceptance, non-attachment and examined the relationships of these qualities with wellbeing more generally.

"The ability to appreciate the temporary nature of personal experiences may be particularly important for the way people manage their day-to-day goals across the second half of life," says study lead author Leeann Mahlo, who is investigating mindfulness in older adulthood as part of her PhD research.

"We found that positive relationships between aspects of mindfulness and wellbeing became stronger from middle age onwards," she says.

"Our findings suggest that if mindfulness has particular benefits in later life, this could be translated into tailored training approaches to enhanced wellbeing in older populations."

Mindfulness skills can help build wellbeing at any age, adds clinical psychology PhD candidate Ms Mahlo.

Tips to develop mindful techniques include:

• Becoming aware of our thoughts and surroundings and paying attention to the present moment in an open and nonjudgmental way. This can prevent us from focusing on the past or worrying about the future in unhelpful ways.
• Understanding that our thoughts, feelings and situations exist in the moment and will not last. This can help us to respond in flexible, more optimistic ways to challenging circumstances, including those that we are facing with concerns related to the COVID-19 disease.
• Finding out more about mindfulness via app-based programs such as Calm, Headspace, Insight Timer, Smiling Mind, and Stop, Breathe & Think. These are available for use on computers or smartphones and offer flexible ways of learning and practising mindfulness - including for people now spending more time at home.

Low risk of coronavirus spreading through tears

While researchers are certain that coronavirus spreads through mucus and droplets expelled by coughing or sneezing, it is unclear if the virus is spread through other bodily fluids, such as tears. Today's just-published study offers evidence that it is unlikely that infected patients are shedding virus through their tears, with one important caveat. None of the patients in the study had conjunctivitis, also known as pink eye. However, health officials believe pink eye develops in just 1 percent to 3 percent of people with coronavirus. The study's authors conclude that their findings, coupled with the low incidence of pink eye among infected patients, suggests that the risk of virus transmission through tears is low. Their study was published online today in Ophthalmology, the journal of the American Academy of Ophthalmology.

To conduct the study, Ivan Seah, MBBS, and his colleagues at the National University Hospital in Singapore collected tear samples from 17 patients with COVID-19 from the time they showed symptoms until they recovered about 20 days later. Neither viral culture nor reverse transcription polymerase chain reaction (RT-PCR) detected the virus in their tears throughout the two-week course of the disease.

Dr. Seah also took samples from the back of the nose and throat during the same time period. While the patients' tears were clear of virus, their noses and throats were teeming with COVID-19. Dr. Seah said he hopes their work helps to guide more research into preventing virus transmission through more significant routes, such as droplets and fecal-oral spread.

Despite this reassuring news, it's important for people to understand that guarding your eyes -- as well as your hands and mouth -- can slow the spread of respiratory viruses like the coronavirus.

Here's why:

• When a sick person coughs or talks, virus particles can spray from their mouth or nose into another person's face. You're most likely to inhale these droplets through your mouth or nose, but they can also enter through your eyes.
• You can also become infected by touching something that has the virus on it -- like a table or doorknob -- and then touching your eyes.

Commonly used mouthwash could make saliva significantly more acidic

The first study looking at the effect of chlorhexidine mouthwash on the entire oral microbiome has found its use significantly increases the abundance of lactate-producing bacteria that lower saliva pH, and may increase the risk of tooth damage.

A team led by Dr Raul Bescos from the University of Plymouth's Faculty of Health gave a placebo mouthwash to subjects for seven days, followed by seven days of a chlorhexidine mouthwash.

At the end of each period, the researchers carried out an analysis of the abundance and diversity of the bacteria in the mouth - the oral microbiome - as well as measuring pH, saliva buffering capacity (the ability to neutralise acids in the mouth), lactate, glucose, nitrate and nitrite concentrations.

The research, published in Scientific Reports today, found using chlorhexidine mouthwash over the seven days led to a greater abundance of species within the families of Firmicutes and Proteobacteria, and fewer Bacteroidetes, TM7 and Fusobacteria. This change was associated with an increase in acidity, seen in lower salivary pH and buffering capacity.

Overall, chlorhexidine was found to reduce microbial diversity in the mouth, although the authors cautioned more research was needed to determine if this reduction in diversity itself increased the risk of oral disease.

One of the primary roles of saliva is to maintain a neutral pH in the mouth, as acidity levels fluctuate as a result of eating and drinking. If saliva pH gets too low, damage can occur to the teeth and mucosa - tissue surrounding the teeth and on the inside of the mouth.

The research also confirmed findings from previous studies indicating that chlorhexidine disrupted the ability of oral bacteria to turn nitrate into nitrite, a key molecule for reducing blood pressure. Lower saliva and blood plasma nitrite concentrations were found after using chlorhexidine mouthwash, followed by a trend of increased systolic blood pressure. The findings supported earlier research led by the University that showed the blood pressure-lowering effect of exercise is significantly reduced when people rinse their mouths with antibacterial mouthwash rather than water.

Dr Bescos said: "There is a surprising lack of knowledge and literature behind the use of these products. Chlorhexidine mouthwash is widely used but research has been limited to its effect on a small number of bacteria linked to particular oral diseases, and most has been carried out in vitro.

"We believe this is the first study to look at the impact of 7-day use on the whole oral microbiome in human subjects."

Dr Zoe Brookes and Dr Louise Belfield, Lecturers in the Peninsula Dental School at the University of Plymouth, are co-authors of the study.

Dr Belfield said: "We have significantly underestimated the complexity of the oral microbiome and the importance of oral bacteria in the past. Traditionally the view has been that bacteria are bad and cause diseases. But we now know that the majority of bacteria - whether in the mouth or the gut - are essential for sustaining human health."

Dr Brookes added: "As dental clinicians, we need more information on how mouthwashes alter the balance of oral bacteria, so we can prescribe them correctly. This paper is an important first step in achieving this.

"In the face of the recent COVID-19 outbreak many dentists are now using chlorhexidine as a pre-rinse before doing dental procedures. We urgently need more information on how it works on viruses"

Half of 65+ adults lack dental insurance

Oral care coverage acts as a strong draw for enrolling in Medicare Advantage plans

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

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IMAGE: KEY FINDINGS FROM THE NATIONAL POLL ON HEALTHY AGING POLL OF ADULTS AGED 65-80 view more 

CREDIT: UNIVERSITY OF MICHIGAN

Nearly all older Americans support adding a dental benefit to the Medicare program that covers most people over age 65, according to a new national poll that also reveals how often costs get in the way of oral health for older adults.

Ninety-three percent of people between the ages of 65 and 80 favor including dental coverage in traditional Medicare, though the percentage dropped to 59% when they were asked if they'd favor it even if they had to pay more for their Medicare benefits.

Just over half of the older adults polled (53%) said they currently have dental coverage. Half of this group are covered as employees or retirees, or spouses of employees.

Another quarter said they have dental coverage because they've chosen to get their Medicare coverage through a Medicare Advantage plan offered by a commercial insurance company. In fact, 72% of those with Medicare Advantage coverage said they'd chosen their plan in part because it covered dental care.

Whether they had insurance or not, cost plays a role in dental decisions, the poll finds. One in five of the older adults polled said they had delayed getting dental care, or gone without it, in the past two years.

The majority of these respondents said cost, or insurance problems, played a role in this decision. Those without dental insurance, and those with lower incomes, were more likely to say they'd delayed or gone without oral care.

The new results come from the National Poll on Healthy Aging, carried out by the University of Michigan Institute for Healthcare Policy and Innovation with support from AARP and Michigan Medicine, U-M's academic medical center. It involved a national sample of more than 1,030 adults aged 65 to 80 who answered a range of questions about their own oral health and dental health policy.

"These results suggest that health care providers and policymakers should seek solutions to better identify and address how cost and other factors act as barriers to dental care among older adults," says Domenica Sweier, Ph.D., D.D.S.

Sweier, a clinical associate professor at the U-M School of Dentistry, helped develop the poll questions and analyze the results. She adds that as providers and policy makers continue to seek solutions, "This will be important to preventing health and social consequences of unmet oral health needs in this population."

Differences across the over-50 age range

A previous National Poll on Healthy Aging report looked at dental health, including insurance and cost factors, among people in their 50s and early 60s. Only one in four of those polled said they lacked dental insurance, but half said they did not know how they would get dental coverage after they retired and some assumed that traditional Medicare would cover their dental care needs.

"Across the spectrum of ages, dental care and coverage vary, and cost plays a major role," says Preeti Malani, M.D., director of the poll and a professor of internal medicine at U-M with special training in the care of older adults. "We know that poor oral health can affect everything from social interactions to eligibility for surgery, so it's important for health professionals as well as policymakers to understand what older adults are experiencing."

One in four of the adults over 65 polled (27%) said they were embarassed by the condition of the teeth, and about the same percentage rated their overall dental health as fair or poor.

The role of dental care costs

One in three hadn't been to the dentist for preventive care such as a cleaning in at least a year. When the research team cross-referenced this with household income, they found that those with incomes over $60,000 were nearly twice as likely as those with incomes less than $30,000 to have gone to the dentist in the past year.

Nearly half of the poll sample (46%) said they were missing teeth but didn't have a denture or implant to fill the gap.

"Coverage of dental care, as well as vision and hearing care, is critical for the long-term health of our population" says Alison Bryant, Ph.D., senior vice president of research for AARP. "Even simple teeth cleanings may not be affordable to seniors living on fixed incomes, so having coverage for dental benefits may help address that problem."

The poll also shines additional light on the growing body of evidence linking oral health and overall health and wellbeing.

Those who said their overall physical or mental health were fair or poor also visited the dentist's office less often, and were more likely to say their oral health was poor. Problems with dry mouth related to medication use, and challenges eating a healthy diet because of untreated dental problems, could make these issue worse, says Malani.

The National Poll on Healthy Aging results are based on responses from a nationally representative sample of 1,039 adults aged 65 to 80 who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have them.

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A full report of the findings and methodology is available at http://www.healthyagingpoll.org, along with past National Poll on Healthy Aging reports.

Past your bedtime? Inconsistency may increase risk to cardiovascular health

Despite increasing awareness of how critical sleep is to our health, getting a good night's rest remains increasingly difficult in a world that's always "on" -- responding to emails at all hours, news cycles that change with every tweet and staring endlessly into the blue light of cell phone, tablet and computers screens.

Scientists have stressed the importance of healthy sleep habits, recommending at least seven hours each night, and have linked lack of sleep to an increased risk in numerous health conditions, including diabetes, stroke and cardiovascular disease.

Now a new study shows whether or not you go to bed on time could also have an effect on your health. Researchers at the University of Notre Dame studied the correlation between bedtime regularity and resting heart rate (RHR) and found that individuals going to bed even 30 minutes later than their usual bedtime presented a significantly higher resting heart rate that lasted into the following day.

"We already know an increase in resting heart rate means an increased risk to cardiovascular health," said Nitesh Chawla, the Frank M. Freimann professor of Computer Science and Engineering at Notre Dame, director of the Center for Network and Data Science and a lead author of the study. "Through our study, we found that even if you get seven hours of sleep a night, if you're not going to bed at the same time each night, not only does your resting heart rate increase while you sleep, it carries over into the next day."

Chawla and his team analyzed data collected via Fitbit from 557 college students over the course of four years. They recorded 255,736 sleep sessions -- measuring bedtimes, sleep and resting heart rate. Significant increases in RHR were observed when individuals went to bed anywhere between one and 30 minutes later than their normal bedtime. Normal bedtime was defined as the one-hour interval surrounding a person's median bedtime. The later they went to bed, the higher the increase in RHR. Rates remained elevated into the following day.

Surprisingly, going to bed earlier than one's standard bedtime also showed signs of increasing RHR, though it depended on just how early. Going to bed 30 minutes earlier than usual appeared to have little effect, while going to bed more than a half hour earlier significantly increased RHR. In cases of earlier bedtimes, however, RHR leveled out during the sleep session. Circadian rhythms, medications and lifestyle factors all come into play when it comes to healthy sleep habits, but Chawla said it's vital to consider consistency as well.

"For some, it may be a matter of maintaining their regular 'work week' bedtime through the weekend," said Chawla. "For shift workers and those who travel frequently, getting to bed at the same time each night is a challenge. Establishing a healthy bedtime routine -- as best you can -- is obviously step number one. But sticking to it is just as important."

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