Sunday, October 31, 2021

Latest Health Research

General Health


Although most colds in children don’t cause serious complications, they can cause stress and worry in parents and caregivers. It’s understandable that you might want to give your child medicine to treat a cold. But most children will get better on their own, and cough or cold medicine will not change the natural course of a cold or make it go away faster. In addition, some cough and cold medicines can have serious side effects, such as slowed breathing, which can be life-threatening, especially in infants and young children. For those reasons, it’s important to know when your ch... read more
Unless you’re a water-polo player, the “egg-beater” technique may mean little to you. But new research from the University of Otago has found it may be the most effective skill you can learn to prevent drowning. Dr Tina van Duijn, from the University’s School of Physical Education, Sport and Exercise Sciences, says it is important during an emergency to be able to perform a moveme... read more

Is the use of epidural analgesia during labor associated with adverse neonatal and childhood outcomes? *Findings* In this population-based cohort study of 435 281 mother-offspring pairs, the use of epidural analgesia in labor was not associated with adverse neonatal outcomes after adjustment for confounders and mediation by mode of delivery. Epidural analgesia was, however, associated with a small reduction in some adverse developmental outcomes at 2 years. *Meaning* In this study, epidural analgesia in labor was not associated with adverse immediate or longer-term offspring o... read more


Chest discomfort associated with a heart attack or heart event may often be felt beyond the chest, with many people reporting pain in their shoulders, arms, jaw, neck, back and upper abdomen. A new approach to evaluate the source and symptoms of chest pain can help clinicians improve patient outcomes and reduce health care costs, according to a new joint guideline from the American Heart Association and the American College of Cardiology. The guideline publishes today in the American Heart Association’s flagship journal *Circulation* and simultaneously in the *Journal of the Amer... read more


The number of people experiencing numbness, tingling and pain in their feet with no known cause has been increasing over the last two decades, according at a new study published in the October 27, 2021, online issue of *Neurology®*, the medical journal of the American Academy of Neurology*. *Called small fiber neuropathy, the condition has different symptoms than large fiber neuropathy, which can cause weakness and balance issues. But in many cases people have both types of neuropathy. For the study, researchers looked at records for everyone diagnosed with small fiber neuropat... read more

Many sunscreens offer just a quarter of their stated SPF protection against ultraviolet A rays that increase the risk of skin cancer, a new Environmental Working Group study finds. For the study, EWG scientists tested 51 sunscreens with SPF between 15 and 110. “Most of the products we tested reduced UV radiation only by half of what would be expected from looking at the SPF on the label,” said David Andrews, Ph.D., a senior scientist at EWG and the lead author of the study unveiled today. The new research, published in the peer-reviewed journal *Photodermatology, Photoimmunolog... read more


Diet

Chicken nuggets, burritos and other popular items consumers buy from fast food outlets in the United States contain chemicals that are linked to a long list of serious health problems, according to a first-of-its-kind study published today. Researchers at the George Washington University and their colleagues bought fast foods from popular outlets and found 10 of 11 potentially harmful chemicals in the samples, including phthalates, a group of chemicals that are used to make plastics soft and are known to disrupt the endocrine system. The research team also found other plasticizer... read more


Green tea has long been known to have health benefits. In particular, it contains catechins called ECG and EGCG that are said to prolong life. These two substances belong to the group of polyphenols. They are considered antioxidants, which means they counteract or prevent oxidative stress in the body caused by aggressive free radicals of oxygen. Until now, research has assumed that the catechins neutralise these free radicals and thus prevent damage to cells or DNA. One source of oxygen free radicals is metabolism; for example, when the mitochondria – the powerhouses of the cell ... read more

In a study published in the *International Journal of Cancer* of breast cancer survivors, nut consumption was linked with lower risks of breast cancer recurrence or death. Among 3,449 breast cancer survivors from the Shanghai Breast Cancer Survival Study who completed a dietary assessment 5 years after diagnosis, there were 374 deaths during a median follow-up of 8.27 years after the dietary assessment. Among 3,274 survivors without a previous recurrence at the time of their dietary assessment, 209 developed breast cancer–specific events, including recurrence, metastasis, or br... read more

A new study suggests 100% orange juice has the potential to help fight inflammation and oxidative stress in adults, paving the way for further research on the topic. Though limited in scope, the study indicates drinking 100% orange juice significantly reduces interleukin 6, a well-established marker of inflammation, in both healthy and high-risk adults. Two additional inflammatory and oxidative stress markers were also reduced; however, the results did not quite reach statistical significance. The findings of this study, which was funded through an unrestricted grant by the Flor... read more

Sleep

*Periodically catching up on sleep can improve gait control for the chronically sleep-deprived.* Good sleep can be hard to come by. But a new study finds that if you can make up for lost sleep, even for just a few weekend hours, the extra zzz’s could help reduce fatigue-induced clumsiness, at least in how you walk. There’s plenty of evidence to show sleep, and how much we get of it, can affect how well we do on cognitive tasks such as solving a math problem, holding a conversation, or even reading this article. Less explored is the question of whether sleep influences the way we ... read more

Like so many other good things in life, sleep is best in moderation. A multiyear study of older adults found that both short and long sleepers experienced greater cognitive decline than people who slept a moderate amount, even when the effects of early Alzheimer’s disease were taken into account. The study was led by researchers at Washington University School of Medicine in St. Louis. Poor sleep and Alzheimer’s disease are both associated with cognitive decline, and separating out the effects of each has proven challenging. By tracking cognitive function in a large group of olde... read more



Aging

Polyphenol-rich diets improve leaky gut syndrome in the elderly
The increase of intestinal permeability is associated with factors such as ageing, food allergies and intolerances and unhealthy diets. This alteration causes a reduction of the gut integrity barrier that triggers the transit of potentially-toxic substances for the blood, and is related to the development of chronic diseases such as diabetes, cardiovascular diseases and even Alzheimer’s. A polyphenol-rich diet improves the intestinal permeability in old people, according to an article published in the journal *Clinical Nutrition*. The study is led by Cristina AndrĂ©s-Lacueva, prof... read more

Learning a second language is an effective and enjoyable way to improve brain health, reports a new study that was jointly conducted by Baycrest and York University. Researchers found that older adults who studied Spanish showed similar improvements in certain critical cognitive skills as did those who engaged in brain training activities that targeted those skills. These results are remarkable given that brain training focuses specifically on improving these aspects of cognition, while language learning does not. As well, those who learned Spanish reported greater enjoyment than ... read more

A new study led by researchers at UCLA Health has found that women over the age of 50 who had breastfed their babies performed better on cognitive tests compared to women who had never breastfed. The findings, published in *Evolution, Medicine and Public Health*, suggest that breastfeeding may have a positive impact on postmenopausal women’s cognitive performance and could have long-term benefits for the mother’s brain. “While many studies have found that breastfeeding improves a child’s long-term health and well-being, our study is one of very few that has looked at the long-t... read more

“Motivation is the royal road to understanding healthy aging,” says a new supplemental issueto *The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences*. Motivation science investigates what it is that people desire and dislike or even fear, how these desires, dislikes, and fears are transformed into goals, how people go about pursuing these goals successfully or disengage from them if necessary, and how these processes change over time. The supplement is comprised of nine articles addressing one or more components of a motivational model of healthy agin... read more

Like so many other good things in life, sleep is best in moderation. A multiyear study of older adults found that both short and long sleepers experienced greater cognitive decline than people who slept a moderate amount, even when the effects of early Alzheimer’s disease were taken into account. The study was led by researchers at Washington University School of Medicine in St. Louis. Poor sleep and Alzheimer’s disease are both associated with cognitive decline, and separating out the effects of each has proven challenging. By tracking cognitive function in a large group of olde... read more


Exercise

There is debate over whether vigorous physical activity is a risk factor for amyotrophic lateral sclerosis (ALS). A new study suggests it depends on whether that vigorous activity you get over your lifetime happens on the job or during leisure time. The research is published in the October 20, 2021, online issue of *Neurology®*, the medical journal of the American Academy of Neurology*.* ALS is a rare, progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. People with ALS lose the ability to initiate and control muscle movement, which oft... read more



COVID

 COVID vaccines 5 times more effective at preventing COVID-related hospitalization than prior infection alone

*Findings suggest people who recovered from the virus should still receive vaccines* A nationwide study from the Centers for Disease Control and Prevention (CDC) shows that mRNA COVID-19 vaccines are associated with significantly more immunity than a prior COVID-19 infection. Researchers from the CDC’s VISION Network gathered data from more than 201,000 hospitalizations in nine different states. About 7,000 people in that group fit the criteria for this study. The research team analyzed the number of unvaccinated individuals who had a positive COVID-19 test more than three m... read more


A new paper in *The Economic Journal* indicates that a large-scale government subsidy aimed at encouraging people to eat out in restaurants in the wake of the first 2020 COVID-19 wave in the United Kingdom accelerated a second COVID19 wave. The COVID19 pandemic caused by the novel coronavirus hurt economies around the world. The hospitality sector was particularly vulnerable due to forced decline in tourism and leisure activities. This rippled across economies, as hospitality workers then reduce their spending and have trouble meeting basic expenses. Some governments have used fi... read more


People who have received two vaccine doses against COVID-19 have a lower, but still appreciable, risk of becoming infected with the delta variant compared with unvaccinated people. Vaccinated people clear the infection more quickly, but the peak viral load among vaccinated people is similar to that seen in unvaccinated people, which may explain why they can still readily pass on the virus in household settings, according to a study published in *The Lancet Infectious Diseases*. Vaccines remain highly effective at preventing severe disease and deaths from COVID-19, but some studie... read more


*Results provide reassurances of the vaccines’ safety.* New research addresses ongoing concerns regarding risks of allergic reactions after receiving mRNA COVID-19 vaccines, particularly for individuals with a history of severe allergic reactions. The *JAMA Network Open* study of employee vaccinations within the Mass General Brigham health care system revealed that although people with such a history reported more allergic symptoms after vaccination, nearly all of them were able to become fully vaccinated. In the study of 52,998 health care employees, 474 (0.9%) reported a his... read more


Vaccination is over 90 per cent effective at preventing deaths from the Delta variant of Covid-19, according to the first country-level data on mortality. The Pfizer-BioNTech vaccine is 90 per cent effective and the Oxford-AstraZeneca vaccine 91 per cent effective in preventing deaths in people who have been double vaccinated, but who have tested positive for coronavirus in the community, research shows. The study, using data from the Scotland-wide EAVE II Covid-19 surveillance platform, is the first to show across an entire country how effective vaccines are at preventing death... read more

Two new studies report that COVID-19 vaccination strongly protects against both infection and serious illness, respectively among adolescents age 12 to 18. Both studies covered periods when the highly contagious Delta variant was the predominant circulating strain. A CDC-supported study, led by Boston Children’s Hospital and published in the *Morbidity & Mortality Weekly Report (MMWR)* on October 19, focused on severe COVID-19 disease requiring hospitalization. It found that two doses of the Pfizer-BioNTech COVID-19 vaccine were 93 percent effective at preventing COVID-19 hos... read more

A new study led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by “la Caixa” Foundation, provides robust evidence that COVID-19 is a seasonal infection linked to low temperatures and humidity, much like seasonal influenza. The results, published in *Nature Computational Science*, also support the considerable contribution of airborne SARS-CoV-2 transmission and the need to shift to measures that promote “air hygiene”. A key question regarding SARS-CoV-2 is whether it is behaving, or will behave, as a seasonal virus like influenza, or whether i... read more

A new study published in The New England Journal of Medicine has found no correlation between COVID-19 vaccinations and risk of first-trimester miscarriages, providing further evidence of the safety of COVID-19 vaccination during pregnancy. The study analyzed several national health registries in Norway to compare the proportion of vaccinated women who experienced a miscarriage during the first trimester and women who were still pregnant at the end of the first trimester. “Our study found no evidence of an increased risk for early pregnancy loss after COVID-19 vaccination and add... read more


Antibodies in the airways quickly wane after SARS-CoV-2 infection, but vaccination results in a strong increase in antibody levels, especially after two doses, according to a new study from Karolinska Institutet in Sweden published in the journal *JCI Insight*. The results suggest that having a second dose of vaccine also after recovering from COVID-19 may be important for protecting against re-infection and to prevent transmission. “What makes the study unique is that we have looked at samples from both blood and airways, which has given us new knowledge of the local immune res... read more

“Motivation is the royal road to understanding healthy aging,” says a new supplemental issueto *The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences*. Motivation science investigates what it is that people desire and dislike or even fear, how these desires, dislikes, and fears are transformed into goals, how people go about pursuing these goals successfully or disengage from them if necessary, and how these processes change over time. The supplement is comprised of nine articles addressing one or more components of a motivational model of healthy agin... read more

Like so many other good things in life, sleep is best in moderation. A multiyear study of older adults found that both short and long sleepers experienced greater cognitive decline than people who slept a moderate amount, even when the effects of early Alzheimer’s disease were taken into account. The study was led by researchers at Washington University School of Medicine in St. Louis. Poor sleep and Alzheimer’s disease are both associated with cognitive decline, and separating out the effects of each has proven challenging. By tracking cognitive function in a large group of olde... read more



*Key antibody functions are delayed in pregnant and lactating women following initial COVID-19 vaccine dose, but the second dose induces robust antibody responses similar to those in nonpregnant women* A new study indicates that the two-dose immunization schedule for COVID-19 mRNA vaccines ultimately stimulates comparable antibody responses in pregnant, lactating, and nonpregnant women of reproductive age, but key antibody functions kick in more slowly in pregnant and lactating women following the first dose. The research, which was led by investigators at Massachusetts General ... read more

Strong antibody response to mRNA vaccines declined over an eight-month follow-up period; lower initial response to single-shot Ad26 vaccine remained stable over time, research shows P Based on the strength of clinical trial data showing the vaccines conferred robust protection against COVID-19, the U.S. Food & Drug Administration granted emergency use authorization to the mRNA-based vaccines known as BNT162b2 (BioNTech, Pfizer) and mRNA-1273 (Moderna) in December 2020, and to the Ad26.COV2.S (Johnson & Johnson) single-shot vaccine in February 2021. To date, nearly 200 million Am... read more

Last Summary

Friday, October 29, 2021

COVID vaccines 5 times more effective at preventing COVID-related hospitalization than prior infection alone

 

Findings suggest people who recovered from the virus should still receive vaccines


 A nationwide study from the Centers for Disease Control and Prevention (CDC) shows that mRNA COVID-19 vaccines are associated with significantly more immunity than a prior COVID-19 infection.

Researchers from the CDC’s VISION Network gathered data from more than 201,000 hospitalizations in nine different states. About 7,000 people in that group fit the criteria for this study. The research team analyzed the number of unvaccinated individuals who had a positive COVID-19 test more than three months before being hospitalized for the virus as well as the number of individuals who received the Pfizer or Moderna vaccine and were not diagnosed with COVID prior to being admitted to the hospital. The research team found that overall, unvaccinated adults with a previous COVID-19 infection were about five times more likely to be hospitalized than those who were vaccinated.

“This data provides powerful evidence that vaccinations offer superior protection against COVID-19 than relying on natural immunity alone,” said Shaun Grannis, M.D., M.S., vice president for data and analytics at Regenstrief Institute and professor of family medicine at Indiana University School of Medicine. “Many have been asking if they should get vaccinated if they’ve already been infected – this research shows the answer is yes.” Regenstrief contributes data and expertise to the VISION Network.

The data analysis also found among adults older than 65, overall mRNA vaccines were nearly 20 times more effective at preventing hospitalizations than prior infection alone.

Authors are from 10 states and 14 institutions, including the public sector, research, clinical and academia. Dr. Grannis was the second author of about 50. Other Regenstrief authors include Brian E. Dixon, PhD, MPA, Regenstrief and IU Richard M. Fairbanks School of Public Health; William F. Fadel, PhD, a Regenstrief fellow; Peter J. Embi, M.D., M.S., Regenstrief and IU School of Medicine; and Nimish Ramesh Valvi, DrPH, MBBS, a Regenstrief fellow.

The study findings are consistent with laboratory evidence that mRNA vaccines create high levels of antibodies, whereas those who recover from COVID-19 have varying levels of antibodies, especially if they experienced mild symptoms or were asymptomatic. 

Should You Give Kids Medicine for Coughs and Colds?

Although most colds in children don’t cause serious complications, they can cause stress and worry in parents and caregivers. It’s understandable that you might want to give your child medicine to treat a cold. But most children will get better on their own, and cough or cold medicine will not change the natural course of a cold or make it go away faster.

 
In addition, some cough and cold medicines can have serious side effects, such as slowed breathing, which can be life-threatening, especially in infants and young children. For those reasons, it’s important to know when your child needs medication, which treatments are recommended, and when to do without medicine.

These days, cold and cough symptoms can be especially worrisome, because they could be symptoms of COVID-19, the flu, or other potentially serious illness. If you are concerned about COVID-19, talk to your child’s health care provider.

Ways to Treat Colds in Infants and Children

Coughs are a normal symptom of a cold and help the body clear the mucus out of the airway and protect the lungs. Non-drug treatments for coughs include drinking plenty of fluids, especially warm drinks to soothe the throat.

The U.S. Food and Drug Administration offers these tips for relieving cough and cold symptoms in infants and children:

cool mist humidifier makes breathing easier by decreasing congestion in nasal passages. Do not use warm mist humidifiers because they can cause nasal passages to swell and make breathing more difficult. 

Saline nose drops or sprays keep nasal passages moist and help avoid stuffiness. 

Nasal suctioning with a bulb syringe or a similar product, with or without saline nose drops, works very well for children younger than a year old. You can use them on older children, too, but they often resist bulb syringes.

Acetaminophen or ibuprofen can be used to reduce fever, aches, and pain. Carefully read and follow the product’s instructions on the Drug Facts label or talk to your pharmacist or health care provider about dosage. 

Encourage children to drink plenty of liquids to stay hydrated.

Giving Children Cough and Cold Medicines

Over-the-counter (OTC) medicines are available to treat cough and cold symptoms. The FDA doesn’t recommend OTC medicines for cough and cold symptoms in children younger than 2 because they could cause serious and potentially life-threatening side effects. Manufacturers voluntarily label these cough and cold products to state: “Do not use in children under 4 years of age.” 

Numerous OTC cough and cold products contain many ingredients that can lead to accidental overdosing. Learn about what drugs (active ingredients) are in a product by reading the Drug Facts label.

Nonprescription cough and cold products can be harmful to children if:

  • They get more than the recommended dose or take the medicine too often.
  • They take more than one product containing the same drug. For example, taking both a pain reliever containing acetaminophen and cough and cold medicine containing acetaminophen.  

How can you be sure to give the correct dose? The FDA encourages drug manufacturers to provide a dosing instrument, such as a syringe or a cup, marked with the correct measurements. Use them—and not household spoons or tools from other medications—to measure medication.

Don’t give children medicines that are packaged and made for adults because adult medicines may overdose a child.

There Are No FDA-Approved Homeopathic Products

At your pharmacy and online, you may see other cough and cold medicine being sold for children advertised as homeopathic. It’s important to note that these homeopathic products are drugs because they are intended to treat or mitigate colds, even though some of these products might look similar to dietary supplements.

Homeopathic products are generally labeled as containing very small amounts of highly diluted substances, including ingredients from plants, animal or human sources, bacteria, minerals, and chemicals. The FDA has found that some of these products contain active drug ingredients in levels that far exceed the amount stated on the product’s label, and could cause significant harm to children.

There are no FDA-approved homeopathic products, and homeopathic products sold in the U.S. have not met the FDA’s requirements for safety and effectiveness. The FDA is not aware of any proven benefits of these products and urges you not to give homeopathic cough and cold medicine to children younger than 4.

In certain instances, children younger than 4 who took these products have experienced serious side effects, some of which required hospitalization, including:

  • Seizure, allergic reaction, and difficulty breathing.
  • Low blood potassium and low blood sugar, which may result in headache, crankiness, drowsiness, and weakness.

These serious side effects occurred soon after children took a homeopathic cough and cold product; however, it is not always possible to know whether a reported side effect was caused by a medicine.

When to Call a Doctor

Not every sniffle or cough merits a trip to the doctor’s office. When in doubt, call your health care provider. 

Some symptoms can signal that your child may have something more serious than a cold. For all children, call a doctor if you see any of these symptoms:

  • A fever of 100.4 degrees Fahrenheit or higher in an infant 2 months or younger.
  • A fever of 102 degrees Fahrenheit or higher in children at any age.
  • Blue lips.
  • Labored breathing, including nostrils widening with each breath; wheezing; fast breathing; the ribs showing with each breath; or shortness of breath.
  • Severe headache.
  • Not eating or drinking, with signs of dehydration (such as decreased urination).
  • Excessive crankiness or sleepiness.
  • Persistent ear pain.
  • If the child is getting worse.
     

Thursday, October 28, 2021

Best water treading technique to prevent drowning

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Dr Tina van Duijn 

IMAGE: DR TINA VAN DUIJN FROM THE UNIVERSITY OF OTAGO'S SCHOOL OF PHYSICAL EDUCATION, SPORT AND EXERCISE SCIENCES.view more 

CREDIT: THE UNIVERSITY OF OTAGO

Unless you’re a water-polo player, the “egg-beater” technique may mean little to you.

But new research from the University of Otago has found it may be the most effective skill you can learn to prevent drowning.

Dr Tina van Duijn, from the University’s School of Physical Education, Sport and Exercise Sciences, says it is important during an emergency to be able to perform a movement in the water that is economic – both energetically and cognitively.

“You should still be able to perform it while in panic, or while assessing the environment, making decisions, or even alerting people who might be able to help you.”

Her new research “A Multidisciplinary Comparison of Different Techniques Among Skilled Water Treaders”, funded by the Swiss National Science Foundation, is the first step in identifying what pattern of water treading is best to prevent drowning.

The study involved monitoring the physical and cognitive demands of four common treading techniques on 21 people experienced in water treading, who were chosen to ensure that all the techniques were performed correctly.

Those techniques are: “running” in the water, “flutter kick” with hands sculling, “upright breaststroke” and the “egg-beater”, where the legs alternate breaststroke kicks.

The swimmers were asked to perform the four techniques for three minutes each in a swimming flume while their oxygen intake and carbon dioxide production, as well as their heart rate, were monitored.

Cognitive effects were assessed through a test during the first minute of treading, where participants had to verbally respond to cues presented on a screen.

It was the “egg-beater” technique, closely followed by the “upright breaststroke”, that came out on top.

Dr van Duijn says a potential reason for the “egg -beater” being the most economic could be because a different physical force is generated when performing sculling movements, compared to kicking and pushing movements.

“Continuous sculling movements have no recovery phase and generate a lift force, which tends to be more effective.”

However, it is also for that reason she was surprised to find the “upright breaststroke” technique proved almost as good as the “egg-beater”, despite including a recovery phase.

Dr van Duijn says it is possible that the combination of synchronous, lateral kicks with sculling hand movements in “upright breaststroke” was sufficiently economic for this task because participants’ hands were not otherwise occupied.

But if someone needed to lift their hands out of water to grab something or signal for help, she suggested the “egg-beater” would likely be the best solution to stay level.

As for the “running” and “flutter-kick” techniques, they were significantly more physically and mentally demanding.

Dr van Duijn hopes her research will emphasise the importance of teaching water treading techniques that withstand the effects of panic, fatigue and multitasking.

Her study lays the groundwork for future research to establish what the ideal movement to perform in drowning situations is for everyone, and the next step will be to test the techniques on less-experienced swimmers, and in different swimming environments.

 “It is often the case that when people are getting caught in rips, or they jump into a lake and it is deeper than they thought, they just kick as fast and as hard as they can.

“Determining which treading water techniques are energetically and cognitively economic is an important first step in approaching evidence-based water safety instruction,” Dr van Duijn says.

Epidural analgesia in labor was not associated with adverse immediate or longer-term offspring outcome

 Is the use of epidural analgesia during labor associated with adverse neonatal and childhood outcomes?

Findings  In this population-based cohort study of 435 281 mother-offspring pairs, the use of epidural analgesia in labor was not associated with adverse neonatal outcomes after adjustment for confounders and mediation by mode of delivery. Epidural analgesia was, however, associated with a small reduction in some adverse developmental outcomes at 2 years.

Meaning  In this study, epidural analgesia in labor was not associated with adverse immediate or longer-term offspring outcomes.

Abstract

Importance  Although use of epidural analgesia during labor is safe, detailed information about its association with neonatal and child outcomes is limited.

Objective  To investigate the association of labor epidural analgesia with neonatal outcomes and childhood development during the first 1000 days of life.

Design, Setting, and Participants  This population-based cohort study used Scottish National Health Service hospital administrative data of all 435 281 singleton live births in Scotland between January 1, 2007, and December 31, 2016, with follow-up over the first 1000 days of life. All 435 281 mother-infant pairs delivering between 24 weeks 0 days and 43 weeks 6 days’ gestation who were in active labor with cephalic presentation and who delivered vaginally or via unplanned cesarean delivery were included. Stillbirths and infants with known congenital anomalies were excluded. Data were analyzed between August 1, 2020, and July 23, 2021.

Exposures  Epidural analgesia in labor.

Main Outcomes and Measures  Neonatal outcomes included resuscitation, Apgar score less than 7 at 5 minutes, and neonatal unit admission. Childhood development measures (gross and fine motor function, communication, and social functioning) were obtained from standardized national childhood surveillance assessments performed at 2 years.

Results   Epidural analgesia was associated with a reduced risk of an Apgar score less than 7 at 5 minutes in both confounder and confounder/mediation analyses. Epidural analgesia was associated with a reduced risk of having developmental concern in any domain at 2 years in confounder and confounder/mediation analyses (CMadj RR, 0.96; 95% CI, 0.93-0.98), with specifically fewer concerns regarding communication (CMadj RR, 0.96; 95% CI, 0.93-0.99) and fine motor skills (CMadj RR, 0.89; 95% CI, 0.82-0.97).

Conclusions and Relevance  The results of this cohort study suggest that labor epidural analgesia is not independently associated with adverse neonatal or childhood development outcomes. 

Most COVID-19 transmission is known to occur in households

 People who have received two vaccine doses against COVID-19 have a lower, but still appreciable, risk of becoming infected with the delta variant compared with unvaccinated people. Vaccinated people clear the infection more quickly, but the peak viral load among vaccinated people is similar to that seen in unvaccinated people, which may explain why they can still readily pass on the virus in household settings, according to a study published in The Lancet Infectious Diseases.

Vaccines remain highly effective at preventing severe disease and deaths from COVID-19, but some studies suggest they may be less effective against the delta variant – currently the dominant strain worldwide – though the reason for this has not been established. Most COVID-19 transmission is known to occur in households yet there is limited data on the risk of transmission of the delta variant from vaccinated people with asymptomatic or mild infections in the community.

Professor Ajit Lalvani of Imperial College London, UK, who co-led the study, said: “Vaccines are critical to controlling the pandemic, as we know they are very effective at preventing serious illness and death from COVID-19. However, our findings show that vaccination alone is not enough to prevent people from being infected with the delta variant and spreading it in household settings. The ongoing transmission we are seeing between vaccinated people makes it essential for unvaccinated people to get vaccinated to protect themselves from acquiring infection and severe COVID-19, especially as more people will be spending time inside in close proximity during the winter months. We found that susceptibility to infection increased already within a few months after the second vaccine dose—so those eligible for COVID-19 booster shots should get them promptly.” [1]

The new study enrolled 621 participants, identified by the UK contact tracing system, between September 2020 and September 2021. All participants had mild COVID-19 illness or were asymptomatic. Demographic and vaccination status information were collected on enrolment, and participants had daily PCR tests to detect infection, regardless of whether or not they had symptroms. It is one of the few studies to date conducted using such detailed data from real households, offering key insights into how vaccinated people can still be infected with the delta variant and pass it on to others.

In this study, participants were defined as unvaccinated if they had not received a single COVID-19 vaccine dose at least seven days before enrolment, partially vaccinated if they received one dose more than seven days before enrolment, and fully vaccinated if they received two doses more than seven days beforehand [2]. The study took place before vaccine boosters had become widely available.

Risk of transmission based on vaccination status was analysed for household contacts exposed to delta variant index cases (the first detected case in a household). By performing PCR tests on swab samples provided daily by each participant for 14–20 days, changes over time in viral load – the amount of virus in a person’s nose and throat – were estimated by modelling PCR data, enabling comparisons between fully vaccinated cases of delta infection, and unvaccinated cases of delta, alpha, and pre-alpha infection.

A total of 205 household contacts of delta variant index cases were identified, of whom 53 tested positive for COVID-19. Of the 205 contacts, 126 (62%) received two vaccine doses, 39 (19%) had received one vaccine dose, and 40 (19%) were unvaccinated. Among household contacts who had received two vaccine doses, 25% (31/126 contacts) became infected with the delta variant compared with 38% (15/40) of unvaccinated household contacts.

Among vaccinated contacts infected with the delta variant, the median length of time since vaccination was 101 days, compared with 64 days for uninfected contacts. This suggests that the risk of infection increased within three months of receiving a second vaccine dose, likely due to waning protective immunity. The authors point to vaccine waning as important evidence for all eligible people to receive booster shots.

A total of 133 participants had their daily viral load trajectories analysed, of whom 49 had pre-alpha and were unvaccinated, 39 had alpha and were unvaccinated, 29 had delta and were fully vaccinated, and 16 had delta and were unvaccinated. Viral load declined more rapidly among vaccinated people infected with the delta variant (0.95 log10 virus copies/mL/day) compared with unvaccinated people with delta (0.79), alpha (0.82), or pre-alpha (0.69). However, the authors note that vaccinated people did not record a lower peak viral load than unvaccinated people, which may explain why the delta variant can still spread despite vaccination as people are most infectious during the peak viral load phase.

Dr Anika Singanayagam, co-lead author of the study, said, “Understanding the extent to which vaccinated people can pass on the delta variant to others is a public health priority. By carrying out repeated and frequent sampling from contacts of COVID-19 cases, we found that vaccinated people can contract and pass on infection within households, including to vaccinated household members. Our findings provide important insights into the effect of vaccination in the face of new variants, and specifically, why the delta variant is continuing to cause high COVID-19 case numbers around the world, even in countries with high vaccination rates. Continued public health and social measures to curb transmission – such as masking wearing, social distancing, and testing – thus remain important, even in vaccinated individuals.” [1]

The authors acknowledge some limitations to their study. Due to the nature of UK symptoms-based community testing, only contacts of symptomatic index cases were recruited. As this real-world study was undertaken when infection was circulating widely, it cannot be excluded that another household member may already have been infected and transmitted COVID-19 to the index case (resulting in misclassification of who is the index case and who is the contact but this would not affect the conclusion that transmission is occurring between vaccinated individuals). As older age groups were vaccinated earlier during the UK vaccine rollout, the age of unvaccinated people infected with the delta variant was lower than for vaccinated participants, meaning age could be a confounding factor. However, higher transmission in unvaccinated contacts was likely driven by the absence of vaccination rather than younger age as susceptibility to COVID-19 infection does not increase with decreasing age. While the authors did not perform viral culture – a better proxy for infectiousness –two other studies that used the technique reached conclusions consistent with their findings.


Chest pain may extend outside the chest, often needs to be checked by a professional

 Chest discomfort associated with a heart attack or heart event may often be felt beyond the chest, with many people reporting pain in their shoulders, arms, jaw, neck, back and upper abdomen. A new approach to evaluate the source and symptoms of chest pain can help clinicians improve patient outcomes and reduce health care costs, according to a new joint guideline from the American Heart Association and the American College of Cardiology. The guideline publishes today in the American Heart Association’s flagship journal Circulation and simultaneously in the Journal of the American College of Cardiology.

Frequently, people have chest discomfort that is caused by a heart issue, and chest pain is the primary symptom reported for a heart attack or heart event. However, there are times when chest pain episodes are not related to a heart event. Experts from the American Heart Association and the American College of Cardiology urge people to seek immediate medical care for chest pain to determine if urgent care or further cardiac testing is needed.

The new guideline recommends medical professionals use standardized risk assessments, clinical pathways and tools to evaluate and communicate with people experiencing chest pain. While evaluation of chest pain has been covered in previous guidelines, this is the first comprehensive guideline from the Association and the College focused solely on the evaluation and diagnosis of chest pain.

“Everyone should know the symptoms that can indicate a heart attack and that calling 911 is the most important thing to do to save their life or that of their loved one experiencing chest pain,” said Chair of the guideline writing group Martha Gulati, M.D., M.S., FACC, FAHA, a professor of cardiology and former academic division chief of the division of cardiology at the University of Arizona in Phoenix. “This standard approach provides clinicians with the guidance to better evaluate patients with chest pain, identify patients who may be having a cardiac emergency and then select the right test or treatment for the right patient.”

Among all adults who come to the emergency department with chest pain, only around 5% will have acute coronary syndrome (ACS is a term to describe when blood supply to the heart muscle is severely reduced or suddenly blocked). More than half will ultimately be diagnosed with a non-cardiac reason for the chest-pain symptoms, including respiratory, musculoskeletal, gastrointestinal, psychological and other causes. Evaluating the severity and the cause of chest pain is crucial. The new guideline advises clinicians to use standard risk assessments to determine if a patient is at low, intermediate or high risk for having a cardiac event. The guideline also highlights that women are unique when presenting with ACS symptoms. Chest pain is the dominant and most frequent symptom for both men and women, however, women may be more likely to also exhibit accompanying symptoms such as nausea and shortness of breath.

For emergency department professionals evaluating people with chest pain, the initial goals should be to identify if there are life-threatening causes and to determine if there is a need for hospitalization or testing. Thorough screening may also determine who is at high risk vs. intermediate or low risk for a cardiac event. An individual at low risk for a cardiac event may be referred for additional evaluation in an outpatient setting rather than being admitted to the hospital. The guideline authors emphasize there are opportunities to reduce unnecessary or inappropriate testing for some adults with chest pain, especially in the emergency department and for those patients screened as low risk for a cardiac event.

“When some people arrive in the emergency department with chest pain, they often won’t need additional or immediate testing, and the health care team should explain to the patient and their family the various initial tests and risk assessment and their risk level,” said Gulati. “Often, patients have additional concerns because they fear a heart attack or other severe cardiac event, which is understandable. However, we have advanced tools that help us determine whether a cardiac emergency or severe heart event is likely or not.”

Clinicians can reduce patient fear and concerns and reduce extra testing through shared decision-making. As outlined in all scientific statements and guidelines from the American Heart Association/American College of Cardiology, the patient-centered process in which clinicians share information and steps with patients as partners to reach a consensus about preferred tests and treatments is essential. Research has shown that shared decision-making allows people at low risk of serious health issues to participate actively in their care. The approach has also found fewer additional tests are performed as a result of shared decision-making, with no differences in outcomes among low-risk patients.

“While there is no one ‘best test’ for every patient, the guideline emphasizes the tests that may be most appropriate, depending on the individual situation, and which ones won’t provide additional information; therefore, these tests should not be done just for the sake of doing them,” added Gulati. “Appropriate testing is also dependent upon the technology and screening devices that are available at the hospital or health care center where the patient is receiving care. All imaging modalities highlighted in the guideline have an important role in the assessment of chest pain to help determine the underlying cause, with the goal of preventing a serious cardiac event.”


Wednesday, October 27, 2021

Potentially harmful industrial chemicals detected in US fast foods

 Chicken nuggets, burritos and other popular items consumers buy from fast food outlets in the United States contain chemicals that are linked to a long list of serious health problems, according to a first-of-its-kind study published today.

Researchers at the George Washington University and their colleagues bought fast foods from popular outlets and found 10 of 11 potentially harmful chemicals in the samples, including phthalates, a group of chemicals that are used to make plastics soft and are known to disrupt the endocrine system. The research team also found other plasticizers, chemicals that are emerging as replacements to phthalates.

“We found phthalates and other plasticizers are widespread in prepared foods available at U.S. fast food chains, a finding that means many consumers are getting a side of potentially unhealthy chemicals along with their meal,” Lariah Edwards, lead author of the study and a postdoctoral scientist at GW, said. “Stronger regulations are needed to help keep these harmful chemicals out of the food supply.”

Previously, a GW research team led by Ami Zota, a professor of environmental and occupational health, looked at fast food consumption in a national survey and found people who reported eating more fast foods had higher levels of phthalates. No one has looked at the link between fast food and non-phthalate plasticizers, which are used in place of banned or restricted phthalates in food packaging and processing equipment.

In this study, Edwards, Zota and their colleagues purchased 64 fast food items from different restaurants and asked for three pairs of unused food handling gloves. The team tested food items and the gloves for 11 kinds of phthalates and plasticizers, finding that:

  • 81% of the food samples studied contained a phthalate called DnBP and 70% contained DEHP. Both these chemicals have been linked in numerous studies to fertility and reproductive problems in humans. These phthalates can also increase risk for learning, attention, and behavioral disorders in childhood.
  • 86% of the foods contained the replacement plasticizer known as DEHT, a chemical that needs further study to determine its impact on human health.
  • Foods containing meats, such as cheeseburgers and chicken burritos, had higher levels of the chemicals studied.
  • Chicken burritos and cheeseburgers had the highest levels of DEHT. The researchers noted that food handling gloves collected from the same restaurants also contained this chemical.
  • Cheese pizzas had the lowest levels of most chemicals tested.

Phthalates and replacement plasticizers are chemicals used to make plastics soft and can migrate out of plastics into the food, which is ingested. Some sources of plastics include food handling gloves, industrial tubing, food conveyor belts and the outer packaging used to wrap fast food meals available in restaurants.

Previous research by Zota’s team suggests that people who eat food cooked at home have lower levels of these chemicals in their bodies, probably because home cooks do not use food handling gloves or plastic packaging. To avoid these industrial chemicals, consumers can switch to mostly home cooked meals, which are often healthier than fast food, Edwards said.

Both Edwards and Zota say their study suggests the need for greater scrutiny and regulation of chemicals used to make food. They point out that replacement plasticizers are increasingly used to replace banned or restricted phthalates yet the studies needed to show that they are safe have yet to be done.

The study also raises the concern that certain racial/minority groups may be disproportionately affected by these chemicals.

“Disadvantaged neighborhoods often have plenty of fast food outlets, but limited access to healthier foods like fruits and vegetables,” Zota said. “Additional research needs to be done to find out whether people living in such food deserts are at higher risk of exposure to these harmful chemicals.”

The study, “Phthalate and Novel Plasticizer Concentrations in Food Items from U.S. Fast Food Chains: A Preliminary Analysis,” was published in the Journal of Exposure Science and Environmental Epidemiology. This research was supported by the Passport Foundation, Forsythia Foundation and Marisla Foundation.

Burning and tingling in your feet? You may have small fiber neuropathy

 

The number of people experiencing numbness, tingling and pain in their feet with no known cause has been increasing over the last two decades, according at a new study published in the October 27, 2021, online issue of Neurology®, the medical journal of the American Academy of NeurologyCalled small fiber neuropathy, the condition has different symptoms than large fiber neuropathy, which can cause weakness and balance issues. But in many cases people have both types of neuropathy.

For the study, researchers looked at records for everyone diagnosed with small fiber neuropathy in Olmsted County, Minn., and the adjacent counties during a 20-year period. They then compared those 94 people with 282 people of similar age and sex who did not have neuropathy. Participants were followed for an average of six years.

The study found that the condition occurred in 13.3 per 100,000 people, with the rate increasing during the study.

“This increase could be due in part to greater awareness,” said study author Christopher J. Klein, MD, of the Mayo Clinic in Rochester, Minn., and a Fellow of the American Academy of Neurology. “Another possibility is that increasing levels of overweight and obesity in our area could be a factor in the higher rates of small fiber neuropathy. Higher body mass index, or BMI, is a risk factor for diabetes and high triglycerides, which may also lead to neuropathy.”

The people in the study with neuropathy had an average BMI of 30.4, compared to 28.5 for the people who did not have neuropathy. A BMI of 18.5 to 24.9 is considered healthy; 25.0 to 29.9 is considered overweight; and 30.0 and higher is considered obese.

About 50% of the people with neuropathy had diabetes, compared to 22% of those without neuropathy.

The people with neuropathy were also more likely to have insomnia, at 86% compared to 54% for those without neuropathy. They were also more likely to have heart attacks, at 46% compared to 27%.

“Based on these findings, people with small fiber neuropathy should be screened for heart problems and their blood glucose should be monitored for signs of diabetes,” Klein said.

The people with neuropathy were also more likely to take opioids for pain.

For 67 of the people with neuropathy, no cause could be determined, called idiopathic neuropathy. For 14 people, the neuropathy was caused by diabetes. Other causes included Sjögren syndrome and lupus.

A total of 36% of the people developed large fiber neuropathy during the study, an average of five years after they developed the small fiber version.

“The good news is that most people with idiopathic neuropathy do not develop major impairments or disability, but they did have many other conditions and an increased risk of heart attack, so the development of treatments and prevention methods is crucial,” Klein said.

The main limitation of the study was that researchers looked back in time at medical records. A study examining all people with symptoms of small fiber neuropathy and following them over time should be conducted to confirm these findings, Klein said.