Month: October 2021

Menstrual Cycles May Impact PTSD Symptoms in Women

Photo by Sydney Sims on Unsplash

New research has found that post-traumatic stress disorder symptoms in women may vary over the course of the menstrual cycle, with more symptoms during the cycle’s first few days when the hormone oestradiol is low and fewer symptoms close to ovulation, when oestradiol is high.

The results could have implications for PTSD diagnosis and treatment, said lead author Jenna Rieder, PhD, an assistant professor of psychology at Thomas Jefferson University in Philadelphia. “When in the cycle you assess women might actually affect whether they meet diagnostic criteria for PTSD, especially for people who are right on the border. And that can have real practical implications, say, for someone who is a veteran and entitled to benefits or for health insurance purposes.”

The research was published in the journal Psychological Trauma: Theory, Research, Practice and Policy.

Oestradiol is a form of oestrogen that regulates the menstrual cycle. During the follicular phase, rising oestradiol levels trigger a cascade of events that result in ovulation. Studies have linked low-oestradiol portions of the cycle to greater activation in the limbic areas of the brain, which are related to emotion, and to lower activation in the prefrontal cortex when viewing emotional content. Low oestradiol has also been linked to greater stress and anxiety as well as increased fear responses.

To find out whether those links were related to traua response, researchers studied 40 women, aged 18 to 33, all of whom had experienced or witnessed a traumatic event, such as a serious injury or sexual violence. In the lab, researchers measured the participants’ level of oestradiol in their saliva, then asked them to describe the trauma that had happened to them and the PTSD symptoms they’d experienced in the past month. They found that lower oestradiol was associated with greater self-reported symptom severity in the participants.

The researchers also measured two stress biomarkers in participants’ saliva, the hormone cortisol and the enzyme salivary alpha-amylase, before and after the participants described their trauma. Salivary alpha-amylase is related to the “fight-or-flight” stress response, and cortisol is related to the body’s slower, more sustained stress response.

“In a healthy system we want a moderate, coordinated response of both of these biomarkers,” Prof Rieder said. In the women in the low-oestradiol portions of their menstrual cycles, the researchers instead found low cortisol and high salivary alpha-amylase levels resulting from recounting their trauma stories – a pattern that’s been linked in previous studies with maladaptive stress responses.

The researchers then asked the participants to answer five daily questionnaires for 10 days spanning the high- and low-oestradiol portions of their menstrual cycles. The questionnaires measured how participants were feeling at each time (from “extremely unpleasant” to “extremely pleasant” and “extremely nonstimulated or activated” to “extremely stimulated or activated”). Participants also completed a PTSD symptom checklist each evening.

Participants were found to have greater variability in their daily moods during the low-oestradiol days of their cycle and reported more severe PTSD symptoms on those days.

This could have implications for diagnosis and treatment of PTSD in women, who have long been underrepresented in PTSD research. “PTSD for a long time was mostly studied in men, in part because it was mainly studied in veterans, who were mostly men,” Prof Rieder said.

As well as its relevance to diagnosis, knowing how the menstrual cycle affects PTSD symptoms could be useful for both clinicians and patients, according to Prof Rieder. “I think this is something that clinicians would want to know, so they can impart this knowledge as part of psychoeducation,” she said. “For women who are naturally cycling, it may be useful to understand how the menstrual cycle affects their symptoms. When you can explain what’s happening biologically, it often becomes less threatening.”

Source: American Psychological Association

Low Vitamin D in Pregnancy Can Raise Autism Risk

Source: Anna Hecker on Unsplash

Low maternal vitamin D intake during pregnancy can affect the development of autism in the child along with various other factors, according to a new study from the University of Turku, Finland, and Columbia University, USA.

The study, published in the Biological Psychiatry journal, included 1558 cases of autism spectrum disorder (ASD) and an equal number of matched controls born in Finland between January 1987 and December 2004, followed up until December 2015. 

Maternal vitamin D deficiency during pregnancy was linked to a 44% increased risk of ASD in the offspring, compared to women with sufficient vitamin D. 

The result persisted even when accounting for maternal age, immigration, smoking, psychopathology, substance abuse, the gestational week of blood draw, season of blood collection, and gestational age.

“The results are significant for public health as vitamin D deficiency is readily preventable,” said first author, Professor Andre Sourander from the University of Turku.

In previous work, the researchers had shown that vitamin D deficiency is also associated with increasede ADHD risk in the offspring. The serum samples were collected before the national recommendation for vitamin D supplementation during pregnancy was introduced in Finland. The current recommendation for pregnant women is a daily supplement of 10 micrograms of vitamin D throughout the year.

“Vitamin D deficiency is a major global problem,” Prof Sourander remarked.

Source: University of Turku

Violence in the ED: A Critical Issue in Healthcare

Phot by Mulyadi on Unsplash

A study by the Mayo Clinic found that most healthcare workers experience violence in emergency departments (EDs), but they seldomly report it to anyone.

Over six months prior to being surveyed, 72% of healthcare workers and other ED staff said they had personally experienced violence (71% verbal abuse and 31% physical assault), Sarayna McGuire, MD, chief resident of Mayo Emergency Medicine in Rochester, Minnesota, reported in a series of three studies at the American College of Emergency Physicians annual meeting.

Nurses and clinicians, along with security personnel, bore the brunt of the attacks: 94% of nurses and 90% of clinicians reported experiencing verbal abuse, and 54% of nurses and 36% of clinicians reported instances of physical assault.

“The whole team is impacted by workplace violence,” Dr McGuire said to MedPage Today. “Even people coming in to draw blood are being assaulted physically and verbally abused.”

Despite this prevalent violence and 58% reporting at least moderate awareness of reporting policies, 77% of all respondents said they never or rarely report violence, while only 10% said they often or always do.

A possible explanation could be that only 7% of non-security staff said they were “extremely familiar” with the procedures. And when participants were asked why ED abuse is not usually reported, the top four reasons given were:

  • No physical injury was sustained (53% of respondents)
  • “It comes with the job” (47%)
  • Staff are too busy (47%)
  • Reporting is inconvenient (41%)

The violence is not without consequences; 18% of respondents said they are considering leaving their position due to the violence, and 48% said violence has changed the way they view or interact with patients.

Men and more experienced staff reported feeling significantly better prepared compared with women. When asked which factors staff thought were most responsible for the violence, the following feature in at least 70% of responses: alcohol, illicit drugs, and significant mental illness.

A total of 86% of respondents said they felt at least moderately prepared to handle verbal abuse, while 68% said they felt prepared to handle physical assault.

“Everyone’s feeling right now that violence has increased in healthcare [during the pandemic], and our data have showed that,” Dr McGuire said. “How is this sustainable? …There is a critical issue in healthcare.”

She added that since reporting of violence is so low, true exposure to violence is probably much higher than the study found.

Study co-author Casey M. Clements, MD, PhD, also of Mayo Emergency Medicine, added that “we know this isn’t isolated to emergency departments.”

He explained that while the study encompassed the pandemic era, violence “has been a problem for some time in healthcare” – violence is a major threat to the healthcare workforce, Dr Clements said. He added that another problem is that physicians typically do not receive any training in de-escalation — “we learn this on the job.”

For the study, the researchers sent an anonymous survey to ED staff at 20 EDs. Also included were social workers, management, and security staff. Women made up 73% of the 833 respondents. Nursing staff (31%) made up the largest medical discipline, and 16% were clinicians.

Dr McGuire suggested that a centralised reporting system would help augment reporting of violence.

“We need to change the mindset that it’s anybody’s job to be assaulted at work,” Dr Clements said. “We cannot go on having our emergency department workers being abused and assaulted on a daily basis.”

Source: MedPage Today

Feeling of Invulnerability against COVID Leads to Vaccine Refusal

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An international survey has found that people who do not believe that being infected with COVID could seriously threaten their health are both less likely to believe in the importance of preventing spread of the disease and less willing to get vaccinated. 

To contain COVID, it may be critical for individuals to feel concern about taking action to prevent transmission within their community. However  such concerns and actions could be impacted by a number of both individual and cultural factors. Leonhardt and colleagues hypothesised that one factor influencing pandemic concerns could be people’s perceived invincibility to COVID. The findings were presented in PLOS ONE.

To test this idea, the researchers analysed responses from over 200 000 people across 51 countries from an ongoing online survey. The survey included a question about how serious it would be to get infected with COVID, as well as questions about willingness to get vaccinated and taking action to reduce spread in one’s community. The researchers also accounted for participants’ overall health, age, sex, and level of education.

Respondents who reported feeling more  invincibile to COVID were less willing to get vaccinated, the researchers found, and also less likely to believe in the importance of individual actions to reduce transmission.

The strength of this link varied between countries. Individuals with high perceived invincibility living in countries with a greater emphasis on individual freedoms and autonomy, such as the US, were less willing to get vaccinated and less willing to take action than individuals with high perceived invincibility living in cultures with greater emphasis on collective action.

The authors say their findings highlight the importance of considering both individual and cultural factors when addressing pandemics. They suggest that suppression efforts employ messaging underscoring the importance of collective action, especially in individualistic cultures. Meanwhile, future research could further explore the impact of cultural factors on health beliefs and behaviours.

The authors added: “While feeling invincible may be beneficial in overcoming economic hardships or during periods of war, the results of our study suggest that it threatens the likelihood that people get vaccinated against COVID, and this is especially the case in individualistic countries, such as the USA, where people tend to focus on their own health rather than the collective health of their community.”

Source: EurekaAlert!

Root Canals Still Preferred Over Tooth Extraction

Source: Unsplash

Few patients regret having a severely damaged tooth saved by a root canal filling, with a PhD thesis finding that 87% would choose the same treatment again if needed, despite the pain and discomfort.

Root fillings are often required because the soft tissue inside the tooth, the dental pulp, is inflamed or infected. The root canal treatment is carried out in stages, on several occasions, where the dentine and other parts are removed and the root canals are finally filled with a combination of a natural, rubberlike material (gutta-percha) and a cement.

Root canal treatment is still a common and necessary measure despite good oral health. In Sweden, as in most countries, most root canal treatments are performed by general dental practitioners in the public or private sector.

In dentist Emma Wigsten of the Institute of Odontology’s thesis, several studies analysed data on a patient group of 243. All of them had started root canal treatment at one of the 20 public dental clinics in the region, and the patients were then followed up for one to three years.

Most of the root canal treatments were prompted by toothache in teeth with caries and large restorations, which culminated in root fillings within a year. Molars were an exception: only just over half of the root fillings met their purpose and, as a result, many molars had to be extracted.

“It seems harder to get a good result in treating the molars, despite time and resources invested. Root canal treatment is complicated: You’re working inside the tooth where you can’t see anything, and the further back you go in the mouth, the more difficult it becomes,” Wigsten said.

“Root canal treatments of molars involve significantly bigger challenges than other tooth groups. So it may be important to investigate whether root canal treatments of molars should be performed to a greater extent by dentists specialising in root canal treatment.”

During the follow-up period of up to three years, half of the patients stated that they had mild pain or discomfort from their root-filled tooth. Nevertheless, most (87%) were satisfied and did not regret opting for root canal treatment over a tooth extraction.

Another component study, at six public dental clinics in Region Västra Götaland, covered 85 patients in whom either root canal treatment was initiated or a tooth was extracted. An improved health-related quality of life was observed in the patients who started root canal treatment, but not in those who underwent a tooth extraction.

“The studies show that the patients’ quality of life benefited from root canal treatment. On the other hand, it’s unclear whether the treatment is cost-effective compared with tooth removal, especially where molars are concerned,” Wigsten concluded.

Source: University of Gothenburg

There’s no better time to say ‘Thank You, Doctor’

Doctor’s Day is celebrated on 16 November to acknowledge and thank South African doctors for the exceptional services they deliver on a daily basis. EthiQal is proud to continue to honour this annual tradition of celebrating doctors countrywide, this November.

“The challenges that our medical professionals have confronted and overcome over the last year have been astounding,” says Alex Brownlee, EthiQal executive.

“The pandemic has placed immense pressure on doctors and their families, through the increased personal risk of exposure, the frustration associated with delayed surgeries and erratic schedules, and the emotional trauma of seeing more suffering and fatalities.”

EthiQal’s Doctors’ Day initiative is celebrating its fourth year running in 2021. Through its “This is why we say thank you” campaign, EthiQal calls on the country to express gratitude to its doctors for their bravery and commitment, by sharing their healthcare hero stories on the dedicated Doctors’ Day webpage.

In return, five lucky entrants that share their gratitude stories will each receive R1 000 in cash. What’s more, EthiQal will donate R10 000 to the Healthcare Workers Care Network – a nationwide healthcare worker support network that offers all healthcare workers across the public and private sectors free support, pro bono therapy, resources, training and psychoeducation.

To qualify, participants must submit their stories by visiting, before 25 November 2021.  Follow the Doctors’ Day stories on social media. (Facebook: @ethiqaldoctor; LinkedIn: EthiQal)

EthiQal proudly also celebrates its 5th birthday on Dr’s Day. EthiQal is the only South African provider of occurrence-based medical professional indemnity insurance for doctors. The dynamic team at EthiQal believes that doctors are national assets and are committed to protecting their well-being and future. 

Mask-wearing Protects Wearers Too

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People who adhered to masking outside of the home, but were more exposed to infection due to their circumstances, still had “significantly” lower COVID infection rates, according to research published in BMJ Open.

Although it has been widely asserted that face coverings serve to protect others, rather than the wearer, this large-scale study established a clear link between wearing a face covering outside the home and infection.

The Oxford-led study links individuals’ and households’ ability to follow non-pharmaceutical interventions (NPIs) often known as COVID behavioural interventions, using the largest and most representative dataset to date in the UK, including people from different ethnic and age groups.

Using the COVID Infection Study (CIS), study participants were asked to complete a short questionnaire, as well as taking regular COVID tests. Respondents were asked to share how often they worked outside the home, how easy it was to keep social distance in their workplace, whether they took public transport and whether they had direct contact with others on a day-to-day basis.

According to the study, “Wearing a face covering outside was a significant predictor of a lower chance of infection before mid-December 2020 in the UK, when a stricter second lockdown was implemented.”

There was a higher rate of infections among those who lacked autonomy to follow COVID behavioural measures and did not comply with masking.

Author Professor Melinda Mills said, “Lack  of  compliance  to  COVID behavioural measures  has  often been  positioned  as  an  attitude  or  choice. Yet there are large groups of people who, due to their household or employment circumstances, cannot follow measures to work from home, engage in physical distancing at the workplace or avoid public transportation. This, in turn, means that they have a higher exposure to becoming infected.

“The inability for some groups of people to follow behavioural interventions exacerbates existing health inequalities and we showed that face coverings are one measure that can mitigate this unequal exposure.”

The team found, “The  level  of  autonomy  to  adhere  to  behavioural interventions does not  predict  COVID infection  alone,  but  rather the risk of infection is diminished when individuals wear face  covering/masks.”

The study concluded that masking reduces the effects of unequal COVID exposure.
Professor Mills added, “Using a very large individual and household sample and COVID swab tests, we showed that the inability for certain groups such as women in large households or those working in occupations where it is hard to maintain physical distancing were protected from infection during key periods in 2020 in the UK”.

Source: Oxford University

Foiling Cancer With its Own Sweet Tooth

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Cold Spring Harbor Laboratory Professor Christopher Vakoc and his lab have found that acute myeloid leukaemia (AML), an aggressive cancer that originates in the bone marrow, depends on a transporter to bring in the nutrient inositol, and the researchers believe they can find a way to cut off the cells’ food supply and kill them.

Cancers may streamline certain cell processes and rely on just one method to survive; for example, some remove backup pathways for DNA repair, “putting all their eggs in one basket” and depending only on a single pathway for survival. Prof Vakoc’s lab could then develop treatments to knock out that remaining pathway, killing the cancer cells.

In a study published in Cancer Discovery, Prof Vakoc and his lab reported that AML depends on inositol, an abundant sugar that is made in many human body tissues. It is also found in a wide variety of foods like fruits, beans, grains, and nuts, so cells can obtain it from outside the body, via the bloodstream.

Prof Vakoc discovered that the AML cells had streamlined and boosted their growth by disabling their own inositol production, instead relying on external inositol, bringing it in with a transporter on the cell surface. If a simple treatment could turn off or block this transporter, the cancer cells would starve. As Prof Vakoc explained, “An antibody approach would be very attractive. You could make an antibody that just sticks to this transporter. It doesn’t need to get into the cell, and it could shut off the transport function. The other possibility, from a drug development point of view, is inositol. You could build a molecular medicine that sort of looks like inositol, but maybe it has a few chemical differences that can clog the transport function.”

Not only could this method kill the cancer cells, but it would also leave normal cells unharmed since they can make their own inositol. 

Source: Cold Spring Harbor Laboratory

Chief Sitting Bull’s DNA Matched to Living Descendant

By Orlando Scott Goff – Heritage Auctions, Public Domain,

A team of researchers led by the University of Cambridge has proven a man’s claim to be the great-grandson of legendary Native American leader Sitting Bull has been confirmed using DNA extracted from Sitting Bull’s scalp lock. This is the first time ancient DNA has been used to confirm a familial relationship between living and historical individuals.

The researchers used a new method to analyse family lineages using ancient DNA fragments, which searches for ‘autosomal DNA’ in the genetic fragments extracted from a body sample. Since half of our autosomal DNA is inherited from the father and half from the mother, this means genetic matches can be checked regardless of whether an ancestor is on the father or mother’s side of the family.

Autosomal DNA from Lakota Sioux leader Sitting Bull’s scalp lock was compared to DNA samples from Ernie Lapointe and other Lakota Sioux. The resulting match confirms that Lapointe is Sitting Bull’s great-grandson, and his closest living descendant.

“Autosomal DNA is our non-gender-specific DNA. We managed to locate sufficient amounts of autosomal DNA in Sitting Bull’s hair sample, and compare it to the DNA sample from Ernie Lapointe and other Lakota Sioux – and were delighted to find that it matched,” said senior author of the study, Professor Eske Willerslev in the University of Cambridge’s Department of Zoology and Lundbeck Foundation GeoGenetics Centre, who also developed the new DNA analysis technique.

Lapointe said: “over the years, many people have tried to question the relationship that I and my sisters have to Sitting Bull.”

Lapointe believes that Sitting Bull’s bones currently lie at a site in Mobridge, South Dakota, in a place that has no significant connection to Sitting Bull and the culture he represented. He also has concerns about the care of the gravesite. There are two official burial sites for Sitting Bull – at Fort Yates, North Dakota and Mobridge – and both receive visitors.

Lapointe, with the help of the DNA evidence confirming his heritage, now hopes to rebury the great Native American leader’s bones in a more appropriate location.

The new technique can be used when very limited genetic data are available, as was the case in this study. This could be used to match up long-dead historical figures and their living descendants.

The technique could also be used on old human DNA that might previously have been considered too degraded to analyse – for example in forensic investigations.

“In principle, you could investigate whoever you want – from outlaws like Jesse James to the Russian tsar’s family, the Romanovs. If there is access to old DNA – typically extracted from bones, hair or teeth, they can be examined in the same way,” said Willerslev, who is a Fellow of St John’s College, Cambridge.

It took the scientists 14 years to find a way of extracting useable DNA from the 5-6cm piece of Sitting Bull’s hair, which was extremely degraded, having been stored for over a century at room temperature in a museum before it was returned to Lapointe and his sisters in 2007.

In traditional DNA analysis, which searches for a genetic match between specific DNA in the Y chromosome passed down the male line, or, in females, specific DNA in the mitochondria passed from a mother to her offspring. Neither are particularly reliable, and in this case neither could be used as Lapointe claimed to be related to Sitting Bull on his mother’s side.

Tatanka-Iyotanka, better known as the Native American leader and military leader Sitting Bull (1831–1890), led 1,500 Lakota warriors at the Battle of the Little Bighorn in 1876 and wiped out US General Custer and five companies of soldiers.

“Sitting Bull has always been my hero, ever since I was a boy. I admire his courage and his drive. That’s why I almost choked on my coffee when I read in a magazine in 2007 that the Smithsonian Museum had decided to return Sitting Bull’s hair to Ernie Lapointe and his three sisters, in accordance with new US legislation on the repatriation of museum objects,” said Willerslev.

He added: “I wrote to Lapointe and explained that I specialised in the analysis of ancient DNA, and that I was an admirer of Sitting Bull, and I would consider it a great honour if I could be allowed to compare the DNA of Ernie and his sisters with the DNA of the Native American leader’s hair when it was returned to them.”

Until this study, the familial relationship between LaPointe and Sitting Bull was based on birth and death certificates, a family tree, and a review of historical records. This new genetic analysis lends further credence to his claims. Before the remain can be reburied, they will have to be analysed in the same to ensure a genetic match to Sitting Bull.

Before the remains from the Mobridge burial site can be reburied elsewhere, they will have to be analysed in a similar way to the hair sample to ensure a genetic match to Sitting Bull. 

Source: Cambridge University

US Health Body Admits Funding Coronavirus Enhancement Study

SARS-CoV-2 virus. Source: Fusion Medical Animation on Unsplash

In an unexpected turn of events, the US National Institutes of Health (NIH) has acknowledged that it funded research into enhancing coronavirus infectivity, Vanity Fair reported.

The agency had last week sent a letter to the US House Committee on Energy and Commerce stating that its grant recipient, EcoHealth Alliance, enhanced a bat coronavirus to become potentially more infectious to humans. This was an “unexpected result” of the research, done in collaboration with Wuhan Institute of Virology.

The NIH letter also noted that EcoHealth Alliance violated terms of its grant conditions, which had stipulated that it was supposed to report to the agency if its work boosted viral growth by a factor of 10.

EcoHealth Alliance was supposed to submit a progress report at the end of the grant period in 2019 but it didn’t arrive at the NIH until August 2021, according to Vanity Fair. However, in a statement to Vanity Fair, EcoHealth Alliance said that it had reported the relevant information “as soon as we were made aware, in our four year report in April 2018.”

In that missing progress report (dated August 2021), lab mice infected with the enhanced virus became more ill than those infected with a wild one, reported Vanity Fair.

The Vanity Fair report also reveals a rather concerning detail contained in a leaked EcoHealth Alliance grant proposal submitted to the Defense Advanced Research Projects Agency in 2018. EcoHealth Alliance and the Wuhan Institute of virology proposed to engineer a furin cleavage site for the coronavirus to more easily enter humans cells. This matches a distinctive segment of SARS-CoV-2’s genetic code.

“If I applied for funding to paint Central Park purple and was denied, but then a year later we woke up to find Central Park painted purple, I’d be a prime suspect,” Jamie Metzl, a member of the WHO advisory committee on human genome editing, told Vanity Fair.

In its letter to US Congress, the NIH emphasised that the virus EcoHealth Alliance was studying could not have sparked the pandemic, as there was a vast genetic difference between it and SARS-CoV-2. NIH Director Francis Collins, MD, PhD, also issued a statement addressing the concerns raised by the letter, noting that such claims were “demonstrably false.”

“The scientific evidence to date indicates that the virus is likely the result of viral evolution in nature, potentially jumping directly to humans or through an unidentified intermediary animal host,” Dr Collins said in the statement.

Gilles Demaneuf, a data scientist in New Zealand, told Vanity Fair, “I cannot be sure that [COVID originated from] a research-related accident or infection from a sampling trip. But I am 100% sure there was a massive cover-up.”

In response to these criticisms of poor oversight and bad scientific judgment, the NIH has “circled its wagons”, Vanity Fair observed.

Source: Vanity Fair