Women and men share most of the same risk factors for cardiovascular disease (CVD), according to a study published in The Lancet. This is the first such study to include people not only from high income countries, but also from low- and middle-income countries – which have the highest burden of CVD. One of the differences observed was a greater sensitivity to diet in women than in men.
The global study assessed risk factors, including metabolic (eg hypertension, obesity and diabetes), behavioural (smoking and diet), and psychosocial (economic status and depression) in about 156 000 people without a history of CVD between the ages of 35 and 70. Living in 21 low, middle and high-income countries on five continents, they were followed for an average of 10 years.
“Women and men have similar CVD risk factors, which emphasises the importance of a similar strategy for the prevention of CVD in men and women,” said first author Marjan Walli-Attaei, a research fellow at the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences (HHS).
Overall, women had a lower risk of developing CVD than men, especially at younger ages.
However, diet was more strongly associated with CVD risk in women than men – “something that’s not been previous described, and which requires independent confirmation,” said Salim Yusuf, lead investigator of the study, senior author, executive director of PHRI, professor of medicine at McMaster University, and cardiologist at HHS.
High levels of bad (LDL) cholesterol and symptoms of depression were more strongly associated with CVD risk in men than in women. The patterns of these findings were generally similar in high-income countries and upper-middle-income countries, and in low-income and lower-middle-income countries.
A new international study revealed that eight in 10 Europeans believe tans are attractive with almost as many (73%) saying tans are healthy, according to a new study presented at the 31st European Academy of Dermatology and Venereology (EADV) Congress.
This is despite decades of awareness campaigns linking too much sun exposure to skin cancer and ageing in many countries. Latest estimates also presented at EADV 2022 found that about 1.7% of adults in Europe have skin cancer (around 7.3 million people).
Results from a survey, conducted by La Roche-Posay Laboratoires and IPSOS, of 17 000 people from 17 countries, including 6 000 people from the UK, Germany, France, Spain, Italy, and Russia, found the ‘healthy tan’ and other myths about sun safety are still very much alive in Europe and other countries.
Other myths included believing sun protection was not needed in cloudy weather and that you did not need sunscreen if you already had a tan.
People surveyed from non-European countries, including North and South America, Africa, Oceania, and Asia, were slightly less enthusiastic about suntans than Europeans, with 67% saying a tan was attractive and 59% believing a tan was healthy.
Although 92% of Europeans were aware of the skin ageing risks posed by the sun (86% outside of Europe), 84% of them admitted they did not protect themselves all year round (79% outside of Europe).
Lead researcher Prof Thierry Passeron commented on the findings: “This research shows just how entrenched the ‘healthy’ suntan myth is – even in those who have already suffered sun damage or developed skin cancer.”
“We must drive awareness of the damage to skin cells caused by exposure to the sun, which can lead to photoaging and skin cancer. This is particularly important in Europe where sun protection appears most inadequate compared to other countries” added Prof Passeron.
The survey also revealed that only 56% of Europeans know sun protection is useful when the weather is overcast (vs 64% outside of Europe), and 24% thought it was safe to go outside without sun protection when they were already tanned (vs 21% outside of Europe).
Only in 10% of Europeans said they routinely or often used all forms of sun protection, such as applying sunscreen, staying in the shade, wearing a hat and protective clothing all year round, compared to 14% amongst those outside of Europe.
“The public must also understand that they need to protect their skin all year round, even during overcast weather conditions. Once sunscreen has been applied, it must be reapplied every two hours to ensure sufficient protection. Other measures such as wearing sunglasses, a hat, and protective clothing, and seeking shade when it is possible, are also key photoprotection habits”, commented Prof Passeron.
Other study findings include:
Just over half of Europeans (51%) said they were likely to wear a hat routinely or often, compared to 57% outside Europe.
When it comes to staying in the shade (73%) of Europeans said they did so routinely or often, compared to 80% of those outside Europe.
A second analysis by the team found awareness of the dangers of the sun were higher in at-risk* groups of people. But 59% of this group said they could not imagine coming back from a holiday without a tan, compared to 48% of those without a medical history.
62% of Europeans and 52% of non-Europeans applied sunscreen routinely or often, especially on their arms, legs, and chest. But 10% of Europeans said they never used suncream at all, compared to 16% outside Europe. Of those who applied sunscreen in the sun – 34% applied it only once a day, compared to 49% outside Europe.
90% of those in at-risk groups said they were aware of the risks the sun posed to their skin, yet 72% still regarded a tan as healthy, which is higher than those who had no history of skin cancer or other sun-exposure related skin conditions (62%). Additionally, of those who said they applied sunscreen in at-risk groups, only 1 in 4 (26%) applied it every 2 hours or more often than is recommended.
Opioid use is a significant cause of premature death, caused by supressing respiratory activity. New research, published in The Journal of Physiology, points to a novel treatment for respiratory depression associated with opioid use that administers electrical pulses to the back of the neck, helping patients regain respiratory control following high dosage opioid use.
Breathing problems can occur after opioid use or post-operative complications from anaesthesia because opioids desensitise the brain stem to rises in carbon dioxide. This can cause respiratory failure, which can be fatal. Current treatments, such as manual lung inflation and medication, can work in the short term to combat breathing problems following opioid use, but getting patients to breathe independently remains a challenge. Therefore, this new research, which administers epidural electrical stimulation (EES) offers an alternative, non-pharmacological treatment.
EES administered at the cervical spinal cord, which is located at the back of the neck, activates a network of neurons in the brainstem that stimulates and coordinates respiratory muscles and improves the rate and depth of breathing.
Researchers from the University of California, Los Angeles (UCLA), targeted sensory-motor circuits in the cervical spinal cord of 18 patients with degenerative spine diseases who were anaesthetised for surgical treatment. They delivered 30 Hertz of EES to the cervical spinal cord continuously for no longer than 90 seconds.
They found that short periods of continuous low-intensity EES not only increased the volume of breath but also actively controlled the frequency and rhythm during opioid-induced breathing problems. The rhythmic breathing pattern was sustained briefly after the EES stopped in the presence of high-dose opioids.
Senior author Dr Daniel Lu, UCLA professor and vice chair of neurosurgery, said: “Our results provide proof of principle that cervical EES could improve respiration following opioid use. We can compare the human body to a car, our goal is to jump start the body so it can run by itself without periodic pushes. We hope to use EES to provide novel approaches to restore breathing for healthcare providers as we are now using defibrillation devices for restoring cardiac activities.”
Future human trials with larger cohorts will be conducted to further assess the practical application and impact of EES to determine whether EES can alleviate or reduce the need for ventilator support in acute pathological conditions such as OIRD, stroke, and traumatic brain, brain stem or spinal cord injury. Experimental studies in mice will be carried out to further investigate the role specific neurons play in response to EES.
A malaria vaccine developed by Oxford University has been described as “world changing” following its successful trial in children in Burkina Faso. Their results of their double-blind randomised controlled trial were published yesterday in The Lancet Infectious Diseases.
The researchers had previously reported that in children, the R21/Matrix-M malaria vaccine reached the WHO-specified goal of 75% or greater efficacy over 12 months.
To test the immunogenicity, and efficacy results at 12 months after administration of a booster vaccination, the researchers conducted a trial was done in children aged 5–17 months in Burkina Faso, who had written informed consent provided by their caregivers. Eligible children were randomised to receive three vaccinations of either 5 μg R21/25 μg Matrix-M, 5 μg R21/50 μg Matrix-M, or a control vaccine (the Rabivax-S rabies vaccine) before the malaria season, with a booster dose 12 months later. Exclusion criteria included any existing clinically significant comorbidity or receipt of other investigational products.
Vaccine safety, efficacy, and a potential correlate of efficacy with immunogenicity, measured as anti-NANP antibody titres, were evaluated over one year following the first booster vaccination. Efficacy analyses were performed for all participants who received the primary series of vaccinations and a booster vaccination.
Between June 2, and July 2, 2020, 409 children returned to receive a booster vaccine, which was the same received in the primary series of vaccinations. R21/Matrix-M had a favourable safety profile and was well tolerated. Vaccine efficacy remained high in the high adjuvant dose (50 μg) group, similar to previous findings at one year after the primary series of vaccinations. Following the booster vaccination, 51% of children receiving R21/Matrix-M with low-dose adjuvant, 39% of children receiving the same but with high-dose adjuvant, and 86% of 140 children who received the rabies vaccine developed clinical malaria by 12 months.
Vaccine efficacy was 71% in the low-dose adjuvant group and 80% in the high-dose adjuvant group. In the high-dose adjuvant group, vaccine efficacy against multiple episodes of malaria was 78%, and 2285 cases of malaria were averted per 1000 child-years at risk among vaccinated children in the second year of follow-up. Among these participants, at 28 days following their last R21/Matrix-M vaccination, titres of malaria-specific anti-NANP antibodies correlated positively with protection against malaria in both the first year of follow-up (Spearman’s ρ –0·32 [95% CI –0·45 to –0·19]; p = 0·0001) and second year of follow-up (–0·20 [–0·34 to –0·06]; p = 0·02).
A booster dose of R21/Matrix-M at 1 year following the primary three-dose regimen maintained high efficacy against first and multiple episodes of clinical malaria. Furthermore, the booster vaccine induced antibody concentrations that correlated with vaccine efficacy. The trial is ongoing to assess long-term follow-up of these participants and the value of further booster vaccinations.
Speaking to BBC News, Prof Katie Ewer said that “this is not like COVID where we have seven vaccines straight away that will work… it’s much, much harder”. This malaria vaccine is the 14th that she has worked on, and it was “incredibly gratifying” to get this far and “the potential achievement that this vaccine could have if it’s rolled out could be really world-changing”.
The Oxford-developed vaccine shares similarities with the current, approved malaria vaccine from GSK: both target the first stage of the parasite’s lifecycle by intercepting it before it can establish itself in the liver.
The vaccines use a combination of proteins from the malaria parasite and the hepatitis B virus, but the Oxford vaccines has a more malaria proteins, which may help the immune system to focus on malaria rather than the hepatitis.
The trial is continuing for a further 2 years to assess both the potential value of additional booster vaccine doses and longer-term safety.
In new research published in the Journal of Bone and Mineral Research, elevated blood levels of a certain chemokine, or small signalling protein, that promotes osteoclast formation were linked with a higher risk of hip fracture in men.
To maintain bone health, a balanced activity of various bone cell types including bone-forming osteoblasts and bone-resorbing osteoclasts has to take place. When osteoclasts dominate without adequate bone formation to compensate, osteoporosis results.
The study included 55 men and 119 women who had experienced a hip fracture an average of 6.3 years after their blood was collected. The participants were matched individually to controls who did not develop hip fractures.
The researchers found higher levels of the chemokine CXCL9 in the pre-fracture blood samples of men with subsequent hip fractures compared with their non-fracture controls. In women, the researchers saw no such.
“The unexpected difference in the results between men and women in our study may be explained by how changes in sex hormone levels during aging could influence the level and effects of CXCL9 differently in older men and women,” explained corresponding author Woon-Puay Koh, MBBS, PhD, from the National University of Singapore (NUS).
“Our findings open the exciting possibility that early interventions targeting CXCL9 or CXCL9-CXCR3 signalling could be beneficial in preventing hip fractures in older men,” added co-corresponding author Christoph Winkler, PhD, also from NUS.
In a study in the Journal of Public Health, participants who exchanged 30 minutes of social media use per day for exercise felt happier, more satisfied, less stressed by the COVID pandemic and less depressed than a control group. These effects persisted even six months after the study had ended.
The downside of social media
While it helped people stay connected during the COVID pandemic, social media consumption has also its drawbacks. Heavy use can lead to addictive behaviour that manifests itself in, for example, a close emotional bond to the social media. In addition, fake news and conspiracy theories can spread uncontrollably on social channels and trigger even more anxiety.
“Given that we don’t know for certain how long the coronavirus crisis will last, we wanted to know how to protect people’s mental health with services that are as free and low-threshold as possible,” explained assistant professor Dr. Julia Brailovskaia, who lead a team from the Mental Health Research and Treatment Center at Ruhr-Universität Bochum. To find out whether the type and duration of social media use can contribute to this, she and her team conducted an experimental study, with a total of 642 participants randomised to one of four groups.
A two-week experiment
The first group reduced the daily social media consumption by 30 minutes during an intervention period of two weeks. Since previous studies had shown that physical activity can increase well-being and reduce depressive symptoms, the second group increased the duration of physical activity by 30 minutes daily during this period, while continuing to use social media as usual. The third group combined both, reducing social media use and increasing physical activity. A control group didn’t change the behaviour during the intervention phase.
Before, during and up to six months after the two-week intervention phase, the participants responded to online surveys on the duration, intensity and emotional significance of their social media use, physical activity, their satisfaction with life, their subjective feeling of happiness, depressive symptoms, the psychological burden of the COVID pandemic and their cigarette consumption.
Healthy and happy in the age of digitalisation
The findings clearly showed that both reducing the amount of time spent on social media each day and increasing physical activity have a positive impact on people’s well-being. The combination of the two interventions in particular increases one’s satisfaction with life and subjective feeling of happiness and reduces depressive symptoms. Even six months after the two-week intervention phase had ended, participants in all three intervention groups spent less time on social media than before: about a half hour in the groups that had either reduced social media time or increased their daily exercise, and about three-quarters of an hour in the group that had combined both measures. Six months after the intervention, the combination group engaged one hour and 39 minutes more each week in physical activity than before the experiment. The positive influence on mental health continued throughout the entire follow-up period.
“This shows us how vital it is to reduce our availability online from time to time and to go back to our human roots,” Julia Brailovskaia concluded. “These measures can be easily implemented into one’s everyday life and they’re completely free — and, at the same time, they help us to stay happy and healthy in the digital age.”
The High Court in Gqeberha has found that the Eastern Cape MEC for Health and Livingstone Hospital are liable to pay damages to the widow of a man who died after falling from the fifth floor of the hospital.
In the ruling last week, Acting Judge Ivana Bands found that the patient, George Williams, had not been properly medicated or monitored. She said that had this been done, Williams would not have been “pacing up and down the ward, in confused, restless and disoriented state”, and would not have fallen to his death from the window.
Judge Bands said the conduct of the medical and nursing personnel who treated Williams after he was admitted to the hospital on 3 October 2013, “fell far short of what is regarded as sound practice” in dealing with patients suffering from alcohol withdrawal – delirium tremens which involves sudden and severe mental or nervous system changes – and secondary schizophrenia.
“Had he been properly medicated, it cannot be gainsaid [denied] that he would have been reduced to a calm and lightly dozing state. This would have enabled the medical and nursing staff to monitor his vital signs and his condition appropriately until such time that delirium tremens had abated,” Judge Bands said.
Judge Bands’s finding of negligence means that Williams’s widow Jeanine can now pursue a monetary damages claim against the MEC and hospital. This could be determined at another trial or through negotiation.
Jeanine Williams, in her papers, contended that the hospital staff were under a legal duty to provide her husband with adequate and timeous medical treatment; that they had not properly sedated him, restricted his movements and monitored his condition.
The defendants, however, argued that Williams had been treated with sedatives, including diazepam (Valium) and that he had been put in an “enclosed locked ward” close to the nurses’ station.
Bands said Wiliams was a known alcoholic who was admitted to the hospital late on 3 October 2013. In the early hours of the morning, he had been given diazepam, with little effect. During the evening of 4 October, he was given more sedatives and an antipsychotic agent, also with no effect.
Soon after, at about 10:30pm, Williams broke the outside entrance glass door of the nurses’ tearoom and fell from the fifth floor. He died about an hour later.
Two key witnesses during the trial were Dr Candice Harris, a professional nurse and general practitioner, who testified for Williams, and Dr Michelle Walsh, a general surgeon, who testified for the MEC and the hospital.
In her evidence, Harris had said delirium tremens was a “medical emergency” and, according to guidelines, immediate management of the condition was necessary. She had stressed the importance of re-orientating the patient and said it was the nurse’s duty to inform the doctor if the patient was not responding to medication.
The judge said Walsh’s evidence was that it was not that the hospital was doing nothing – “they were doing something”.
“She said the sedation prescribed is usually based on what the assessing doctor thinks will have the desired effect to calm the patient to the extent that they would sit calmly in a chair. It is common cause that this desired state was never reached,” the judge said.
“Not only was he under-sedated, there is no evidence that the initial dose, which had no effect, was ever increased as per the published guidelines, in spite of multiple entries in the hospital records that he remained confused, disorientated, restless and walking up and down – and that he had become so agitated that the nursing staff feared he would assault them,” the judge said.
Bands said Williams had not been treated according to the guidelines, thus the MEC and the hospital are liable for any proven damages.
Although bones are considered a mostly structural component of the human body, bones are in fact active living tissues that can respond to applied mechanical forces. For example, martial arts training, with its kicks, punches and throws, has been shown to increase bone mineral density in the arms, legs and spines of practitioners.
At present, it is unclear whether this thickening of the skull is beneficial or detrimental: theoretically, a thicker skull is a stronger skull, suggesting that this may be the bone’s attempt to protect the brain from subsequent impacts.
“This is a bit of a conundrum,” Assoc Prof Semple said. “As we know, repeated concussions can have negative consequences for brain structure and function. Regardless, concussion is never a good thing.”
The team hopes that the microstructural skull alterations caused by concussion are now considered by researchers in the field to better understand how concussions affect the whole body.
A form of mild traumatic brain injury, concussion have been linked to long-term neurological consequences if they happen repetition.
While most studies focus on its effect on the brain and its function, they largely ignore the overlying skull bones.
Study collaborator Professor Melinda Fitzgerald, from Curtin University and the Perron Institute in Western Australia, has previously shown that repeated concussive impacts lead to subtle problems with memory, and evidence of brain damage.
In this new study, high-resolution neuroimaging and tissue staining techniques were used in a pre-clinical animal model, and revealed an increase in bone thickness and density, in close proximity to the site of injury.
“We have been ignoring the potential influence of the skull in how concussive impacts can affect the brain,” Associate Professor Semple said. “These new findings highlight that the skull may be an important factor that affects the consequences of repeated concussions for individuals.”
Future studies are planned, with collaborator and bone expert Professor Natalie Sims from St Vincent’s Institute of Medical Research in Melbourne, to understand if a thickened skull resulting from repeated concussions alters the transmission of impact force through the skull and into the vulnerable brain tissue underneath.
A serious neonatal health threat, preterm labour has long mystified researchers – and how does the uterus normally stay dormant, letting it stretch and expand during the 40 weeks it takes a foetus to grow? New research published in The Journal of Physiology suggests that a protein called Piezo1 keeps the uterus relaxed throughout gestation.
Preterm birth is a major cause of neonatal mortality and morbidity. The identification of Piezo1 in the uterus, and its role to maintain relaxation of uterus through stretch-activation during pregnancy, paves the way for drugs and therapies to be developed that could one day treat or delay preterm labour.
The muscular outer layer of the uterus is peculiar because it is the only muscle that it is not regulated by nerves and it must remain dormant for the 40 weeks despite significant expansion and stretch as the foetus develops into a baby. The researchers from University of Nevada USA studied tissue samples of the smooth muscle of the uterus to explore the mechanistic pathways to better understand the dynamics controlling the uterus, how pregnancy is maintained and what maintains quiescence until labour.
Stretching the uterus tissue, to mimic what happens during pregnancy, activates Piezo1 channels. This drives the flow of calcium molecules generating a signalling cascade that activates the enzyme nitric oxide synthase to produce the molecule nitric oxide. This Piezo1 cascade promotes and maintains the dormant state of the uterus.
Piezo1 controls the uterus by working in a dose-dependent manner, where channel activity is stimulated by the chemical Yoda1 and inhibited by a chemical called Dooku1 (Star Wars fans will no doubt recognise the inspiration behind these two names). When Piezo1 is upregulated, the uterus remains in a relaxed state. However, in preterm tissue, the expression of Piezo1 is significantly downregulated, ‘switching off’ the dormant signalling to the muscle, so the uterus contracts and initiates labour.
Professor Iain Buxton at the Myometrial Research Group at the University of Nevada said: “Pregnancy is the most impressive example of a human muscle enduring mechanical stress for a prolonged period. Finding Piezo1 in the muscular layer of the uterus means the uterus is controlled locally and is coordinated by a stretch-activated mechanism rather than hormonal influence from the ovaries or the placenta, which has been the assumption.
“It is troubling that there are still no drugs available to stop preterm labour. Thanks to the Nobel Prize winning discovery of Piezo proteins, which are responsible for how the body responds to mechanical force, and our investigation we are now closer to developing a treatment. Piezo1 and its relaxation mechanism provide a target for us which we could potentially activate with drugs. We need to test this with further studies and we hope to carry out clinical trials in the future.”
Contraction and relaxation were assessed in tissue samples compared for the following gestational periods: non-pregnant, term non-labouring, term labouring, preterm non-labouring and preterm labouring. The presence of Piezo1 channels was discovered using molecular tools while pregnant tissues contracting in a muscle bath were stimulated with Piezo1 channel activator and inhibitor to characterize the regulation of quiescence.
More research is needed to understand just how all the molecular signals and steps involved in the Piezo1 channel regulate uterus relaxation, and to identify other chemicals that may be involved.
With more than 64% of women suffering from premenstrual mood swings and anxiety, they represent a “key public health issue globally,” according to a new study in Archives of Women’s Mental Health.
The UVA Health study found that most women have premenstrual symptoms every menstrual cycle, with one of the most common symptoms, regardless of age, being mood swings or anxiety. At least 61% of women in all age groups surveyed reported mood-related symptoms every menstrual cycle, which the researchers say suggests “that premenstrual mood symptoms are a key public health issue globally.”
“Our study demonstrates that premenstrual mood symptoms are incredibly common worldwide,” said senior author Jennifer L Payne, MD. “More important, a majority of women reported that their premenstrual symptoms interfered with their everyday life at least some of the time.”
Better understanding premenstrual symptoms
To better understand the type of premenstrual symptoms women experience and how those symptoms affect their daily lives, the researchers analysed more than 238 000 survey responses from women ages 18–55 from 140 countries on the Flo app, which helps women track their menstrual cycle or track their mood or physical symptoms during and after pregnancy.
Food cravings topped the most common symptoms (85.28%), followed by mood swings or anxiety (64.18%) and fatigue (57.3%). Among the study respondents, 28.61% said their premenstrual symptoms interfered with their everyday life during every menstrual cycle, while an additional 34.84% said their premenstrual symptoms interfered with their everyday life sometimes.
“The incidence of reported premenstrual mood and anxiety symptoms varied significantly by country from a low of 35.1% in Congo to a high of 68.6% in Egypt,” Payne said. “Understanding whether differences in biology or culture underlie the country level rates will be an important future research direction.”
A group of symptoms — absentmindedness, low libido, sleep changes, gastrointestinal symptoms, weight gain, headaches, sweating or hot flashes, fatigue, hair changes, rashes and swelling — was significantly more frequent among older survey respondents, the researchers found. The increase in physical symptoms among older survey respondents “makes sense,” the researchers said, as many of these symptoms are associated with perimenopause, a transition period to menopause marked by irregular menstrual cycles.
Payne is hopeful that this survey data will help women get better care by making healthcare providers more aware of the frequency of these symptoms, especially anxiety and mood-related symptoms.
“There are a number of treatment strategies that are available to treat premenstrual symptoms that interfere with a woman’s every day functioning,” she said. “Increasing awareness of how common these symptoms are, and that if they impact functioning that there are treatments available, will help women improve their quality of life.”
