Many people can agree that an altered passage of time, known as “temporal disintegration” in psychiatric literature, was a common experience during the COVID pandemic, ranging from difficulty in keeping track of days of the week to feeling that the hours themselves rushed by or slowed down. Prior work linked these distortions to persistent negative mental outcomes such as depression and anxiety following trauma.
A new study, published in Psychological Trauma: Theory, Research, Practice, and Policy, documents how pervasive the experience was in the first six months of the pandemic. Pandemic-related secondary stresses such as daily COVID-related media exposure, school closures, lockdowns and financial difficulties were also found to be predictors of distortions in perceived time.
“Continuity between past experiences, present life and future hopes is critical to one’s well-being, and disruption of that synergy presents mental health challenges,” said corresponding author E. Alison Holman, UCI professor of nursing. “We were able to measure this in a nationally representative sample of Americans as they were experiencing a protracted collective trauma, which has never been done before. This study is the first to document the prevalence and early predictors of these time distortions. There are relatively new therapies that can be used to help people regain a more balanced sense of time, but if we don’t know who is in need of those services, we can’t provide that support.”
Researchers assessed results of responses regarding distorted time perceptions and other pandemic related experiences from a national sample of 5661 participants. Surveys were conducted during March 18-April 18, 2020 and Sept. 26-Oct. 26, 2020 with respondents who had completed a mental and physical health survey prior to the COVID outbreak.
“Given that distortions in time perception are a risk factor for mental health problems, our findings have potential implications for public health. We are now looking at temporal disintegration, loneliness, and mental health outcomes over 18 months into the pandemic,” Prof Holman said. “This will help us gain insight into how these common experiences during the pandemic work together, so we can better understand how to help people struggling with these challenges.”
University of College London researchers have used gene therapy to partially restore the function of cone receptors in two children with achromatopsia, a rare genetic disorder which can cause partial or complete colourblindness.
The findings, published in Brain, suggest that treatment activates previously dormant communication links between the retina and the brain, thanks to the developing adolescent brain’s plastic nature.
The academically-led study has been running alongside a phase 1/2 clinical trial in children with achromatopsia, using a new way to test whether the treatment is changing the neural pathways specific to the cones.
Achromatopsia is caused by disease-causing variants to one of a few genes. As it affect the cones in the retina, are responsible for colour vision, people with achromatopsia are completely colourblind, while they also have very poor vision and photophobia. Their cone cells do not send signals to the brain, but many remain present, so researchers have been seeking to activate the dormant cells.
Lead author Dr Tessa Dekker said: “Our study is the first to directly confirm widespread speculation that gene therapy offered to children and adolescents can successfully activate the dormant cone photoreceptor pathways and evoke visual signals never previously experienced by these patients.
“We are demonstrating the potential of leveraging the plasticity of our brains, which may be particularly able to adapt to treatment effects when people are young.”
The study involved four young people with achromatopsia aged 10 to 15 years old.
The two trials, which each target a different gene implicated in achromatopsia, are testing gene therapies with the primary aim of establishing that the treatment is safe, while also testing for improved vision. Their results have not yet been fully compiled so the overall effectiveness of the treatments remains to be determined.
The accompanying academic study used a novel functional magnetic resonance imaging (fMRI) mapping approach to separate emerging post-treatment cone signals from existing rod-driven signals in patients, allowing the researchers to pinpoint any changes in visual function, after treatment, directly to the targeted cone photoreceptor system. They employed a ‘silent substitution’ technique using pairs of lights to selectively stimulate cones or rods. The researchers also had to adapt their methods to accommodate eye movements due to nystagmus, another symptom of achromatopsia. The results were compared to tests involving nine untreated patients and 28 volunteers with normal vision.
Each of the four children was treated with gene therapy in one eye, enabling doctors to compare the treatment’s effectiveness with the untreated eye.
For two of the four children, there was strong evidence for cone-mediated signals in the brain’s visual cortex coming from the treated eye, six to 14 months after treatment. Before the treatment, the patients showed no evidence of cone function on any tests. After treatment, their measures closely resembled those from normal sighted study participants.
The study participants also completed a test to distinguish between different levels of contrast. This showed there was a difference in cone-supported vision in the treated eyes in the same two children.
The researchers say they cannot confirm whether the treatment was ineffective in the other two study participants, or if there may have been treatment effects that were not picked up by the tests they used, or if effects are delayed.
Co-lead author Dr Michel Michaelides (UCL Institute of Ophthalmology and Moorfields Eye Hospital), who is also co-investigator on both clinical trials, said: “In our trials, we are testing whether providing gene therapy early in life may be most effective while the neural circuits are still developing. Our findings demonstrate unprecedented neural plasticity, offering hope that treatments could enable visual functions using signalling pathways that have been dormant for years.
“We are still analysing the results from our two clinical trials, to see whether this gene therapy can effectively improve everyday vision for people with achromatopsia. We hope that with positive results, and with further clinical trials, we could greatly improve the sight of people with inherited retinal diseases.”
Dr Dekker added: “We believe that incorporating these new tests into future clinical trials could accelerate the testing of ocular gene therapies for a range of conditions, by offering unparalleled sensitivity to treatment effects on neural processing, while also providing new and detailed insight into when and why these therapies work best.”
One of the study participants commented: “Seeing changes to my vision has been very exciting, so I’m keen to see if there are any more changes and where this treatment as a whole might lead in the future.
“It’s actually quite difficult to imagine what or just how many impacts a big improvement in my vision could have, since I’ve grown up with and become accustomed to low vision, and have adapted and overcome challenges (with a lot of support from those around me) throughout my life.”
The choice of words that doctors doctors use when diagnosing female patients with polycystic ovary syndrome (PCOS) can negatively impact their wellbeing and how they view their condition later on in life, according to new research published in the British Journal of General Practice.
PCOS can result in a range of physical symptoms, such as dysmenorrhoea or amenorrhoea, and metabolic issues. University of Surrey researchers found that the use of the word ‘raised’ by practitioners when discussing test results can lead to higher levels of body dissatisfaction and dieting behaviour amongst women, whilst the use of the word ‘irregular’ can result in concerns about fertility.
Jane Ogden, Professor of Health Psychology at the University of Surrey, said: “Diagnostic consultations may take a few minutes, yet how these minutes are managed, what words are used and how this makes a patient feel may change how they make sense of their condition and influence their wellbeing in the longer term. It is important that doctors have an awareness of the words they use and think about how they could be perceived by patients.”
In one of the first studies of its kind, researchers investigated the impact of PCOS diagnostic consultations and whether the language used impacted the subsequent wellbeing of patients.
To assess the impact, researchers surveyed 147 females with PCOS and asked about their satisfaction with their consultation, the language used during it and their overall wellbeing.
Researchers found that those who had felt uncomfortable with the consultation process were more likely to report poorer body esteem, reduced quality of life and greater concerns about health in later life. Over a quarter of those surveyed were dissatisfied with how doctors managed their distress and were unhappy with the lack of rapport they had with their practitioners.
Prof Ogden added: “Words matter, as patients often replay conversations that they have had with doctors in a bid to make sense of situations. Although words such as ‘raised’ and ‘irregular’ are simple words they are vague which can cause women to worry, as they automatically think the worst, as they have not been provided with all the facts. Such anxiety at the time of diagnosis, can negatively impact how they feel about themselves as their life progresses.”
A new Australian and New Zealand Journal of Public Health study has found that Australian children who were born via caesarean section (C-section) have a greater risk of cardiovascular disease (CVD) and obesity. These findings have prompted a call to limit the increasingly popular practice.
According to a Lancet review, C-sections are already known to have a number of negative outcomes, with evidence higher rates of maternal mortality and morbidity than after vaginal birth. C-sections are further associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth. Short-term risks of C-section include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced gut microbiome diversity. Associations of C-section with greater incidence of late childhood obesity and asthma are frequently reported.
Researchers used data from the Longitudinal Study of Australian Children to analyse the health outcomes of children delivered by C-section.
“C-section births have risen across the world with a disproportionately higher rate in developed countries. In Australia, the C-section birth rate has increased from 18.5% in 1990 to 36% in 2019 and nearly half of Australian babies are projected to be caesarean born by 2045,” said study author Dr Tahmina Begum.
A relationship was discovered between C-section births and certain cardiovascular disease (CVD) risk factors in children.
“Four out of six individual CVD risk components and the composite index of the five CVD risk components showed a positive association with C-section birth. Our study also provided a direct relationship between C-section and increased overweight and obesity among children at 10–12 years of age,” said Dr Fatima.
A biologically plausible link involved the gut microbiome, she said. “There’s an altered microbial load from C-section birth as compared to vaginal birth. This altered microbial ecosystem hampers the ‘gut-brain axis’ and releases some pathogenic toxins that cause metabolic damage.”
Other possible causes included foetal stress from physiological or pharmacological induction of labour during a C-section. She said the study provides important insights into health care policy and the strategic direction towards chronic disease risk reduction.
“Growing rates of C-sections conducted for non-clinical reasons is a major public health concern that calls for a reduction in the rate of unnecessary C-sections and their associated human and economic costs,” said Dr Begum.
The New York Times reports that low oral doses of the cheap antihypertensive drug minoxidil – a key ingredient in many hair-loss treatments such as Rogaine – is now being widely used as an off-label prescription for male and female hair loss.
Since the accidental discovery of minoxidil’s topical efficacy in treating hair loss in the 1980s, it had became a staple in `Rogaine for male and female patients. However, applying the foam or lotion onto scalps is time-consuming and uncomfortable for many – as well as expensive.
There is not much in the way of clinical evidence as to its efficacy. A 2019 study in the Journal of the American Academy of Dermatology is so far the only randomised open study to compare 1mg oral minoxidil against 5% topical minoxidil for hair loss in female patients.
The oral minoxidil was not inferior to the topical version, and indeed trend analysis suggested it might be more effective.
According to the Times, the off-label designation might scare off some, but such drugs are widely used in practice.
Dermatologist Robert Swerlick, of the Emory University School of Medicine, noted that “most things we [dermatologists] do are off-label because there is nothing on-label.”
Brett King, a Yale School of Medicine dermatologist, told the Times that it would likely stay off-label because there wasn’t a financial incentive for Big Pharma to invest in proper trials.
“Oral minoxidil costs pennies a day,” King told the Times. “There is no incentive to spend tens of millions of dollars to test it in a clinical trial. That study truly is never, ever going to be done.”
Until researchers have the motivation and funding to conduct randomised controlled trials into low-dose oral minoxidil as a baldness treatment, the situation is likely to remain unchanged even if it is growing in popularity with certain dermatologists.
