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.
A recent report by the US Centers for Disease Control and Prevention found more than 80% of urine samples from children and adults in the US contained the herbicide glyphosate. A study published in Scientific Reports takes this research one step further and is the first to link the use of the herbicide Roundup®, a widely used weed killer, to convulsions in animals.
Glyphosate, the weed killer component in Roundup®, is the world’s most commonly used herbicide by volume and by land-area treated. Glyphosate-resistant crops account for almost 80% of transgenic crop cultivated land, which has resulted in an estimated 6.1 billion kg of glyphosate sprayed across the world from 2005 to 2014. Roundup® is used at both industrial and consumer levels, and its use is projected to dramatically increase over the coming years. A major question, yet to be fully understood, is the potential impact of glyphosate on the nervous system.
“It is concerning how little we understand the impact of glyphosate on the nervous system,” said project leader Akshay S. Naraine, a PhD student at FAU and the International Max Planck Research School for Synapses and Circuits. “More evidence is mounting for how prevalent exposure to glyphosate is, so this work hopefully pushes other researchers to expand on these findings and solidify where our concerns should be.”
Resultsshowed that glyphosate and Roundup® increased seizure-like behaviour in soil-dwelling roundworms and provides significant evidence that glyphosate targets GABA-A receptors. These communication points are essential for locomotion and are heavily involved in regulating sleep and mood in humans. What truly sets this research apart is that it was done at significantly lower levels than recommended by the EPA and those used in past studies.
“The concentration listed for best results on the Roundup® Super Concentrate label is 0.98% glyphosate, which is about 5 tablespoons of Roundup® in 1 gallon [3.8 litres] of water,” said Naraine. “A significant finding from our study reveals that just 0.002% glyphosate, a difference of about 300 times less herbicide than the lowest concentration recommended for consumer use, had concerning effects on the nervous system.”
Using C. elegans, a soil-dwelling roundworm, researchers first tested glyphosate alone and then both the US and UK formulations of Roundup® from two distinct time periods – before and after the UK’s 2016 ban on polyethoxylated tallowamine (POEAs). These conditions were selected to pinpoint which effects are specific to the active ingredient glyphosate, Roundup® formulations in general, the POEAs surfactants, or any combination of these.
The study found that the active ingredient glyphosate exacerbated convulsions in C. elegans and suggest the GABA-A receptor as a neurological target for the observed physiological changes. The data also indicate that there is an important distinction between exposure to glyphosate and Roundup®, with Roundup® exposure increasing the percentage of C. elegans that did not recover from seizure activity. The non-recovery phenotype and prolonged convulsions in C. elegans from this study have helped to set a foundation for understanding nuanced physiological effects of herbicide that occur at concentrations exponentially below neurotoxic levels.
“Given how widespread the use of these products is, we must learn as much as we can about the potential negative impacts that may exist,” said lab head Ken Dawson-Scully, PhD, professor at Nova Southeastern University. “There have been studies done in the past that showed the potential dangers, and our study takes that one step further with some pretty dramatic results.”
Findings also generate concern over how herbicide use might affect soil-dwelling organisms like C. elegans.
“These roundworms undergo convulsions under thermal stress, and our data strongly implicates glyphosate and Roundup® exposure in exacerbating convulsive effects. This could prove vital as we experience the effects of climate change,” said Naraine.
This study provides evidence to further investigate how chronic exposure and accumulation may lead to neurodegenerative diseases such as Parkinson’s disease. Importantly, there also is a sub-neurodegenerative threshold that may dramatically impact dysregulation of neurotransmission.
“As of now, there is no information for how exposure to glyphosate and Roundup® may affect humans diagnosed with epilepsy or other seizure disorders,” said Dawson-Scully. “Our study indicates that there is significant disruption in locomotion and should prompt further vertebrate studies.”
Caregivers who consume digital media for relaxation are more likely to engage in negative parenting practices, according to a new multinational study. The study, published in Computers and Human Behaviour, aimed to investigate the relationship between caregivers’ use of digital media, mental health, and parenting practices at the start of the COVID pandemic.
On average, caregivers spend three to four hours a day consuming digital media.
“All members of the family matter when we try to understand families in a society saturated with technology,” said study lead author Jasmine Zhang, a master’s candidate in clinical psychology at Waterloo. “It’s not just children who are often on devices. Parents use digital media for many reasons, and these behaviours can impact their children.”
To conduct the study, the researchers surveyed 549 participants who are parents of at least two children between the ages of five and 18. Caregivers provided information about their digital use, their own mental health and their children’s, family functioning, and parenting practices.
The researchers found that caregivers with higher levels of distress engage in more screen-based activities and were more likely to turn to devices for relaxation. This consumption was correlated with negative parenting practices such as nagging and yelling. They also found that negative parenting behaviours were more likely when technology interrupted family interactions. The experiment didn’t focus on specific apps or websites that caregivers use but rather found that caregivers who spend time on screens were retreating from being present with their family, which is correlated with negative parenting practices.
Not all media consumption had negative outcomes: keeping in touch digitally was related to lower levels of anxiety and depression and higher levels of positive parenting practices such as listening to their children’s ideas and speaking of the good their children do.
“When we study how parents use digital media, we need to consider caregivers’ motivations for using devices in addition to how much time they spend on them,” Zhang said.
Study co-authore Dillon Browne, Canada Research Chair in Child and Family Clinical Psychology and professor of psychology at Waterloo, expects that these patterns will continue after the pandemic.
“The family media landscape continues to grow and become more prominent,” said Prof Browne. “Going forward, it’s important to consider the nuances of digital media as some behaviours are related to well-being, and others are related to distress.”
The researchers plan further research and hope that their work will yield guidelines for caregivers to manage their screen-based behaviours.
Published in The Journal of Pediatrics, a study reviewing medical records has found that new diagnoses of type 2 diabetes in children has surged 77% since the pandemic, accelerating a trend that is already a great concern for parents and healthcare professionals.
The new analysis documented the rise in cases with measures of increased body mass index (BMI) and higher blood glucose and haemoglobin A1c test results.
During the first year of the pandemic, medical records showed that more boys (55%) were diagnosed with type 2 diabetes than girls (45%), a reversal of the percentages during the pre-pandemic years.
In addition, during the pre-pandemic years, more patients were diagnosed while outpatients (57%) than during the pandemic year, when more were diagnosed and treated as inpatients (57%), suggesting greater severity.
Overall, the researchers found that 21% of the young people diagnosed presented with “metabolic decompensation,” of which the most serious symptoms include vomiting, lethargy, confusion and rapid breathing. Pre-pandemic, such symptoms occurred in only 9% of children with new-onset type 2 diabetes. Because the study involved a retrospective review of medical records, the investigators say there is a potential for inconsistencies in reporting or missing information.
“It used to be rare to hear about a child with type 2 diabetes, but its prevalence in adolescents has almost doubled in the past 20 years,” said Dr Kesley. “Type 2 diabetes is associated with rapidly progressive disease and early onset of complications and, unfortunately, was on the rise even prior to the COVID pandemic.”
Data suggests diagnoses of type 2 diabetes in children are increasing by 4 to 5% per year. The COVID pandemic introduced multiple challenges and increased attention to children with pre-existing disorders such as diabetes.
“In the spring of 2020 we were inundated with new youth-onset type 2 diabetes cases,” said Dr Kelsey. “We were used to seeing 50-60 new cases per year and that increased to more than 100 new cases in a year. Colleagues at other institutions were seeing the same thing, so we gathered a team of researchers to evaluate the frequency and severity of new cases during the first year of the pandemic compared to the mean of the prior two years. It was challenging because there is not a funded national registry for youth-onset type 2 diabetes, so this work was done with an enormous and voluntary effort of investigators across the country who are dedicated to treating diabetes in youth.
“To our knowledge, this is the first multicentre study to report the impact of the COVID pandemic on rates of newly diagnosed youth onset type 2 diabetes,” Dr Kesley said. “We found that the pandemic was associated with an increase in new type 2 diabetes cases compared to the two prior years, as well as an increase in proportion of youth presenting in metabolic decompensation.”
Contributing factors could be stem from the immense behavioural and environmental changes since the onset of the pandemic. Worldwide, children were enrolled in school virtually, extracurricular activities were limited and daily routines were adjusted to decrease the potential exposure to COVID. Consequences of this included increased screen time, unhealthy eating habits, decreased physical activity and poor sleep habits, which all have associations with increased BMI.
Whether COVID infection was the direct cause for the increase, or just associated with environmental changes and stressors during the pandemic is unclear. “Further studies are needed to determine whether this rise is limited to the United States and whether it will persist over time,” said Dr Kesley. “There is still a lot of work to be done.”
Users of medical cannabis are more likely to also use nicotine products than the general population, according to a Rutgers University study published in the American Journal on Addictions.
“Simultaneous use of cannabis and nicotine is a growing concern, but while the relationship between recreational cannabis and nicotine use is well-established, little is known about nicotine use among users of medical cannabis,” said Mary Bridgeman, a clinical professor at Rutgers Ernest Mario School of Pharmacy.
The researchers surveyed 697 patients aged 18–89 at a medical marijuana dispensary on their nicotine and cannabis use, how they self-administered the cannabis (smoked, vaped) and the medical conditions that qualified them for using therapeutic cannabis.
Nearly 40% of medical marijuana users reported using nicotine – sharply higher than the 14% of US adults who smoke.
Therapeutic cannabis users who also used electronic cigarettes or didn’t use nicotine at all were about four times more likely to vape, rather than smoke, cannabis than those who exclusively smoked cigarettes.
The study also found 75% of the respondents smoked cannabis rather than vaped and about 80% of the cigarette smokers reported planning to quit in the next six months.
“These findings reveal that while medical cannabis dispensaries may recommend vaping rather than smoking cannabis due to the health concerns associated with combustible products, this recommendation alone may not influence patients who also smoke cigarettes,” said Professor Marc Steinberg, co-author of the study.
“Between the higher rates of nicotine use in those using medical cannabis, the fact that cigarette smokers opt to smoke cannabis as well and that those people also are seeking to quit using nicotine presents a strong argument that dispensaries provide tobacco control messaging at the point-of-sale to encourage cigarette smokers to quit,” Prof Steinberg added. “The strategy also could increase the chances that a medical cannabis user would vape the product, which is a less harmful route than smoking.”
Some 10 million people annually are projected to die annually from antimicrobial resistance AMR in 2050, says Briëtte Du Toit, Programme Manager and Training Coordinator at Infection Control Africa Network (ICAN). While efforts to develop new antibiotics and conserve current ones are under way, it is vitally important to limit hospital-acquired infections as this is where many resistant strains spread. One of the key ways of controlling this is through the proper use of handwash basins, which necessitates a collaboration between the medical and engineering disciplines.
Presenting at the 14th SAFHE Southern African Healthcare, Du Toit stressed the importance of proper handwashing protocol and the critical importance of handwash basin design and placement to control the spread of hospital-acquired infections amid rising antimicrobial resistance.
The simple protocol of hand washing is perhaps one of the most important in modern medicine. In the past, clinicians might perform and autopsy and then deliver a child, all without washing their hands. It was only until the mid 1800s when Hungarian doctor Ignaz Semmelweis discovered the importance of hand washing, causing infection rates to plummet after the introduction of this most simple of protocols.
In modern hospitals, handwash basin design and placement, along with inadequate water supply and inadequate knowledge on the part of staff, contributes to inadequate hand washing and therefore high infection rates, Du Toit pointed out.
The design of handwash basins may seem straightforward, but there are many factors to consider. Water may drop onto other surfaces, or splash onto HCWs’ clothes. If medical supplies are stored nearby, then stray water droplets may also land on them.
A study of handwash basins showed that only 23% of basins were used for handwashing, while the remainder were used for a variety of activities including waste disposal. Of the basins used for waste disposal, 55% were contaminated. Another study showed that, in the ICU setting, washbasins were used for handwashing a mere 4% of the time. A sluice is also needed in close proximity to patients, otherwise staff will use handwash basins for incorrect disposal of body fluids.
Having the outlet directly beneath the tap as in a traditional domestic basin increases contamination. A bowl depth less than 19cm also contributed to contamination. Without a bowl cover, 9% of gowns and 6% of hands were found to be contaminated with gram-negative bacili (GNB), versus 2% of gowns and 0% of hands when a cover was present.
Significant improvements were also seen in ‘water-free’ protocols at the point of care, which involved the extensive use of disposable wipes, bottled water and practices such as using electric shaving. The implementation of water-free protocols at one hospital saw a drop in GNB colonisations from 26.3 to 21.6 / 1 000 ICU admission days. An even greater effect was seen for long-term ICU stays, with a 3.6 fold-reduction for stay exceeding 14 days.
Du Toit concluded by stressing the importance of collaboration between the medical and engineering fields, sharing data. Engineers should also be on IPC committees. Likewise, medical personnel should be part of the project team during building and renovations.
