A population-based study analysing over one million individuals suggests that babies born via caesarean section delivery may face a higher risk of developing Crohn’s disease later in life. The findings, published in Acta Obstetricia et Gynecologica Scandinavica, add to a growing body of evidence on long-term impacts of caesarean section delivery.
More and more people are being delivered by caesarean section, and there is interest in understanding possible long-term health consequences of this mode of delivery. One possible route is through a lack of the early exposure of the infant to colonising bacteria via a vaginal delivery. Previous studies suggest that infants delivered by CS are at increased risks of disorders involving the immune system, such as asthma and allergies, type 1 diabetes, celiac disease, obesity, immune deficiencies, and leukaemia and other malignancies affecting young people.
In this study, all full-term individuals registered in the Medical Birth Register in Sweden between 1990 and 2000 were followed until 2017. Among 1 102 468 individuals, of whom 11.6% were delivered by caesarean section and 88.4% were vaginally delivered, caesarean section was associated with a 14% higher risk of developing Crohn’s disease after adjusting for confounding factors. No associations between delivery mode and appendicitis, ulcerative colitis, cholecystitis, or diverticulosis were found.
“Our study is the largest in this field, showing new interesting associations between caesarean section and increased risk later in life for Crohn’s disease. We hypothesise that the underlying mechanism could be the gut microbiome, but further studies will have to confirm this,” said senior author Anna Löf Granström, of the Karolinska Institute.
Adults with low blood levels of urate, the end-product of the purine metabolism in humans, may be at higher risk of sarcopenia and may face a higher risk of early death, according to a new study published in Arthritis & Rheumatology.
Whether or nor low serum urate (SU) levels contribute to adverse outcomes has been the subject of controversy. The study involved 13 979 participants aged 20 years and older, sourced from the National Health and Nutrition Examination Survey from 1999–2006.
Low serum urate concentrations (<2.5 mg/dL in women; <3.5 mg/dL in men) were associated with low lean mass, underweight BMI (<18.5 kg/m2), and higher rates of weight loss. While low SU was associated with increased mortality (61%) before adjusting for body composition, its effect was reduced and non-significant after adjustment for body composition and weight loss.
“These observations support what many have intuited, namely that people with low serum urate levels have higher mortality and worse outcomes not because low urate is bad for health, but rather that low urate levels tend to occur among sicker people, who have lost weight and have adverse body composition,” explained lead author Joshua F. Baker, MD, MSCE, of the University of Pennsylvania. “While this observational study doesn’t disprove a causal association, it does suggest that great care is needed in interpreting epidemiologic associations between urate levels and health outcomes.”
In a study published in the New England Journal of Medicine, researchers have found that metformin, a commonly prescribed diabetes medication, lowers the odds of emergency department visits, hospitalisations, or death due to COVID by over 40%; and over 50% if prescribed early in onset of symptoms. The study also found no positive effect from treatment with either ivermectin or low-dose fluvoxamine.
“Our trial suggests that metformin may reduce the likelihood of needing to go to the emergency room or be hospitalised for COVID,” said Carolyn Bramante, MD, principal investigator of the study.
The primary outcome was in fact low oxygen on a home oxygen monitor, which none of the medications in the trial prevented.
The COVID-OUT trial studied whether metformin, low-doses of the antidepressant fluvoxamine, the controversial antiparasitic ivermectin, or their combinations could serve as possible treatments to prevent ER visits or hospitalisation, as well as Long COVID.
Patients were randomised to receive one of the three drugs individually: placebo, or a combination of metformin and fluvoxamine or metformin and ivermectin. Although the study was placebo-controlled with exact-matching placebo pills, Dr Bramante said that 83% of volunteers received medications supported by existing data because of the six-arm design. Each participant received 2 types of pills to keep their treatment assignment masked, for 3 to 14 days of treatment. Each volunteer tracked their symptoms, and after 14 days, they completed a survey.
The 1323 participants in the trial were limited to adults with a body mass index greater than or equal to 25 kg/m2, which qualifies as overweight. To qualify for the study, volunteers enrolled within three days after receiving a positive COVID test. It was among the first randomised clinical trials for COVID to include pregnant women.
The study included those who were vaccinated and those who were not. This is the first published trial where the majority of participants were vaccinated.
“Although we know COVID vaccines are highly effective, we know that some new strains of the virus may evade immunity and vaccines may not be available worldwide. So we felt we should study safe, available and inexpensive outpatient treatment options as soon as possible,” said Dr Bramante. “Understanding whether outpatient treatments could ensure more people survive the illness if they contract it and have fewer long-term symptoms is an important piece of the pandemic response.”
The clinical trial launched in January 2021 after researchers noticed that outpatient metformin use appeared to decrease the likelihood of mortality from, or being hospitalised for COVID. Their research was published in the Journal of Medical Virology and in The Lancet Healthy Longevity. Test-tube studies also found that metformin inhibited the -CoV-2 in lab settings. These findings, along with additional prospective studies supporting the use of higher-dose fluvoxamine and ivermectin, provided the evidence to include all three medications as well as combination arms.
The majority of people who were likely infected with the Omicron variant were unaware they had the virus, according to a new study published in JAMA Network Open.
“More than one in every two people who were infected with Omicron didn’t know they had it,” said Susan Cheng, MD, MPH, corresponding author of the study. “Awareness will be key for allowing us to move beyond this pandemic.”
Previous work estimated that between 25% and 80% of people infected with SARS-CoV-2 may be asymptomatic. Compared to other variants, Omicron is associated with generally less severe symptoms that may include fatigue, cough, headache, sore throat or a runny nose.
“Our study findings add to evidence that undiagnosed infections can increase transmission of the virus,” said Sandy Y. Joung, MHDS, an investigator at Cedars-Sinai and first author of the study. “A low level of infection awareness has likely contributed to the fast spread of Omicron.”
As part of research into the effects of COVID and the impact of vaccines, the investigators began collecting blood samples from healthcare workers more than two years ago. In the second half of 2021, just before the start of the Omicron variant surge, the investigators were able to expand enrolment to include patients. Of the healthcare workers and patients who have participated in the research, investigators identified 2479 people who had contributed blood samples just prior to or after the start of the Omicron surge. The investigators identified 210 people who likely were infected with the Omicron variant based on newly positive levels of SARS-CoV-2 antibodies.
Study participants were invited to provide health status updates through surveys and interviews. Only 44% of study participants testing positive were aware of their infection. Of the 56% of study participants who were unaware, only 10% reported having any recent symptoms that they attributed to a common cold or other type of infection.
More studies involving larger numbers of people from diverse ethnicities and communities are needed to learn what specific factors are associated with a lack of infection awareness, according to the investigators.
Cheng and colleagues are also studying patterns and predictors of reinfections and their potential to offer long-lasting immunity to SARS-CoV-2. In addition to raising awareness, this information could help people manage their individual risk.
Maintaining excellent cardiovascular health may lower the risk for abnormalities in the small vessels of the brain, a new study suggests.
Scientists aren’t sure what causes the condition, known as cerebral small vessel disease, or CSVD. Previous research shows CSVD contributes to about half of dementia cases, a quarter of clot-caused strokes and most bleeding strokes.
For the new study, researchers looked at data from 3067 older adults in Lishui, China. The study team ranked each person’s cardiovascular health as “poor,” “intermediate” or “ideal” based on three medical factors (blood pressure, cholesterol and blood sugar) and four modifiable behaviours (not smoking, maintaining a healthy weight, eating healthy and being physically active).
Next, they compared cardiovascular health to brain MRI scans that looked for signs of CSVD, such as cerebral microbleeds – remnants of blood that has leaked out of small vessels – and lesions called white matter hyperintensities.
The study found participants with ideal cardiovascular health had 26% lower odds of having CSVD than those with poor cardiovascular health. The research was published Wednesday in the journal Stroke.
“The findings were somewhat expected, since a healthy lifestyle can benefit both the arteries and the brain,” said study co-author Yuesong Pan, a researcher of neurological diseases at Capital Medical University’s Beijing Tiantan Hospital in China.
“This suggests that in clinical practice, the target is to attain an ideal (cardiovascular health) score, not just an intermediate score,” he said. “Patients can use a simple self-measuring scale to adjust their lifestyle, assess the risk of CSVD and reduce their CSVD burden.”
Researchers used the American Heart Association’s tool for scoring cardiovascular health that was recently updated to add sleep duration as an eighth factor for ideal heart and brain health. Pan suggested people use the tool, now known as Life’s Essential 8, to find out their risk for cardiovascular disease.
Dr. José Rafael Romero, a neurologist who wasn’t involved in the research, said CSVD is important because “it does not have a specific treatment and it is such a strong contributor to stroke and dementia, which are epidemic conditions around the world.”
In 2020, 7.1 million people worldwide died of stroke, according to AHA statistics. In the US, stroke ranks fifth among all causes of death, with more than 160 000 deaths in 2020, based on data from the Centers for Disease Control and Prevention.
Alzheimer’s disease – the main cause of dementia – is the seventh-leading cause of death in the US. An estimated 6.5 million people age 65 and older have the condition, according to the Alzheimer’s Association. That number is expected to reach 12.7 million by 2050.
“The study is important because it gives additional information on how to lower CSVD risk, which may have an enormous public health benefit,” said Romero, an associate professor of neurology at Boston University School of Medicine who wrote an editorial published alongside the new research.
“It shows that we shouldn’t stop halfway. We should aim for achieving all the goals and achieving ideal cardiovascular health.”
Pan said the study was limited by incomplete dietary data and because it didn’t follow participants over a period of time. He called for larger, long-term observational studies to learn more about the relationship between CSVD and cardiovascular disease risk factors.
Romero said randomised clinical studies are needed to see whether controlling cardiovascular disease risk does indeed lower small vessel disease risk. He also called for future studies to evaluate the usefulness of screening high-risk people for CSVD using brain MRI.
In general, he said, health care professionals and health organisations need to come up with a clearer plan on how to fight CSVD.
“Often, there is no dedicated effort to control risk factors and track this consistently, particularly in patients that have high risk,” Romero said. “We really need to develop programs for effective and sustained implementation of these guidelines for preventing cardiovascular disease.”
Children living near unconventional oil and gas (UOG) or ‘fracking’ developments at birth had a 2–3 times greater risk of leukaemia diagnoses between 2 and 7 years old, researchers have found.
Their study, published in the journal Environmental Health Perspectives, included nearly 2500 Pennsylvania children, 405 of whom were diagnosed with acute lymphoblastic leukaemia (ALL).
ALL arises from mutations to lymphoid immune cells. Although long-term survival rates are high, survivors may have long-term health risks and psychological issues. Unconventional oil and gas development, more commonly referred to as fracking (short for hydraulic fracturing), is a method for extracting gas and oil from shale rock. The process involves high-pressure injection of water, sand, and chemicals into bedrock to release oil or gas for extraction.
For communities living nearby, UOG development can pose a number of potential threats. As well as air pollution from vehicles and construction, there is also water pollution from hydraulic fracturing or spills of wastewater. Hundreds of chemicals have been reportedly used in UOG injection water or detected in wastewater, some of which are known or suspected carcinogens. The lack of data about this has given rise to concerns over the proximity of UOG to residential areas.
“Unconventional oil and gas development can both use and release chemicals that have been linked to cancer, so the potential for children living near UOG to be exposed to these chemical carcinogens is a major public health concern,” said the study’s senior author, Nicole Deziel, associate professor of epidemiology at the Yale School of Public Health.
“Studies of UOG exposure and cancer are extremely few in number. We set out to conduct a high-quality study to further investigate this potential relationship,” added Cassandra Clark, the study’s first author and a postdoctoral associate at the Yale Cancer Center. “Our results indicate that exposure to UOG may be an important risk factor for ALL, particularly for children exposed in utero.”
Oil and gas-related chemicals exposure could be through drinking water, the researchers found. The watershed, the zone from which a drinking water well serving their home would likely draw water, were compared with the distance from the home to the nearest of those UOG wells. UOG wells falling within the watershed area are expected to be more likely to impact the home’s drinking water supply, they said.
This work adds to a growing body of literature on UOG exposure and children’s health used to inform policy, such as setback distances (the required minimum distance between a private residence or other sensitive location and a UOG well). Current setback distances are the subject of much debate in the United States, with some calling for setback distances to be lengthened to more than 305m and as far as 1000m. The allowable setback in Pennsylvania, where the study was conducted, is 152m.
“Our findings of increased risk of ALL at distances of two kilometres or more from UOG operations, in conjunction with evidence from numerous other studies, suggest that existing setback distances, which may be as little as 150 feet (50m), are insufficiently protective of children’s health,” Clark said. “We hope that studies like ours are taken into account in the ongoing policy discussion around UOG setback distances.”
For many smokers, a coffee is needed to make that first cigarette of the day satisfying. A new study suggests that a chemical compound – not caffeine – may help blunt morning nicotine cravings.
Researchers in the study identified two compounds in coffee that directly affect certain high-sensitivity nicotine receptors in the brain. In smokers, these brain receptors can be hypersensitive after a night without nicotine.
Published in the journal Neuropharmacology, the findings have yet to be tested in humans but are an important step toward better understanding how coffee and cigarettes affect nicotine receptors in the brain, explained Roger L. Papke, PhD, a pharmacology professor in the University of Florida College of Medicine. The caffeine in coffee gives a wellness boost to its drinkers, but smokers may get something more.
“Many people like caffeine in the morning but there are other molecules in coffee that may explain why cigarette smokers want their coffee,” Prof Papke said.
The researchers applied a dark-roasted coffee solution to cells that express a particular human nicotine receptor. An organic chemical compound in coffee may help restore the nicotine receptor dysfunction that leads to nicotine cravings in smokers, the researchers concluded.
Prof Papke hypothesises that one of the compounds in brewed coffee, known as n-MP, may help to quell morning nicotine cravings.
Prof Papke said he was intrigued by the idea that nicotine-dependent smokers associate tobacco use with coffee in the morning and alcohol in the evening. While alcohol’s effect on nicotine receptors in the brain has been well researched, the receptors’ interaction with coffee is less studied.
“Many people look for coffee in the morning because of the caffeine. But was the coffee doing anything else to smokers? We wanted to know if there were other things in coffee that were affecting the brain’s nicotine receptors,” Prof Papke said.
The findings, he said, provide a good foundation for behavioural scientists who could further study nicotine withdrawal in animal models.
Birthing women denied nitrous oxide(N20) to relieve labour pain as a result of the COVID pandemic received opioids instead, without any adverse outcomes for mother or child, according to a new study published in the Australian and New Zealand Journal of Obstetrics and Gynaecology. Some anaesthetists have also argued for reducing N20 use as it is a greenhouse gas.
The study, conducted at Lyell McEwin Hospital in Australia, looked at the impact of withholding nitrous oxide (N20), a decision adopted by many hospitals worldwide over fears of virus transmission from the aerosol-generating procedure.
Anaesthetist Professor Bernd Froessler and colleagues compared patient notes for all 243 women birthing at Lyell McEwin over a seven week period in March/April 2020, half of whom did not have access to N20.
They found that although opioid use “significantly increased” when N20 was withheld, there was no increase in epidural use and no change in labour duration, Caesarean section rates, birthing complications or newborn alertness.
Nitrous oxide is used by more than 50% of Australian women to relieve pain in labour, followed by epidurals (40%) and opioids (12%), according to the Australian Institute of Health and Welfare.
However, N20 represents 6% of global greenhouse gas emissions, with 1% due to medical use (ie, around 0.06% of total global warming is due to medical N20). This has led to a debate in medical circles whether it should be replaced with other methods of pain relief.
Many obstetricians argue that effective pain relief in childbirth should be the priority, particularly given the low percentage of emissions, but the Australian and New Zealand College of Anaesthetists has advocated for a reduction in N20 use in a bid to improve environmental sustainability in anaesthesia.
“Obviously no-one wants to deprive labouring women of adequate and easy pain relief but given there are other analgesic options, including epidurals and opioids, perhaps these could be considered,” said Prof Froessler.
UniSA statistician and researcher Dr Lan Kelly said that the findings should reassure women that pain relief besides N20 does not compromise their health or their baby’s.
However, in a recent Sydney Morning Herald article, principal midwifery officer at the Australian College of Midwives, Kellie Wilton, said mothers should not be made to feel guilty about their pain relief choices and suggested hospitals could introduce nitrous oxide destruction systems to allow for its ongoing use.
When nitrous oxide destruction systems were introduced in Swedish hospitals, the carbon footprint from the gas was halved.
In the COVID era, when vaccinations are all the more important, new research published in the European Journal of Pain shows that children’s vaccination and needle fear can be reduced with a couple of different techniques used by nurses.
These techniques divide the children’s attention or redress their fears by framing the positive elements of their experience.
Working with children aged 8–12 years, the preliminary study found that two new nurse-led techniques show promise in reducing needle fear in primary-aged children:
Divided Attention – where a child’s attention and expectations are drawn away from the needle.
Positive Memory Reframing – where a child’s exaggerations about the distress and discomfort of needles are redressed through discussion about the positive elements of the experience so that the form more realistic memories of the event.
Dr Felicity Braithwaite, lead researcher of the study, said that helping children reduce fear and distress around vaccinations is a key area of research in the COVID era.
“For many children, undergoing a needle procedure can be painful and distressing,” Dr Braithwaite said.
“Negative experiences of vaccinations in childhood can often lead to medical avoidance and vaccine hesitancy into adulthood, which can have devastating consequences when it comes to outbreaks of preventable diseases.
“By investing more time into techniques to help children manage their fears about needles, we hope to change these outcomes and deliver better health outcomes for the next generation.”
The study involved 41 children and their parents, with participants randomised to one of four groups – usual care, divided attention, positive memory reframing, or a combination of the latter two interventions. Clinical outcomes were assessed at baseline, immediately post-vaccination and at two-weeks post-vaccination.
The Divided Attention technique involved a one to two minute distraction game where a nurse tapped the child’s arm above and below the vaccination spot in a random order, with the child focussing their attention on guessing which spot was touched each time. This game takes advantage of the potential analgesic effects of distraction.
The Positive Memory Reframing technique involved talking to children about a past injection and emphasising positive aspects, such as how brave the child was and praising specific strategies they used to reduce their own distress, for example, deep breathing and looking away. The aim is to foster a sense of self-efficacy to help children better cope.
Both techniques were tested outside of clinical locations, such as in schools, to maximise their applicability in real-world settings.
Narrowed arteries in the neck – a major risk factor for stroke – may be detected by analysing smartphone video that picks up the motion of blood flowing just beneath the skin, a small study shows.
The research, published Wednesday in the Journal of the American Heart Association, may be useful in developing a non-invasive, early screening tool for detecting blockages in the carotid arteries that can lead to strokes.
“Between 2% and 5% of strokes each year occur in people with no symptoms, so better and earlier detection of stroke risk is needed,” study author Dr. Hsien-Li Kao said in a news release. He is an interventional cardiologist at National Taiwan University Hospital in Taipei.
“This was an exciting ‘eureka’ moment for us,” he said. “Existing diagnostic methods – ultrasound, CT and MRI – require screening with specialised medical imaging equipment and personnel. Analysis of video recorded on a smartphone is non-invasive and easy to perform, so it may provide an opportunity to increase screening.”
The carotid arteries, found in the neck, can become blocked by a buildup of fatty deposits known as plaque. That condition – carotid artery stenosis – restricts blood flow to the brain and may lead to an ischemic stroke. Nearly 87% of all strokes in the US are this type of stroke.
The carotid artery is just below the skin’s surface. When velocity and blood flow patterns change, those changes are reflected in the motion of the overlying skin, Kao said. However, those differences cannot be detected by the naked eye.
In the study, researchers used motion magnification and pixel analysis to detect subtle changes in pulse characteristics on the skin’s surface captured in 30-second smartphone video recordings. An older-generation smartphone was used to make video clips of the necks of 202 Taiwanese adults, who were an average 68 years old when the study took place between 2016 and 2019. While recordings were being made, participants lay on their backs with their heads tilted back in a custom-made box that restricted movement.
Among participants, 54% had previously been diagnosed with a blockage of 50% or more in the carotid artery. The phone videos were 87% accurate in predicting who had a blockage in the artery. Narrowing in the arteries was confirmed using a Doppler ultrasound test.
Kao said further research could determine whether it is possible to take recordings and perform the motion analysis remotely, in conjunction with a downloadable app.
“More research is needed to determine whether video recorded on smartphones is a promising approach to help expedite and increase stroke screening,” he said. “Carotid artery stenosis is silent until a stroke happens. With this method, clinicians may be able to record a video of the patient’s neck with a smartphone, upload the videos for analysis and receive a report within five minutes. The early detection of carotid artery stenosis may improve patient outcomes.”
