Infections, other factors raise risk of pregnancy-related stroke in women with preeclampsia

Urinary tract infections, chronic high blood pressure and bleeding or clotting disorders may increase the risk of pregnancy-associated stroke in women with preeclampsia, a high-blood pressure disorder unique to pregnancy, according to new research in the American Heart Association’s journal Stroke.

Women with preeclampsia are at higher risk of stroke during pregnancy and after delivery. But while preeclampsia affects 3 percent to 8 percent of all pregnancies, pregnancy-related stroke remain rare.

In a study of women admitted to hospitals in New York State from 2003 through 2012, researchers identified 88,857 women with preeclampsia. Of that number, 197 had pregnancy-associated stroke.

Compared with women who had preeclampsia but did not have a stroke, women who had preeclampsia and pregnancy-associated stroke were:

  • seven times more likely to have severe preeclampsia or eclampsia; and
  • about three times more likely to have infections when they arrive at hospital, or had high blood pressure before developing preeclampsia or had blood disorders involving clots or excessive bleeding.

“Preeclampsia is a very complex disorder that’s not completely understood,” said Eliza Miller, M.D., study lead author and vascular neurology fellow at New York-Presbyterian Hospital/Columbia University Medical Center in New York City. “Our study sought to discover if there are other risk factors or clues that may help identify the women with preeclampsia who are at the highest risk for pregnancy-related stroke. We were looking for risk factors that could be prevented or treated.”

Researchers noted a link with urinary tract infections was interesting “because those infections are not only treatable, but could be preventable,” Miller said.

Using billing data from the New York State Department of Health inpatient database, researchers compared women aged 12 to 55 years old with preeclampsia and pregnancy-associated stroke to a matched control group of women with preeclampsia who did not have strokes. Among the women with preeclampsia and stroke, most strokes occurred postpartum, after women had been discharged home after delivery. More than one in 10 of the preeclampsia-related strokes were fatal.

The study’s reliance on patients’ billing data limited the level of detail researchers could analyze and restricted them from drawing definitive conclusions. But the associations were strong enough, Miller said, to help generate new ideas and directions for more research.

“Preeclampsia is a very common disorder, and a lot of people are not aware of its association with stroke,” Miller said. “Women with preeclampsia should take any neurological symptoms, such as severe headache, very seriously, especially during the postpartum period. This needs to be a major focus of future stroke research in women.”

The American Heart Association recommends home blood pressure monitoring for all people with high blood pressure.

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New eye test detects earliest signs of glaucoma

A simple eye test could help solve the biggest global cause of irreversible blindness, glaucoma.

In clinical trials, the pioneering diagnostic — developed by researchers at University College London (UCL) and the Western Eye Hospital — allowed doctors to see individual nerve cell death in the back of the eye.

Glaucoma affects 60 million people in the world, with 1 in 10 suffering total sight loss in both eyes.

Early detection means doctors can start treatments before sight loss begins. The test also has potential for early diagnosis of other degenerative neurological conditions, including Parkinson’s, Alzheimer’s and multiple sclerosis.

Results of first clinical trials with glaucoma patients are published in the journal BRAIN.

Professor Francesca Cordeiro at UCL Institute of Ophthalmology, who led the research, said: “Detecting glaucoma early is vital as symptoms are not always obvious. Although detection has been improving, most patients have lost a third of vision by the time they are diagnosed. Now, for the first time, we have been able to show individual cell death and detect the earliest signs of glaucoma. While we cannot cure the disease, our test means treatment can start before symptoms begin. In the future, the test could also be used to diagnose other neurodegenerative diseases.”

Loss of sight in patients with glaucoma is caused by the death of cells in the retina at the back of the eye. This cell death is called apoptosis.

As with other neurodegenerative conditions, more and more nerve cells are lost as the disease progresses.

Professor Philip Bloom, Chief Investigator at Western Eye Hospital, part of Imperial College Healthcare NHS Trust, added: “Treatment is much more successful when it is begun in early stages of the disease, when sight loss is minimal. Our developments mean we could diagnose patients 10 years earlier than was previously possible.”

The technique developed is called DARC, which stands for detection of apoptosing retinal cells. It uses a specially developed fluorescent marker which attaches to cell proteins when injected into patients. Sick cells appear as white fluorescent spots during eye examination. UCL Business, the commercialisation company of UCL, holds the patents for the technology.

The examination uses equipment used during routine hospital eye examinations. Researchers hope that eventually it may be possible for opticians to do the tests, enabling even earlier detection of the disease.

Bethan Hughes, from Wellcome’s Innovation team said: “This innovation has the potential to transform lives for those who suffer loss of sight through glaucoma, and offers hope of a breakthrough in early diagnosis of other neurodegenerative diseases. Loss of sight as you age is an incredibly difficult disability, impacting quality of life and independence.”

Initial clinical trials were carried out on a small number of glaucoma patients and compared with tests on healthy people. The initial clinical trials established the safety of the test for patients.

Further studies will now be carried out to into DARC and how it can be used not only to diagnose and treat glaucoma patients but also for other neurodegenerative conditions.

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‘Diet’ products can make you fat, study shows

High-fat foods are often the primary target when fighting obesity, but sugar-laden “diet” foods could be contributing to unwanted weight gain as well, according to a new study from the University of Georgia.

Researchers found that rats fed a diet high in sugar but low in fat — meant to imitate many popular diet foods — increased body fat mass when compared to rats fed a balanced rodent diet. The high-sugar diet induced a host of other problems, including liver damage and brain inflammation.

“Most so-called diet products containing low or no fat have an increased amount of sugar and are camouflaged under fancy names, giving the impression that they are healthy, but the reality is that those foods may damage the liver and lead to obesity as well,” said the study’s principal investigator, Krzysztof Czaja, an associate professor of veterinary biosciences and diagnostic imaging in UGA’s College of Veterinary Medicine.

“What’s really troubling in our findings is that the rats consuming high-sugar, low-fat diets didn’t consume significantly more calories than the rats fed a balanced diet,” Czaja said. “Our research shows that in rats fed a low-fat, high-sugar diet, the efficiency of generating body fat is more than twice as high — in other words, rats consuming low-fat high-sugar diets need less than half the number of calories to generate the same amount of body fat.”

Over a four-week period, researchers monitored body weight, caloric intake, body composition and fecal samples in three groups of rats. One group of test subjects consumed a diet high in fat and sugar, another group was fed a low-fat, high-sugar diet and a third group was given a balanced or “normal” diet.

Both the low-fat, high-sugar and high-fat, high-sugar groups displayed an increase in liver fat and significant increases in body weight and body fat when compared to the balanced diet group. Liver fat accumulation was significant in the high-sugar, low-fat group, which Czaja said “is a very dangerous situation, because the liver accumulating more fat mimics the effect of non-alcoholic fatty liver disease.”

Non-alcoholic fatty liver disease is caused by fat buildup in the liver, and serious forms of the disease can result in liver damage comparable to that caused by heavy alcohol use.

The unbalanced diets also induced chronic inflammation in the intestinal tract and brain. Former studies in rats conducted by Czaja have shown that brain inflammation alters gut-brain communication by damaging the vagus nerve, which controls sensory signals, including the brain’s ability to determine when one is full.

“The brain changes resulting from these unbalanced diets seem to be long term, and it is still not known if they are reversible by balanced diets,” Czaja said.

This study expands upon the researchers’ previous work that determined high-fat diets alter the gut microbiome, the collection of bacteria, viruses and other microbes that live in the digestive tract. The recent study found that the unbalanced diets decreased the microbiome’s bacterial diversity, and the low-fat, high-sugar diet increased gut bacteria that are associated with liver damage.

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Materials provided by University of Georgia. Original written by Elizabeth Fite. Note: Content may be edited for style and length.

 

Growing body of evidence supports use of mind-body therapies in breast cancer treatment

In newly updated clinical guidelines from the Society for Integrative Oncology (SIO), researchers at Columbia University’s Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center with an interdisciplinary team of colleagues at MD Anderson Cancer Center, University of Michigan, Memorial Sloan Kettering Cancer Center, and other institutions in the U.S. and Canada, analyzed which integrative treatments are most effective and safe for patients with breast cancer.

This systematic review adds to the growing literature on integrative therapies for patients with breast cancer and other cancer populations. The latest results are published online and in print in CA: A Cancer Journal for Clinicians, a publication of the American Cancer Society.

The researchers evaluated more than 80 different therapies and developed grades of evidence. Based on those findings, the Society for Integrative Oncology makes the following recommendations:

  • Use of music therapy, meditation, stress management and yoga for anxiety and stress reduction
  • Use of meditation, relaxation, yoga, massage and music therapy for depression and mood disorders
  • Use of meditation and yoga to improve quality of life
  • Use of acupressure and acupuncture for reducing chemotherapy-induced nausea and vomiting
  • A lack of strong evidence supporting the use of ingested dietary supplements or botanical natural products as part of supportive care and/or to manage breast cancer treatment-related side effects

“Studies show that up to 80 percent of people with a history of cancer use one or more complementary and integrative therapies, but until recently, evidence supporting the use of many of these therapies had been limited,” said Heather Greenlee, ND, PhD, assistant professor of Epidemiology at Columbia University’s Mailman School of Public Health, and past president of SIO. “Our goal is to provide clinicians and patients with practical information and tools to make informed decisions on whether and how to use a specific integrative therapy for a specific clinical application during and after breast cancer treatment,” Greenlee continues.

In their systematic evaluation of peer-reviewed randomized clinical trials, the researchers assigned letter grades to therapies based on the strength of evidence. A letter grade of “A” indicates that a specific therapy is recommended for a particular clinical indication, and there is high certainty of substantial benefit for the patient.

Meditation had the strongest evidence supporting its use, and is recommended for reducing anxiety, treating symptoms of depression, and improving quality of life, based on results from five trials. Music therapy, yoga, and massage received a B grade for the same symptoms, as well as for providing benefits to breast cancer patients. Yoga received a B grade for improving quality of life based on two recent trials. Yoga and hypnosis received a C for fatigue.

“The routine use of yoga, meditation, relaxation techniques, and passive music therapy to address common mental health concerns among patients with breast cancer is supported by high levels of evidence,” said Debu Tripathy, MD, chair of Breast Oncology at The University of Texas MD Anderson Cancer Center, and a past president of SIO. “Given the indication of benefit coupled with the relatively low level of risk, , these therapies can be offered as a routine part of patient care, especially when symptoms are not well controlled.”

Acupressure and acupuncture received a B grade as an addition to drugs used for reducing chemotherapy-induced nausea and vomiting. In general, there was a lack of strong evidence supporting the use of ingested dietary supplements and botanical natural products as part of supportive cancer care and to manage treatment-related side effects.

“Clinicians and patients need to be cautious about using therapies that received a grade of C or D and fully understand the potential risks of not using a conventional therapy that may effectively treat cancer or help manage side effects associated with cancer treatment,” warned Lynda Balneaves, RN, PhD, associate professor, College of Nursing, Rady Faculty of Health Sciences, Winnipeg, Canada, and president-elect of SIO.

“Patients are using many forms of integrative therapies with little or no supporting evidence and that remain understudied,” noted Dr. Greenlee. “This paper serves as a call for further research to support patients and healthcare providers in making more informed decisions that achieve meaningful clinical results and avoid harm.”

New tools visualize where bacterial species live in the gut, control their activity

Gut microbes play wide-ranging roles in health and disease, but there has been a lack of tools to probe the relationship between microbial activity and host physiology. Two independent studies in mice published April 20 in the journal Cell have overcome this hurdle, making it possible to simultaneously visualize multiple bacterial strains in the gut by making them express unique combinations of fluorescent proteins. This approach allowed the researchers to pinpoint the location of the bacteria in the gut based on the rainbow of colors they emitted. Additionally, these tools also allowed precise control of the activity of bacterial genes in real time and in specific locations.

“We found that tools from synthetic biology can allow us to ask new questions about the gut microbiota,” says Andrew Goodman of Yale University School of Medicine, senior author of one of the studies. “We also imagine these strategies may provide a starting point for on-demand delivery of therapeutics or other molecules from the microbiota.”

Advances in sequencing technology have enabled in-depth characterization of bacterial species found in the gut, but tools to manipulate the gut microbiome have lagged far behind. Although tools have been developed for model organisms such as Escherichia coli, these systems do not work in Bacteroides, the most abundant genus within the guts of people in the United States.

In one of the studies, Justin Sonnenburg of the Stanford University School of Medicine and his team developed a way to engineer Bacteroides, making it possible to simultaneously track multiple bacterial strains in the gut. These tools included a panel of synthetic promoters — DNA sequences that initiate transcription of particular genes.

Using this panel of promoters, the researchers genetically engineered six different Bacteroides species to produce unique combinations of a red fluorescent protein (RFP) called mCherry and green fluorescent protein (GFP). They introduced the engineered species into mice that had been raised in a germ-free environment, and after two weeks, they analyzed sections of colon tissue using a fluorescence microscope to pinpoint the location of the bacteria in different parts of the gut.

In a separate experiment, Sonnenburg and his team genetically engineered two Bacteroides strains to produce either GFP or RFP. They then introduced the RFP-expressing strain into the mouse gut, followed by the GFP-expressing strain one week later. It was clear that the RFP-expressing strain successfully colonized the colon and outcompeted the GFP-expressing strain, especially in tube-like glands called crypts. The findings demonstrate that colonization of these specific intestinal structures is a key step that allows longer-term gut residents to outcompete invading species.

In future research, Sonnenburg and his team will continue to develop these tools to engineer bacteria to produce proteins at a precise time or location. “On the commercial side, the expression tools may allow us to deliver therapeutic proteins to the gut by producing them in the microbes that live inside of us,” says Weston Whitaker, lead author of the Stanford study. “The use of bacterial cells for drug delivery opens the door to smart therapeutics that are produced at the right time and location.”

In the other study, Yale’s Andrew Goodman and his team also developed a panel of synthetic promoters enabling the fine-tuned control of gene activity in diverse Bacteroides species. The researchers integrated these promoters into the Bacteroides genome and modulated gene activity using a tetracycline-regulated system, which allows transcription to reversibly turn on or off depending on the presence of a synthetic compound called anhydrotetracycline.

In the OFF state, gene activity controlled by the synthetic promoters was completely shut off, but in the presence of anhydrotetracycline, gene activity rapidly increased by a factor of 9,000. The researchers next introduced the engineered bacteria into mice and confirmed that their tools allow gene activity in gut bacteria to be tightly controlled, simply by adding different amounts of anhydrotetracycline to the drinking water of mice.

If extended to humans, this approach could potentially enable on-demand delivery of therapeutic compounds. Moreover, precise control of bacterial gene activity in specific locations in the gastrointestinal tract could be achieved by administering anhydrotetracycline through different routes, for example, via time- or pH-dependent delayed release capsules or surgically through catheterization. In future studies, Goodman and his team will apply their system to other microbes and other types of interactions between gut microbes and their hosts.

“These tools open the door to new types of studies to better understand our microbiota and to define how gut commensal bacteria can be engineered for therapeutic purposes,” Sonnenburg says. “However, before gut commensals can be engineered for therapeutics, it will be important to develop methods of safely and reliably colonizing the human gut, which will require more research.”

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E-cigarette flavors linked to use in youth and young adults, researchers report

Flavored e-cigarettes and e-cigarette marketing could be increasing e-cigarette use among youth and young adults, according to researchers from the Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin. These findings are part of a series of papers by UTHealth researchers that were published in the journal Tobacco Regulatory Science. In one of the studies, researchers found that for those who had used any tobacco product in the past 30 days, flavored tobacco use, including flavored e-cigarette use, was high for youth and young adults in Texas. The findings are based on data from 2,483 youth ages 12 to 17 and 4,326 young adults ages 18 to 29 in four metropolitan across Texas: Houston, Dallas/Fort Worth, San Antonio and Austin.

“Our study supports a growing body of evidence that suggests the use of flavors in tobacco products, like e-cigarettes, are appealing to youth and young adults,” said Melissa B. Harrell, Ph.D., M.P.H., associate professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health in Austin. “What is most surprising is that before this, no one has yet asked young people, ‘if flavors were removed from these products, would you continue to use them?’ ”

Among those who reported currently using e-cigarettes, 98.6 percent of youth and 95.2 percent of young adults in Texas said that their first e-cigarette was flavored. If flavors were not available, 77.8 percent of adolescents and 73.5 percent of young adults who used e-cigarettes said they would not use them. It is estimated that there are more than 7,500 flavors of e-cigarettes available on the market. Many of these are sweet flavors and taste like fruit or dessert. “Taste is an important factor,” said Harrell, who serves as lead researcher for one of the studies. “These flavors mask the flavor of tobacco, which can have a harsh taste.”

In a second study, researchers observed that advertising could have a significant role in the uptake of e-cigarettes among youth.

From 2011 to 2013, e-cigarette advertisements on TV increased by more than 250 percent and reached more than 24 million adolescents, researchers reported. In 2014, 70 percent of middle and high school students in the United States had seen an e-cigarette advertisement on TV, in a retail store, on the internet, or in newspapers and magazines. This second study, the first longitudinal study of its kind, shows that Texas youth who see an e-cigarette advertisement in a retail store or on the internet are more likely to start using e-cigarettes or be susceptible to them in the future. In 2015, nearly 3 million middle and high school students nationwide were e-cigarette users, according to data from the National Youth Tobacco Survey. Analysts predict that e-cigarette sales will exceed $10 billion this year nationwide.

Though e-cigarettes are typically marketed as a harmless alternative to traditional cigarettes, previous research has shown they are not free from harmful chemicals. Chemicals and carcinogens, like acetaldehyde, formaldehyde and tobacco-specific nitrosamines, which are common in cigarettes, have been found in e-cigarettes. It is unknown whether adults are able to quit cigarette smoking successfully by using e-cigarettes. The data used for the studies was collected by the Tobacco Center of Regulatory Science on Youth and Young Adults (Texas TCORS), a center created by several of The University of Texas System institutions to develop research that can guide future decisions on tobacco regulations at the national level.

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Insomnia associated with increased risk of heart attack and stroke

Insomnia is associated with increased risk of heart attack and stroke, according to research published today in the European Journal of Preventive Cardiology.

“Sleep is important for biological recovery and takes around a third of our lifetime, but in modern society more and more people complain of insomnia,” said first author Qiao He, a Master’s degree student at China Medical University, Shenyang, China. “For example, it is reported that approximately one-third of the general population in Germany has suffered from insomnia symptoms.”

“Researchers have found associations between insomnia and poor health outcomes,” continued Miss He. “But the links between insomnia and heart disease or stroke have been inconsistent.”

The current meta-analysis assessed the association between insomnia symptoms and incidence or death from cardiovascular disease (acute myocardial infarction, coronary heart disease, heart failure), stroke, or a combination of events. Insomnia symptoms included difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and non-restorative sleep.

The authors analysed 15 prospective cohort studies with a total of 160 867 participants. During a median follow-up of three to 29.6 years, there were 11,702 adverse events.

There were significant associations between difficulty initiating sleep, difficulty maintaining sleep, and non-restorative sleep and the risk of heart disease and stroke, with increased relative risks of 1.27, 1.11, and 1.18, respectively, compared to those not experiencing these insomnia symptoms. There was no association between early-morning awakening and adverse events.

Miss He said: “We found that difficulty initiating sleep, difficulty maintaining sleep, or non-restorative sleep were associated with 27%, 11%, and 18% higher risks of cardiovascular and stroke events, respectively.”

“The underlying mechanisms for these links are not completely understood,” continued Miss He. “Previous studies have shown that insomnia may change metabolism and endocrine function, increase sympathetic activation, raise blood pressure, and elevate levels of proinflammatory and inflammatory cytokines — all of which are risk factors for cardiovascular disease and stroke.”

Women with insomnia symptoms had a slightly higher risk of cardiovascular and stroke events than men, especially for non-restorative sleep, but the difference between sexes did not reach statistical significance.

Miss He said: “We cannot conclude that insomnia is more dangerous for women, given the limitations of meta-analyses and the lack of a statistically significant difference between sexes. However, we do know that women are more prone to insomnia because of differences in genetics, sex hormones, stress, and reaction to stress. It may therefore be prudent to pay more attention to women’s sleep health.”

Miss He concluded: “Sleep disorders are common in the general population and sleep health should be included in clinical risk assessment. Health education is needed to increase public awareness of insomnia symptoms and the potential risks, so that people with sleep problems are encouraged to seek help.”

Molecular therapy set to protect at-risk patients against heart attack and stroke

Even a single dose of a specific ribonucleic acid molecule, known as a small interfering RNA (siRNA), offers patients at high risk of cardiovascular disease long-lasting protection against high LDL cholesterol — one of the main risk factors for heart attack and stroke. This is the result of a clinical study that researchers from Charité and Imperial College London have published as leading authors in the current edition of New England Journal of Medicine*.

As a component of cell walls and a building block of numerous hormones, cholesterol plays an important role in the cell’s lipid metabolism. However, too much LDL cholesterol in the blood results in an increased risk of atherosclerosis (hardening of the arteries) and problems such as heart attack and stroke. Patients suffering from a genetic disorder which causes very high levels of LDL cholesterol are at a particularly high risk. In these patients, a protein known as PCSK9 (proprotein convertase subtilisin/kexin type 9) prevents the liver from removing LDL cholesterol from the blood.

In their study, Prof. Ulf Landmesser, Head of Charité’s Department of Cardiology (Campus Benjamin Franklin), and Prof. Kausik Ray from Imperial College London, used the principle of RNA interference. The process, which was discovered a few years ago, uses RNA molecules (small interfering RNA) to inhibit the synthesis of harmful proteins. When double-stranded siRNA is introduced into a cell, it will bind to a molecule known as the RNA-induced silencing complex (RISC complex). This allows the process to be used in a targeted manner to silence specific genes.

In their study, the researchers investigated how effective and efficient a specific siRNA was at targeting the PCSK9 protein. A total of 501 high-risk patients with high LDL cholesterol levels received varying subcutaneous doses of either inclisiran or placebo. Results showed that inclisiran led to a significant reduction in levels of both the protein and LDL cholesterol, with LDL cholesterol levels being reduced by up to 41.9 percent after a single dose, and up to 52.6 percent after two doses.

“It was particularly interesting to see just how sustained the effect of treatment was, with the effect of a single dose remaining apparent for a duration of over nine months,” explains Prof. Ulf Landmesser. He adds: “The next step will be to further develop this treatment by conducting a large clinical outcome trial. We are hoping to test what might become a new type of therapy for the prevention of heart attack and stroke in high-risk patients.”

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Bad cold? If you’re lonely, it may feel worse

Suffering through a cold is annoying enough, but if you’re lonely, you’re likely to feel even worse, according to Rice University researchers.

A study led by Rice psychologist Chris Fagundes and graduate student Angie LeRoy indicated people who feel lonely are more prone to report that their cold symptoms are more severe than those who have stronger social networks.

“Loneliness puts people at risk for premature mortality and all kinds of other physical illnesses,” LeRoy said. “But nothing had been done to look at an acute but temporary illness that we’re all vulnerable to, like the common cold.”

The study is the subject of a paper published this week in Health Psychology.

The researchers drew a distinction between feeling lonely and actual social isolation.

“This paper is about the quality of your relationships, not the quantity,” LeRoy said. “You can be in a crowded room and feel lonely. That perception is what seems to be important when it comes to these cold symptoms.”

Carrying out this task meant finding lonely people, isolating them — and giving them a cold.

A total of 159 people age 18-55, nearly 60 percent of them men, were assessed for their psychological and physical health, given cold-inducing nasal drops and quarantined for five days in hotel rooms.

The participants, scored in advance on the Short Loneliness Scale and the Social Network Index, were monitored during and after the five-day stay. After adjusting for demographics like gender and age, the season, depressive affect and social isolation, the results showed those who felt lonely were no more likely to get a cold than those who weren’t.

But those who were screened in advance for their level of loneliness and became infected — not all of the participants did — reported a greater severity of symptoms than those recorded in previous studies used as controls. The size of the participants’ social networks appeared to have no bearing on how sick they felt.

“Previous research has shown that different psycho-social factors like feeling rejected or feeling left out or not having strong social bonds with other people do make people feel worse physically, mentally and emotionally,” LeRoy said. “So we had that general framework to work with.”

The effect may be the same for those under other kinds of stress, Fagundes said. “Anytime you have an illness, it’s a stressor, and this phenomenon would probably occur,” he said. “A predisposition, whether it’s physical or mental, can be exaggerated by a subsequent stressor. In this case, the subsequent stressor is getting sick, but it could be the loss of a loved one, or getting breast cancer, which are subjects we also study.

“What makes this study so novel is the tight experimental design. It’s all about a particular predisposition (loneliness) interacting with a particular stressor,” he said.

“Doctors should take psychological factors into account at intake on a regular basis,” Fagundes said. “It would definitely help them understand the phenomenon when the person comes in sick.”

“We think this is important, particularly because of the economic burden associated with the common cold,” LeRoy added. “Millions of people miss work each year because of it. And that has to do with how they feel, not necessarily with how much they’re blowing their noses.”

The findings are also an incentive to be more socially active, she said. “If you build those networks — consistently working on them and your relationships — when you do fall ill, it may not feel so bad.”

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Materials provided by Rice University. Original written by Mike Williams. Note: Content may be edited for style and length.

 

Apixaban superior to warfarin for reducing brain bleeds in patients with AFib

In a new analysis, patients with atrial fibrillation showed a substantially reduced risk of dangerous bleeding in the brain, known as intracranial hemorrhage, when taking the newer anticoagulant apixaban compared to those taking warfarin.

The study, published online in Blood, the Journal of the American Society of Hematology (ASH), also showed that taking aspirin increased the risk of intracranial hemorrhage, especially in older patients.

“Intracranial hemorrhage has high morbidity and high mortality and is the most severe and most feared complication among physicians prescribing oral anticoagulants,” said Renato D. Lopes, MD, PhD, a cardiologist at Duke Clinical Research Institute, the study’s lead author. “This study shows apixaban is a better option for oral anticoagulation than warfarin because it reduces stroke while substantially reducing intracranial hemorrhage.”

Atrial fibrillation is a type of irregular heartbeat that affects between 2.7 and 6.1 million Americans, according to estimates from the Centers for Disease Control and Prevention. An erratic heartbeat can allow blood to pool in the heart, which can lead to the formation of a blood clot that travels through the bloodstream and blocks a blood vessel in the brain, causing a stroke. Patients with atrial fibrillation are five times more likely to experience a stroke compared to the general population.

Medical guidelines recommend the use of oral anticoagulant medications in patients with atrial fibrillation who are at high risk for stroke. These medications reduce the blood’s clotting ability, which substantially lowers the risk of stroke, but also increases the risk of uncontrolled bleeding.

Intracranial hemorrhage is a rare, but serious complication of these medications, occurring in about 1 percent of patients prescribed anticoagulants for atrial fibrillation. This type of bleeding in the brain can occur spontaneously or after trauma (such as a fall); can cause a range of symptoms including headache, vomiting, seizures, and coma; and has been associated with a 30-day mortality rate of 50 percent.

Historically, warfarin, a vitamin-K antagonist, has been considered the standard of care for oral anticoagulation therapy, but warfarin requires careful management to ensure patients receive the proper dosing. Drugs in a class of newer anticoagulants known as non-vitamin K antagonist oral anticoagulants, or NOACs, are easier to manage and have been shown to be as effective as warfarin, leading to a surge in the use of NOACs in patients with atrial fibrillation and other conditions in recent years.

The new analysis is the first to compare apixaban, a NOAC, to traditional warfarin in terms of the risk for intracranial hemorrhage.

The trial enrolled more than 18,000 patients in North America, Latin America, Europe, and Asia. All patients had atrial fibrillation and at least one additional risk factor for stroke. Patients were randomized to each medicine; half received apixaban and half received warfarin. Outcomes were tracked for a median of 1.8 years.

Intracranial hemorrhage occurred at a rate of 0.80 percent per year in patients taking warfarin and 0.33 percent per year in patients taking apixaban, meaning that patients taking apixaban were 58 percent less likely to experience intracranial hemorrhage compared to those taking warfarin. The difference was even greater for patients experiencing trauma-related intracranial hemorrhage; patients taking apixaban were 75 percent less likely to experience trauma-related bleeding compared to those taking warfarin. The results were consistent across all types and locations of bleeding in the brain.

The vast majority of patients taking warfarin showed INR (International Normalized Ratio) values, a measure of clotting factors, in the target range or below the target range within about two weeks of experiencing intracranial hemorrhage, which suggests their warfarin dosage was properly or under-calibrated, respectively.

Among all patients, the highest risk for intracranial hemorrhage was seen in patients who were age 80 or older, were treated in Asia or Latin America, or had a previous stroke or mini-stroke. Taking concomitant aspirin at the start of the study was found to significantly increase the risk of intracranial hemorrhage. About 30 percent of patients with atrial fibrillation use aspirin. Aspirin is a blood thinner that prevents platelets from clumping together, but it is not an anticoagulant medication and is not considered to effectively prevent strokes in patients with atrial fibrillation.

“We know that aspirin has only a modest effect in preventing stroke in atrial fibrillation patients, yet it was one of the top predictors of intracranial hemorrhage,” said Dr. Lopes. “Our finding demonstrates that aspirin is not as safe as one might think.” The increased risk of intracranial hemorrhage associated with aspirin use was particularly pronounced in older patients.

Future studies could help elucidate how the development and availability of antidotes for NOACs may affect the treatment and associated outcomes of intracranial hemorrhage, said Lopes.

 

Why do we choose to get vaccinations?

Since vaccines protect not only those who take them, but also the people who otherwise could have been infected, there are many plausible motives for choosing to get vaccinated. Apart from the most obvious – wanting to protect oneself or one’s children from becoming ill – research shows that many also are affected by care for others.

But if you care about others, who is it you care about? In his doctoral thesis in political science, Rafael Ahlskog has studied the distinction between narrow and wide caring for others – altruism. Narrow altruism includes those nearest – family and friends – while wide altruism can include strangers you have never met, people living far away or who are very different from yourself: in short a broader form of social caring. The results from a number of survey experiments show that both types of altruism can affect our willingness to get vaccinations, but in different people.

“Before you have a family and children, a broader form of caring seems to affect decisions to vaccinate, but this caring gives way to the narrower form when family and children become part of the picture,” says Rafael Ahlskog.

This knowledge could play an important role in the design of future vaccination campaigns, but also highlights a deeper evolutionary logic which modern humans sometimes are governed by: as social beings, in the right circumstances, we can afford to take into account a broader societal context, but when we get the chance to invest in the evolutionary ‘core values’ (survival and procreation) the larger context is easily forgotten.

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Dementia: The right to rehabilitation

Rehabilitation is important for people with dementia as it is for people with physical disabilities, according to a leading dementia expert.

Linda Clare, Professor of Clinical Psychology of Aging and Dementia at the University of Exeter, said people with dementia have a right to cognitive rehabilitation — and it is as relevant for them as physical rehabilitation for people with physical impairments.

Writing in the journal PLOS Medicine, Professor Clare said both share a goal to enable people to participate in everyday life, and in their families and communities, in a way that is meaningful to them.

Professor Clare said: “We tend to think of rehabilitation in terms of people with physical impairment following an injury, but it is equally important in people with cognitive impairment. As a society, we now have a much greater recognition that people with physical disabilities have the right to access services and opportunities, but there it still a long way to go for people with “hidden” disabilities such as dementia, in a landscape where the numbers of people with dementia are expected to rise from 44 mill in 2015 to 117 million by 2050.

Professor Clare oversees the GREAT trial, which is assessing the success of cognitive rehabilitation in more than 500 people across eight sites in the UK. It focuses on tailor-made approaches to the specific, individual problems people encounter at different stages of dementia. Examples may include people wanting to use email to stay in contact with family and friends, gain confidence to go outside, or manage daily tasks better. For people in the more advanced stages of dementia, approaches may focus on being able to dress independently or engage in pleasurable activities.

Professor Clare believes the positive rehabilitation approach may be partially funded through redeploying some of the spend on dementia, through preventing physical difficulties, limiting the costs of managing distressing symptoms, and delaying institutionalisation. She stressed the need to develop service systems that train staff and involve families.

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Cortisol excess hits natural DNA process and mental health hard

High concentrations of the stress hormone, Cortisol, in the body affect important DNA processes and increase the risk of long-term psychological consequences. These relationships are evident in a study from the Sahlgrenska Academy on patients with Cushing’s Syndrome, but the findings also open the door for new treatment strategies for other stress-related conditions such as anxiety, depression and post-traumatic stress.

“If these results can be verified and repeated in other studies, they would have significance for future possibilities for treating stress-induced psychological consequences,” says Camilla Glad, postdoctoral researcher at the Department of Internal Medicine and Clinical Nutrition.

The uncommon disease, Cushing’s Syndrome, involves a substantial overproduction of Cortisol resulting from a benign tumor of the pituitary or adrenal gland. The condition is characterized by abdominal obesity, fat deposits in the face and neck, high blood pressure and diabetes. To a high extent, the affected individuals also risk suffering from chronic fatigue syndrome, anxiety, depression and cognitive impairment

Reduced DNA methylation

“Even if the physical symptoms improve after an operation on the tumor, our previous studies show that the psychiatric problems largely often persist. Some patients will never return to working life and may not even venture out into society for everyday activities. They quite simply constitute a patient group with major problems for whom we are extremely eager to find new ways to help,” says Camilla Glad.

The fact that a high stress load can affect DNA is to some extent already known. Studies on individual genes have shown that extreme stress with temporary high levels of Cortisol affect so-called DNA methylation resulting in changes in the expression and characteristics of genes.

In this particular study, DNA methylation in the entire human genome for the patient group has been studied for the first time, and the results are clear: The individuals with Cushing’s Syndrome, 48 in all, had a significantly lower level of DNA methylation than a healthy control group.

In addition, researchers found specific DNA methylation changes linked to the persistent psychiatric problems the patients often suffered from. Interestingly, some of these findings were made in genes linked to Cortisol sensitivity and development and plasticity of the brain.

Dampening the effects

“If there is a programmed sensitivity for Cortisol where the response is depressions and anxiety at very low levels then this is not good for the future. We are talking about changes in DNA that have the potential to persist for the remainder of the patient’s life, and which can also be hereditary.” says Camilla Glad.

“If we can show that DNA methylation leads to affected levels of certain proteins, this will open the door to new treatment possibilities. With the knowledge we have today, I do not think we will be able to affect DNA methylation itself, but might, however, in the long-term, be able to counteract its effects,” she says.

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Emotion: An important link to HIV prevention in black adolescents with mental illnesses

Nearly half of all US adolescents aged 13 to 19 are sexually active. But black adolescents, who represent only 14 percent of that population, account for 63 percent of new cases of HIV among adolescents. In addition, it’s estimated that more than 2 million adolescents, many of whom are sexually active, experience a major depressive episode. Could unique psychological factors that hamper emotional regulation help explain differences in HIV/STI risk-related sexual behaviors among heterosexually active black youth with mental illnesses?

A new University of Pennsylvania School of Nursing (Penn Nursing) study has investigated this question. The findings suggest that psychoeducation and skills building may help sever the emotion-behavior link that contributes to HIV/STI risk among this demographic. The study, “Feelings Matter: Depression Severity and Emotion Regulation in HIV/STI Risk-Related Sexual Behaviors,” which has been published in the Journal of Child and Family Studies, was designed to examine contextual factors related to HIV/STI risk among heterosexually active black adolescents with mental illnesses. It explicitly focused on depression and emotion regulation to uncover how these factors in?uence sexual decision-making.

“Blacks, adolescents, and people with mental illnesses are all disproportionately affected by HIV/STIs,” explains the study’s lead author Bridgette M. Brawner, PhD, APRN, Assistant Professor of Nursing in the Department of Family and Community Health. “We know that the unique psychopathology of mental illness, including impulsivity and engaging in unprotected sex to alleviate depressed mood, may heighten one ‘s HIV/STI risk. Our study indicates we need to better understand unique HIV/STI prevention needs among black adolescents with mental illnesses and that improving coping mechanisms to help regulate emotion should be addressed in HIV/STI prevention research.”

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Researchers warn of hazards of smoking and need for wider use of varenicline to quit

More than 35 million Americans are trying to quit smoking. Smoking cigarettes causes 480,000 premature deaths each year due mainly to a two-fold risk of cardiovascular disease and a 20-fold risk of lung cancer. In a commentary published in the current issue of the American Journal of Medicine, researchers from the Charles E. Schmidt College of Medicine at Florida Atlantic University reassure clinicians and their patients that varenicline, whose brand name is Chantix, is a safe and effective way to achieve smoking cessation and that failure to use this drug has caused preventable heart attacks and deaths from cardiovascular disease.

In 2006, varenicline was approved as a safe and effective means to quit smoking and achieved permanent quit rates of approximately 25 percent. In 2009, however, varenicline received a black box warning by the FDA based on their adverse event reports of neuropsychiatric symptoms like depression and thoughts of suicide.

There were plausible alternative explanations including that nearly half of the subjects had psychiatric histories, 42 percent were taking psychotropic drugs and about 42 percent were suffering from depression. Nonetheless, since then, there has been a 76 percent decline in the number of prescriptions dispensed from a peak of about 2 million in the last quarter of 2007 to about 531,000 in the first quarter of 2014.

In their commentary, the FAU researchers emphasize that, until recently, the totality of randomized evidence on varenicline had been restricted to eight small trials, which did not demonstrate a hazard. The researchers caution that the reliable detection of small to moderate risks and benefits of drug therapies requires cogent data from large-scale randomized trials designed a priori to test the hypothesis.

Such a large randomized trial was recently completed that included both apparently healthy individuals as well as those with severe mental illness. The trial was conducted for 12 weeks on about 8,000 long-term smokers and included equal subgroups of those without as well as with psychiatric disorders. In subjects without psychiatric disorders, those treated with varenicline had less neuropsychiatric symptoms and in subjects without psychiatric disorders there were no increases in these symptoms. Both groups of participants assigned at random to varenicline achieved significantly higher abstinence rates at 12 weeks than those assigned to placebo, nicotine patch or bupropion. Just a few months ago, the FDA removed the black box warning from varenicline.

The commentary was coauthored by Dianna Gaballa, a fourth-year medical student; Joanna Drowos, D.O., M.P.H., an associate professor of integrated medical science and associate chair of the Department of Integrated Medical Science; and Charles H. Hennekens, M.D., Dr.P.H., the first Sir Richard Doll Professor and senior academic advisor to the dean, all in FAU’s Charles E. Schmidt College of Medicine.

“The existing totality of evidence suggests an urgent need to increase the use of varenicline in the general population as well as in those with serious mental illness who on average die about 20 years earlier than the general population, in part, because their smoking rates may be as high as 75 percent,” said Hennekens.

Quitting smoking significantly reduces risks of cardiovascular disease beginning within a matter of months and reaching the non-smoker status within a few years, even among older adults. For lung and other cancers, however, reductions do not even begin to emerge for years after quitting and, even after 10 years, quitters achieve death rates only about midway between the continuing smoker and non-smoker.

“For reducing risks of cardiovascular disease it’s never too late to quit, but to reduce risks of cancer, it’s never too early,” said Hennekens.

The authors speculate that if use of varenicline had not plummeted by 76 percent following the black box warning in 2009, perhaps 17,000 premature deaths from cardiovascular disease may have been avoided each year during the last few years. Public health efforts and effective cessation treatments including behavioral counseling and medication have resulted in a 14 percent decrease in smoking in the U.S. while the rates are markedly increasing in developing countries.

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