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A breakthrough gene therapy treatment for Haemophilia A has been shown to offer long-term benefits that have already transformed the lives of 13 men in the UK.

Clinical researchers led by Professor John Pasi from Queen Mary University of London first announced in 2017 that 85% of men treated with a single infusion of a missing gene were showing normal or near-normal levels of the blood-clotting protein, factor VIII, one year on.

In a new paper published in the New England Journal of Medicine, Professor Pasi, who is also Director of the Haemophilia Centre at Barts Health NHS Trust, confirmed that all the patients involved in the trial were still benefiting from a substantial fall in the rates of bleeding three years after receiving the treatment. None of the 13 patients had required regular factor VIII to prevent bleeding during that period.

The 13 patients included five patients from the Royal London Hospital, part of Barts Health NHS Trust.

A lack of factor VIII causes Haemophilia A, which accounts for around 80 per cent of all Haemophilia cases. With the blood unable to clot, patients are at risk of excessive bleeding from even the slightest injury - as well as potentially life-threatening spontaneous internal bleeding. Patients have to undergo three or more intravenous injections each week to control and prevent bleeding. Eliminating these regular injections greatly reduces the burden of treatment needed to keep bleeding at bay.

Professor Pasi said: "Our 2017 paper showed that gene therapy could significantly boost factor VIII levels in men with Haemophilia A. Our new data are critical in helping the scientific and medical communities understand this pioneering technology. This latest study confirms both safety and the long-term beneficial impact of the treatment. A long-term treatment that effectively ends the life-long regime of regular injections can transform care and massively improve the quality of life of hundreds of thousands of people born with this challenging genetic condition."

The treatment could be particularly important in the developing world where access to clotting products is difficult.

Delirium (sudden confusion or a rapid change in mental state) remains a serious challenge for our health care system. Delirium affects 15 to 26 percent of hospitalized older adults and can be particularly problematic because those experiencing the condition may interfere with medical care or directly harm themselves or others. Besides behavioral therapy and physical restraints, antipsychotic medicines are among the few therapeutic options healthcare providers can use to ease delirium and protect patients and caregivers--but antipsychotics also come with risks of their own.

To learn more about the effect of antipsychotic medicines on older hospitalized patients, a research team created a study published in the Journal of the American Geriatrics Society. This study included information from hospitalized patients at a large academic medical center in Boston.

The researchers looked specifically at death or non-fatal cardiopulmonary arrest (heart attack) during hospitalization.

The researchers learned that adults taking "first-generation" or "typical" antipsychotic medications (medicines first developed around the 1950s) were significantly more likely to experience death or cardiopulmonary arrest, compared to people who did not take those drugs. Taking "atypical" or "second-generation" antipsychotics (so named because they were developed later) raised the risk for death or cardiopulmonary arrest only for people aged 65 or older.

In the past, other studies have suggested that typical antipsychotic medications could cause sudden death, and that atypical antipsychotics could raise peoples' risks for falls, pneumonia and death. What's more, another large study also suggested that both types of antipsychotic medicines posed a risk for fatal heart attacks.

Despite these known risks, atypical antipsychotics are often prescribed for people in the hospital. One recent study of patients at Beth Israel Deaconess Medical Center in Boston found that antipsychotics were prescribed for nine percent of all adults who were hospitalized for non-psychiatric causes. Another large recent study found that using antipsychotics to prevent or treat delirium did not lower the risk for death, did not lessen the severity of delirium or shorten its duration, and did not shorten the time people spent in the intensive care unit (ICU) or their hospital length of stay.

"Delirium is common in older hospitalized patients and difficult to treat, but antipsychotic medications should be used with caution regardless of age," said the authors.

New Rochelle, NY, January 6, 2020--Not only is excessive gestational weight gain (GWG) associated with increased long-term maternal weight, but a new study has shown that there is a cumulative effect of excessive GWG over multiple pregnancies. The study, which analyzed the effect of the number of excessive GWG pregnancies on body mass index (BMI) at midlife, is published in Journal of Women's Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. Click here to read the full-text article on the Journal of Women's Health website through February 6, 2020.

"The Effect of Gestational Weight Gain Across Reproductive History on Maternal Body Mass Index in Midlife: The Study of Women's Health Across the Nation" was conducted by Franya Hutchins, MS, School of Public Health, University of Pittsburgh (PA), and coauthors from University of Pittsburgh, University of California (Berkeley), University of Massachusetts Medical School (Worcester), and Kaiser Permanente (Oakland, CA).

The researchers found that each additional pregnancy with excessive GWG was associated with a higher BMI among women ages 42-53. Overall, nearly 40% of women reported a GWG that was higher than the recommended GWG in at least one pregnancy. Almost half (47.6%) of the women with excessive GWG in at least one pregnancy had an obese BMI at midlife, compared to 22.9% of those who had never experienced excessive GWG.

Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health and Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, states: "Hutchins et al. showed that each pregnancy with excessive GWG was associated with a 64% increase in the likelihood of obesity at midlife, regardless of race/ethnicity, number of pregnancies, and physical activity level. This finding makes a strong argument for avoiding excessive gestational weight gain in any pregnancy."

RIVERSIDE, Calif. -- A team of researchers at the University of California, Riverside, used automated computer methods to mine a large online discussion forum for electronic cigarette users and found this group reported numerous adverse health effects for at least seven years.

The research, published in the Journal of Medical Internet Research, shows health problems associated with e-cigarettes existed well before summer 2019 when vaping-associated pulmonary illness, or VAPI, was recognized by the medical community. This development suggests many more e-cigarette users may have serious symptoms.

Recently, the Centers for Disease Control and Prevention, or CDC, linked VAPI to vitamin E. A number of VAPI cases are not, however, linked to the vitamin. VAPI is also referred to as EVALI, or e-cigarette or vaping product use-associated lung injury.

"The sudden uptick in symptoms and conditions related to VAPI comes at least 10 years after e-cigarette products gained widespread popularity in the United States, including the rise in popularity of JUUL and marijuana vape products," said Prue Talbot, a professor of cell biology in the Department of Molecular, Cell, and Systems Biology, who led the research. "Our data, which shows many of the symptoms characterizing the current patients have been reported online for at least seven years, suggests cases similar to those in the current VAPI epidemic have existed previously and been unreported or simply not linked to vaping."

The researchers collected data posted between January 2008 and July 2015 on a large e-cigarette online discussion forum. They designed a web crawler in Java to extract and parse information on symptoms and disorders from the forum. The crawler, programmed to focus on only those posts that belonged to seven health subforums, browsed through more than 41,000 posts, of which 45% were negative in sentiment, 38% were neutral, and 17% were positive.

The top five symptoms in the database were headache, coughing, pain in throat, itching, and malaise. The top five disorders in the dataset were dehydration, asthma, pharyngitis, common cold, and aptyalism.

E-cigarette research has shown some flavor chemicals can dilate blood vessels and cause headache, nausea, and fatigue. Prolonged inhalation of some flavor chemicals can cause headaches, dizziness, and/or respiratory symptoms. Metals identified in e-cigarette aerosols have been linked to neurological and respiratory symptoms. Nicotine, a major component in most e-cigarette fluids, can affect neurological, respiratory, digestive, mouth/throat, and circulatory systems. Nicotine inhalation can cause headaches, nausea, mouth/throat pain, cough, and heartburn.

"Our data underscore the idea that e-cigarette use is not free of adverse health effects and suggest that the epidemic we are seeing now will continue to grow given the many reports in the forum of symptoms characteristic of VAPI," said My Hua, a graduate student in Talbot's lab and first author of the research paper. "It is important that vigilant reporting of cases, tracking symptoms, and engaging in research on the health effects related to e-cigarette use be continued and expanded to understand and contain VAPI."

The study is the first to use automated methods to analyze online posts uploaded over a seven-year period on an e-cigarette website and to identify the symptoms and disorders most frequently reported online by e-cigarette users.

"We used a modified version of the MetaMap medical information extraction tool, which has been shown to have high accuracy in extracting medical concepts like symptoms or disorders," said Vagelis Hristidis, a professor of computer science and engineering and a co-author of the study. "It is possible that some posts mention a disorder in the wrong context, for example, making a joke about it, but from our manual screening of thousands of posts, this number of posts would be very small to meaningfully affect the results."

Hristidis, an expert on data mining, explained the crawler mines data from each discussion thread in the e-cigarette forum and stores its content locally. A parsing tool then extracts the individual posts from the thread. Finally, a medical information extraction tool analyzes each post's text and identifies mentions of symptoms or disorders.

As of December 27, 2019, more than 2,500 hospitalized EVALI cases or deaths have been reported to the CDC from 50 states, the District of Columbia, and two U.S. territories; 27 states and the District of Columbia have confirmed 55 deaths associated with vaping.

"The symptoms and disorders we report in our study may be of interest to physicians and health care providers treating patients who use e-cigarettes," Talbot said.

Talbot and Hua are working with a health clinic at UC Riverside to include vaping-related questions in medical history questionnaires filled out by patients. They have also provided an e-cigarette fact sheet to the UCR clinic for distribution to patients; the plan is to provide the fact sheet to all clinics in the UC system.

BOSTON-- According to the World Health Organization's latest statistics, from 2017, more than 800 women around the world die every day from preventable causes related to pregnancy and childbirth -- the vast majority of them in resource-poor areas. The leading reason is postpartum hemorrhage (PPH), which accounts for 27 percent of maternal mortality and occurs to some degree in five to seven percent of all deliveries.

Advanced interventions to stop the bleeding before the problem becomes unmanageable include emergency hysterectomy, a particular suturing technique, and ligation or embolization of the uterine artery -- but because these require extensive training and/or high-tech equipment, not all hospitals around the world have access to them. A simple, inexpensive alternative, the uterine balloon tamponade (UBT), has been available since the early 1980s. In it, a balloon is inserted through the cervix by catheter and inflated with water, filling the uterine cavity and arresting the hemorrhage.

Two studies -- published in 2013 and 2019 -- brought into question the effectiveness of UBT, but a paper published today in the American Journal of Obstetrics and Gynecology "really puts a nail in that coffin," according to principal investigator Thomas Burke, MD, FACEP, FRSM, director of the Global Health Innovation Lab in the Emergency Department at Massachusetts General Hospital and an associate professor at Harvard Medical School and the Harvard T.H. Chan School of Public Health.

"The reason we undertook this study is that those two trials caused a great deal of confusion and controversy regarding UBT," Burke said. "We decided to take an extremely rigorous approach, bringing together all of the world's literature on this technique and inviting independent investigators to join. It was a massive project." Burke and his colleagues conducted a systematic review and meta-analysis of 91 randomized control trials, nonrandomized studies, and case series, and found an overall success rate of 85.9 percent for UBT.

"So what this really teaches us is that the challenges experienced in these two trials were about the program implementation, not the device itself," he said. "There's no question the device works fine. But saving a life is much more complex than just handing someone a device that's new to their practice. We need to study how to integrate the device into a health system so that good uptake, appropriate use, and best practice result in quality care."

Burke pointed out that it is "exquisitely clear" that in many areas of the world, maternal mortality drops significantly when UBT is used. "They have saved many lives," he said. "But there are still places where one in six women lose their lives from pregnancy-related causes and in 2020 that should never be. It's an embarrassment to humankind."

DUARTE, Calif. -- The benefits of a daily aspirin may extend beyond heart health to colorectal cancer treatment, say City of Hope researchers who have found aspirin appears to reduce tumor growth and inhibit recurrence of the disease.

The trick now, researchers say, is to determine the right dosage of aspirin that can be used as a daily prophylactic without triggering dangerous side effects such as stomach and brain bleeds.

"Some might say aspirin is a 'miracle drug' because of its potential to prevent diseases that result from chronic inflammation, such as cancer, Alzheimer's, Parkinson's and arthritis," said Ajay Goel, Ph.D., senior author of a new study and chair of the Department of Molecular Diagnostics, Therapeutics and Translational Oncology at City of Hope.

"The reason aspirin isn't currently being used to prevent these diseases is because taking too much of any anti-inflammatory eats at the stomach's mucus lining and causes gastrointestinal and other problems. We are getting closer to discovering the right amount of daily aspirin needed to treat and prevent colorectal cancer without causing scary side effects."

The study, published in the journal Carcinogenesis on Jan. 6, used mouse models and mathematical modeling to parallel the amount of daily aspirin people in the U.S. and Europe are taking in clinical trials. The City of Hope-led research found that as the aspirin doses increased, the rate of cell death increased while the division rates of cells decreased, meaning tumor cells were more likely to die and not proliferate.

"We are now working with some of the people conducting those human clinical trials to analyze data and use mathematical modeling. This process adds a layer of confidence to the findings and guides future human trial designs," Goel said, adding that colorectal cancer is among the top five cancers diagnosed every year.

Research details

Goel and his colleagues tested three varying daily doses of aspirin in four colorectal cancer cell lines, including tumors with microsatellite instability and mutations in the PIK3CA gene, which has been tied to increased risk of endometrial, colon and aggressive breast cancers.

Then the researchers divided 432 mice into four groups: control, low-dose aspirin (15mg/kg), medium-dose aspirin (50mg/kg) and high-dose aspirin (100mg/kg) - the mouse equivalent of 100mg, 300mg and 600mg for humans. The tumors from three mice in each treatment group were analyzed on days three, five, seven, nine and 11.

Researchers inspected "cellular apoptosis" (programmed cell death) and found that the percentage of cells programmed to die increased in all cell lines. Exactly how much, however, depended on the amount of aspirin that was consumed, suggesting that aspirin triggers a domino effect of cell death in all colorectal cell lines regardless of genetic background.

Notably, the scientists observed that low-dose aspirin was especially effective in suppressing tumor growth in animal models that had more PIK3CA genes. The finding was significant because the mutated version of these genes has been associated with increased risk of certain cancers.

To further validate the findings, the scientists applied mathematical modeling to the experimental data. They measured the rates of cell division and cell death and used mathematical modeling to determine the probability that tumor cell colonies could survive and develop into actual tumors.

"Speaking metaphorically, they were building a hurricane model to predict the path a cyclone would take," said Russell Rockne, Ph.D., a mathematical oncology scientist at City of Hope who was not involved in the study. "Mathematics and computational biology increasingly play a larger role in basic and translational research in cancer. Mathematical oncologists like myself take data, separate it into discreet parts and use math to explain why something like aspirin could have an inhibitory effect against colorectal cancer."

Pelvic examinations and cervical cancer screenings are no longer recommended for most females under age 21 during routine health visits, but a new study has found that millions of young women are unnecessarily undergoing the tests, which can lead to false-positive testing, over-treatment, anxiety and needless cost.

Researchers at UC San Francisco and the Centers for Disease Control and Prevention (CDC) estimated that 1.4 million pelvic examinations and 1.6 million Pap tests performed on U.S. females 15 to 20 years old in a single year may have been medically unnecessary.

The findings suggest that despite professional guidelines and recommendations against routine pelvic examinations and Pap tests in this age group, there's a critical lag in clinical practice. The estimated cost of these unnecessary exams was approximately $123 million a year.

The study appears Jan. 6, 2020 in JAMA Internal Medicine.

"Recent media reports have called attention to inappropriate gynecologic examinations in young women," said senior author George F. Sawaya, MD, professor of Obstetrics, Gynecology and Reproductive Sciences at UCSF and director of the UCSF Center for Healthcare Value.

"Parents of adolescents and young women should be aware that cervical cancer screening is not recommended routinely in this age group. Pelvic exams are not necessary prior to getting most contraceptives and are often not needed to screen for sexually transmissible infections," Sawaya said.

Cervical cancer screening is not recommended for individuals under age 21, according to the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists, and the American Cancer Society. Additionally, leading professional organizations recommend against performing pelvic examinations in asymptomatic women who are not pregnant.

The new analysis was intended to estimate how often pelvic examinations and Pap tests occurred among young women in the U.S., as well as the proportion that were potentially unnecessary. The population-based study used data from 2011 to 2017.

Researchers classified the pelvic examination into two types: medically indicated or potentially unnecessary. Pelvic examinations were considered medically indicated if performed during pregnancy or in association with use of an intrauterine device, or in the context of treatment for a sexually transmitted disease.

The investigators estimated that of approximately 2.6 million young women who received a pelvic exam during the previous year, more than half (54.4 percent) were potentially unnecessary, representing an estimated 1.4 million young women.

Additionally, the researchers found that nearly a fifth of females younger than the recommended age had a Pap test within the past year. Because 72 percent were performed as "part of a routine exam," they were potentially unnecessary, representing an estimated 1.6 million young women. Almost all of the pelvic examinations were performed at the same time as the Pap test.

Young women who had been screened for a sexually transmitted infection were 3.8 times more likely to receive a Pap test and 60 percent more likely to receive a pelvic examination, compared with those who had not been screened.

Similarly, young women who used a hormonal contraception other than IUD were 75 percent more likely to receive a Pap test and 31 percent more likely to receive a pelvic examination, compared with those who did not use those contraception methods.

"This study suggests that healthcare providers and young women need to communicate clearly and often about the best time for these tests," said first author Jin Qin, ScD, an epidemiologist with the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention. "We want to ensure that guidelines are followed, and lives are saved."

PITTSBURGH, Jan. 6, 2020 - Early clinical treatment may significantly reduce recovery time following a concussion, according to new research led by the University of Pittsburgh Sports Medicine Concussion Program.

The results, published today in JAMA Neurology, suggest delays in seeking treatment can lead to unnecessarily longer recovery.

"Our study emphasizes the importance of seeking appropriate, specialized care early on. Delaying clinical care following a concussion leaves patients to deal with symptoms on their own and negates the positive effects of early and targeted interventions," said senior author Anthony Kontos, Ph.D., research director at Pitt's Sports Medicine Concussion Program.

A concussion is a mild traumatic brain injury caused by a jolt to the head or body that disrupts the function of the brain. This injury can result in physical, cognitive, emotional and/or sleep-related symptoms that may or may not involve a loss of consciousness. The symptoms can last from several minutes, to days, weeks, months or longer.

Kontos and his team analyzed 162 athletes with diagnosed concussion injuries between the ages of 12 and 22 years. Athletes treated within the first week of injury recovered faster than athletes who did not receive care until eight days to three weeks after injury. Once in care, the length of time spent recovering was the same for athletes evaluated within the first week of injury compared to those evaluated eight days to three weeks post-injury, indicating the days before initial clinical care was the primary driver for the longer recovery duration.

"Early clinical care including behavioral management interventions and targeted exertion, vestibular and oculomotor rehabilitation exercises also may minimize missed time at work, school or sports, helping the patient return to a normal routine sooner," said Michael “Micky” Collins, Ph.D., executive and clinical director, UPMC Sports Medicine Program.

Kontos and his colleagues say future research should look into the biological reasons why earlier engagement with care promotes faster recovery, as well as explore whether their findings could apply to other types of patients, such as military personnel.

More women than men die of heart failure. The reason is that only 50 per cent of the heart failure cases among women are caused by having a heart attack, which can be treated with modern methods.

For the other 50 per cent of women experiencing heart failure the cause is generally related to having untreated high blood pressure levels over time, which leads to progressive stiffening of the heart. There is no effective treatment for this kind of heart failure yet.

"Men and women have different biologies and this results in different types of the same heart diseases. It is about time to recognise these differences," says Professor Eva Gerdts, Department of Clinical Science, University of Bergen.

"Another important point concerning how to avoid heart disease is to ask about what the national health service is doing on this issue. Heart disease remains among the most common cause of death and reduced quality of life in women. Medically speaking, we still do not know what the best treatment for heart- attack or -failure is in many women. It is an unacceptable situation," Gerdts claims.

Gerdts has recently published an invited review paper in Nature together with Professor Vera Regitz-Zagrosek ved Charité Universitätsmedizin.

The researchers have compared common risk factors for heart disease and how these affect men and women differently. They have, among other things, focused on the sex differences in the effect of obesity, high blood pressure and diabetes.

Women gain more weight

According to The World Health Organization (WHO) 11 per cent women and 15 per cent men are obese (BMI over 30 kg/ m2) globally. In Norway one in five adults are obese.

"If we see this from a life span perspective, we can see that obesity increases with age, and that this trend is greater for women than men. Obesity increases the risk of having high blood pressure by a factor of three. This, in turn, increases the risk of heart disease," Gerdts points out.

According to Gerdts, obesity also increases the risk of diabetes 2. A woman with diabetes has a much higher relative risk of heart complications and death than a man.

"We know that women with diabetes 2 are usually obese and some of this fat is stored in the heart, which makes it more vulnerable for disease."

Oestrogen influence heart risk

Gerdts explains that many of the differences between woman and men when it comes to heart disease are connected to the sex hormone, oestrogen. The hormone prevents the formation of connective tissue in the heart, which makes it harder for the heart to pump. In men the effects are the opposite.

"We see that obese men store oestrogen in their fat cells in the abdomen, which has a bad effect on the heart."

After menopause, women lose the oestrogen advantage. Their arteries becomes stiffer and more vulnerable for disease. We see this in the fact that for persons under 60, high blood pressure is most common amongst men. For persons over 60, it is the opposite.

"We think that this is part of the explanation for why high blood pressure seems to indicate higher risk of heart disease amongst women."

Women smoke more

In addition, smoking is also a part of the risk scenario for women. During the past decades, more women have started smoking than men.

"Many women start smoking to reduce their appetite and to control their weight. However, this is not a good choice from a health perspective."

"For women, the effects of risk factors such as smoking, obesity and high blood pressure increase after menopause," says Eva Gerdts.

Postnatal women respond positively to attending commercial weight management groups, University of Warwick-led study finds

Could help those who are overweight to lose weight in the first year after giving birth but further evidence is needed

Many women struggle to lose weight gained before or during pregnancy

Being overweight is associated with poorer health long-term for a woman and her baby and can impact likelihood of breastfeeding

Researchers are now calling for a large-scale definitive clinical trial

Women who were overweight at the start of their pregnancy would welcome support after they have given birth in the form of commercial weight management groups, University of Warwick-led research has found.

The conclusions come from a feasibility study led by the Warwick Clinical Trials Unit and published in BJOG: An International Journal of Obstetrics and Gynaecology, which aimed to assess if commercial weight management groups could help women who were overweight (classed as a BMI of ?25kg/m2) when they became pregnant to return to a more healthy weight after giving birth. This feasibility study, funded by the NIHR, aimed to determine whether it would be possible to recruit women to a future larger clinical trial of weight management programmes and if they were likely to see a benefit from attending.

The researchers found that women who attended weight management groups which they could start from 8 to 16 weeks after giving birth lost slightly more weight (around 3kgs) as assessed at 12 months postnatally, than those women not offered access to groups, with those who attended more of the 12 group sessions offered experiencing the greatest weight loss.

The researchers argue that this suggests that women could benefit in health terms from attending a commercially available weight management programme post pregnancy, and a larger clinical trial should now be conducted to determine the definitive health and other benefits of such a programme and the cost effectiveness to the health service.

To investigate whether a weight management programme could help women who've had a baby to better manage their weight, the researchers recruited 193 women with BMIs greater than 25 when they became pregnant and randomly assigned them to either a commercially available weight management group, in this case Slimming World, with a lifestyle information leaflet, or to receive standard NHS maternity care only. All women were recruited from a large inner city maternity unit in the South of England.

Lead author Professor Debra Bick, from the University of Warwick's Clinical Trials Unit, said: "We now need to find out if commercial weight management programmes are both clinically effective and cost effective when offered to women who have given birth in the previous three to four months. While it is difficult to predict the economics in the long term, this could save money for the health service by preventing poor health in the long term. If we can confirm that commercial programmes are successful in a future clinical trial then this is an intervention that the NHS should seriously consider for women who are overweight or obese before pregnancy."

Previous research has shown that commercial weight management programmes have been more effective in helping individuals with higher BMIs to lose weight than health service provided ones. In this study, the researchers made no changes to the weight management programme offered and found that the participants responded positively to the flexible timings, the opportunity to mix with other group attendees and the opportunity to take their babies with them. Women were able to attend 12 weekly sessions, with the support offered incorporating dietary advice suited to breastfeeding and promoting physical activity.

While women shouldn't put pressure on themselves to lose weight after having a baby, we know that retaining weight is associated with poorer long-term health for the woman, and often leads to further weight gain in subsequent pregnancies. It is also known to reduce the likelihood of women breastfeeding and increase the likelihood of their child being obese*.

Professor Bick adds: "During pregnancy is the wrong time to attempt weight loss and post-pregnancy seems to be a better time to talk about women about their weight and longer term health. We found that women want advice and guidance on managing their weight after giving birth, but busy lifestyles make it difficult for lots of women. We also have to consider that weight management is not just a health issue - family commitments, food choices, budgets and need to return to paid employment are also factors which can influence women's decisions about seeking support for weight management.

"If a postnatal woman is concerned about her weight, support is out there, including seeking advice from her GP. This feasibility trial has shown that we could recruit and follow up women who had higher BMIs to 12 months after giving birth. We also know more about how we could encourage women offered the intervention to attend all sessions offered as part of a weight management programme. A larger definitive trial will provide very important evidence on whether commercial weight management groups could be of benefit for women, their families and the NHS."

Dr Cath Taylor, Reader in Healthcare Workforce Organisation and Wellbeing at the University of Surrey, said: "Maintaining a healthy diet and weight is important for all post-natal women, not only is it better for their overall wellbeing it enables them to be more active with their children and helps incorporate healthy habits and choices into their household.

"It is clear from our findings that weight management groups may be helpful for weight loss in postnatal women, which is beneficial to them and their families, however some are hesitant in starting and/or continuing with such programmes. We investigated the reasons for this and found that many barriers could be easily addressed, for example misconceptions about the safety of Slimming World whilst breastfeeding. We will address such barriers in our future study and thereby hope to further enhance uptake and retention, and thereby the benefits of the intervention."

Rochester, Minn. — Heart problems are a common development for people with diabetes. In fact, about 33% of people in the U.S. admitted to the hospital for heart failure also have diabetes. Heart failure may be the result of a co-condition, such as hypertension or coronary heart disease, but not always.

A study published in Mayo Clinic Proceedings, Diabetes Mellitus Is an Independent Predictor for the Development of Heart Failure: A Population Study, examines the idea of diabetic cardiomyopathy and heart failure from the effects of diabetes alone.

Utilizing the Rochester Epidemiology Project, researchers evaluated the long-term impact of diabetes on the development of heart failure, both with preserved ejection fraction — a measurement of the percentage of blood leaving the heart with each contraction — and reduced ejection fraction. They also looked at mortality in a community population, controlling for hypertension, coronary artery disease and diastolic function. Horng Chen, M.D., cardiologist at Mayo Clinic in Rochester, Minnesota, is senior author of the study.

From an initial group of 2,042 residents of Olmsted County, 116 study participants with diabetes were matched 1:2 for age, hypertension, sex, coronary artery disease and diastolic dysfunction to 232 participants without diabetes. Over the 10-year follow-up period, 21% of participants with diabetes developed heart failure, independent of other causes. In comparison, only 12% of patients without diabetes developed heart failure. Cardiac death, heart attack and stroke were not statistically different in the study between the two groups.

The study shows that diabetes is an independent risk factor for the development of heart failure in the community dwelling population. Furthermore, the outcome data support the concept of a diabetic cardiomyopathy.

This research extends previous findings and demonstrates that even without a known cardiac structural abnormality and with a normal ejection fraction, diabetic patients are still at increased risk of developing heart failure as compared to their nondiabetic counterparts.

"The key takeaway is that diabetes mellitus alone is an independent risk factor for the development of heart failure," says Dr. Chen. "Our hope is that this study provides a strong foundation for further investigations into diabetes and heart failure. There is still much to learn and study in terms of this association and how to best diagnose and treat this condition."

The FH Foundation, World Heart Federation, and an international coalition join together to tackle the global burden of familial hypercholesterolemia (FH), a vastly under-recognized and poorly managed public health concern. A Global Call to Action on familial hypercholesterolemia (FH) was published today in JAMA Cardiology. Authored by a global panel of scientific experts, advocacy leaders, public health officials, and individuals with FH from 40 countries, the report notes glaring gaps in screening and guideline-based care for FH, the most common cause of early and aggressive heart disease.

The international coalition was convened by the FH Foundation and World Heart Federation to reexamine and update key recommendations issued by the World Health Organization (WHO) in their report on Familial Hypercholesterolemia in 1998. In the 20 years since that report, few of these recommendations have been systematically implemented on a country-by-country basis, leaving nine out of 10 people born with FH undiagnosed.

"Familial hypercholesterolemia represents an unprecedented opportunity for prevention of heart disease," said Katherine Wilemon, Founder and CEO of the FH Foundation. "Our aim initiating this Call to Action is to highlight that we have had the scientific understanding, and effective therapies, to stop inherited coronary heart disease, but have allowed generations of families to go uncared for. It is time to address Familial hypercholesterolemia as a public health priority."

FH is an inherited metabolic disorder found in all races and ethnicities and impacts 34 million people worldwide. Left untreated, individuals with FH have a 20-times higher risk of illness and death from cardiovascular disease (CVD). However, if diagnosed and treated, heart attacks, strokes and the need for surgery can be prevented.

The FH Global Call to Action coalition cites mounting scientific data, the commercialization of novel therapies, and technological advances as further impetus for public health officials and governments to commit to early screening and coordinated lifetime care for this large and vulnerable population.

"The success of the concrete and actionable recommendations we issue today will depend on support from governments, which is why we are jointly addressing them as a global community now," said Jean-Luc Eiselé, CEO of the World Heart Federation. "Each of the partnering organizations is committed to advocating to improve and expand FH care in their countries. The Global Call to Action on FH is an unprecedented opportunity to prevent premature cardiovascular disease in future generations worldwide."

Infertility impinges on the human right to have a child, according to new research published today, which also calls for greater healthcare equity and more inclusive reproductive health surveillance.

The ability to decide if, when, and how often to reproduce is a human right and a biomedical and social goal, says the report entitled 'Reproductive Justice for the Invisible Infertile: A Critical Examination of Reproductive Surveillance and Stratification' in the online journal, Sociology Compass.

The report, by researchers at Lancaster University in the UK and the University of Oregon in the US, says that while biomedical attempts to address infertility have proliferated, their availability has been unequally distributed to individuals and couples who need access to services.

The authors document how reproductive health statistics are produced in the United States, highlighting who is left out of these statistics. They argue that reproductive health statistics have created a self-reinforcing and false notion that infertility is primarily a problem faced by white, middle-class women.

This, adds the report, creates a group of people known as the 'invisible infertile', including groups such as working class people, those with disabilities, and people in prison. The reproductive needs of the invisible infertile are often overlooked.

In addition to critically assessing scientific tools, the report also examines the history of family planning in the U.S. This includes the inception and provisions of Title X, the federal family planning program which funds reproductive health clinics for the public.

The report comes in the midst of efforts by the Trump administration to scale back Title X provisions - efforts which have resulted in a scaling back of public reproductive health services and closure of some Planned Parenthood clinics.

The Title X program is more likely to be used by the invisible infertile, but does not provide an adequate array of infertility services. Meanwhile, the private insurance system provides more generous coverage for services, but is often out of reach for marginalized groups.

As a result, according to Lancaster's Dr Jasmine Fledderjohann and Oregon's Dr Liberty Barnes, inequalities in rates of infertility, reproductive health surveillance, and access to reproductive healthcare to address infertility abound.

"Individuals who are excluded from infertility tracking, services, and treatment - the 'invisible infertile' - are structurally limited in their ability to realise their human right to reproduce," says Dr Fledderjohann.

"Using existing resources in public and private clinical spaces may be a useful starting point for addressing these disparities, but a broader commitment to equitable and inclusive surveillance and healthcare provision is also needed. In other words, recent efforts to scale back Title X provisions are a step in the wrong direction."

Drs Barnes and Fledderjohann apply the reproductive justice framework, developed by black feminist activists in the 1990s, to their analysis of infertility surveillance and treatment.

The reproductive justice framework outlines three core human rights: to have a child, not to have a child, and to parent children in a safe and healthy environment.

They argue that, where infertility is unrecognized and access to services to treat infertility is restricted to the privileged, the invisible infertile are denied their right to have a child.

This analysis highlights systematic and linked exclusions of marginalized groups from reproductive health surveillance and the public and private provision of reproductive healthcare, including: older, non-white, single parents, working class, LGBTQ, geographically remote, less educated, HIV-positive, institutionalised, and disabled individuals.

The research suggests that because the primary focus of state-run reproductive health initiatives, including observation, family planning and healthcare access is population control through pregnancy prevention, the needs of the infertile are often ignored.

The research, a critical review of sociological and public health literature, provides evidence that, for marginalized groups, pregnancy prevention and contraception are prioritised over childbearing and rearing.

"This contributes to the invisibility of infertility amongst marginalised groups and undermines reproductive health as a broader population goal and human right," said Dr Barnes.

"The way we monitor and financially support public reproductive health services is, simply put, a matter of human rights and reproductive justice," she continued.

While the research has focused on the US as a case study, the authors also note that the processes outlined in the report operate within and between countries to create 'invisible infertility' around the globe.

The researchers call for social science, clinical and public health communities to approach their work through a reproductive justice framework.

"Reproductive health researchers and family planning clinicians can begin by recognising the breadth of reproductive health, acknowledging that achieving pregnancy is as important to individuals' lives as avoiding it," the report concludes.

PHILADELPHIA--People living in predominately Hispanic neighborhoods are less likely to receive CPR from a bystander following an out-of-hospital cardiac arrest compared to people living in non-Hispanic neighborhoods, researchers from Penn Medicine and the Duke University of School of Medicine reported in the journal Circulation. This same group also had a lower likelihood of survival.

Most previous studies, including ones led by Penn, have concentrated on gender, age, and residents of predominantly black neighborhoods, who are also less likely to receive CPR from bystanders. However, few have been conducted around CPR delivery in the Hispanic population, despite it being the fastest growing community in the United States.

"This is an underrecognized disparity that deserves more attention and resources if we're going to better understand what's driving it," said senior author Benjamin S. Abella, MD, MPhil, a professor of Emergency Medicine in the Perelman School of Medicine at the University of Pennsylvania and director of the Penn Center for Resuscitation Science. "One of the first steps is to focus on ways to implement programs that help more people from the Hispanic community get CPR trained and ultimately save more lives."

Administering CPR following cardiac arrest can double or even triple a person's chance of survival, according to the American Heart Association.

"It is critical to consider how to address these disparities, including targeted CPR training for Hispanic populations," said lead author Audrey L. Blewer, PhD, MPH, an assistant professor in the department of Family Medicine and Community Health at Duke, who began the study as the assistant director for Educational Programs at the Center for Resuscitation Science at Penn Medicine.

The team conducted a retrospective cohort study using data from the Resuscitation Outcomes Consortium, a network of regional clinical centers in the United States and Canada that study out-of-hospital treatments of cardiac arrest and trauma. The study analyzed over 27,000 different cardiac arrest events between 2011 and 2015.

In neighborhoods with less than 25 percent Hispanic residents, CPR was administered in 39 percent of events, compared to only 27 percent of events in neighborhoods with more than 75 percent Hispanic residents.

Patients who suffered a cardiac arrest in neighborhoods with predominately Hispanic residents also had a 44 percent lower likelihood of survival, as compared to those who lived in neighborhoods with predominantly non-Hispanic residents. Most of the bystander CPR events occurred in the home.

"These findings should inform future messaging around bystander CPR and educational initiatives, including the provision of dispatch CPR targeting largely Hispanic neighborhoods," the authors wrote.

Without a doubt, Tyrannosaurus rex is the most famous dinosaur in the world. The 40-foot-long predator with bone crushing teeth inside a five-foot long head are the stuff of legend. Now, a look within the bones of two mid-sized, immature T. rex allow scientists to learn about the tyrant king's terrible teens as well.

In the early 2000s, the fossil skeletons of two comparatively small T. rex were collected from Carter County, Montana, by Burpee Museum of Natural History in Rockford, Illinois. Nicknamed "Jane" and "Petey," the tyrannosaurs would have been slightly taller than a draft horse and twice as long.

The team led by Holly Woodward, Ph.D., from Oklahoma State University Center for Health Sciences studied Jane and Petey to better understand T. rex life history.

The study "Growing up Tyrannosaurus rex: histology refutes pygmy 'Nanotyrannus' and supports ontogenetic niche partitioning in juvenile Tyrannosaurus" appears in the peer-reviewed journal Science Advances.

Co-authors include Jack Horner, presidential fellow at Chapman University; Nathan Myhrvold, founder and CEO of Intellectual Ventures; Katie Tremaine, graduate student at Montana State University; Scott Williams, paleontology lab and field specialist at Museum of the Rockies; and Lindsay Zanno, division head of paleontology at the North Carolina Museum of Natural Sciences. Supplemental histological work was conducted at the Diane Gabriel Histology Labs at Museum of the Rockies/Montana State University.

"Historically, many museums would collect the biggest, most impressive fossils of a dinosaur species for display and ignore the others," said Woodward. "The problem is that those smaller fossils may be from younger animals. So, for a long while we've had large gaps in our understanding of how dinosaurs grew up, and T. rex is no exception."

The smaller size of Jane and Petey is what make them so incredibly important. Not only can scientists now study how the bones and proportions changed as T. rex matured, but they can also utilize paleohistology-- the study of fossil bone microstructure-- to learn about juvenile growth rates and ages. Woodward and her team removed thin slices from the leg bones of Jane and Petey and examined them at high magnification.

"To me, it's always amazing to find that if you have something like a huge fossilized dinosaur bone, it's fossilized on the microscopic level as well," Woodward said. "And by comparing these fossilized microstructures to similar features found in modern bone, we know they provide clues to metabolism, growth rate, and age."

The team determined that the small T. rex were growing as fast as modern-day warm-blooded animals such as mammals and birds. Woodward and her colleagues also found that by counting the annual rings within the bone, much like counting tree rings, Jane and Petey were teenaged T.rex when they died; 13 and 15 years old, respectively.

There had been speculation that the two small skeletons weren't T. rex at all, but a smaller pygmy relative Nanotyrannus. Study of the bones using histology led the researchers to the conclusion that the skeletons were juvenile T. rex and not a new pygmy species.

Instead, Woodward points out, because it took T. rex up to twenty years to reach adult size, the tyrant king probably underwent drastic changes as it matured. Juveniles such as Jane and Petey were fast, fleet footed, and had knife-like teeth for cutting, whereas adults were lumbering bone crushers. Not only that, but Woodward's team discovered that growing T. rex could do a neat trick: if its food source was scarce during a particular year, it just didn't grow as much. And if food was plentiful, it grew a lot.

"The spacing between annual growth rings record how much an individual grows from one year to the next. The spacing between the rings within Jane, Petey, and even older individuals is inconsistent - some years the spacing is close together, and other years it's spread apart," said Woodward.

The research by Woodward and her team writes a new chapter in the early years of the world's most famous dinosaur, providing evidence that it assumed the crown of tyrant king long before it reached adult size.