Culture

Doctors may be able to predict their patients' risks of fatal coronary heart disease more accurately by taking into account the number of adverse social factors affecting them, according to a new study led by researchers at Weill Cornell Medicine and NewYork-Presbyterian.

The researchers, whose findings appear Dec. 3 in Circulation, analyzed data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study that tracked cardiovascular-related health outcomes in more than 20,000 people for a decade. The new analysis showed that participants who had more adverse social determinants of health, such as low income and educational attainment, were significantly more likely to die of coronary heart disease--mostly heart attacks--during the study. For example, people with three or more social determinants of health, on a list of seven, were about 67 percent more likely to have a fatal heart attack, even when accounting for differences in age and other health factors.

The researchers suggest that doctors consider using simple counts of these factors to better estimate their patients' health risks and provide more aggressive treatment where applicable.

"Physicians tend to view social determinants of health as a peripheral part of clinical care management, but we think it should play a much more central role," said lead author Dr. Monika Safford, John J. Kuiper Professor of Medicine at Weill Cornell Medicine and chief of the Division of General Internal Medicine at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center.

Social determinants of health have remained on the periphery of medicine, despite their potential for improving patient risk assessment, largely because no one has demonstrated an easy way to use them in day-to-day clinical practice.

"Physicians tend to be very busy people--they're unlikely to adopt a complex tool for risk assessment," Dr. Safford said. "Our approach therefore was to keep it simple."

The analysis covered more than 22,000 people, who initially did not have diagnosed coronary heart disease, in the long-running REGARDS Study, on which Dr. Safford has been a lead investigator. The stroke-focused study has included ancillary studies of heart attacks and related health outcomes.

Dr. Safford and her colleagues identified a list of nine social determinants of health that prior research has linked individually to greater risks of heart attacks, strokes and related outcomes. They found that about half (48.8 percent) of those in the study group had two or more of these adverse social factors, and that having more of them generally predicted worse coronary heart disease outcomes during the study period. Participants with three or more social determinants were, for example, about three times more likely to suffer fatal coronary heart disease, compared to those with none of these factors.

These initial findings suggested that a count of social determinants of health could be a quick and easy source of information for doctors about their patients' coronary heart disease risks--even if it is only predictive because the factors are linked to known cardiovascular risk factors such as hypertension and obesity. However, a further analysis suggested that a high count also contains an independent signal of fatal-coronary heart disease risk.

The researchers narrowed their social determinants of health list to the seven that were most strongly linked to fatal coronary heart disease: Black race, low education, low income, living in a zip code with high poverty, residence in one of the U.S. states with the least public health infrastructure, not seeing close friends/family in the past month, and lack of health insurance. They then adjusted the outcomes data based on differences in health factors, such as a greater burden of chronic disease in the high social determinants group. They still found that people with three or more social determinants had a 67 percent greater risk of fatal coronary heart disease.

A similar analysis found that people with two or more social determinants had a 14 percent greater risk of nonfatal heart attack, although that association was not statistically significant.

Noting a patient's high number of social determinants of health could enable a cardiologist or general practitioner not only to anticipate a higher chance of bad outcomes, but also to mitigate that added risk with more intensive treatment, Dr. Safford said.

"Our group has also done studies on social determinants of health and the risks of stroke, diabetes, and heart failure, and we've had similar findings in every case, so we may be close to the point where counting social determinants of health is generally adopted into clinical practice," she said.

Friends are more than just trusted confidantes, say Michigan State University researchers who have examined the cultural and health benefits of close human relationships in a new study.

"Friendships are one of the untapped resources people can draw on to pursue a happier and healthier life. They literally cost nothing and have health and well-being benefits," said William Chopik, an assistant professor of psychology at MSU and the study's senior author.

Published in Frontiers of Psychology, the study is the largest of its kind and included 323,200 participants from 99 countries. Prior studies compared only a few specific cultures to one another -- but did not take such a comprehensive view.

"We found that placing a value on friendship was good for people's health and well-being regardless of where they lived. However, looking at friendships as an important part of life is more important in some cultures than it is in others."

Using the World Values Survey, the researchers pulled data from multiple sources including datasets on friendship, health, happiness findings; economic variables; and cultural variables.

Researchers found that around the world those who invest in friendships enjoy better physical and psychological health, particularly older adults or those with less education. The benefits are especially evident in cultures that are more individualistic, unequal or constraining.

"People who come from more privileged settings have a lot of resources that contribute to their health and happiness, but it looks like -- for those who don't have those resources -- friendships might serve as a particularly important factor in their lives," Chopik said.

One of the goals of MSU's Close Relationships Lab -- founded and run by Chopik -- is to examine friendships and study them in ways that people can improve their lives for the better.

"In today's world there's a general feeling that we're in a 'friendship crisis' in which people are lonely and want friends but struggle to make them," Chopik said. "We show here that they're beneficial for nearly everyone, everywhere. But why are they so hard to form and keep? That's what we're working on next."

The year 2021 marks the 100th anniversary of a fundamental discovery that's taught in every biochemistry textbook. In 1921, German physician Otto Warburg observed that cancer cells harvest energy from glucose sugar in a strangely inefficient manner: rather than "burn" it using oxygen, cancer cells do what yeast do -- they ferment it. This oxygen-independent process occurs quickly, but leaves much of the energy in glucose untapped.

Various hypotheses to explain the Warburg effect have been proposed over the years, including the idea that cancer cells have defective mitochondria -- their "energy factories" -- and therefore cannot perform the controlled burning of glucose. But none of these explanations has withstood the test of time. (Cancer cells' mitochondria work just fine, for example.)

Now a research team at the Sloan Kettering Institute led by immunologist Ming Li offers a new answer, based on a hefty set of genetic and biochemical experiments and published January 21 in the journal Science.

It comes down to a previously unappreciated link between Warburg metabolism and the activity of a powerhouse enzyme in the cell called PI3 kinase.

"PI3 kinase is a key signaling molecule that functions almost like a commander-in-chief of cell metabolism," Dr. Li says. "Most of the energy-costly cellular events in cells, including cell division, occur only when PI3 kinase gives the cue."

As cells shift to Warburg metabolism, the activity of PI3 kinase is increased, and in turn, the cells' commitment to divide is strengthened. It's a bit like giving the commander-in-chief a megaphone.

The findings revise the commonly accepted view among biochemists that sees metabolism as secondary to cell signaling. They also suggest that targeting metabolism could be an effective way to thwart cancer growth.

Challenging the Textbook View

Dr. Li and his team, including graduate student Ke Xu, studied Warburg metabolism in immune cells, which also rely on this seemingly inefficient form of metabolism. When immune cells are alerted to the presence of an infection, a certain type called T cells shift from the typical oxygen-burning form of metabolism to Warburg metabolism as they grow in number and ramp up infection-fighting machinery.

The key switch that controls this shift is an enzyme called lactate dehydrogenase A (LDHA), which is made in response to PI3 kinase signaling. As a result of this switch, glucose remains only partially broken down and the cell's energy currency, called ATP, is quickly generated in the cell's cytosol. (In contrast, when cells use oxygen to burn glucose, the partially broken down molecules travel to the mitochondria and are further broken down there to make ATP on a delay.)

Dr. Li and his team found that in mice, T cells lacking LDHA could not sustain their PI3 kinase activity, and as a result could not effectively fight infections. To Dr. Li and his team, this implied that this metabolic enzyme was controlling a cell's signaling activity.

"The field has worked under the assumption that metabolism is secondary to growth factor signaling," Dr. Li says. "In other words, growth factor signaling drives metabolism, and metabolism supports cell growth and proliferation. So the observation that a metabolic enzyme like LDHA could impact growth factor signaling through PI3 kinase really caught our attention."

Like other kinases, PI3 kinase relies on ATP to do its work. Since ATP is the net product of Warburg metabolism, a positive feedback loop is set up between Warburg metabolism and PI3 kinase activity, securing PI3 kinase's continued activity -- and therefore cell division.

As for why activated immune cells would preferentially resort to this form of metabolism, Dr. Li suspects it has to do with the cells' need to produce ATP quickly to ramp up their cell division and infection-fighting machinery. The positive feedback loop ensures that once this program is engaged, it will be sustained until the infection is eradicated.

The Cancer Connection

Though the team made their discoveries in immune cells, there are clear parallels to cancer.

"PI3 kinase is a very, very critical kinase in the context of cancer," Dr. Li says. "It's what sends the growth signal for cancer cells to divide, and is one of the most overly active signaling pathways in cancer."

As with immune cells, cancer cells may employ Warburg metabolism as a way to sustain the activity of this signaling pathway and therefore ensure their continued growth and division. The results raise the intriguing possibility that doctors could curb cancer growth by blocking the activity of LDHA -- the Warburg "switch."

A new study exploring the impact of repeated sleep loss during a simulated working week has found that consuming caffeinated coffee during the day helps to minimize reductions in attention and cognitive function, compared to decaffeinated coffee1.

While this effect occurred in the first three-to-four days of restricted sleep, by the fifth and final day, no difference was seen between caffeinated and decaffeinated coffee drinkers. This therefore suggests that the beneficial effects of coffee for people with restricted sleep are temporary1.

It is estimated that over 30% of adult Western populations sleep less than the recommended seven to eight hours on weekday nights and 15% regularly sleep less than six hours2,3. This can have a considerable impact on people's health and wellbeing, including causing sleepiness and impairing vigilance and attention4.

Denise Lange, study co-author, commented: "Previous research suggests that acute consumption of caffeinated coffee can reduce the impact of sleep deprivation on deficits of attention and cognitive function in a short-term setting. This study is among the first to examine whether this effect can be translated into a real-world situation, where caffeinated drinks are commonly consumed every day by people who experience chronic sleep restriction. Our study indicates that moderate coffee intake can mitigate some repercussions of reduced sleep over a few days, however, this is not a substitute for a good night's sleep in the long term."

The study was conducted at the state-of-the-art Institute of Aerospace Medicine, in Cologne Germany. 26 participants carrying a distinct genotype of the gene encoding the adenosine A2A receptor were randomly assigned to groups either drinking caffeinated coffee (containing 300 mg caffeine) or decaffeinated coffee under double-blind conditions. During five days, the sleep of all participants was restricted to five hours per night and each day they rated their subjective sleepiness and were tested on levels of vigilance, alertness, reaction-time, accuracy and memory1.

Just over 200,000 Americans suffer from systemic lupus erythematosus, or SLE, a condition in which the body's immune system mistakenly attacks its own healthy tissues, especially joints and skin, a new study shows.

Led by a researcher at NYU Grossman School of the Medicine, the study provides the first national estimate of how widespread the autoimmune disease is since the U.S. Centers for Disease Control and Prevention (CDC) set up a half dozen state registries to track the illness more than a decade ago. SLE affects mostly women, can be fatal, and often involves debilitating flare-ups of fatigue and pain that keep nearly half of adult patients from working.

Importantly, the researcher says the report, publishing in the journal Arthritis and Rheumatology online Jan. 21, comes statistically close to officially reclassifying the illness as a rare disease, which disproportionately affects mostly American Indian/Alaskan Native, Black, and Hispanic females. The U.S. Rare Diseases Act of 2002 classifies such conditions as those affecting 200,000 or fewer Americans.

Until now, researchers had relied on disease estimates that were larger but unverified.

"Our study potentially redefines systemic lupus erythematosus as a rare disease in the United States and lays the groundwork for where we need to focus our efforts to reduce the burden of this disease on Americans," says study lead investigator and rheumatologist Peter Izmirly, MD. Izmirly is an associate professor in the Department of Medicine at NYU Langone Health.

Rare-disease classification could, the investigator says, significantly change efforts to study and treat SLE by decreasing the number of study participants needed for testing new treatments and shaping the design of clinical trials needed before seeking regulatory approval. He also says the team's findings could help plan which neighborhoods or population groups need extra medical resources, including specialty rheumatology clinics, to combat SLE.

Current treatments for lupus, he notes, include steroids or other anti-inflammatory and immunosuppressing medications, especially newer biologic drugs, made from living cells, to prevent patients' immune system's attack on their tissues.

For the study, researchers at NYU Langone and elsewhere analyzed records for 5,417 adults and children diagnosed with SLE since 2002 at all of the state registries for the disease, as well as the Indian Native Health Service. They then calculated the number of people with SLE for every gender and ethnic group and applied those demographic numbers to national population statistics from the 2018 U.S. Census. They concluded that among every 100,000 people nationwide, 72.8 had SLE, for a total of 204,295 out of a population of 330 million.

Their calculations also found that nine times more women than men have SLE, the dominant form of lupus. SLE rates were highest among Native American/Alaskan Native females, at 270.6 per 100,000. Black females ranked next, at 230.9 per 100,000, followed by Hispanic females, at 120.7 per 100,000. Similar disparities were seen among males with SLE, with American Indians/Alaskan Natives having the highest number, at 53.8 per 100,000, and Black males next, at 26.7 per 100,000.

New research has shown that people are more likely to follow Covid-19 restrictions based on what their friends do, rather than their own principles.

Research led by the University of Nottingham carried out in partnership with experts in collective behaviour from British, French, German and American universities shows how social influence affects people's adherance to government restrictions. The researchers found that the best predictor of people's compliance to the rules was how much their close circle complied with the rules, which had an even stronger effect than people's own approval of the rules.

The research published in British Journal of Psychology highlights a blindspot in policy responses to the pandemic. It also suggests that including experts in human and social behaviour is crucial when planning the next stages of the pandemic response, such as how to ensure that people comply with extended lockdowns or vaccination recommendations.

The lead researcher, Dr Bahar Tunçgenç from the University of Nottingham's School of Psychology and a research affiliate at the University of Oxford said: "When coronavirus first hit the UK in March, I was struck by how differently the leaders in Europe and Asia were responding to the pandemic. While the West emphasised 'each person doing the right thing', pandemic strategies in countries like Singapore, China and South Korea focussed on moving the collective together as a single unit. To understand what would work most effectively for bringing people on board in this moment of crisis, we set out to conduct a global study."

To investigate the role that social networks might play in preventing the spread of Covid-19, the researchers asked people from over 100 countries how much they, and their close social circle, approved of and followed the Covid-19 rules currently in place in their area.

The researchers found that people didn't simply follow the rules if they felt vulnerable or were personally convinced. Most diligent followers of the guidelines were those whose friends and family also followed the rules. Close circle's compliance had an even stronger effect than people's own approval of the rules. This discovery applied to all age groups, genders, countries, and was independent of the severity of the pandemic and strength of restrictions.The study also revealed that people who were particularly bonded to their country were more likely to stick to lockdown rules - the country was like family in this way, someone for whom one is willing to stick their neck out.

"Public policies are on the wrong track: We see scientists and politicians trying to boost the public's approval of the measures, so that vaccination campaigns and lockdowns get the support of the citizens, but approval does not mean compliance! You may make up your own mind about the measures, or listen to experts, but eventually, what you do depends on what your close friends do" says Ophelia Deroy, who is a professor of philosophy of mind and neuroscience at Ludwig Maximilian University of Munich.

Dr Tuncgenc concludes: "There is much that human behaviour research can offer to implement effective policies for the Covid-19 challenges we will continue to face in the future. Practical steps could include social apps, similar to social-based excercise apps, which tell people whether their close friends are enrolled for the vaccine. Using social media to demonstrate to your friends that you are following the rules, rather than expressing outrage at people who aren't following them could also be a more impactful approach. At national and local levels, public messages by trusted figures can emphasise collective values, such as working for the benefit of our loved ones and the community. Our message to policymakers is that even when the challenge is to practise social distancing, social closeness is the solution!"

Pharmacists play an important role in managing medication-based therapies for older community-dwelling patients, according to a study published in the British Journal of Clinical Pharmacology.

In the study of patients aged 65 years and older who came to a pharmacist-led outpatient clinic at a general hospital in Beijing, China between 2016 and 2018, pharmacists were helpful not only for identifying and solving drug-related problems, but also for improving measures such as blood pressure and cholesterol, and for reducing the cost of medications for patients.

"To the best of our knowledge, this study was the first to evaluate the outcomes of pharmacist-led medication therapy management services in ambulatory elderly patients in mainland China," the authors wrote.

Pathogenic bacteria in humans are developing resistance to antibiotics much faster than expected. Now, computational research at Chalmers University of Technology, Sweden, shows that one reason could be significant genetic transfer between bacteria in our ecosystems and to humans. This work has also led to new tools for resistance researchers.

According to the World Health Organisation, antibiotic resistance is one of the greatest threats to global health, food safety and development. It already causes over 33,000 deaths a year in Europe alone.

Completely different species of bacteria can spread resistance genes to each other through plasmids - small DNA molecules where bacteria store some of their genes outside the chromosome. When two bacterial cells come into contact, they can copy plasmids to each other. This is called conjugation, and it is the most important mechanism for spreading antibiotic resistance.

"In recent years, we've seen that resistance genes spread to human pathogens to a much greater degree than anyone expected," says Jan Zrimec, researcher in systems and synthetic biology at Chalmers University of Technology. "Many of the genes appear to have originated in a wide array of bacterial species and environments, such as soil, water and plant bacteria.

"This has been difficult to explain, because although conjugation is very common, we've thought that there was a distinct limitation for which bacterial species can transfer plasmids to each other. Plasmids belong to different mobility groups, or MOB groups, so they can't transfer between just any bacterial species.

Zrimec has developed new methods of data analysis that show that genetic transfer may be much more boundless and widespread than previously expected.

Among other things, he has developed an algorithm that can identify specific DNA regions that are necessary for conjugation - called oriT regions - in large amounts of data consisting of genetic sequences from the DNA of thousands of plasmids. The algorithm can also sort plasmids into MOB groups based on the identified oriT regions.

He has used the algorithm to explore known gene sequences from over 4,600 naturally occurring plasmids from different types of bacteria, which has not been possible to do systematically before. The results show, among other things, that:

The number of oriT regions may be almost eight times higher than those found with the standard method used today.

The number of mobile plasmids may be twice as high as previously known.

The number of bacterial species that have mobile plasmids may be almost twice as high as previously known.

Over half of these plasmids have oriT regions that match a conjugation enzyme from another plasmid that has previously been classified in a different MOB group. This means that they could be transferred by one of these plasmids that happens to be in the same bacterial cell.

The last part means that there may be transfer mechanisms between large numbers of bacterial species and environments where we previously believed there were barriers.

"These results could imply that there is a robust network for transferring plasmids between bacteria in humans, animals, plants, soil, aquatic environments and industries, to name a few," Zrimec explains. "Resistance genes occur naturally in many different bacteria in these ecosystems, and the hypothetical network could mean that genes from all of these environments can be transferred to bacteria that cause disease in humans.

"This may be a possible reason for the rapid development of resistance in human pathogens that we have observed in recent years. Our extensive use of antibiotics selects for resistance genes, which could thus flow in from a much larger naturally occurring genetic reservoir than we previously estimated."

The results need to be verified experimentally in the future, but the data analysis methods Zrimec developed can already be employed by many of the researchers working with antibiotic resistance in various medical and biological fields. They provide a powerful new tool for systematically mapping out the potential transferability of different plasmids.

"This has been a major limitation of the research field up to now," Zrimec says. "I hope that the methods will be able to benefit large parts of the research into antibiotic resistance, which is an extremely interdisciplinary and fragmented area. The methods can be used for studies aiming to develop more effective limitations to antibiotic use, instructions for how antibiotics are to be used and new types of substances that can prevent the spread of resistance genes at the molecular level."

More about: Genetic transfer through conjugation:

In order for conjugation to start, an enzyme is needed - a relaxase - which fits onto a specific location on the plasmid. The relaxase has to recognise and bind to a region where the DNA ring can be nicked and a strand can be transferred to the next bacterium. This DNA region is called the origin of transfer, or oriT.

Previously, it was thought that an individual plasmid must contain both the gene for the relaxase and a matching oriT in order to be transferred to other bacteria. But a bacterial cell can contain several plasmids, and in recent years various researchers have shown that a relaxase from one plasmid can fit with an oriT region on another plasmid in the same cell and activate the conjugation of that plasmid.

This means that it may be enough for a plasmid to have only an oriT to be able to conjugate, which in turn means that many plasmids that have previously been classed as nonmobile, because they lack the relaxase gene, can be conjugative. But until now it has not been known how common the phenomenon is among bacteria. This is one of the knowledge gaps that Zrimec's results are helping to fill in.

More about: The new method compared with the current standard:

The current standard tools for assessing the transferability of plasmids are based on searching for the DNA sequences for the relaxase enzyme or for oriT regions that the enzyme can bind to. There are several key limitations to this. For one, some tools produce incomplete results, while others require extremely time-consuming and resource-demanding laboratory tests.

Zrimec's new data analysis method is based solely on identifying oriT regions, using special physiochemical properties found specifically in oriT regions of DNA. Through previous research, he has shown that these physiochemical signatures - which determine which relaxase can bind to the oriT region - are more stable and specific than the DNA sequences themselves. This allows the classification of the plasmids to the right MOB group based on the oriT region, independently of relaxase, which also allows researchers to map out the overall transferability between different bacterial species and environments.

The method can manage large amounts of data and can be used to search effectively for oriT regions on plasmids in their entirety.

ROCHESTER, Minn. -- Approximately 1.5 million heart attacks and strokes occur every year in men and women in the U.S. Sex and age play a large part in who experiences a heart attack, the methods used to treat these heart attacks, and the eventual post hospital outcomes of the people who experience heart attacks. Mayo Clinic researchers discuss these sex and age differences in study findings published in Mayo Clinic Proceedings.

In this study, Mayo Clinic researchers wanted to see if age was a key factor in sex-related differences in patients with a heart attack. Using public all-payer hospitalization data from the Nationwide Inpatient Sample, the team of researchers evaluated more than 6.7 million hospitalization records for heart attacks. They categorized the information by sex and divided the patients into four age categories: under 45, 45-64, 65-84 and over 84.

To fully compare the treatment given, patients were further categorized by the type of their heart attack. With a STEMI, or ST elevation myocardial infarction heart attack, there is a complete blockage of an artery supplying blood to the heart. With a NSTEMI, or non-ST elevation myocardial infarction heart attack, there is no ST elevation, but there is typically a significant but partial artery blockage.

The findings show several main points regarding sex and age differences, according to Mohamad Adnan Alkhouli, M.D., an interventional cardiologist at Mayo Clinic and first author of the study.

Women had fewer acute heart attacks than men across all age groups. However, because there are more women than men over 84, more women had heart attacks in that age group. In the NSTEMI and STEMI groups, women had distinctive differences in their risk profiles for heart disease, compared to men. Women were more likely to have hypertension, diabetes, anemia, atrial fibrillation, chronic lung disease and previous stroke. However, women were less likely than men to have had a previous heart attack and less likely to have an implantable defibrillator, a previous revascularization or experience cardiogenic shock.

The data show a clear difference between the sexes for managing a heart attack in the hospital. In the NSTEMI group, women of any age were less likely than men to undergo coronary angiography imaging of the heart's blood vessels, angioplasty to open clogged arteries with a balloon catheter, coronary artery bypass grafting to redirect blood flow, or receive mechanical circulatory support. In the STEMI group, women were also less likely to have coronary angiography or primary angioplasty, or receive mechanical circulatory support. This was true across all age groups.

Compared with men, the data show that worse hospital outcomes among women are confined to those who are younger. In the NSTEMI group, women under 65 were more likely than men to die at the hospital because of their heart attack. This difference in mortality in women versus men also was observed in patients under 85 in the STEMI group. For both categories of heart attack, younger women were more likely to have vascular complications and major bleeds, although the same was not true for stroke and acute kidney injury.

"These data suggest that younger women are particularly at higher risk of major complications after a heart attack and therefore should be the focus of further research to identify strategies to mitigate this increased risk," says Dr. Alkhouli.

CLEVELAND, Ohio (Jan. 20, 2021)--Hot flashes, insomnia, and vaginal dryness are commonly reported symptoms that accompany the menopause transition. A new study suggests that such symptoms--especially psychological and sexual problems--are worse for women who have premature ovarian insufficiency (POI) than for women undergoing natural menopause. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Premature ovarian insufficiency is defined as the cessation of ovarian function that leads to menopause before the age of 40 years. The condition is associated with increased risks for a number of long-term health comorbidities, including osteoporosis, cardiovascular disease, mood disorders, cognitive impairment, and sexual dysfunction. It can also lead to a shorter life expectancy.

Despite research around the various risk factors associated with POI, few studies have examined the effect of POI relative to the prevalence, severity, and factors affecting menopause symptoms. In this new study involving nearly 300 Chinese women, researchers specifically investigated menopause symptoms in women with POI and compared them with the severity and prevalence of similar symptoms in women who experienced natural menopause.

What they found was that women with POI experience a high prevalence of menopause symptoms, especially those in the psychological and sexual domains, and that these symptoms are often more severe than those experienced by women who undergo natural menopause. The symptoms likely to be most severe include mood swings, hot flashes, insomnia, fatigue, and sexual dysfunction (including vaginal dryness, dyspareunia, and decreased libido).

On the basis of these results, the researchers have suggested that healthcare providers be more cognizant of psychological complications and sexual dysfunction risks in women with POI and work with them to identify options for relief.

Results are published in the article "Menopausal symptoms in women with premature ovarian insufficiency: prevalence, severity and associated factors."

"This study of Chinese women showed that those with POI had more prevalent menopause-related symptoms than women with menopause at the average age. It is important to note that regardless of the prevalence or severity of symptoms, women with POI should receive hormone therapy at least until the average age of menopause unless there are contraindications to its use in order to mitigate potential long-term adverse health effects, including fractures, heart disease, cognitive impairment, and early mortality--in addition to mood disturbances and sexual dysfunction," says Dr. Stephanie Faubion, NAMS medical director.

A 15-year research and advocacy effort to make microwave ovens safer has led to a change in national manufacturing standards that will make microwaves more difficult for young children to open, protecting them from the severe microwave-related burns that scar hundreds of kids under 5 years old in the United States each year. Researchers at Rush University Medical Center and other leaders of the campaign, who worked diligently to document the frequency and severity of these injuries and young children's vulnerability to them, published the results of their efforts in The Journal of Pediatrics on Jan. 20.

"The efforts we have made over the last 15 years have recently led to a change in how microwaves are made. In 2023, manufacturers will be required to incorporate two distinct actions into opening the door of a microwave oven," said Kyran Quinlan MD, MPH, a professor of pediatrics and the director of the Division of General Pediatrics at Rush University Medical Center. Quinlan and fellow Rush pediatrician Gina Lowell, MD, worked closely with colleagues from the University of Chicago Medical Center Burn Unit to achieve the goal of child resistant microwave doors.

"We believed that if young children were less able to open microwave oven doors, they would be less likely to be able to remove the heated items, such as liquids and noodle soups, and they would therefore be less at risk for severe burns," Quinlan added. 'These burns are terribly painful, require burn unit care, and can be life-changing because of the permanent scarring that often results."

An abstract presenting the results from the advocacy effort was chosen as the Program Description Abstract of the Year during the annual conference of the Injury Free Coalition for Kids in December 2019.

According to the American Burn Association, 22.5% of the patients in burn units across the United States are children, and most of the children are admitted for scalds rather than burns suffered in fires.

The researchers' 15-year journey began with documenting the issue, and learning how microwave ovens are regulated and how to effectively advocate for child-resistant microwave oven doors. In 2008, the researchers published an analysis of three years of burn unit data that found that a significant percentage of burns involved young children opening a microwave themselves and removing and spilling the oven's heated contents.

In that report, the youngest child burned was 18 months old, and nearly half of the cases required skin grafts -- a process of removing skin from one part of the body to cover the section of skin that was burned.

The researchers then evaluated and documented the abilities of healthy young children ages 15 months to 4 years to use microwave ovens. They recorded whether the children could open the microwave oven door with either a push mechanism or a pull mechanism, turn on the microwave and remove its contents.

The study revealed that children as young as 17 months could open both a push- and a pull-open microwave oven door, remove what was in the microwave, and even turn it on. Nearly all children were able to perform each of these tasks by the age of 2.

The researchers then worked to submit a proposed change in the design requirements of microwave oven doors to make them more difficult for young children to open. Quinlan and Lowell worked with the child product safety advocacy group Kids in Danger to enlist college engineering students to design child-resistant microwave doors to demonstrate their feasibility. The team also presented their research at national meetings and created a short video to put a face with the statistics about microwave-related childhood burns.

Eventually, Quinlan and Marla Robinson MSc, OTR/L, assistant director of therapy services at University of Chicago Medical Center and a partner in the advocacy campaign, became voting members of the Underwriters Laboratories Standards Technical Panel for microwave ovens, which sets the standards required for any microwave sold in the United States.

After previous failed attempts to change the standard for microwave oven doors, the panel passed the change by a single vote in September 2018. The new microwave ovens also will be required to include labels warning families of the risk of severe scalds to young children.

"Early on, we felt that making microwave oven doors harder to open would truly protect young children from these burns, which were frequently severe," Quinlan said. "This took longer than we expected, but it was so worth it.

"We knew we had work to do to share this idea and to provide enough information to convince others who could be a part of the change we sought, but ultimately, our idea was a good one, and with persistence we realized our goal."

Scientists have discovered how bacteria commonly responsible for seafood-related stomach upsets can go dormant and then "wake up".

Vibrio parahaemolyticus is a marine bacterium that can cause gastroenteritis in humans when eaten in raw or undercooked shellfish such as oysters and mussels.

Some of these bacteria are able to turn dormant in poor growth conditions such as cold temperatures - and can remain in that state of hibernation for long periods before resuscitating.

University of Exeter scientists have identified a population of these dormant cells that are better at waking up, and have discovered an enzyme involved in that waking up process.

"Most of these bacteria die when they encounter poor growth conditions, but we identified sub-populations of bacteria that are able to stay dormant for long periods of time," said lead author Dr Sariqa Wagley, of the University of Exeter.

"We found that this population has a better ability to revive when conditions improve.

"Our tests show that when these dormant bacteria are revived they are just as virulent and able to cause disease."

The findings could have implications for seafood safety, as dormant cells are not detectable using routine microbiological screening tests and the true bacterial load (amount of bacteria) could be underestimated.

"When they go dormant, these bacteria change shape, reduce respiration activities and they don't grow like healthy bacteria on agar plates used in standard laboratory tests, so they are much harder to detect," Dr Wagley explained.

"Using a range of tools, we were able to find dormant bacteria in seafood samples and laboratory cultures and look at their genetic content to look for clues in how they might survive for long periods.

"It is important to note that thorough cooking kills bacteria in seafood.

"Our results may also help us predict the conditions that dormant bacteria need in order to revive."

Working with the seafood industry, the Exeter team identified a lactate dehydrogenase enzyme that breaks down lactic acid into pyruvate, a key component of several metabolic pathways (chemical reactions in a cell).

The findings suggest that lactate dehydrogenase is essential both for maintaining bacterial dormancy and resuscitation back to an active form.

Vibrio parahaemolyticus usually grows in warm and tropical marine environments, although Dr Wagley said that due to rising sea temperatures in recent years it is now prevalent in UK waters during the summer months.

During the winter, it is not detected in the marine environment around the UK and it is thought to die due to the cold winter temperatures.

This study could explain how Vibrio parahaemolyticus is able remerge in the environment during the summer.

BEER-SHEVA, Israel...January 20, 2021 -Ben-Gurion University of the Negev researchers have discovered that the protein BMP5/7 offers promising therapeutics that could slow down or halt the progression of Parkinson's disease.

The findings were published in the prestigious clinical neurology journal, Brain.

Parkinson's disease, which affects over one million people in U.S. and 10 million worldwide, causes tremors and severe movement impairment due to progressive degeneration of dopamine-producing brain cells. It is believed that the protein "alpha-synuclein," present in all human brains, misfolds and forms toxic clumps in these cells, which causes the disease.

While current Parkinson's disease therapies improve symptoms, they are not effective in advanced illness stages and, unfortunately, do not slow or cure the disease.

Dr. Claude Brodski, M.D., head of the BGU's Laboratory for Molecular Neuroscience, discovered that BMP5/7 signaling in neurons was significantly reduced in dopamine-producing brain cells, which could contribute to Parkinson's disease advancement.

"Indeed, we found that BMP5/7 treatment can, in a Parkinson's disease mouse model, efficiently prevent movement impairments caused by the accumulation of alpha-synuclein and reverse the loss of dopamine-producing brain cells," says Dr. Brodski. "These findings are very promising, since they suggest that BMP5/7 could slow or stop Parkinson's disease progression. Currently, we are focusing all our efforts on bringing our discovery closer to clinical application."

BGN Technologies, Ben-Gurion University's technology transfer company, has filed several patent applications covering this breakthrough discovery.

Dr. Galit Mazooz Perlmuter, senior vice president of business development, bio-pharma at BGN Technologies, notes, "There is a vast need for new therapies to treat Parkinson's disease, especially in advanced stages of the disease. Dr. Brodski's findings, although still in their early stages, offer a disease-modified drug target that will address this devastating condition. We are now seeking an industry partner for further development of this patent pending invention."

In the first systematic large-scale evaluation of the UK National Early Warning Risk Score (NEWS) 2 as a scoring system for predicting severe COVID-19 outcomes in patients, researchers at King's College London have found poor-to-moderate accuracy for identifying patients at risk of being transferred to intensive care units (ICUs) or dying after 14 days of hospitalisation. Accuracy of predictions in short term (three days) showed moderate success.

For people who are hospitalised with severe COVID-19, it is vital to quickly identify which patients may deteriorate and require transfer to an intensive care unit (ICU) for organ support or may die. NEWS2 is an early warning score that combines physiological parameters such as respiration rate, oxygen saturation, blood pressure and temperature. NEWS2 is currently used almost universally in UK NHS Trusts to identify which patients are at risk of deteriorating early.

The paper was published today (Thursday 21 January) in BMC Medicine.

Accuracy of NEWS2

Researchers analysed data from 1,276 COVID-19 patients admitted to King's College Hospital NHS Foundation Trust during the first wave in March-April 2020. The team then validated their models using data for over 6,000 patients across eight other hospitals globally (five in the UK, one in Norway, and two in China). At all UK sites, around one third of patients with COVID-19 were transferred to ICU or died within 14 days of hospital admission.

The researchers evaluated how well patients' NEWS2 scores measured at hospital admission anticipated who would have severe COVID-19 outcomes, which means either being transferred to ICU or dying. In all UK sites, combining NEWS2 and age to predict outcomes showed moderate success in the short term (three days), but for poor-to-moderate success for medium-term (14 days) outcomes.

Dr Ewan Carr, Statistician Research Fellow at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, and co-lead author said: "We have conducted the largest study to date evaluating the accuracy of NEWS2 for predicting medium-term COVID outcomes. NEWS2 is widely used in UK NHS trusts but little is known about how well it can predict severe COVID outcomes and so evaluating its accuracy is important as we look to improve patient care now and in future.

By collecting data from nine hospitals globally, our results have robust external validation. We found consistency across sites both in the performance of NEWS2 alone, as well as for the supplemented model. In short, NEWS2 tended to have poor-moderate performance but was improved by adding common blood and physiological measures."

The research team used CogStack, an existing platform developed by NIHR Maudsley BRC and in use at King's College Hospital NHS Foundation Trust, which allows for rapid extraction and processing of data from patient's electronic health records.

Professor Richard Dobson, Head of the Department of Biostatistics & Health Informatics, NIHR Maudsley BRC, said: "The CogStack platform allows us to extract information from deep within hospital records at King's College Hospital NHS Foundation Trust in real time in order really explore complex questions such as this. This includes being able to extract information relating to co-morbidities, for example, that may only be mentioned in passing in the physician narrative"

Improving predictive ability

Researchers found that accuracy in predicting severe outcomes was improved by considering routinely-collected blood and physiological parameters from patients including age, oxygen saturation and neutrophil count, which is an important infection-fighting immune system cell. In models that supplemented NEWS2 with these parameters the ability to predict severe outcomes was improved.

Dr James Teo, Consultant Neurologist at King's College Hospital and Clinical Director of Data Science and lead of CogStack platform, said: "Our results for the first time validates NEWS2, and shows how it could be improved by adding common blood and physiological parameters. Thankfully, this NHS scoring system is easy to adapt and implement in real-world clinical practice, compared to other complex risk-scoring models.

I, alongside all the authors and collaborators, would like to thank the guidance and contributions of the patients and members of the King's Electronic Records Research Interface that made this all possible."

In the Early Bronze Age of Europe, ancient people used bronze objects as an early form of money, even going so far as to standardize the shape and weight of their currency, according to a study published January 20, 2020 in the open-access journal PLOS ONE by Maikel H. G. Kuijpers and C?t?lin N. Popa of Leiden University, Netherlands.

Money is an important feature of modern human society. One key feature of money is standardization, but this can be difficult to identify in the archaeological record since ancient people had inexact forms of measurement compared with today. In this study, the authors assessed possible money from the Early Bronze Age of Central Europe, comparing the objects based on their perceived - if not precise - similarity.

The objects studied were made of bronze in shapes described as rings, ribs, and axe blades. The authors examined more than 5,000 such objects from more than 100 ancient hoards. They statistically compared the objects' weights using a psychology principle known as the Weber fraction, which quantifies the concept that, if objects are similar enough in mass, a human being weighing them by hand can't tell the difference.

They found that even though the objects' weights varied, around 70% of the rings were similar enough to have been indistinguishable by hand (averaging about 195 grams), as were subsets of the ribs and axe blades.

The authors suggest that this consistent similarity in shape and weight, along with the fact that these objects often occurred in hoards, are signs of their use as an early form of standardized currency. Later, in the Middle Bronze Age of Europe, more precise weighing tools appear in the archaeological record along with an increase in scrap bronze, pointing to a developed system of weighing.

The authors add: "The euros of Prehistory came in the form of bronze rings, ribs and axes. These Early Bronze Age artefacts were standardized in shape and weight and used as an early form of money."