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  • Lyme Disease Cases Rose By Almost 70% in the U.S.

    Lyme Disease Cases Rose By Almost 70% in the U.S.

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    NEW YORK — Lyme disease cases in the U.S. jumped nearly 70% in 2022, which health officials say is not due to a major increase of new infections but instead a change in reporting requirements.

    Reported cases surpassed 62,000 in 2022, after averaging about 37,000 a year from 2017 through 2019, the Centers for Disease Control and Prevention said in a report released Thursday. Numbers for 2023 will be released later this year.

    Lyme disease is the most common tick-borne infection in the U.S., occurring mostly in the Northeast, Midwest and mid-Atlantic states.

    Read More: What Happened to the Lyme Disease Vaccine?

    An estimated 476,000 Americans are diagnosed with it each year, but only a fraction are officially reported.

    Traditionally, health departments received positive lab tests and went back to doctor’s offices to gather more information about the patients. But reporting fell off in 2020 and 2021 when health department staffers were busy working on COVID-19.

    Starting in 2022, all that’s required to report cases—at least in high-incidence states—is a positive lab test. It’s possible that better, more sensitive testing is being used more and that may have contributed to the increase, but it’s too early to tell, CDC officials said.

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    Mike Stobbe/AP

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  • More People Die After Smoking Drugs Than Injecting Them

    More People Die After Smoking Drugs Than Injecting Them

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    NEW YORK — Smoking has surpassed injecting as the most common way of taking drugs in U.S. overdose deaths, a new government study suggests.

    The Centers for Disease Control and Prevention called its study published Thursday the largest to look at how Americans took the drugs that killed them.

    CDC officials decided to study the topic after seeing reports from California suggesting that smoking fentanyl was becoming more common than injecting it. Potent, illicit versions of the painkiller are involved in more U.S. overdose deaths than any other drug.

    Some early research has suggested that smoking fentanyl is somewhat less deadly than injecting it, and any reduction in injection-related overdose deaths is a positive, said the study’s lead author, Lauren Tanz.

    But “both injection and smoking carry a substantial overdose risk,” and it’s not yet clear if a shift toward smoking fentanyl reduces U.S. overdose deaths, said Tanz, a CDC scientist who studies overdoses.

    Illicit fentanyl is an infamously powerful drug that, in powder form, increasingly has been cut into heroin or other drugs. In recent years, it’s been a primary driver of the U.S. overdose epidemic. Drug overdose deaths in the U.S. went up slightly in 2022 after two big leaps during the pandemic, and provisional data for the first nine months of 2023 suggests it inched up last year.

    For years, fentanyl has mainly been injected, but drug users have increasingly smoked it. People put the powder on tin foil or in a glass pipe, heated from below, and inhale the vapor, explained Alex Karl, a RTI International researcher who studies drug users in San Francisco.

    Smoked fentanyl is not as concentrated as fentanyl in a syringe, but some drug-takers see upsides to smoking, Kral said. Among them: People who inject often deal with pus-filled abscesses on their skin and risk infections with hepatitis and other diseases.

    “One person showed me his arms and said, ‘Hey, look at my arm! It looks beautiful! I can now wear T-shirts and I can get a job because I don’t have these track marks,’” Kral said.

    CDC investigators studied the trend by using a national database built from death certificates, toxicology reports and reports from coroners and medical examiners.

    They were able to get suitable data from the District of Columbia and 27 states for the years 2020 to 2022. From those places, they got information on how drugs were taken in about 71,000 of the more than 311,000 total U.S. overdose deaths over those three years—or about 23%.

    The researchers found that between early 2020 and late 2022, the percentage of overdose deaths with evidence of smoking rose 74% while the percentage of deaths with evidence of injection fell 29%. The number and percentage of deaths with evidence of snorting also increased, though not as dramatically as smoking-related deaths, the study found.

    It’s complicated to map out exact percentages of deaths that occurred after smoking, injecting, snorting, or swallowing drugs, experts say. In some cases a person may have used multiple drugs, taken different ways. In other cases, no drug-taking method was identified.

    The study found that in late 2022, of the deaths for which a method was identified, 23% of the deaths occurred after smoking, 16% after injections, 16% after snorting, and 14.5% after swallowing.

    Tanz said she feels the data is nationally representative. Data came from states from every region of the country, and all showed increases in smoking and decreases in injecting. Smoking was the most common route in the West and Midwest, and roughly tied with injecting in the Northeast and South, the report said.

    Kral described the study as “mostly good” but said it has limitations.

    It can be difficult to ascertain the how and why of an overdose death, especially if no witness was present. Injections might be more commonly reported because of injection marks on the body; to detect smoking “they likely would need to find a pipe or foil on the scene and decide whether to write that down,” he said.

    Kral also noted that many people who smoke fentanyl use a straw to inhale vapors from the burning powder, and it’s possible investigators saw a straw and assumed it was snorted.

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    MIKE STOBBE/AP

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  • How Long Should You Isolate With COVID-19?

    How Long Should You Isolate With COVID-19?

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    Since 2021, people with COVID-19 have been told to isolate themselves for at least five days to avoid spreading the disease. But that practice may soon join most mask mandates as relics of the peak pandemic era.

    The U.S. Centers for Disease Control and Prevention (CDC) is said to be weighing a new, symptom-based approach to isolation for the general public, the Washington Post reported on Feb. 13. Under that potential approach, which may be rolled out for public feedback this spring, people could leave home when their symptoms are mild and improving and they’ve been fever-free for at least 24 hours without medication, according to the Post.

    That possible shift, which echoes similar moves in California and Oregon, would bring the CDC’s recommendations for COVID-19 in closer step with its guidance on the flu. When people are sick with the flu, the CDC recommends they stay home until at least 24 hours after their fever has broken naturally, or until other symptoms clear—which the agency says can take up to five days.

    A CDC representative did not confirm or deny the Post’s report when asked by TIME. The agency has “no updates to COVID guidelines to announce at this time,” the representative wrote in an email. “We will continue to make decisions based on the best evidence and science to keep communities healthy and safe.”

    While the shift is not yet official, experts have previously predicted that 2024 will bring a further relaxation of COVID-19 policy. “The guidance becomes lighter and lighter over time, and that actually makes sense as people build up more immunity,” Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administration’s former COVID-19 response coordinator, said in a January interview with TIME. “I do expect that some of those guidances will dissipate.”

    Read More: We’re In a Major COVID-19 Surge. It’s Our New Normal

    The virus itself has not evolved to become less contagious. But people’s tolerance for public-health precautions has plummeted. Many people in the U.S. haven’t paid attention to COVID-19 guidance in a long time, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “You have to face reality,” he says.

    Meeting people where they are may encourage them to take at least some precautions, he says. Some people who are unwilling or unable to isolate for five full days might be open to staying home for a shorter period of time when they’re acutely ill, for example.

    Not all experts are as optimistic. Lucky Tran, a science communicator at Columbia University, called the potential end of five-day isolation periods “a reckless anti-public-health policy that goes against science, encourages disease spread, and puts everyone at risk. The bare minimum we should have learned from this devastating pandemic that has killed and disabled millions is that we should stay home when sick.” The rumored adjustment “would completely ignore the continued suffering” of people who are immunocompromised, chronically ill, disabled, or otherwise at heightened risk of severe COVID-19, Tran adds.

    Eleanor Murray, an assistant professor of epidemiology at the Boston University School of Public Health, says it would be “really strange” for the CDC to relax its current guidance, given that even a five-day isolation period isn’t always long enough to stop the spread. Studies have shown that a significant portion of people who catch COVID-19 test positive, and thus potentially remain contagious, for longer than five days. (The CDC currently recommends that people with COVID-19 wear a high-quality mask, such as an N95 or KN95, around others for at least 10 days after getting sick; it’s not clear whether that suggestion would remain in place if the guidelines change this spring.)

    The absence of symptoms also isn’t a guarantee that someone is no longer infectious, Murray says. Research has long suggested that pre-symptomatic or asymptomatic people can spread the virus, although they may not be as contagious as people who are sicker. At-home tests aren’t a perfect measure either, although they can provide some information about potential contagiousness.

    Even still, Dr. Tara Bouton, an assistant professor at the Boston University Chobanian and Avedisian School of Medicine who has researched COVID-19 isolation periods, feels it’s reasonable to loosen isolation guidance at this stage of the pandemic, when fewer people who get infected die or become hospitalized. That’s in large part because lengthy isolation periods disproportionately penalize people whose income depends on working in person, Bouton says. “The ability to isolate is a privilege,” Bouton says, and public-health policy needs to balance the costs and benefits of asking people to do it.

    Murray, however, fears that relaxing isolation guidance will make it easier for businesses to deny their employees time off to recover. If the CDC removes its current guidance—which, Murray notes, is a recommendation rather than a mandate—it would be “providing information that is not evidence-based and is not going to help people make informed decisions, but will probably be used to limit paid leave.”

    So what would the experts do if they got sick with COVID-19?

    Even though Bouton feels that a blanket five-day isolation recommendation is no longer necessary, she says she would stay home around that long because she’s able to—and because working as an infectious-disease doctor puts her in contact with lots of immunocompromised patients, who remain at increased risk of severe disease if they get infected.

    Murray says she would stay home until her symptoms cleared up and wait until she’d gotten two consecutive negative test results, spaced out by at least a day, before exiting isolation. (Often, that approach requires more than five days of isolation, since people can test positive on at-home rapid tests for more than a week.)

    Tran says he’d go even further: he’d stay home for 10 days, self-test multiple times before ending isolation, and wear a mask—as he usually does anyway—upon returning to public spaces.

    Osterholm, too, says he’d stay home for five days and continue to wear an N95 in the immediate aftermath of his illness. Efforts like those are important, he says—but they’re also not everything. He’d like the public-health community to devote more attention to encouraging vaccination among vulnerable older adults, many of whom have not gotten the latest shot, and streamlining Paxlovid access for high-risk patients.

    Those efforts, Osterholm says, could save lives at a time when most COVID-19 deaths occur among people who are elderly or otherwise at high risk—and at a time when Americans are moving on from COVID-19, whether official guidance tells them to or not.

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    Jamie Ducharme

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  • People Are Comfortable Discussing Mental Health at Work—Just Not Their Own

    People Are Comfortable Discussing Mental Health at Work—Just Not Their Own

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    As employees and employers adjust to new working conditions, including more flexible remote or hybrid schedules, they are also prioritizing something else that hasn’t traditionally been part of the workplace environment: mental health.

    In a new poll conducted by the National Alliance on Mental Illness (NAMI), researchers found encouraging signs that workers and their managers are more comfortable addressing mental health issues such as burnout and stress. But there are still gaps when it comes to creating a supportive mental-health environment in the workplace.

    More than 2,000 people, including executives, completed the survey. All worked at companies with at least 100 employees. The participants answered questions about how comfortable they felt bringing up mental-health issues at work, what resources were available to them, and whether their employers provided mental-health benefits as part of their insurance coverage, among other things. About 74% of employees said they felt it was acceptable to discuss mental health issues at work, and slightly more—77%—said they would be comfortable if their colleagues discussed them. About 86% felt they could be themselves at work, and four out of five said they were satisfied with the emotional support they received from managers.

    That was the good news. When it came to bringing up their own mental-health concerns at work or using the resources available to them, people were much less open. Only 58% said they would feel comfortable talking about their own mental health with colleagues. “The common reasons people gave were stigma, judgment, not seeing others talk about mental health, and seeming weak to their colleagues,” says Barb Solish, national director of NAMI’s office of innovation.

    About half of the participants said they felt burned out at work, and 27% said they considered quitting because of how their employment was affecting their mental health.

    Read More: I Tried to Cure My Burnout. Here’s What Happened

    While employees generally feel that discussing mental health at work is appropriate, one in four say they don’t know if their company offers coverage for mental-health services, Solish says. “Companies have a lot of room to improve when it comes to communicating about these options to employees,” says Solish.

    Addressing the gaps starts at the top, she says, with executives setting an example for how employees could and should prioritize mental health. “Leadership sets the tone,” says Solish. “If the CEO and other leaders are open about themselves, that creates a culture of psychological safety that helps employees to feel that if [their leaders] can talk about their mental-health concerns, then maybe I can. It can be as simple as a CEO sending an email saying, ‘I felt burned out this week, and here are the resources at the company that helped me, and may also help you.’”

    Equipping managers with the skills they need to talk about and provide support for employees on mental-health issues is also important. 70% of managers or executives had not received training to address mental-health issues, even though nearly 75% of employees felt that these leaders were responsible for creating a safe environment to address these concerns.

    Employees can also take actions to improve their own mental health at work, Solish says. They can ask and become informed about what services (like counseling) are covered through their insurance plans, as well as programs that their companies offer to address stress and burnout. Some of these may include resources outside of the workplace, but the employer could be the gateway to these programs.

    “Investing in employee mental health is not just the right thing to do, it’s also an investment in the economic health of an organization,” says Solish. “If people are uncomfortable about talking about mental health and uncomfortable seeking services and support, then they become more burned out, and that is going to hurt the organization. Mental health has a direct impact on a company’s success or failure.”

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    Alice Park

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  • A Man Has Died From Alaskapox. Here’s What We Know About the Virus

    A Man Has Died From Alaskapox. Here’s What We Know About the Virus

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    Alaska’s health department reports that the first person in the state has died from a recently discovered virus called Alaskapox.

    The elderly man—who was immunocompromised due to cancer treatments—first noticed an unusual lesion in his right armpit last September, according to Alaska health officials who spoke to TIME about the case. He was prescribed antibiotics at his local emergency room on the Kenai Peninsula, but after multiple visits and a worsening, painful infection, he was transferred to a hospital in Anchorage.

    The patient tested positive for orthopoxvirus, but extensive testing ruled out cowpox, mpox, and chickenpox, which are members of the same viral family. Doctors sent a sample to the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, where scientists confirmed the presence of Alaskapox.

    After initially improving, the man’s health declined, and he eventually experienced renal and respiratory failure.

    What is Alaskapox?

    Alaskapox was first reported in a man in the Fairbanks region in 2015. Six additional cases have since been reported, all in residents of the same area—one in 2020, two in 2021, one in 2022, and two in 2023 (including the latest case). All of the patients before the most recent one had relatively mild symptoms of rashes and swollen lymph nodes and recovered without treatment. Infectious disease experts tested small mammals in the region and found four species—including voles, flying squirrels, and other rodents—were infected with the virus, and were likely the reservoir for infecting people.

    The latest case is “the first case of serious Alaskapox infection seen in Alaska, the first case that involved somebody who was immunocompromised, the first case that required hospitalization, the first case that ultimately resulted in death, and the first case to occur outside of the Fairbanks area,” says Dr. Joseph McLaughlin, staff physician in the Alaska Department of Health and the state epidemiologist.

    How Alaskapox might spread

    The man in the fatal case lived alone in the Kenai Peninsula and reported taking in a stray cat that scratched him several times, including near the right underarm. The cat tested negative for Alaskapox virus, but McLaughlin says that it’s possible that cats and dogs who hunt small mammals could remain uninfected but retain the virus on their claws, potentially transmitting it when they scratch people. “We are very interested in studying the role of domestic pets as potential intermediate vectors in transmitting the virus from rodents to humans,” he says.

    Alaska health authorities believe the man’s weakened immune system might have contributed to his severe case. The virus from this latest case is also genetically different from previously identified Alaskapox viruses, which isn’t surprising since orthopox viruses change as they circulate among animal reservoirs. So far, “there is no evidence to make us believe that this strain would have increased virulence or transmissibility,” says Dr. Julia Rogers, an epidemic intelligence officer with the CDC assigned to the Alaska division of public health. “That can’t be ascertained without additional cases and investigations.”

    What’s concerning for public health experts is the fact that his case occurred about 500 miles outside the region where previous infections had been reported, suggesting that the virus is more widespread in mammal populations than previously thought. The Alaska Department of Health, the CDC, and the University of Alaska have collaborated to trap and test small rodents in the Fairbanks area for Alaskapox to determine where the virus is circulating, and now those plans will expand to include testing animals down to the Kenai Peninsula. “Right now the most pressing question is how widely distributed this virus is in small mammals throughout Alaska, and perhaps even beyond the state,” says McLaughlin. If Alaskapox has spread beyond Alaska, it’s most likely that animals in neighboring areas such as the Yukon and Russia could also be carrying the virus.

    Though human-to-human transmission of Alaskapox hasn’t been recorded, other viruses in this family can spread this way. Therefore, health officials warn that people infected with Alaskapox or who have suspected infections should avoid touching them and get tested as soon as possible. In some cases, people such as healthcare workers who are immunocompromised and who might have been exposed can be vaccinated with the vaccine for mpox, Jynneos, to minimize the severity of infection.

    It’s not clear yet how widespread the Alaskapox virus is, but McLaughlin says it’s likely been circulating among animals for a long time, and that health officials have only recently detected it as people have become infected. “Alaskapox remains a rare disease, and we don’t have any evidence to indicate that the incidence is increasing over time,” he says. Even so, health officials urge people with unexplained lesions and rashes to report them immediately to their doctors, who can then determine if additional testing at public health labs is needed to identify the virus.

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    Alice Park

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  • Why People Love Snow So Much

    Why People Love Snow So Much

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    When it’s dark outside in Anchorage, Alaska, therapist Karen Cunningham pulls on long johns, one of her 16 pairs of snow pants, a hat, gloves, her warmest coat, and snow boots, and lies down in a pile of fresh snow. “It’s pitch black, and these white things are just floating down so gently,” she says. “It’s hope for me. From the darkness comes all these infinite possibilities and creations.”

    Snow lovers like Cunningham are prone to wax poetic about how they fall for sparkling flakes again and again—even this year, as a record-setting 100-plus inches have already hit Anchorage. A humming anticipation takes hold of the city on the eve of potential storms, and “everybody prays for a snow day,” she says. “Everybody’s like, ‘Let’s shut the city down for a little bit, and go outside and play in it.’”

    What exactly makes snow so special? Psychologists and scientists have theories about why it’s the most celebrated type of precipitation. Its unpredictable nature contributes to the aura of anticipation around it—and so does the good, old-fashioned fun you can have in it.

    It reminds us of childhood

    Trevor Harley’s earliest memories revolve around the weather. When he was 4, at Christmastime, he woke up at his grandmother’s house to find a world transformed. “I don’t think I’d ever seen snow before, and it was a really thick, heavy snowfall,” says Harley, emeritus professor of psychology at the University of Dundee in Scotland and author of the book The Psychology of Weather. “It was absolutely amazing.”

    Freshly fallen snow, he believes, is one of the most beautiful things humans see in their lifetimes. Part of the appeal is its ability to turn grimy streets into something magical. “I can’t think of any other event or thing in life that has the transformative nature of snow,” Harley says. Because it happens infrequently—at least in most parts of the world—it’s a novelty, often prompting nostalgic memories: of snow days, childhood fun, and holidays spent yearning for a white Christmas. “It makes us happy,” he says. “Thinking about snow when we were young, and all the good times we had, cheers us up.”

    It’s a feast for your senses

    Snow engages all five senses, points out Cunningham, the therapist in Alaska. Not only is it easy on the eyes, but it’s fantastic at reflecting sunlight. That helps brighten the dark days in Cunningham’s city, where there are only six hours of sunlight during some parts of the year. Beyond that, “You can feel it, you can taste it, there’s a certain smell to it,” she says. “And the sound of silence—the sound of snow just floating down—is so healing.” Research suggests a couple inches of snow can absorb up to 60% of sound, which means the world really does seem quieter (and more peaceful) when it’s coated in white.

    Read More: Why Skiing Is a Ridiculously Good Workout

    It’s fleeting

    Kari Leibowitz, a health psychologist and author of the forthcoming book How To Winter: Harnessing Your Mindset To Embrace All Seasons of Life, calls herself a reformed “winter hater.” She spent a year living in northern Norway—a part of the Arctic where the sun doesn’t rise from the middle of November until the end of January—to study how people manage to thrive during such dark, cold months. Now based in Amsterdam, she’s learned to enjoy snow and especially appreciates its ephemeral nature. “It’s like a rainbow,” she says. “It’s not going to be around forever.” That forces people to seize the present moment in a way they otherwise might not.

    It breaks us out of our routines

    Snow unlocks an array of winter activities that give people license to play, notes Leibowitz. “You can ski, you can snowshoe, you can snowmobile, all of that,” she says—and is there any greater glee than sledding down a generous hill? Snow prompts an almost childlike sense of free-spirited fun.

    It’s unpredictable

    As anyone who’s ever been disappointed by an under-performing forecast knows, predicting exactly how much snow will fall is tricky: Even a slight change in factors like atmospheric temperature or wind speeds can knock a winter weather event sideways. If a storm track shifts 20 or 30 miles, a would-have-been foot of snow can turn into a dusting, says AccuWeather chief meteorologist Jonathan Porter. “I think part of the excitement around it is that snow can be very localized, with sharp variations even within a city,” he says. “That makes people interested.”

    It’s disappearing

    These days, in many parts of the world, there’s less snow in the forecast. Research published in the journal Climate in 2023 found that global annual snow cover has dropped by about 5% since 2000. That’s bad news for ice fishermen, agriculture workers, winter recreationists, and the planet as a whole. Snow plays an important role in regulating the temperature of Earth’s surface and filling rivers and reservoirs that provide drinking water; plus, winter tourism drives local economies around the world.

    “Unfortunately, it’s the season that will vanish first,” says Kathleen Gasperini, founder of the non-profit Snow Lovers, which aims to save winter for future generations by building awareness, urging businesses to adopt scientific and snow-friendly practices, and advocating for the use of clean energy sources.

    Gasperini encourages snow enthusiasts who are worried about declining snowfall to take action by contacting their local ski resorts and pushing for environmental measures, from implementing recycling programs to installing solar panels. Resorts could also offer reduced tickets for young ski clubs—ensuring that a new generation of snow lovers will understand exactly why snow matters.

    “It’s a fragile season, and that’s one of the heartbreaks of climate change,” she says. “People really, really love snow, and it would be so sad if our kids and grandkids never get to see it.”

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    Angela Haupt

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  • More Pregnant People Are Relying on Early Prenatal Testing

    More Pregnant People Are Relying on Early Prenatal Testing

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    WASHINGTON — In Utah, more of Dr. Cara Heuser’s maternal-fetal medicine patients are requesting early ultrasounds, hoping to detect serious problems in time to choose whether to continue the pregnancy or have an abortion.

    In North Carolina, more obstetrics patients of Dr. Clayton Alfonso and his colleagues are relying on early genetic screenings that don’t provide a firm diagnosis.

    The reason? New state abortion restrictions mean the clock is ticking.

    Since Roe v. Wade was overturned, many health care providers say an increasing number of patients are deciding the fate of their pregnancies based on whatever information they can gather before state bans kick in. But early ultrasounds show far less about the condition of a fetus than later ones. And genetic screenings may be inaccurate.

    When you find out your fetus has a serious problem, “you’re in crisis mode,” said Sabrina Fletcher, a doula who has helped women in this predicament. “You’re not thinking about legal repercussions and (state) cutoff dates, and yet we’re forced to.”

    About half of states ban abortion or restrict it after a certain point in pregnancy. In Utah, it’s generally illegal after the 18-week mark; in North Carolina, after 12 weeks.

    This leaves millions of women in roughly 14 states with no option to get follow-up diagnostic tests in time to feasibly have an abortion there if they wanted, a paper published last March in the journal Obstetrics and Gynecology found. Even more states have abortion cutoffs too early for mid-pregnancy ultrasounds.

    “More people are trying to find these things out earlier to try to fit within the confines of laws that in my mind don’t have a place in medical practice,” said Alfonso, an OB-GYN at Duke University.

    Checking for prenatal problems

    When done at the right time, doctors said prenatal testing can identify problems and help parents decide whether to continue a pregnancy or prepare for a baby’s complex needs after delivery.

    One of the most common tests is the 20-week ultrasound, sometimes called an “anatomy scan.” It checks on the fetal heart, brain, spine, limbs and other parts of the body, looking for signs of congenital problems. It can detect things like brain, spine and heart abnormalities and signs of chromosomal problems such as Down syndrome. Follow-up testing may be needed to make a diagnosis.

    The type of ultrasounds patients receive – and when in pregnancy they have one done – can vary depending on the risk level of the patient, as well as the equipment and policies each practice has. For example, some women may have a first-trimester ultrasound to estimate a due date or check for multiple fetuses. But it’s not standard practice because it is too early to see many of the fetus’ limbs and organs in detail, the American College of Obstetricians and Gynecologists says.

    It’s impossible to spot problems like serious heart defects much before mid-pregnancy because the fetus is so small, Heuser said. Nonetheless, she said, more patients are having ultrasounds at 10 to 13 weeks to get access to abortion if needed.

    Experts say there are no statistics on exactly how many people opt for early ultrasounds or make choices based on them. But some health care providers say they’ve noticed an uptick in requests for the scans, including Missouri genetic counselor Chelsea Wagner. She counsels patients from around the nation through telehealth, frequently discussing the results of ultrasounds and genetic tests.

    Wagner said these early ultrasounds can’t provide the assurance patients are looking for because “you can’t give somebody an ‘everything looks good’ or a clean bill of health off of an ultrasound at 10 weeks.”

    Doctors also can’t make a firm diagnosis from a genetic screening, which is done at 10 weeks gestation or later.

    These screenings, also called “non-invasive prenatal tests,” are designed to detect abnormalities in fetal DNA by looking at small, free-floating fragments circulating in a pregnant woman’s blood.

    They screen for chromosomal disorders such as trisomy 13 and 18, which often end in miscarriage or stillbirth, Down syndrome and extra or missing copies of sex chromosomes.

    The accuracy of these tests varies by disorder, but none is considered diagnostic.

    Natera, one of only a handful of U.S. companies that makes such genetic tests, said in an email that prenatal test results are reported as either “high risk” or “low risk” and that patients should seek confirmatory testing if they get a “high risk” result.

    Some may be pretty accurate, doctors said, but false positives are possible. In 2022, the Food and Drug Administration issued a warning about the screenings, reminding patients and doctors that results need further confirmation.

    “While genetic non-invasive prenatal screening tests are widely used today, these tests have not been reviewed by the FDA and may be making claims about their performance and use that are not based on sound science,” Jeff Shuren, the director of the FDA’s Center for Devices and Radiological Health, wrote in a statement.

    The agency is poised to release a new regulatory framework in April that would require prenatal screenings, and thousands of other lab tests, to undergo FDA review.

    An ‘awful’ decision to make

    Even before Roe was overturned, pregnant patients have sometimes been confused by what prenatal testing does – or doesn’t – reveal about the pregnancy or fetus, said bioethicist Megan Allyse, whose research focuses on emerging technologies around women’s reproductive health. She said it’s important for doctors to go over the limitations of such screens and emphasize that the results they receive are not diagnoses.

    Alfonso and Wagner said they advise getting diagnostic tests too. In addition to amniocentesis, which removes and tests a small sample of cells from amniotic fluid, these also include CVS, or chorionic villus sampling, which tests a small piece of tissue from the placenta. Both carry a small risk of miscarriage.

    But lately, Wagner said, there’s “more urgency to patients’ decisions” in many states.

    That’s because of the specifics of test timing. It can take a week or two to get the results of genetic screenings. CVS is offered at 10 to 13 weeks gestation, with initial results taking a few days and more detailed results around two weeks. Amniocentesis is typically done at 15 to 20 weeks, with similar timing for results.

    If a state has a 12-week abortion ban, for instance, “some people may have to act on a screening,” Alfonso said.

    Wagner said she’s had to counsel patients who couldn’t afford to travel out of state for an abortion if they waited for diagnostic testing.

    “They are forced to use the information they have to make choices they never thought they’d have to make,” she said.

    Some states restrict abortion so early that women would not have the chance to get any prenatal testing done before the cutoff.

    That was the case for 26-year-old Hannah in Tennessee, which has a strict abortion ban. An ultrasound in late November, at about 18 weeks gestation, revealed she had amniotic band sequence, which is when very thin pieces of the amniotic membrane get attached to the fetus, sometimes causing fetal amputation and other problems. In Hannah’s case, the bands were attached to many of her baby boy’s body parts and ripped open multiple areas of his body.

    She called clinics in Ohio and Illinois looking for a place to terminate the pregnancy, while her genetic counselor’s office phoned roughly six facilities. She finally found a clinic 4 ½ hours away in Illinois and had the procedure in early December at 19 weeks gestation. A set of results from the amniocentesis – which was done to look for the cause of the problem – came back the day after her abortion, and other results after that.

    Hannah, who didn’t want her last name used for fear of backlash, said it’s “awful” to have to think about state timelines, and to travel long distances out of state, when dealing with something like this. But she’s grateful she had a firm diagnosis from the ultrasound and enough information to feel confident in her decision, which she made so her baby wasn’t in “pain and misery.”

    “I know some women are not that lucky,” Hannah said. She named her son Waylen.

    ___

    Ungar reported from Louisville, Kentucky.

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    LAURA UNGAR and AMANDA SEITZ

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  • Novo Nordisk Has a Weight-Loss Pill But Can’t Make It Yet

    Novo Nordisk Has a Weight-Loss Pill But Can’t Make It Yet

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    Novo Nordisk A/S has a successor waiting in the wings for the generation of weight-loss shots it pioneered: a pill that helps people shed pounds without the drawbacks of an injection.

    The medicine is the next frontier in the obesity fight, promising further billions in revenue, and Novo is leading once again. Trouble is, it can’t launch the drug widely without endangering its existing best-sellers.

    The pill helps patients lose roughly as much weight as the blockbuster Wegovy. But the oral version requires far more of the same active ingredient, called semaglutide, and Novo already can’t make enough of it to meet demand.

    That leaves Novo in a bind. Either it finds a way to further ramp up production or it curtails the pill’s launch, ceding ground to rivals rushing to develop competing products, like Eli Lilly & Co., Amgen Inc. and Pfizer Inc.

    Chief Executive Officer Lars Fruergaard Jorgensen acknowledges that Novo underestimated the demand when it originally drew up plans for a pill. 

    Now the company, which originally planned to apply for U.S. regulatory approval last year, has to consider how best to manage its limited semaglutide supply.

    “It’s clear that when we make a tablet version and use semaglutide, we need to use a lot,” Jorgensen said in an interview on Wednesday in New York. “We cannot conquer the world with that technology as a template.”

    Read More: Weight-Loss Drugs Come With Serious Side Effects, According to a New Study

    Novo has postponed a U.S. regulatory filing to this year and now says it will await the results of more clinical tests, including one investigating a lower-dose version that would require less of the active ingredient.

    At stake is how to stay on top of the wave of obesity sales that has boosted Novo’s market value beyond $530 billion, making it Europe’s top company and a growth engine for the Danish economy. Shares of Novo rose nearly 2.5% Friday, and are up 72% in the past 12 months. 

    Novo on Monday struck a deal to pay $11 billion for three factories as part of its shareholder Novo Holdings A/S’s acquisition of Catalent Inc. Jorgensen, in a Bloomberg Television interview, touted the transaction as a “huge opportunity to serve more patients” seeking treatment with Wegovy and its sister drug, the diabetes shot Ozempic.

    Competition is heating up between Novo and Lilly, whose recently approved Zepbound is predicted to become the best-selling drug in history. An experimental weight-loss pill it’s developing moved last year into the last stage of clinical tests.

    A tablet is the next milestone for a market that Bloomberg Intelligence analysts estimate will reach $80 billion by 2030. But it’s not the only consideration for drugmakers, who are also working on making next-generation treatments that trigger fewer side effects, require less frequent administration or minimize the muscle loss that can occur with rapid weight change. 

    Lilly’s experimental pill is a different type of molecule from Novo’s that, at least in theory, should be easier to make and potentially cheaper, said Michael Shah, an analyst for Bloomberg Intelligence. It can also be taken with food, he said. In a survey, about a third of doctors told Shah and colleagues that they prescribe oral drugs before shots. While injecting Wegovy with a pen isn’t as complicated as some might think, “a pill would essentially open up the market,” Shah said.

    Strongest dose

    Volunteers taking the Novo pill alongside diet and exercise counseling lost about 17% of their body weight over 68 weeks in test results released last year. The medicine contained 50 milligrams of semaglutide, about 20 times as much as in the strongest dose of the weekly Wegovy injection.

    Novo already sells a pill for diabetes under the name Rybelsus that uses less semaglutide than its experimental one — though still more than the shots — and whose annual revenue is about a fifth of Ozempic’s.

    The Danish company has other pills in development. They include a drug acquired last year in the purchase of Inversago Pharma, which Jorgensen said could probably be made in much larger quantities. Another early-stage one works in a similar way to CagriSema, Novo’s experimental next-generation shot.

    Different needs

    While the drugmaker is proceeding on all these fronts, Jorgensen said that Novo may not need to sell an obesity pill widely to stay competitive.

    Japan is an example of a market where a tablet is key, he said, because only specialists prescribe injected therapy. Novo has separate studies to test its pill in Asian patients. And in the US, he allowed, a daily pill will be a preferred option for some. But converting the entire market, with hundreds of millions of potential patients, will not be possible, the CEO said. The drugmaker’s market surveys suggest it isn’t necessary.

    “The majority would say, ‘Well, I would prefer a tablet,’” Jorgensen said. “But if you give them the option of a weekly injection with the efficacy that semaglutide is bringing, that is very attractive.”

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    Naomi Kresge

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  • What to Know About Complementary Treatments for IBD

    What to Know About Complementary Treatments for IBD

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    One of the hallmarks of inflammatory bowel disease (IBD) is its unpredictability. Flares come and go, often with little rhyme or reason. Especially for people with moderate-to-severe IBD, most conventional forms of treatment—namely prescription drugs—are not enough to prevent flares or symptoms entirely. 

    In an effort to better control their IBD, many people with the condition turn to complementary and alternative treatments, also known as “CAM.” Definitions of CAM vary, but it usually includes herbal medicines or supplements, mind-body techniques like meditation, and Eastern medicine practices such as acupuncture. By some estimates, up to 60% of IBD patients have attempted to treat their condition with one or more of these CAM approaches. A broader definition of CAM could also include lifestyle adjustments revolving around sleep, stress, diet, or exercise—many of which have been embraced by gastroenterologists and other IBD clinicians.

    While there was a time when most doctors would have discouraged CAM approaches to IBD, experts say that’s no longer the case. “People don’t necessarily tell their doctor because they feel it may not be welcome news, but I think many doctors are more open to it than people would think,” says Dr. Joshua Korzenik, an IBD specialist and gastroenterologist at Brigham and Women’s Hospital in Boston. He says IBD care providers understand their patients’ need to explore CAM treatments, and he doesn’t discourage them. “As much as the medicines we have are amazing, they have their risks and side-effects,” he says. “We all want to find something in the alternative realm that is effective with very little toxicity.”

    Despite the huge interest in CAM treatments for IBD—among both patients and their care providers—a lot of these approaches have not been thoroughly studied. “For many of these alternative treatments, the data just aren’t there for or against them,” says Dr. Joseph Feuerstein, an IBD researcher and associate professor of medicine at Harvard Medical School. “This is why a lot of doctors don’t bring these up with their patients,” he adds. “They’re not going to recommend something without sufficient evidence.” However, some CAM approaches are supported by solid research. Others appear to be at the very least safe, and may be worth a shot. “It’s important to bring these up with your doctor,” Feuerstein says. Many IBD specialists will have some familiarity with the latest CAM research, and they can help patients identify safe and evidence-supported options while avoiding those that may be risky—or just a waste of time and money. 

    Here, you’ll find a breakdown of the most popular or promising CAM treatments. From acupuncture to yoga, here’s what the latest science has to say. 

    Supplements, botanicals, and herbal therapies

    Humans have used botanical medicines for thousands of years, and experts say there are multiple herbs and botanicals that have shown promise for the treatment of IBD. “Probably the best studied with the most good data is curcumin, which is found in turmeric root,” Korzenik says. Research has found that curcumin has potent anti-inflammatory effects, and that it can significantly reduce disease activity among people with IBD, particularly those with ulcerative colitis. “I’ve had a lot of patients use it and have success,” Korzenik says. Chamomile, Indian frankincense, and wheatgrass juice are some other botanical treatments that research has found to be safe and possibly beneficial among people with IBD. Exploring these (with a care provider’s supervision) may be worthwhile. 

    Cannabis is another plant that has undergone a lot of scientific scrutiny for the treatment of IBD. “Marijuana comes up a lot,” Feuerstein says. “Crohn’s is one of the conditions that can qualify a person for a medical cannabis card, though long-term safety and efficacy studies are lacking.” Some research comparing marijuana cigarettes containing THC (the psychoactive substance in cannabis) to a THC-free placebo found that smoking marijuana with THC led to significantly more symptom improvements. “Trials show improvement in symptoms and subjective disease severity, and anecdotally I can say patients tell me they feel better,” he says. “That said, the studies have shown consistently there is no improvement in healing or underlying inflammation.” In other words, cannabis seems to help manage IBD symptoms in some people, but it is not treating the underlying disease. (Due to the lack of safety data, Feuerstein says he does not specifically recommend this treatment to his patients.)

    Probiotics and prebiotics are another hot area of interest, both among researchers and IBD patients. These are substances that may support the growth or spread of healthy gut bacteria. Probiotics are themselves packed with “good” bacteria, while prebiotics are foods or supplements that provide sustenance for healthy bacteria. “I think that, conceptually, probiotics and prebiotics make sense,” Feuerstein says. “The problem is that it’s not one-size-fits-all.” Each type of probiotic or prebiotic is different, and so each may act differently in a given person.

    There’s now a mountain of research showing that the community of microorganisms that live in the human gut—often referred to as the gut microbiome—is critical to the health and functioning of the gastrointestinal tract. These microorganisms also help regulate inflammation and other aspects of immune functioning. However, experts today have only a very hazy grasp of what a healthy microbiome looks like, and using probiotics or prebiotics to alter the microbiome in ways that can treat IBD appears to be a highly individualized process—meaning what works for one person may not work for another. 

    Feuerstein also says that supplement quality control and consistency is a major issue. “You could buy a type of bacteria that studies have linked to benefits, but depending on the manufacturer, two products could be completely different,” he says. “These products aren’t regulated by the [U.S. Food and Drug Administration.]” It’s also not clear whether benefits people derive from these products are durable or curative. On the other hand, research suggests probiotics and prebiotics are relatively safe. “What I tell people is if you’re going to try something like this, talk with your doctor first and try it for at least three months,” Feuerstein says. He also recommends sticking with one product to improve the odds that what you’re giving your gut is consistent. “Changing your microbiome takes a commitment, so you have to give it time to work,” he adds.

    Read More: 6 Myths About IBD, Debunked

    Mind-body practices

    Not long ago, Western medicine tended to treat the mind and body as separate. Diseases of the gut were thought to have little to do with the state or health of a person’s mind. But thanks in part to work on the connection between psychological stress and physical illness, medical science now has a greater appreciation of the interrelationship between mental and physical health. There’s good evidence that psychotherapy and other forms of mental health treatment can help people with IBD. Likewise, many clinicians now recommend therapeutic mind-body practices for these conditions. 

    “Stress seems to play a huge role in IBD,” Feuerstein says. Stress can contribute to inflammation and microbiome disturbance, research shows, and periods of high stress can trigger IBD flares. “We encourage approaches that can help people control stress.”

    Research has found that many popular mind-body techniques for stress reduction—namely mindfulness practices (including mindfulness-based stress reduction), yoga, tai chi, and breath work—are all associated with quality-of-life improvements among people with IBD. “One yoga class of 90 minutes per week has a significant impact on the course of the disease, as well as on symptoms,” says Dr. Jost Langhorst, professor and chair of integrative gastroenterology at the University of Duisburg-Essen in Germany. 

    Acupuncture also has a fair amount of research supporting both its safety and efficacy among people with IBD. “It’s something we use, and we know it’s something we can add on top of conventional medicine to help people improve their quality of life and control their symptoms,” Langhorst says.

    The role of diet and exercise

    At Langhorst’s clinic, he and his colleagues prioritize a “multimodal” approach to IBD care. That means they attempt to treat IBD with a range of therapies that target not just the gut, but also the patient’s overall health and well-being. “These are conditions that can be influenced by a lot of lifestyle factors,” he says. “We know that strengthening a person’s overall health makes a big difference.”

    To that end, he says that improving a patient’s diet and exercise habits is something he and his team often prioritize. “Diet is of enormous importance,” he says. “We know things like ultra-processed foods or high portions of red meat, sugar, or alcohol contribute to a higher burden of disease.” However, offering very precise dietary advice can be tricky. Most dietary guidelines for people with IBD recommend “limiting” the items Langhorst mentioned, but they stop short of offering more specific recommendations because the truth is this is going to vary from person to person. “We tell everyone to avoid artificial sweeteners as they can cause diarrhea, but in general it’s hard for us to identify diets or food that are triggering a person’s flares,” says Harvard’s Feuerstein. “Until we know more, it’s probably best to eat a healthy balanced diet versus any specific fad diet.”

    Exercise comes in for many of the same hedges and caveats. Every expert recognizes its benefits, but offering very specific recommendations is tough based on the existing research. A 2019 research review in the journal BMC Gastroenterology summed up the state of the science quite well: “Exercise interventions in IBD patients can be assumed to be safe and beneficial for the patients‘ overall-health, and IBD specific physical and psychosocial symptoms. But there is still a high demand for more thoroughly conducted studies.”

    Read More: IBD Patients on the Most Effective Ways Doctors Can Treat Their Condition

    How to approach complementary treatments for IBD

    There are many treatment options that fall into the CAM bucket. While all of the remedies mentioned above are supported by research, there are plenty more that could ultimately prove to be beneficial—or bogus. How is a person with IBD supposed to navigate this space? Experts say that asking for your care provider’s help is the best approach. Not only can your care team help you identify safe and potentially helpful complementary treatments, but they can also steer you away from things that may be dangerous.  

    “Everyone in my field is getting away from this picture of IBD where you come in, you take your medications, and that’s it,” Korzenik says. “We’re all looking at the broader context of the disease and the effects of reducing stress, getting more sleep, getting more exercise, etcetera.”

    Finally, experts stress that if you’re going to attempt complementary treatments, they should truly be complementary. In other words, don’t abandon the medications or other treatments your IBD care team has prescribed. “For people who want to do something more for themselves, in addition to the standard medical therapies, I think conceptually a lot of CAM make sense and are worth exploring,” Feuerstein says. “Just be sure to bring them up with your doctor.” 

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    Markham Heid

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  • Why Do I Keep Getting COVID-19 But Those Around Me Don’t?

    Why Do I Keep Getting COVID-19 But Those Around Me Don’t?

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    COVID-19 doesn’t always affect people the same way. If someone gets sick, for example, not everyone in that person’s close social circle will get infected—even if they recently spent time together. But why? In a paper recently published in Nature Communications, researchers delve into the different factors at play, from genetics to public health interventions, all of which affect how a virus spreads from one person to another.

    They found that at the beginning of the pandemic, environmental factors like social distancing, isolation, hand washing, mask wearing, and vaccination played a bigger role in whether people got infected, while over time, genetic factors have become more important. Now, genetics may account for anywhere from 30% to 70% of one’s chance of getting COVID-19, they concluded.

    To reach that estimate, the researchers studied the health records from more than 12,000 people (who came from about 5,600 families total) who tested positive for COVID-19 at a large New York City hospital from Feb. 2020 to Oct. 2021. To capture the role that non-genetic factors, such as a person’s environment, play in their chance of getting infected with the virus or how severely ill they got if they were infected, they also categorized each person’s potential exposure by weighing factors like who lived in their household, contact with their extended family, and what kind of housing they had.

    Read More: When Will We Get New COVID-19 Drugs?

    At the beginning of the study, the researchers estimated that genetics accounted for about 33% of a person’s likelihood of getting infected, while by the end, genetics accounted for 70%. That’s a huge jump from previous studies, which estimated that a person’s genes only explained about 1% of their likelihood of infection. This indicates that more genes are likely contributing than previously thought.

    “We don’t know what the specific genetic variants are yet, but we do know there are other genetic variants that confer some sort of susceptibility, which might explain why some people are reinfected multiple times and others seem resistant even if they are family members living together,” says Nicholas Tatonetti, associate professor of computational biomedicine at Cedars-Sinai and senior author of the paper.

    Why did genetics gain a bigger role as the pandemic progressed? At the beginning of the outbreak, public health measures such as mask mandates, lockdowns, and isolation practices had a bigger influence on who got infected, since nearly everyone was encountering SARS-CoV-2 for the first time and had little immunity to fend off the virus. But as people became infected and vaccinated, those environmental factors became more homogenized, and genetic factors related to people’s different immune responses began to emerge as the more prominent driver of who got infected and to what extent.

    It’s not an exact science, but Tatonetti says this type of modeling can help public health experts understand when interventions like masks are most impactful. And it seems to be at the start of outbreaks. “These results show that public health practices really do matter, and they worked,” he says. That’s important to remember, since genetic factors are out of our control—while behavior changes can help us tip the balance, at least somewhat, in our favor.

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    Alice Park

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  • Viagra May Lower the Risk of Alzheimer’s

    Viagra May Lower the Risk of Alzheimer’s

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    Viagra is best known for helping erectile dysfunction, but the latest research suggests it might also lower the risk of Alzheimer’s disease.

    Viagra belongs to a group of drugs known as phosphodiesterase Type 5 inhibitors, which work by relaxing blood vessels and increasing blood flow in the penis. In a study published in Neurology, researchers found that the drugs were also associated with a lower risk of Alzheimer’s disease.

    The study analyzed the health records of nearly 270,000 men in the U.K. who were diagnosed with erectile dysfunction from 2000 to 2017. The researchers compared rates of Alzheimer’s disease among men who had been prescribed drugs to treat their erectile dysfunction (primarily sildenafil, the generic name for Viagra) to those among men who had not been prescribed the drugs. In the U.K., lifestyle changes are the first line of treatment for the condition, and if those are not effective, then doctors prescribe medications. (In 2018, after the participants were enrolled, sildenafil became available without a prescription at pharmacies.)

    Men who were prescribed a medication had an 18% lower risk of having Alzheimer’s than those who were not. The reduction was greater among men who got 20 or more prescriptions over the study’s five-year follow up period.

    “We didn’t have strong expectations and were thinking that surely there was no direct evidence between these drugs and reduced risk of Alzheimer’s. But we definitely found a protective effect,” says Ruth Brauer, lecturer at the University College of London’s School of Pharmacy and senior author of the paper. “We feel these are excellent candidates for drug repurposing [for Alzheimer’s].”

    Read More: Football Can Damage the Brains of High-School Players

    The study isn’t the first to explore the connection between erectile dysfunction drugs and Alzheimer’s risk. Two previous studies, both conducted in the U.S., reached conflicting conclusions: one found a 69% lower risk of Alzheimer’s among users of the drugs, while the other found no association. Brauer points out, however, that one of those studies relied on insurance data, while her study included more detailed information from anonymized medical health records from the U.K.’s National Health Service. That allowed her team to better adjust for potential confounding factors that could affect either erectile dysfunction or Alzheimer’s risk, such as smoking, alcohol use, and other health conditions. Even after controlling for those factors, the connection between the drugs and a lower risk of Alzheimer’s remained.

    Erectile dysfunction treatments work by relaxing the blood vessels and increasing blood flow. That effect may extend to the brain, where improved circulation could help to clear the buildup of toxic proteins tightly linked to Alzheimer’s disease. Based on animal studies, the drugs also indirectly increase levels of a brain chemical called acetylcholine, which is involved in memory, learning, and attention. (The first medications to treat Alzheimer’s symptom increase brain levels of acetylcholine.)

    Although the data don’t establish a causal relationship between erectile dysfunction drugs and a lower risk of Alzheimer’s, Brauer points to another piece of evidence that strengthens the association. When she broke down the data by age, the drugs had a stronger protective effect among men 70 years or older compared to men under 70. “The drugs seem to have a greater benefit among individuals at the greatest risk of Alzheimer’s,” she says. “We feel these promising results should justify taking these drugs further as candidates for repurposing.”

    One limitation of the study is that the scientists only had data on the number of prescriptions the men received, and could not verify if they filled the prescriptions or used the medications properly. They could also not account for how much physical or sexual activity the men were doing; it’s possible, for example, that men with erectile dysfunction are more sexually and physically active than other men.

    Brauer hopes that other researchers will further explore the potential of erectile dysfunction drugs by conducting trials to address these issues by including men without erectile dysfunction, along with women. If the connection remains strong, these drugs could potentially provide another way for people to protect themselves from the neurodegenerative disorder.

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    Alice Park

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  • Deadly Listeria Outbreak Linked to California Cheeses

    Deadly Listeria Outbreak Linked to California Cheeses

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    A California cheese and dairy company is the source of a decade-long outbreak of listeria food poisoning that killed two people and sickened more than two dozen, federal health officials said Tuesday.

    New lab and inspection evidence linked soft cheeses and other dairy products made by Rizo-Lopez Foods of Modesto, California, to the outbreak, which was first detected in June 2014, the Centers for Disease Control and Prevention said.

    Since then, at least 26 people in 11 states have been sickened. They include a person who died in California in 2017 and one who died in Texas in 2020, CDC officials said.

    On Monday, the company recalled more than 60 soft cheeses, yogurt and sour cream sold under the brands Tio Francisco, Don Francisco, Rizo Bros, Rio Grande, Food City, El Huache, La Ordena, San Carlos, Campesino, Santa Maria, Dos Ranchitos, Casa Cardenas, and 365 Whole Foods Market.

    The CDC previously investigated cases of food poisoning tied to queso fresco and other similar types of cheese in 2017 and 2021, but there was not enough evidence to identify a source.

    New illnesses were reported in December, prompting CDC to reopen the investigation. The strain of listeria linked to the outbreak was found in a cheese sample from Rizo-Lopez Foods. Federal officials confirmed that queso fresco and cojita made by the company were making people sick.

    The recalled products were distributed nationwide at stores and retail deli counters, including El Super, Cardenas Market, Northgate Gonzalez, Superior Groceries, El Rancho, Vallarta, Food City, La Michoacana, and Numero Uno Markets.

    Listeria infections can cause serious illness and, in rare cases, death. People who are pregnant, older than 65 or have weakened immune systems are particularly vulnerable. Symptoms—like muscle aches, fever and tiredness—usually start within two weeks after eating contaminated foods, but can start earlier or later.

    The CDC said consumers who have these products should discard them and thoroughly clean the refrigerator, counters and other contact sites. Listeria can survive in the refrigerator and easily contaminate other foods and surfaces.

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    JONEL ALECCIA/AP

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  • 7 Ways to Deal With Climate Despair

    7 Ways to Deal With Climate Despair

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    Forget climate anxiety: many people are in flat-out climate despair. About two-thirds of Americans (65%) report being worried about global warming, according to a January report from the Yale Program for Climate Communication. One in 10 say they’ve recently felt depressed over their concerns for the planet, and a similar percentage describe feeling on edge or like they’re unable to stop worrying about global warming.

    No wonder more people are seeking care from climate-aware therapists. Some go to therapy to figure out whether they should have kids in the age of rapid climate change. Others are dealing with post-traumatic stress disorder from natural disasters or are burned out from advocacy work.

    But if the threat is existential, is there value in sorting out how you feel about it? “The very first step is full validation,” says Leslie Davenport, a climate psychology educator and author of books including Emotional Resiliency in the Era of Climate Change: A Clinician’s Guide. “Things like, ‘This makes so much sense, I hear you, I understand, let’s talk about this more.’” Understand that it’s not irrational to be full of worry, rage, fear, guilt, or grief when the planet’s on fire.

    Here, climate-aware therapists share their most effective coping strategies for going from overwhelmed to empowered.

    Talk about it.

    Climate change tends to get the religion-and-politics treatment—people avoid talking about it, says Carol Bartels, a therapist based in Long Beach, Calif. “But we need to talk about it,” she adds. “We need to know that other people are feeling the same.”

    Join a climate café—discussion spaces, both online and in-person, where people can talk freely about their fears and other feelings related to climate change. Or try the Good Grief Network, a peer-support group that follows a 10-step approach to help people process any type of grieving, including for the planet.

    Use your connections.

    Research suggests that the lonelier and more socially isolated someone feels, the higher their levels of climate distress. Finding your people can help. Join local land-restoration efforts, get involved with community gardening, or stop by your favorite park’s clean-up day. “A lot of the messaging we get is very individualist, like, ‘Stop driving so much,’” says Jenni Silverstein, a licensed clinical social worker based in Santa Rosa, Calif., an area that’s been ravaged by wildfires. “Those actions are valuable, but this is a collective situation, and collective responses are where we have power.” We accomplish more with others than we do by ourselves, she adds.

    If you’re struggling to find a like-minded community, think about where you already have a foot in the door. If you work in the medical field, for example, ask your colleagues if they want to help start an initiative for reduced waste, Davenport suggests, or your department could oversee a new rooftop garden. “You have some influence—you’re already part of a community,” she says. “If each of us engaged in the places where we’re already active, it would make a huge difference.”

    Analyze your carbon footprint.

    Some people cope with climate distress by distancing themselves from the problem—they ignore it, hoping it will go away, says Dr. Lise Van Susteren, a psychiatrist in Washington, D.C., who co-founded the Climate Psychiatry Alliance. It’s more effective to “take the energy of all those emotions and redirect them into constructive action,” she says, and that starts with analyzing your own carbon footprint. Online calculators can help you determine the total amount of greenhouse gases generated by your actions. It can also be helpful to simply take inventory of your habits, Van Susteren points out: Could you walk or bike instead of driving to work? What about cutting CO2 emissions by taking the train instead of an airplane? “Be honest with yourself so you can understand both the opportunities and challenges,” she advises.

    Share your views.

    This is no time for humility. Make sure everyone around you knows what you’re doing to combat climate change, says Van Susteren. “What motivates people is not our independence—we follow the crowd.” Someone might not make green choices in the interest of future generations, but will do it if everyone else is. So post about your advocacy work or the trees you planted on Facebook, and tell whoever you’re standing next to at parties.

    If you’re surrounded by people who don’t appear to prioritize the environment as much as you do, lead by example rather than trying to change their minds, Bartels advises. She grows fruits and vegetables and shares them with her neighbors, for example—even the ones who don’t care about climate-friendly lifestyles. If they ask about her garden, she explains how to get started. “Getting angry with people does zero good,” she says. “It’s important to keep the dialogue open. When we make enemies out of people who could be our allies, we’re making a grave mistake.”

    Make it a family affair.

    Some research suggests that climate change is especially affecting young people’s mental health. If your kids are coming to you with concerns, listen to and validate them, Van Susteren says. Then get imaginative about how your whole family can take action together. If your kids are young, “you’re not going to talk about climate tipping points, but you can say, ‘Let’s plant a garden, let’s clean up a park. Let’s show Mother Earth that we care about her.’”

    Middle-schoolers like to do things with their community, she adds, so consider banding together to raise money to install solar panels at the school. Older teens might like to start or join climate clubs; if they express interest in going to a protest, ask if they’d like you to tag along, or if you can help them get there. “You can also have family meetings and say, ‘We’ve taken your feelings seriously, and we’ve decided as a family that these are some of the things we can do,’” Van Susteren suggests. For example, “‘That’s why we’re not going to fly off here or fly out there; we’re going to get a hybrid instead and drive through the Shenandoah and camp out and look at the stars.’” Brainstorm activities or changes that will help you all feel like you’re making a difference.

    Get artsy.

    Making art can help people regulate and work through their emotions, says Ariella Cook-Shonkoff, a psychotherapist based in Berkeley, Calif., who specializes in art therapy and eco-therapy. “You’re doing patterned, repetitive movements and getting into a flow state,” she says. “It’s calming.” Try it in the natural world—by sketching in front of the ocean or on a bench in the woods, for example.

    She often challenges clients to use colors, shapes, and lines to express how they’re feeling at that moment. You might be surprised at what comes out on the paper; art is a way of tapping into thoughts you didn’t even realize you had, Cook-Shonkoff says. As you study your finished work and try to make sense of its meaning, you might gain a deeper understanding of how you’re really feeling. “You can start to distill those emotions and be able to communicate them with other people,” she says. “There’s a lot of dialogue that can happen.”

    Savor time outside.

    Spending time outside in green spaces benefits well-being—though Davenport acknowledges it can be complex. You go to your favorite lake, but it’s closed because there’s toxic algae growth caused by warm water. A hike in the woods in the dead of winter is lovely, but the unseasonable warmth unnerves you. “Love and grief are two sides of the same coin,” she says. It’s worth pushing through the challenging feelings, she says, “because doing so can renew your sense of why it’s important to fight for this.”

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    Angela Haupt

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  • Football Can Damage the Brains of High-School Players

    Football Can Damage the Brains of High-School Players

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    As much as fans will have to spend to attend the Feb. 11 Super Bowl, the game of football costs some professional players a vastly higher price, particularly when it comes to brain health. Researchers have found high rates of chronic traumatic encephalopathy (CTE)—a degenerative brain disease characterized by memory loss, confusion, mood swings, violence, suicidality and more—in autopsy studies of professional football players. CTE is caused by the head trauma and whole-body hits that are characteristic of the sport, which can lead to the dangerous buildup of certain proteins around blood vessels in the brain.

    Now it appears that the risk of brain trauma may also affect much younger athletes. According to a new study in JAMA Network Open, high-school football players can show alterations in brain tissue too. While it’s impossible to determine the presence of CTE without conducting an autopsy of the brain, the work provided disturbing evidence that playing the game early in life may lead to serious problems later on.

    “It’s a risk,” says Keisuke Kawata, an associate professor of clinical neuroscience at the Indiana University School of Public Health, and a coauthor of the new paper. “There are some brain changes that are normal over time. But among adolescent football players, we saw changes that it usually takes until middle age to exhibit.”

    To conduct their work, Kawata and his colleagues recruited 275 athletes from five Midwest high schools, 200 of whom were football players and 75 of whom participated in noncontact sports—specifically swimming, cross country, and tennis. All of the volunteers were males ages 13 to 18. Magnetic resonance imaging (MRI) scans were taken of their brains from May 2021 to July 2022, spanning two sports seasons.

    Read More: Scientists Are Just Beginning to Understand COVID-19’s Effect On the Brain

    The researchers discovered disturbing changes across multiple regions of the brain. One of the most significant was in the so-called sulcal regions, or the bottoms of the multiple folds that give the brain its characteristic cauliflower-like look. In a number of areas—including the cingulate cortex, which helps govern decision-making; the precentral gyrus, which controls volitional muscle movements; and the frontotemporal regions, which are broadly associated with personality, behavior, and language—the investigators saw a pronounced increase in sulcal depth. It is in the sulcal pits that spinal fluid can pool, and, when set in violent motion, can damage adjacent tissue.

    “It’s called the water-hammer effect,” says Kawata. “The torque and force are more pronounced there, and we start to see possible degeneration.”

    Pits were deeper in the football players than they were in kids who play noncontact sports, but the peaks of tissue around the sucal region, known as the gyri, were higher—again in the cingulate cortex, as well as in the frontoparietal region, associated with goal- or task-directed behavior; the precuneus, which, among other things, is involved in memory and mental imagery; and the lingual gyrus, which has a hand in memory and processing vision. The mechanism behind the growth of the gyri is not as clear as it is with the water-hammer effect, but there are clues. The researchers cite a 2016 study, which looked at mild cases of traumatic injury and suggested that elevated gyri might be a compensatory mechanism the brain switches on to support other impaired regions.

    Elsewhere in the football players’ brains, the MRIs detected atrophy of tissue. The outer surface of the brain, covering both cerebral hemispheres and representing about half of the organ’s overall mass, is the cerebral cortex, which takes part in a range of functions including learning, reasoning, memory, decision-making, intelligence, personality, and emotion. The researchers found thinning across much of the cortex—a discovery that particularly worries Kawata.

    Read More: A Blood Test for Alzheimer’s Disease Is Almost Here

    Ordinarily, he says, “it takes years and years to show this kind of macro level structural change. Some studies show 30 or 40 years before we see such cortical shrink.”

    The paper reaches no conclusions on what impact the cortical thinning has on the players’ cognitive processes; the cerebral cortex has so many jobs, distributed across so much brain area, that it will take further research to survey that landscape. But cognition and information processing are not the only functions in play. As with CTE and dementia, any changes to the morphology of the brain can have a hand in the development of psychiatric disorders. The researchers point to a 2019 paper which showed that increased cortical thickness and the growth of gyri in the cingulate cortex appear to be associated with major depressive disorder.

    “This is quite relevant,” says Kawata. “[Professional] football players with degenerative brain disorders almost always have psychiatric comorbidities. They become combative, irritable, violent. The student athletes are very well-behaved, respectful, nice football players. But there is a neurological sign that they may be at risk for psychiatric conditions.”

    For now, the investigators are not calling for a ban on full-contact football for youth, and Kawata, for one, sees virtues to the game. “It would be very detrimental to some kids to just go home in the middle  of the season,” he says. “They’d be on the couch, eating chips and watching TV all day long. I think that’s much worse than being on the field and learning.” But as the pros and scientists know, time on the field may exact a steep toll. 

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    Jeffrey Kluger

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  • A Chicago Children’s Hospital Has Taken Its Networks Offline After a Digital Attack

    A Chicago Children’s Hospital Has Taken Its Networks Offline After a Digital Attack

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    CHICAGO — A Chicago children’s hospital has been forced to take its networks offline after an unspecified digital attack, limiting access to medical records and hampering communication by phone or email since the middle of last week.

    Lurie Children’s Hospital initially described the issue Wednesday as a network outage. On Thursday, officials released public statements saying the hospital had taken its networks offline as part of its response to a “cybersecurity matter.”

    “We are taking this very seriously, investigating with the support of leading experts, and are working in collaboration with law enforcement agencies,” the hospital said in a statement Thursday. “As Illinois’ leading provider for pediatric care, our overarching priority is to continue providing safe, quality care to our patients and the communities we serve. Lurie Children’s is open and providing care to patients with as limited disruption as possible.”

    On Friday, the hospital announced a separate call center for patients to get prescriptions refilled or ask non-urgent questions about care or appointments.

    Media representatives for the hospital did not immediately return messages from The Associated Press on Monday seeking more information, including whether the attack was caused by ransomware. The extortion-style attack is popular among those seeking financial gain by locking data, records or other critical information then demanding money to release it back to the owner.

    A 2023 report by the Department of Health and Human Services warned of dramatic increases in digital attacks on health care and public health entities in recent years, causing delayed or disrupted care for patients across the country.

    Health care providers aren’t alone; state courts, county or state governments and schools all have struggled to recover from cyber-based attacks.

    The latest annual report for Lurie Children’s said the hospital treated around 260,000 patients last year. Chicago-area pediatrician practices that work with the hospital also have reported being unable to access digital medical records because of the attack.

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    KATHLEEN FOODY/AP

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  • An Experimental Weight-Loss Drug Shows Lasting Results in Early Study

    An Experimental Weight-Loss Drug Shows Lasting Results in Early Study

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    An experimental weight-loss shot from Amgen Inc.—taken less frequently than wildly popular treatments from Eli Lilly & Co. and Novo Nordisk A/S—appears to keep weight off even after patients stop taking it.

    Patients given a monthly injection of Amgen’s drug, dubbed MariTide, lost up to 14.5% of their body weight in just 12 weeks, according to a small, early-stage study published Monday in the journal Nature Metabolism. And some people kept the weight off for up to 150 days after stopping the drug, findings show.

    “That is really a remarkable and distinguishing characteristic of this molecule,” Narimon Honarpour, senior vice president of global development at Amgen, said in an interview.

    Investors and analysts have been eagerly awaiting updates on Amgen’s shot since the Thousand Oaks, California-based company shared early results at a conference in 2022. The latest Nature Metabolism study offers the most detailed look yet at Amgen’s drug, which is now in mid-stage studies. Another readout is expected later this year.

    Amgen’s drug works a bit differently than Wegovy or Zepbound. It’s what’s known as an antibody-drug conjugate, or ADC, a type of molecule more commonly used as a targeted cancer treatment. One part of the drug, an antibody, blocks the GIP receptor, while the other part, two peptides, mimics a gut hormone called GLP-1.

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    Read More: What Happens When People Stop Taking the Weight Loss Drug Zepbound

    “There’s something special about having them glued together the way they are on the same molecule,” said Saptarsi Haldar, vice president of cardiometabolic disorders at Amgen. The antibody component of the drug also allows it to stick around in the body longer than weekly weight-loss shots.

    Amgen designed the drug specifically as a treatment for obesity, but is now testing it in patients with diabetes—the opposite of how weight-loss drugs came to be at Eli Lilly and Novo Nordisk. The decision to inhibit GIP, rather than mimic it like Eli Lilly’s Zepbound, was based on insights gleaned from its expertise in human genetics.

    “Those genes told us loud and clear that decreased activity of the GIP receptor was associated with decreased BMI, or body-mass index,” Haldar said. 

    Amgen’s study, which enrolled 110 patients with obesity, was intended to assess MariTide’s safety and tolerability, but it revealed the drug’s dramatic effects on weight. Patients in one group were randomly assigned to receive a single dose of MariTide and were followed for 150 days, while another group of patients were given a dose every four weeks for three months.

    Patients who received a single shot of the highest dose had lost up to 8.2% of their body weight after 92 days, suggesting the drug has a prolonged weight-loss effect, according to the study. 

    Safety and side effects were similar to other GLP-1 drugs, findings show. Nausea and vomiting were the most commonly reported side effects and typically lasted for about 72 hours. Four patients in a group receiving the highest dose of the drug withdrew before getting a second shot due to mild gastrointestinal issues, according to the study.

    Although the early results are promising, more studies are needed before the drug reaches patients. Honarpour said the results of the company’s mid-stage study are an important next step. Still, Amgen sees ample opportunities for newcomers like itself to enter the obesity market, and is also working on an oral weight-loss drug with results expected in the first half of the year.

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    Madison Muller/Bloomberg

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  • You May Not Need a Lead Apron for a Dental X-ray

    You May Not Need a Lead Apron for a Dental X-ray

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    Those heavy lead aprons may be on their way out at the dentist office, depending on where you live.

    The nation’s largest dental association said Thursday it will no longer recommend the use of lead aprons and thyroid collars on patients who are getting dental X-rays.

    There are two main reasons for the change. X-ray beams are now more focused, so there is less concern about radiation hitting other parts of the body. Also, the aprons and collars can sometimes block dentists from getting the images they need.

    The best thing to lower radiation exposure is to make sure the patient needs the X-ray and to do it right the first time, said Dr. Purnima Kumar, who chairs the American Dental Association Council on Scientific Affairs, which released the recommendation.

    Read More: Robots Created to Help Patients in Hospitals Pass Testing Phase

    Dental X-rays use a relatively small amount of radiation to begin with, she said.

    “It’s like taking a flight from, let’s say, from Michigan to San Francisco, it gives you the equivalent of one dental X-ray,” Kumar said.

    The association’s recommendation is just that. True change depends on state dental boards, dentists and patients, Kumar said. For example, California state rules require dentists to use the aprons.

    Read More: AI Learns to Speak Like a Baby

    Sanjay Mallya, a radiologist and professor at the University of California, Los Angeles, said there is “no hard science,” that the aprons are needed.

    “Yet at the same time, we do have the letter of the law that requires that,” said Mallya, who helped write the American Academy of Oral and Maxillofacial Radiology’s recommendation in the fall against the use of lead aprons and thyroid collars. Kumar noted it was that group’s recommendation that spurred the American Dental Association to look at the topic.

    The most recent guidance is also backed by medical physicists with the U.S. Food and Drug Administration.

    Mallya also said X-rays may cause patients and dentists to be complacent about the things that should be done to prevent unnecessary radiation exposure — such as making sure an X-ray is necessary and using digital X-ray instead of film ones because they use less radiation.

    It will take advocacy and education to change more minds around the use of the aprons among patients, dentists and policymakers, he said.

    “That is going to be the next step for us,” he said.

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    Devi Shastri/AP

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  • Why Some Autoimmune Diseases Strike Far More Women Than Men

    Why Some Autoimmune Diseases Strike Far More Women Than Men

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    WASHINGTON — Women are far more likely than men to get autoimmune diseases, when an out-of-whack immune system attacks their own bodies — and new research may finally explain why.

    It’s all about how the body handles females’ extra X chromosome, Stanford University researchers reported Thursday — a finding that could lead to better ways to detect a long list of diseases that are hard to diagnose and treat.

    “This transforms the way we think about this whole process of autoimmunity, especially the male-female bias,” said University of Pennsylvania immunologist E. John Wherry, who wasn’t involved in the study.

    More than 24 million Americans, by some estimates up to 50 million, have an autoimmune disorder — diseases such as lupus, rheumatoid arthritis, multiple sclerosis and dozens more. About 4 of every 5 patients are women, a mystery that has baffled scientists for decades.

    Read More: Your Brain Doesn’t Want You to Exercise

    One theory is that the X chromosome might be a culprit. After all, females have two X chromosomes while males have one X and one Y.

    The new research, published in the journal Cell, shows that extra X is involved — but in an unexpected way.

    Our DNA is carried inside each cell in 23 pairs of chromosomes, including that final pair that determines biological sex. The X chromosome is packed with hundreds of genes, far more than males’ much smaller Y chromosome. Every female cell must switch off one of its X chromosome copies, to avoid getting a toxic double dose of all those genes.

    Performing that so-called X-chromosome inactivation is a special type of RNA called Xist, pronounced like “exist.” This long stretch of RNA parks itself in spots along a cell’s extra X chromosome, attracts proteins that bind to it in weird clumps, and silences the chromosome.

    Stanford dermatologist Dr. Howard Chang was exploring how Xist does its job when his lab identified nearly 100 of those stuck-on proteins. Chang recognized many as related to skin-related autoimmune disorders — patients can have “autoantibodies” that mistakenly attack those normal proteins.

    Read More: Healthy Activities Save Kids’ Lives. Why Are They So Hard to Find?

    “That got us thinking: These are the known ones. What about the other proteins in Xist?” Chang said. Maybe this molecule, found only in women, “could somehow organize proteins in such a way as to activate the immune system.”

    If true, Xist by itself couldn’t cause autoimmune disease or all women would be affected. Scientists have long thought it takes a combination of genetic susceptibility and an environmental trigger, such as an infection or injury, for the immune system to run amok. For example, the Epstein-Barr virus is linked to multiple sclerosis.

    Chang’s team decided to engineer male lab mice to artificially make Xist — without silencing their only X chromosome — and see what happened.

    Researchers also specially bred mice susceptible to a lupus-like condition that can be triggered by a chemical irritant.

    The mice that produced Xist formed its hallmark protein clumps and, when triggered, developed lupus-like autoimmunity at levels similar to females, the team concluded.

    “We think that’s really important, for Xist RNA to leak out of the cell to where the immune system gets to see it. You still needed this environmental trigger to cause the whole thing to kick off,” explained Chang, who is paid by the Howard Hughes Medical Institute, which also supports The Associated Press’ Health and Science Department.

    Read More: COVID-19 Antiviral Drugs Promise Speedier Recoveries. But They’re Not Available in the U.S.

    Beyond mice, researchers also examined blood samples from 100 patients — and uncovered autoantibodies targeting Xist-associated proteins that scientists hadn’t previously linked to autoimmune disorders. A potential reason, Chang suggests: standard tests for autoimmunity were made using male cells.

    Lots more research is necessary but the findings “might give us a shorter path to diagnosing patients that look clinically and immunologically quite different,” said Penn’s Wherry.

    “You may have autoantibodies to Protein A and another patient may have autoantibodies to Proteins C and D,” but knowing they’re all part of the larger Xist complex allows doctors to better hunt disease patterns, he added. “Now we have at least one big part of the puzzle of biological context.”

    Stanford’s Chang wonders if it may even be possible to one day interrupt the process.

    “How does that go from RNA to abnormal cells, this will be a next step of the investigation.”

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    Lauran Neergaard / AP

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  • The Psychology of the Cold-Weather Shorts Guy

    The Psychology of the Cold-Weather Shorts Guy

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    When Tom Holland, a 54-year-old exercise physiologist, shovels snow at home in Connecticut, someone always starts shouting at him. A neighbor—lots of neighbors, actually—will drive by, roll down the window, and ask: “Really? You’re in shorts?”

    Holland is, in fact, in shorts, as he is 364 other days of the year. He’s been wearing them in all temperatures since he was a kid—maybe for attention at first, he admits, but now because he runs hot and is simply more comfortable pantsless. He’s in shorts when he walks his two dogs, goes for a run in below-freezing temps, or cleans his at-home outdoor ice rink in the dead of night. He wears them to his kids’ wintertime ice-hockey games—a sharp juxtaposition to his wife, who stays warm with a battery-operated heated vest. Holland almost always forgoes jackets, too. “I’d rather be a little bit cold most of the time than hot all the time,” he says.

    Everyone seems to know a cold-weather shorts guy. He stands out on sidewalks otherwise populated by people in parkas. He’s parading around every college campus and taking a lap around every snow-covered cul de sac. There’s even one in the Senate. So as Holland’s neighbors want to know: Why does their wardrobe stay the same when the seasons change? And aren’t they cold?

    Tom HollandChris Fanning Photography

    A flurry of psychological forces

    There’s no single reason why some people—usually men—like wearing shorts in chilly weather. The habit could be driven by a desire to demonstrate toughness or masculinity, says Carolina Estevez, a psychologist based in Austin; shorts guys might assume others will be impressed by their ability to tolerate punishing temperatures. Or it could be a way to make a statement and express themselves in a unique way. “It sets them apart from others and makes them memorable, reinforcing their sense of individuality,” she says. Some are likely drawn to novel and intense experiences and get a thrill out of braving the cold. Once they develop a reputation for wearing shorts year-round, they might continue doing so to avoid cognitive dissonance, Estevez says—the mental discomfort triggered by behaving in ways that contradict our perceptions about ourselves.

    Ryan McCormick, who’s 45 and splits his time between New York and North Carolina, wears shorts every day and has found that being able to withstand the arctic chill increases his mental and physical fortitude. (He slips into a jacket if he’s going to be outside for a long time, but otherwise sticks to shorts and a T-shirt regardless of the weather.) “I use this as a means to condition my body,” he says. “I’m testing myself and seeing how long I can take it.” Personal growth, he believes, is the result of persevering through discomfort—he doesn’t want to get too cozy in any aspect of life.

    Philadelphia psychologist Lauren Napolitano says her husband also wears shorts year-round—the result, she believes, of his chronic optimism and perpetual good mood. “In his mind, it’s never really that cold,” she says. “Some people just have this disposition where they don’t see obstacles—they have a sunny temperament.” It might not melt the snow, but it helps shield them against its harshness.

    In pursuit of comfort—and fashion

    Some people are born better able to tolerate the cold than others, says Dr. Clayton Cowl, an occupational medicine specialist at the Mayo Clinic in bitterly cold Rochester, Minn. “There’s probably something to the genetics of it that we aren’t quite certain of,” he says. Research suggests that body temperature varies from person to person, and some men simply get warm quickly, based on factors like age, body weight, stress levels, and lifestyle habits. Women, meanwhile, tend to have colder hands and feet by a few degrees. Plus, they usually have less muscle mass and a lower metabolic rate than men, which makes their baseline temperature chillier.

    Cold-weather shorts guys may simply run hot. Stephen Triplett, 56, sports shorts year-round, even when the temperature plummets below 0 degrees Fahrenheit in Bozeman, Mont. He doesn’t like wearing pants, and since he works inside, he usually only experiences a few chilly minutes a day. “I’d much rather be comfortable eight or 10 hours a day inside than stuck in jeans,” he says. He claims he’s not bothered by the cold—most of the time. Once he took his kids swimming at a hotel and, afterwards, went outside in shorts and flip-flops to heat up the car. It was about 25 degrees below zero Fahrenheit, and his hair was wet. “In that moment you think, ‘Oh my gosh, I might die,’” he says. “Then you turn on the car and blast the heater and by the time you get home, you’re like, ‘Oh man, I’m so glad I didn’t pull jeans on over my swimsuit.’”

    Read More: 9 Ways to Reset Your Relationship With Social Media

    Triplett’s preference attracts a lot of comments. Enough people have asked him what would happen if his car broke down in the cold that he now keeps a blanket in the trunk. Once, an older man, similarly dressed, approached him in the grocery store and asked if people teased him, too. Mostly, though, neighbors slow down when he’s shoveling snow in shorts and remark on what a “tough guy” he is. “I don’t know if it’s sarcasm or admiration, but I choose to assume the best,” he says.

    Another member of the shorts-are-more-comfortable camp, Josh Weaver, 34, now lives in Los Angeles. It’s easy to wear shorts every day there, but his proclivity dates back to time he spent growing up in the Midwest, including going to college in Michigan. Jeans feel too tight on his thighs and calves, he says, so he’s turned shorts into a fashion statement. He owns about 15 to 20 pairs of athletic shorts, 10 “dress” shorts, a few pairs of jean shorts, and several suits that consist of short-sleeve blazers and shorts. “Shorts have this weird connotation of being less than—literally because they’re less than pants,” he says. “But there’s a way to have respectable shorts, as long as it matches the situation and the attire.” And if he encounters anyone who’s offended by his wardrobe choices? “If you have a problem looking at my knees, tell me,” he says. “I have no problem putting on some joggers.”

    Josh WeaverCourtesy Josh Weaver

    Is wearing shorts in the cold safe?

    There’s no threshold for when it becomes too cold to wear shorts outside. For the most part, strutting around in shorts isn’t dangerous, says Cowl, the Mayo Clinic doctor, especially since many shorts guys wear a jacket or at least a sweatshirt to keep their torso warm.

    “It’s very rare that you see someone come in to get treated for frostbite,” Cowl says. If these bare-legged folks are exerting energy—perhaps jogging or shoveling—their core body temperature increases, ensuring they don’t get too cold. Some should tread carefully, though, he advises: Kids don’t tend to have the decision-making skills to determine what’s best for them, and people with conditions like peripheral neuropathy, who don’t have strong feeling in their limbs, may not realize they’ve been outside for too long.

    Read More: How to Be a Healthier Drinker

    In general, your body will tell you if it’s too cold, Cowl says. Are your extremities turning red or pale? Are you shivering uncontrollably? In extreme cases, someone might start to feel confused or pass out. Use common sense, he says, and go inside—or put on some pants—at the first sign of suffering.

    If you’re still concerned about the shorts-wearer in your life, take comfort in the fact that some eventually reform. Adam Bertocci, who’s 41 and based in Bronxville, N.Y., considers himself a recovering cold-weather shorts guy. Starting at a young age, he would wear shorts well past the time of year when others began covering their legs. “[It’s] an easy way to prove yourself,” he says. “You don’t have to be the best; you don’t have to win. You just need to show up, endure, and never give in.” Back then, wearing shorts during winter was a harmless way for good kids to rebel, he recalls—plus, after the fifth time that someone asks you if you’re cold, a certain stubbornness kicks in, ensuring the shorts stay on. “It becomes a label you embrace,” he says. “Because why not?”

    Adam BertocciCourtesy Adam Bertocci

    Well, wind chills and polar vortexes, for starters. Somewhere around his second year at Northwestern University in Evanston, Ill.—where it can get colder than the Arctic—the frigid temps overwhelmed Bertocci. He recalls walking four to six blocks to an off-campus comic-book store, and feeling like he’d morphed into a snowman. “It defeated me,” he says. “That place crushed my shorts-in-the-winter spirit more effectively than any other facet of adulthood.”

    He still keeps his pants-wearing to a minimum, though. Bertocci doesn’t like to be too warm, and jokes that he’s more likely to retire to Calgary than to Florida. “The truth is, guys aren’t that complicated,” he says. “If our internal temperatures were all to shift, we’d change our clothes to accommodate it—even if that meant throwing away every amusing side benefit to being this guy.”



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    Angela Haupt

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  • Healthy Activities Save Kids’ Lives. Why Are They So Hard to Find?

    Healthy Activities Save Kids’ Lives. Why Are They So Hard to Find?

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    It was a quiet Saturday morning, and as a pediatrician who had a busy week, that meant it was the perfect time to cozy up with a large mug of coffee at my kitchen table and make my way through the many lab results that had come into the electronic health record inbox since the previous day. I may not be setting a great example of work-life balance. But clinic days are filled with seeing patients, teaching trainees, and answering questions from our care team. Saturdays are the only time I’m able to give patients and their families undivided attention and no-rush answers.  

    Most of the labs I was preparing to share with families were related to screening tests that we send for children if their body mass index (BMI), the imperfect but helpful measure of weight for height and age, is elevated to a point that it may be causing problems with blood sugar, cholesterol levels, or liver function. Discussing weight in pediatrician’s offices is complicated and should be undertaken with care, but with more than one in four Medicaid-insured children 10-17 years old meeting criteria for obesity, our role is to help inform families and to advocate for their health.  

    Next on my list of families to call was the mother of a bright and bubbly ten-year-old girl who I’ll call Mindy. When we were in the office earlier in the week, after listening to her lungs, I showed her mother the slight darkening of the skin on the back of Mindy’s neck. That color change was a sign that her body was likely creating extra insulin to keep her blood sugar at a normal level. That same insulin was also causing some of her skin cells to proliferate. I called that Saturday morning to share that the lab results had confirmed this: Mindy did indeed have blood sugars that put her in the pre-diabetes range.

    Read More: Weight Bias Is a Problem in Health Care. Here’s What Doctors Can Do

    On the phone, Mindy’s mother expressed understandable sadness that quickly transitioned to determination to find healthy activities for her child. What she shared next was heartbreaking. “I’m working two full-time jobs, and I can’t afford to enroll her in sports,” she told me.” I can’t let my child have the opportunities she wants. It’s not fair. The odds are stacked against us.” 

    I paused and took a breath. In a few short sentences, Mindy’s mom had expressed what data have shown us about disparities in health and their links to economic opportunities; there are seemingly insurmountable barriers that are not her or her daughter’s fault. 

    But it was Saturday, and I had time. So, I replied, “You are 100% right. Are you near a computer?” She responded that she would make sure her kids were in a safe spot and then headed to her computer. When she said she was ready, I tried to match her determination: “Let’s figure this out together.” 

    We spent the next 30 minutes Googling.  

    “I think the state department of health announced free swimming lessons recently, let me check,” I said. “Oh yes, it says they are at some YMCAs, let’s find the one nearest to you. Maybe try calling that number during the week?”

    “Oh! There’s a non-profit that helps with school sports enrollment fees, let me find it. Hmm, it seems they aren’t open for applications yet this year, but hopefully they will be soon.”  

    “Let’s take a look at your town’s sports and summer offerings.”  

    “There’s a great program for families to learn about healthy eating and exercise together—oh yes, that may conflict with your busy work schedule, and sounds like it may be a far drive, but let me give you their contact information.” 

    Mindy’s mom ended that call armed with new options and ideas for activities for her child. She was thankful, and we discussed a plan to check in at the office in a few months. The truth was, this Saturday-morning conversation was probably one of the most important and fulfilling discussions I had had that week, because we were finding solutions to help a motivated family set up healthy habits for a child’s future. 

    But this conversation only happened because of a combination of lucky factors: Mindy’s mother was tech-savvy and could peruse English-language websites, we could Google together, and I had time on a Saturday morning. And even when these stars aligned, there were no promises that any of the potential programs we found would be a match or had funding. This phone call was in no way a solution to the underlying problem of access to lifestyle interventions and activities for children in the U.S.  

    The latest guidelines for the treatment of obesity from the American Academy of Pediatrics made a splash in the press because they discussed treatment options that included medications and surgery. But key elements of these guidelines that didn’t make as many headlines were lifestyle interventions, where families learn about and participate in nutritional food preparation, exercise, sleep hygiene, and healthy habits together over multiple sessions. Mindy’s mom was interested in this type of intervention, but could she access the one that we found that was a 30-minute drive away and often overlapped with her work schedule?

    Mindy’s mom is right: currently, it isn’t fair. But we can make it easier for our nation’s youth and families to have access to prevention that works. We need more local, state, federal, and insurance funding so that we can increase the availability and accessibility of lifestyle-intervention programs. Furthermore, Mindy’s mother was planning to wait a few months to apply to a nonprofit to be able to maybe receive support to enroll in school sports. Perhaps school sports should be covered by medical insurance—or, better yet, they should be freely available for any child. Certainly, we must improve access to sports, activities, and lifestyle intervention for families across the U.S.  

    I’m hoping that one day, once we have put these preventive interventions into practice, I can spend fewer Saturdays calling families regarding their children’s blood sugar and cholesterol levels. When that day comes, families like Mindy’s will have already had access to opportunities to learn about health as a family, to play, and to thrive. 

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    Julia Rosenberg

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