Babies who receive a certain compound when breastfed are less likely to experience chronic illness later in life
This compound is called 3SL and is present in the milk of mothers who get enough exercise
If 3SL can be isolated, it could be included in infant formula or supplements to benefit babies
Exercise is part of a healthy lifestyle, but a new study suggests it also increases the amount of a beneficial compound called 3SL in the breast milk of both humans and mice.
Based on that, researchers think that its benefits to babies could last for decades, potentially making them less likely to experience such chronic illnesses as obesity, type 2 diabetes and heart disease as they age.
“As long as they were given 3SL during their nursing period, they were protected as they aged,” said Kristin Stanford, who led the mouse portion of the study at Ohio State University’s Wexner Medical Center. “In the absence of any self-intervention, this has absolutely provided a really strong protective effect.”
Though past studies have shown the benefit of maternal exercise to offspring, this study begins to answer the question of why, Stanford said.
The more steps, the better
The human side of the research was led by Aline Andres at Arkansas Children’s Nutrition Center and included 150 pregnant and postpartum women who used activity trackers to count their steps. The women then provided samples of breast milk, which researchers analysed.
Mothers whose trackers had recorded even a moderate number of steps showed a greater amount of 3SL in their breast milk, without considering exercise intensity. And more steps showed even greater levels of 3SL in the women.
Andrea Berardi was one of those women. The Ohio resident has always enjoyed exercise, running marathons and doing deep-stretch yoga classes, so continuing to stay active during pregnancy came naturally. Now the mom of a 6-month-old daughter, she joined the study right after her daughter was born.
Though Berardi initially thought she would breastfeed her daughter for six months, her goal now is one year. To think that what she’s doing now could enhance her daughter’s health for years to come is amazing, she said.
“So many people want to give their children the best step forward and do everything that’s best for them,” Berardi said. “Anything to help her bypass those major issues in her medical charts, that’s obviously a goal of mine.”
Improved glucose metabolism
Stanford was thrilled to see the human findings mirrored what her team saw in mice.
“It was really exciting for us to have them do the study in a totally different institution and see the same thing that we had seen in mice that they were seeing in humans,” said Stanford, who is an associate professor of physiology and cell biology at Ohio State’s Dorothy M. Davis Heart and Lung Research Institute.
The research was published on 29 June in the journal Nature Metabolism and also included scientists from the University of California, San Diego, and the Joslin Diabetes Center in Boston.
In mice, researchers found the offspring of those who exercised had reduced fat mass or body weight, as well as improved glucose metabolism, Stanford said. When other mouse pups were given the breast milk of the exercise-trained mice, they showed these same benefits.
“This showed that the milk is definitely an important factor in that,” Stanford said. “It was really enough to contribute to these overall metabolic effects.”
Even when the mouse pups were fed a high-fat diet later, they still had improved metabolism, cardiac function and body composition. The increased 3SL in breast milk for moms who were more active held true, even if the moms were overweight.
‘Breast milk is remarkable’
“It didn’t really matter what your starting BMI [body mass index] was or your starting body weight, as long as you were moving, we saw these effects,” Stanford said.
“If something as simple as increasing your steps per day while you’re pregnant can protect your child from some of these things or even have a minimal effect on how they develop in a positive way, I think that the implications for public health can be pretty dramatic,” Stanford added. But the study could not prove that exercise actually caused 3SL levels to rise.
Researchers also are examining whether they can isolate 3SL for potential future inclusion in infant formula or infant supplements.
Breast milk is remarkable, said Connie Diekman, a food nutrition consultant in St. Louis.
“The validation of this study is what we have long said, that breast is best,” Diekman said. “It is that foundation that it lays for the rest of life that is so vitally important and that we don’t fully understand.
“It appears even if a mom can do it for six weeks or two months, that infant gets a very significant benefit for the rest of their lives,” she added.
For mothers who may not be able to breastfeed or who choose not to, “you still can provide your infant a well-balanced, healthful eating plan,” Diekman said.
A dangerous bacterium that can cause lung failure may now be found in the US
The infection is called melioidosis and was previously contracted only in countries outside America
Because there’s no vaccine, and the disease doesn’t respond to most antibiotics, it’s often fatal
Potentially deadly antibiotic-resistant bacteria could be hiding in the dirt and water of the southernmost US states, warns a new report from the US Centers for Disease Control and Prevention.
The bacterial infection, called melioidosis, caused the lungs of a 63-year-old Texan to shut down in late 2018, forcing doctors to put him on a ventilator to save his life, the researchers said.
US citizens who’ve caught melioidosis in the past typically picked it up in a foreign country, but this man had not recently travelled abroad, said Johanna Salzer, a veterinary medical officer with the CDC’s Bacterial Special Pathogens Branch.
What’s more, the bacteria that caused the man’s melioidosis were genetically similar to two prior US cases, one in Texas in 2004 and one in Arizona in 1999.
Resistant to many antibiotics
“We feel like this is evidence that it could be in the environment” in the United States, Salzer said. “We just need to find it.”
Melioidosis is caused by the bacteria Burkholderia pseudomallei. Humans pick up the bacteria by inhaling dust or tiny droplets of water, or by dirt or water getting into an open wound, Salzer said.
There are an estimated 160 000 cases of melioidosis every year around the world, and 89 000 deaths, “which is really high for a disease a lot of people don’t know about,” Salzer said. It most commonly kills through blood poisoning or respiratory failure.
The fatality rate is estimated to exceed 70% if a person sick with melioidosis is left untreated, Salzer said.
There’s no vaccine for the bacterium, and it is naturally resistant to many commonly used antibiotics. These include penicillin, ampicillin, cephalosporins, gentamicin, tobramycin and streptomycin, the researchers said.
Patients often require at least two weeks of IV drugs followed by several months of oral antibiotics to wipe out the infection.
On antibiotics for three months
The man, from Atascosa County, Texas, went to the hospital in November 2018. He’d had fever, chest pain and shortness of breath for three days, according to the report in the June issue of the CDC journal Emerging Infectious Diseases.
Doctors diagnosed him with pneumonia, and a blood test revealed a B. pseudomallei infection. He subsequently developed a large ulcer on his chest.
Four days after admission to the hospital, the man stopped breathing and was put on a ventilator. He was transferred to another hospital, which switched him to an antibiotic that was more effective against the bacteria.
The patient left the hospital after three weeks, but remained on daily antibiotics for another three months, according to the report. The disease also injured his kidney, which required dialysis three times a week.
These bacteria are most commonly found in the tropical climates of Southeast Asia, South and Central America, and northern Australia. It also has been detected in two US territories, Puerto Rico and the US Virgin Islands, Salzer said.
Tough to diagnose
Previously, B. pseudomallei “has never been found in the environment in the continental United States,” Salzer said.
Unfortunately, the handful of cases cited by the researchers seem to indicate that the bacteria might have made a home for themselves in the southern United States.
“There is global modelling that the bacteria could survive, and survive well, in Texas and areas of Florida,” Salzer said.
The CDC plans to partner with academic institutions to search for the bacteria in the continental United States, in much the same way that it was uncovered in Puerto Rico and the Virgin Islands, Salzer said.
Melioidosis can be tough to diagnose, Salzer said.
“It’s been called the Great Mimicker or the Imitator Disease,” Salzer said. “If you’re not looking for it, it doesn’t have really clear and reliable symptoms in all people.”
Many have diabetes
Symptoms also can take months or years to develop, making it even more difficult for doctors to puzzle out their patient’s illness, the report added.
The CDC experts urge doctors to test for the presence of the bacteria in patients in the southwestern United States who:
Have symptoms that seem to indicate pneumonia, blood infection, skin lesions or internal organ abscesses
Have chronic diseases that put them at increased risk for dangerous infections, especially diabetes or kidney disease
Don’t improve after treatment with commonly used antibiotics
More than 60% of melioidosis patients have diabetes, including the man in Texas, Salzer said.
Dr Robert Glatter is an emergency medicine physician with Lenox Hill Hospital in New York City. “Lack of an international travel history should not rule out a diagnosis of melioidosis. People who also travel to the southwest US are consequently at increased risk,” he said.
“Increased healthcare provider awareness and education regarding the geographical distribution of this disease along with risk factors and pitfalls for managing melioidosis can help reduce mortality,” Glatter added.
The findings show a strong link between mother and infant transmission.
Researchers have found the virus in an at-term placenta, umbilical cord, the vagina and in breast milk.
Claudio Fenizia, from the University of Milan said none of the infants born during the study period tested positive for Covid-19.
There is “strong evidence” that Covid-19-positive mothers can pass the virus on to their unborn infants, scientists said Thursday, in findings that could affect how pregnant women are shielded during the pandemic.
While there have been isolated cases of babies infected with the virus, the findings show the strongest link yet between mother and infant transmission.
Researchers in Italy studied 31 pregnant women hospitalised with Covid-19, and found the virus in an at-term placenta, umbilical cord, the vagina of one woman and in breast milk.
They also identified specific Covid-19 antibodies in the umbilical cords of several pregnant women as well as in milk specimens.
Claudio Fenizia, from the University of Milan and lead study author, said the findings “strongly suggest” that in-vitro transmission is possible.
“Given the number of infected people worldwide, the number of women that could be affected by this could be potentially very high,” he told AFP.
Fenizia stressed that none of the infants born during the study period tested positive for Covid-19.
“Although in utero transmission seems to be possible, it is too early to clearly assess the risk and potential consequences,” he said.
The World Health Organisation said last month that new mothers infected with Covid-19 should continue breastfeeding.
“We know that children are at relatively low-risk of Covid-19, but are at high risk of numerous other diseases and conditions that breastfeeding prevents,” said WHO chief Tedros Adhanom Ghebreyesus.
Among other findings, the team identified a specific inflammatory response triggered by Covid-19 in the women’s placenta and umbilical cord blood plasma.
Fenizia said that the women studied were all in their third trimester, given the timeframe of Italy’s epidemic, adding that more research is currently under way among Covid-19-positive women in the early stages of pregnancy.
“Our study is aimed at raising awareness and inviting the scientific community to consider the pregnancy in positive women as an urgent topic to further characterise and dissect,” he said.
“I believe that promoting prevention is the safer advice we could possibly give right now for these patients”.
The study was released during a week-long International AIDS Conference, held online for the first time in its history due to the pandemic.
When the coronavirus pandemic started, there was a sharp increase in cases of stress cardiomyopathy in the US
This condition seems like a heart attack, but is something quite different
So-called ‘broken heart syndrome’ appears to be caused by stress
Doctors at one Ohio hospital system have discovered yet another possible consequence of the Covid-19 pandemic: More cases of “broken heart syndrome”.
The condition – which doctors call stress cardiomyopathy – appears similar to a heart attack, with symptoms such as chest pain and breathlessness. But its cause is different: Experts believe it reflects a temporary weakness in the heart muscle owing to a surge in stress hormones.
And at two Cleveland Clinic hospitals, diagnoses of stress cardiomyopathy shot up in the early weeks of the Covid-19 pandemic.
During March and April, the new study found, stress cardiomyopathy was diagnosed in nearly 8% of patients who arrived in the emergency department with chest pain and other possible heart symptoms.
Stress of the pandemic
That was four to five times higher than rates seen in pre-pandemic periods, which hovered between 1.5% and 1.8%.
And while Covid-19 can lead to heart complications, none of the patients with stress cardiomyopathy tested positive for the infection, said Dr Ankur Kalra, a cardiologist who worked on the study.
“That suggests this is not a reflection of the virus, but the stress of the pandemic,” he said.
Stress cardiomyopathy is a relatively new diagnosis, and doctors are still trying to understand it fully, Kalra said. But it got its nickname because it may arise after an emotionally difficult event, like a divorce or death of a loved one.
But other stressful situations – from a traffic accident to surgery – can also be triggers, Kalra said.
The condition may not arise immediately after the trigger, however, said Dr David Kass, a professor of cardiology at Johns Hopkins University School of Medicine in Baltimore.
Distinct from a heart attack
Kass said a person could, for example, develop stress cardiomyopathy after living through an earthquake then dealing with the fear of another one.
The condition is thought to occur when the heart muscle is overwhelmed by a flood of catecholamines – better known as stress hormones, according to Kass. That temporarily reduces the heart’s pumping ability.
The condition is quite distinct from a heart attack, he explained. There are no blockages in the arteries, and while heart muscle cells may be temporarily stunned, they do not die off.
The symptoms do mimic a heart attack, said Dr James Januzzi, a trustee with the American College of Cardiology and a cardiologist at Massachusetts General Hospital in Boston.
But as tests are done, he said, the true cause grows clearer.
For one, Januzzi explained, stress cardiomyopathy looks different from a heart attack on electrocardiogram, which measures the heart’s electrical activity. And when doctors do an angiogram to peer inside the heart arteries, they’ll find no blockages in a patient with stress cardiomyopathy.
People avoiding the ER
The good news, Januzzi said, is that people with the condition typically recover quickly, with no long-term heart damage.
Kass said that given all the stresses of the pandemic – from fear of the virus to job losses to social isolation – it’s not hard to imagine why stress cardiomyopathy would increase.
But he also sounded a note of caution on the findings: From the start of the pandemic, many US hospitals saw a significant drop in heart attack patients – possibly because people feared a trip to the ER and were not calling 911.
And that, Kass said, could be one reason why the percentage of stress cardiomyopathy diagnoses rose.
“The denominator has changed,” he said. “So it’s hard to know whether this is actually happening a lot.”
Januzzi agreed that could be a factor.
Managing stress
What’s interesting, he said, is that none of the patients tested positive for Covid-19. Cases of “Covid-associated” stress cardiomyopathy have been reported in patients with the infection, Januzzi noted, but cases associated with the pandemic itself would be new.
And it’s “very plausible”, he said, that these stressful times could be leading to a true increase in the condition.
For the general public, Januzzi said, it’s critical to act on symptoms of chest pain and difficulty breathing: Get to the ER and let doctors diagnose it.
Kalra agreed. He also urged people to do their best to manage stress – getting regular exercise, for example, or using meditation to quiet the mind.
The findings were published online on 9 July in JAMA Network Open.
Viruses are everywhere, but most do not harm humans
Conditions have to be just right for viruses to ‘leap’ from an animal to a human
Human behaviour, like modern travel, makes it easier for viruses to spread
Factors smaller than a cell and as large as the planet are at play when a virus leaps from an animal to a human.
The question of how that happened with SARS-CoV-2, which causes the disease Covid-19, is crucial for several reasons, said best-selling author and science journalist David Quammen. The answer could help scientists find a vaccine to end this pandemic. It could uncover ways to prevent the next.
And prevention, he and other experts say, will involve making people everywhere understand their own role, even if they live far from the places where the viruses emerge. As Quammen put it: “All the eating and buying and consuming and reproducing that we’re doing are pulling dangerous viruses closer to us.” Which means everyone has a chance to be part of the solution.
Viruses are everywhere
You could write a book about the myriad ways animals, humans and viruses interact. Quammen did. “Spillover,” released in 2012, warned about a pandemic unfolding almost exactly as Covid-19 has.
Not all human viruses come from animals. But several of the most infamous, including West Nile and HIV, did. Even so, it takes a lot for a virus to make such a leap, said Raina Plowright, an associate professor of epidemiology at Montana State University in Bozeman.
Viruses are everywhere, she said. Take a walk, and you might inhale them from plants, soil, birds, even pets. Most do no harm. They’re killed by the mucus in our respiratory tract, or the acid in our stomach, or they can’t bind to our cells to reproduce.
Plowright describes these many barriers as a series of walls stacked like Swiss cheese: All the holes have to line up precisely for something to get through.
Animals that harbour a virus are called reservoir hosts. They serve as a kind of viral warehouse. Sometimes, a virus might hitch a ride on what’s known as a vector, often an insect, to get from host to human. Mosquitos that spread West Nile virus from birds to people are an example.
Often, a spillover, or zoonotic, virus gets help from a middleman species, called an amplifier.
Billions of potential hosts
New influenzas, for example, often start in wild waterfowl. They might first spill into domestic birds – poultry, chickens and ducks, which might share a farm with pigs. Pigs can harbour human influenza and serve, as Quammen put it, as a place for viral genes to “mix and match”.
If that mixing causes a mutation that gives a virus an easy way to be transmitted from animal to human and to leap between people, that virus suddenly has billions of potential hosts around the world, he said. “That’s a virus that’s won the evolutionary sweepstakes.”
SARS-CoV-2 is thought to have originated in bats. Its genetic fingerprint suggests it evolved similarly to a virus that Chinese researchers warned about in 2017.
Bats, which have been reservoir hosts for several lethal viruses in recent decades, are an area of expertise for Plowright. She makes an appearance in Quammen’s book for her work on the Hendra virus, which has killed horses and humans in Australia.
Bats have some amazing adaptations that let them host viruses without harm, she said. But those viruses often need an amplifier to get into humans. That connection might happen when a bat harbouring a communicable virus is kept near other animals at a crowded wildlife market. It’s not clear if that’s what happened with SARS-CoV-2, she said.
Modern travel good for viruses
But such interactions don’t need to be exotic. With the Hendra virus, for instance, horses picked it up from grass beneath trees where bats fed, then spread it to human caretakers.
Closeness is crucial. “If you have a bat shedding a pathogen in the middle of a forest with no humans, then it’s of no risk,” Plowright said. But if that bat sheds the virus in a town or market, it is.
And here’s how humans help with that: “We’re rapidly changing our environments and rapidly changing our contacts with bats,” she said.
Development brings humans closer to bats and robs them of food. A stressed, hungry bat is more susceptible to viruses, she said. It’s also likely to go searching near people for something to eat.
Modern travel is another way humans make life easier on viruses, said Quammen, who’s working on a book about Covid-19. A bat-filled cave in rural China is only a plane ride away from Los Angeles or London. As one expert told him, “A disease anywhere is a disease everywhere.”
‘A roll of the dice’
You also can find risk factors in your own pocket, he said. Your cellphone needs a mineral called coltan that’s mined mostly in the Democratic Republic of the Congo. The miners who work there need to eat, but their only protein might come from hunting bushmeat – such as monkeys, rodents and bats. “Bingo,” said Quammen. “You’ve got contact between humans and wild animals.”
Plowright agrees people need to think about such connections if they want to be a part of stopping the next pandemic.
Each human encounter with a wild animal, and each time we plunge into their space, is a roll of the dice on whether we might stir up a dangerous virus.
“We’re rolling the dice thousands of times every second now,” Plowright said.
Apart from correcting your vision, such lenses would be able to measure your blood glucose and deliver medication
It is, however, a challenge to measure glucose levels without using blood
Contact lenses may someday do more than correct poor vision, with new, preliminary research in animals suggesting they could also monitor your diabetes and deliver medications.
The new lenses were designed to check blood sugar levels and to deliver drugs to the eye, possibly for the eye disease related to diabetes called diabetic retinopathy. After trying them out on rabbits, scientists found the new lenses worked on both counts.
It may sound like science fiction, but the researchers noted there is already a contact lens that’s been approved by the US Food and Drug Administration for measuring the pressure in the eye when worn overnight. Levels of eye pressure are important to know for people with the eye disease glaucoma.
Ultrathin electrical circuits
“Among various wearable devices, a smart contact lens is especially promising for health care applications because it can be used as an excellent interface between the human body and an electronic device,” said senior study author Sei Kwang Hahn. He’s a professor at Pohang University of Science and Technology in South Korea, and a visiting professor at Stanford University in California.
Hahn said this is the first study to show a combination of blood sugar sensing and drug delivery technology in a contact lens. However, what works well in animals doesn’t always work well in humans.
The smart contact lens contains ultrathin, flexible electrical circuits and a microcontroller chip. It’s currently about 0.2 millimeters (mm) thick, and Hahn said the researchers hope to reduce that to 0.15 mm. Hahn said the current lens is already thinner than the FDA-approved lenses that measure eye pressure.
Dr John Hovanesian, a clinical spokesperson for the American Academy of Ophthalmology, said the lens would likely be comfortable enough for people to wear, but it is significantly thicker than a standard contact lens.
Chemicals on the contact lens bind with glucose and trigger an electrical current change that is proportional to the amount of glucose. The electric current is also used to dissolve gold membranes that seal drug reservoirs, triggering the release of a dose of the drug, Hahn explained.
Lots of exciting possibilities
“This study is ambitious and bold. They’re trying a moonshot. But, I would be cautious in my expectations,” Hovanesian said.
“One of the biggest challenges to monitoring glucose in the eye with contacts is that you have to be cautious about the use of contact lenses in people with diabetes because infections and injuries can become more serious,” he noted.
Still, he added, “there are a lot of exciting possibilities with this.”
One big possibility is the potential to deliver drugs that are commonly used to treat diabetic retinopathy via the contact lens. Those drugs are currently delivered via injections to the eye.
In this study, the researchers used a drug called genistein, which isn’t approved by the FDA in the United States.
No need to draw blood
Sanjoy Dutta, vice president of research at JDRF (formerly the Juvenile Diabetes Research Foundation), said, “They’ve done good preliminary preclinical work. Looking forward, we need to know how accurate tear glucose is compared to blood glucose. And, the Achilles’ heel may be in connecting the two components (glucose sensing and drug delivery).”
Dutta said that there are a number of research projects looking at ways to measure glucose levels without having to draw blood or wear a continuous glucose monitor. Some other options that have been tried or are being tried are monitoring through sweat, tears, saliva and infrared light.
“Any non-blood-based glucose monitoring is very challenging,” Dutta noted.
Hahn and his team are hoping to begin human clinical trials in 2021. If those go well, their hope is to have a commercial product as soon as 2023.
The findings were published on 24 April in the journal Science Advances.
Rapid eye movement (REM) sleep is necessary for the body to repair itself
People with lower levels of REM sleep were found to have higher mortality
We should get the right amount of sleep – seven hours recommended for adults
Deep sleep is essential for good health, and too little of it may shorten your life, a new study suggests.
REM (rapid eye movement) sleep is when dreams occur and the body repairs itself from the ravages of the day. For every 5% reduction in REM sleep, mortality rates increase 13% to 17% among older and middle-aged adults, researchers report.
“Numerous studies have linked insufficient sleep with significant health consequences. Yet, many people ignore the signs of sleep problems or don’t allow enough time to get adequate sleep,” said lead researcher Eileen Leary. She is a senior manager of clinical research at Stanford University in Palo Alto, California.
“In our busy, fast-paced lives, sleep can feel like a time-consuming nuisance. This study found in two independent cohorts that lower levels of REM sleep were associated with higher rates of mortality,” she said.
Ways to optimise REM
How REM sleep is associated with risk of death isn’t known, Leary said. Also, this study couldn’t prove that poor REM causes death, only that it’s associated with an increased risk of dying early.
“The function of REM is still not well understood, but knowing that less REM is linked to higher mortality rates adds a piece to the puzzle,” she said.
It’s still too early to make recommendations about improving REM sleep based on this study, Leary said.
“As we learn more about the relationship, we can begin looking at ways to optimise REM. But that is outside the scope of this project,” she said.
For the study, Leary and her colleagues included more than 2 600 men, average age 76, who were followed for a median of 12 years. They also collected data on nearly 1 400 men and women, average age 52, who were part of another study and were followed for a median of 21 years.
Reliable predictor of mortality
Poor REM sleep was tied to early death from any cause as well as death from cardiovascular and other diseases, the researchers found.
REM sleep’s links to mortality were similar in both groups.
“REM sleep appears to be a reliable predictor of mortality and may have other predictive health values,” Leary said. “Strategies to preserve REM may influence clinical therapies and reduce mortality risk, particularly for adults with less than 15% of REM sleep.”
Previous studies have focused on total sleep time and have shown that both not enough total sleep and too much total sleep can be associated with increased risk of dying early, said Dr Michael Jaffee, an associate professor of neurology at the University of Florida in Gainesville.
“When we sleep, we go through different stages to include REM sleep. REM describes our eye movements during this stage and is also the state associated with when we have dreams,” he said.
This study shows that it is not just total sleep time that may be important, but assuring the right balance of the different stages of sleep, said Jaffee, who co-authored an editorial that accompanied the study.
Proper sleep time
Neurologists need to look for conditions affecting patients, such as obstructive sleep apnoea, that can reduce REM, and doctors should also be aware that certain medications they prescribe can reduce REM, he said.
The study also opens up additional avenues for research to determine if scientists should focus on treatments that affect not just total sleep but target sleep stage balance, Jaffee said.
“This study shows yet another reason for the importance of proper sleep time – recommendations for adults is seven hours – and a good balance of sleep stages by assuring that any possible conditions, such as obstructive sleep apnoea, that can cause a reduction in REM to be evaluated and managed,” he said.
“Anyone with difficulty with sleeping or with loud snoring can benefit from discussing this with their physician,” Jaffee added.
The report was published online on 6 July in JAMA Neurology.
Trigger warnings are meant to alert trauma survivors about unsettling text or content that they might find potentially distressing.
But these words of caution at the start of films or books may provide no help at all – and might even hamper a traumatised person’s ability to grapple with deep psychological scars, a new study reports.
“We found that trigger warnings did not help trauma survivors brace themselves to face potentially upsetting content,” said lead researcher Payton Jones, a doctoral candidate in clinical psychology at Harvard University. “In some cases, they made things worse.”
Trigger warnings seem to increase the extent to which people see trauma as central to their identity, which can exacerbate cases of post-traumatic stress disorder (PTSD) in the long run, Jones and his colleagues found.
Some real soul-searching
“We found evidence that trigger warnings increased the extent to which trauma survivors saw their worst event as central to their life story,” Jones said. “Seeing trauma as central to one’s life is not a good thing.”
The study’s results are strong enough that they should provoke some real soul-searching about who’s really being helped by trigger warnings, said Guy Boysen, a professor of psychology at McKendree University in Lebanon, Illinois.
“It’s a pretty convincing argument that in the population that trigger warnings are supposed to be for, it’s not really doing much,” Boysen said. “It’s time in this research area to flip the question and ask not whether trigger warnings work, but is there any population in which they do anything?”
Previous studies on trigger warnings have had similar findings, but have been criticised because participants were from the general public and not specifically people with a history of trauma, said Boysen, an expert on the topic.
Where did trigger warnings originate?
The concept of trigger warnings evolved from work on PTSD, a condition in which reminders of trauma cause some to experience extreme emotional reactions, Boysen said.
Online discussion groups for survivors of sexual trauma came up with the idea of providing warnings in advance, so people could talk about their experiences without causing pain in others, the researchers said in background notes.
Since then, the concept has flourished. About half of all college professors told National Public Radio in a 2016 survey that they’d used trigger warnings to prepare students for potentially difficult material.
However, the practice has been adopted without any real research to confirm whether it actually helps, Jones said.
To test the effectiveness of trigger warnings, the researchers recruited 600 people who’d been exposed to a traumatic event – actual or threatened death, serious injury, or sexual violence.
Participants were split into two groups. Both read a series of literature passages that ranged from neutral to mildly distressing to markedly distressing.
The only difference was that one group received trigger warnings prior to reading distressing passages, while the other did not. Participants rated their emotions after finishing each passage, and also completed a series of psychological questionnaires at the end.
Overall, both groups appeared to react similarly to the passages. Neither seemed to be spared the emotional impact of reading the text, the researchers said.
Avoidance doesn’t help
But people given trigger warnings were more likely to express the belief that their trauma is an essential part of a survivor’s life story – something that won’t help them overcome their trauma, Jones said.
According to Boysen, “Avoidance is bad. The reason people don’t get over their phobias and traumas and fears is because they don’t allow themselves to be exposed to reminders of them or the things themselves, and that just increases their symptomology.”
Jones said the report is “one of the very first studies to test whether trigger warnings work as intended. The key takeaway for me is not that trigger warnings are ‘bad,’ but that for many years we have been implementing a policy for trauma survivors without testing whether it is actually helpful or harmful.”
Boysen suggested that trigger warnings might not work as intended because there’s simply no way to make them specific enough in a general setting.
He gave the example of a person who has been robbed at gunpoint in their own home by burglars.
“What is the trigger going to be for that? Is it going to be seeing a person who looks like that, is it going to be talking about guns, talking about robbery? It could be anything, right?” Boysen said.
Useful on an individual basis
“The triggers for things that might lead to automatic distress are so diverse, and so individualised, it’s impossible to predict in a general way what’s going to be triggering for people, because it’s 100% totally unique to that person,” Boysen added.
While generalised trigger warnings don’t appear to help, Boysen said they still could be useful on an individual basis – for example, if a student with a solid grasp of their trauma trigger lets a professor know in advance what type of content could cause distress.
“That’s a different thing, because the teacher then has more of a specific idea of what could be effective,” Boysen said.
The new study was published recently in Clinical Psychological Science.
Every day waste-pickers are searching for recyclables on rubbish dumps across South Africa
They are too poor to buy personal protective equipment to protect them against SARS-CoV-2
However, the risk of infection from most kinds of rubbish is small
At Arlington and Uitenhage waste disposal sites in Port Elizabeth, hundreds of people daily search for recyclable materials to sell and food to eat.
Martin Witbooi from Walmer is one of them.
He tells Spotlight personal protective equipment (PPE) is “a luxury”. “We normally wash and wear gloves and masks that we get from industrial waste. Otherwise, without those trucks from industrial areas, we have to make our makeshift masks with clothing. As a result, some of us see no point in wearing gloves or masks every time we carry out our duties.”
The 31-year-old father of two tells Spotlight that many people (working at the Arlington landfill site) “are afraid of Covid-19, but it is virtually impossible for us not to get this virus because we are exposed to it”. “Even right now we don’t know who has this virus as people here are always coughing and complain of fever and chest pains. If we are not yet infected, we literally survived by the grace of Jesus Christ.”
Small risk from waste
Covid-19 rates in the area are soaring. At 30 603 (as of 2 July), The Eastern Cape has the third most confirmed cases of South Africa’s nine provinces – and most of those cases are clustered around Nelson Mandela Bay.
What is the risk from waste? “Now that 95% of people who tested positive for Covid-19 are being kept at home, the waste they are generating includes personal protective equipment,” says Professor Angela Mathee, Director of the Environmental Health Research Unit at the South African Medical Research Council (SAMRC).
Mathee says the discarded used PPE could end up at landfill sites which can pose some risk for people rummaging through waste.
But the risk from most types of waste is small.
Head of the Division of Medical Virology at Stellenbosch University, Professor Wolfgang Preiser, says that studies show that in controlled settings (like a laboratory) the virus remains infectious for between hours to several days depending on factors like the type of surface, temperature, and moisture.
‘Dirt’ may shield virus
“But there are also studies that have looked for virus ‘survival’ (which means testing whether the virus on the surface will actually infect cell cultures in the laboratory), and found that under special circumstances, it can ‘survive’ for several days.” Preiser says the current “recommendation [is] for waste from households where someone is in quarantine or in isolation [to] be double-bagged before being put out with the domestic waste”. “If no one opens that double bag again, no problem,” he says.
“I would not worry too much about recyclables such as glass bottles and paper being picked up. Even if someone, for example, coughed into their hand and did not wash it before disposing of the bottle, it is unlikely that small amounts of infectious secretions would allow the virus to remain infectious. Used tissues and masks are a different problem,” he says. “If there is quite a large amount of secretions with a lot of virus, the ‘dirt’ may shield the virus from outside influences and allow it to remain infectious for longer.”
But Preiser notes none of this “should be much to worry about if those who handle this had gloves (not single-use medical ones, but proper working gloves that can be washed or cleaned after use) and could wash their hands regularly or use alcohol-based hand rub – especially before drinking, eating or smoking after having handled rubbish.”
He also notes that “those going through household waste in search of recyclables, are at risk in places where there is rampant community transmission”. “Formal waste services should have issued their staff with protective equipment and instructions. As they do not really handle the waste itself, but the bins and bags, their risk is then small. Nevertheless, there are frequent cases of Covid-19 among municipal solid waste staff,” Preiser says although noting this may be due to staff contracting Covid-19 in the community and then transmitting to their colleagues.
Unsafe even before Covid-19
For Zukisa Pikini of Uitenhage, the landfill site is the only way of surviving. “Without this dump I won’t be able to feed my family. It’s better to come here and search for food instead of sleeping with an empty stomach. For the past three months I have been working at the dump just to feed my 12-year-old boy, and life is hard here. It is survival of the fittest. All of us eat rubbish and we constantly fight over it. Nothing is guaranteed,” she says.
“I feel scared to work in this environment because I’m taking TB and HIV treatment and I also have one lung,” says Pikini. She tells Spotlight she registered for food parcels, but have not received any. Pikini says she knows that she is putting herself at risk for contracting diseases. “I have no choice but to work for my kids.”
“We (the SAMRC) have done a study recently (last year) on the health of people who are living on landfill sites,” says Mathee. “It shows 90% of them are wearing some kind of PPE, but mostly garden gloves, but because you are wearing gloves, it doesn’t mean you are completely safe. The study found informal waste-workers at landfill sites are vulnerable, as 37% of them had some kind of common mental disorder like anxiety, depression or stress.”
The study looked at the prevalence of respiratory health symptoms among waste-recyclers at two sites in Gauteng. “A persistent cough was the most common symptom reported (46.8%), followed by breathlessness (19.6%) and rapid breathing (15.8%),” the study found.
“Many of them reported that they had injuries from rat bites, dog bites and some of the landfills have steep slopes, so they often fall,” says Mathee. “They also have very low access to health care. When they fall ill, they often do not go to clinics or hospitals for medical assistance. They just work through their illnesses,” she says.
“I know their challenge that they are poor and if PPEs are not supplied by somebody, they won’t be able to afford it themselves.” Mathee, however, still encourages waste-pickers to wear PPEs.
No PPE plans for waste-pickers
The SAMRC study noted that occupational health and safety awareness is important to minimise hazards faced by informal workers. “In addition, providing waste-recyclers with the correct protective clothing, such as respiratory masks, and training on basic hygiene practices, could reduce the risks associated with waste sorting,” the study notes.
In a research briefing note, Dr Melanie Samson, Senior Lecturer in Human Geography at Wits University noted that in 2014 waste-pickers saved the country’s municipalities up to R750 million in landfill airspace (airspace is the projected bank cubic yards [BCY] of the landfill to be filled with waste as determined by survey and/or other engineering techniques).
Despite this, it appears that the Nelson Mandela Bay Metro has no immediate plan to provide waste-pickers with PPEs.
Mamela Ndamase, spokesperson for the Nelson Mandela Bay Metro told Spotlight all municipal refuse collectors are “regularly provided with work-wear to protect them”. On providing PPEs to waste-pickers, however, she said she will have to consult the relevant department on this matter.
Siyabulela Nciniba (39) calls the Arlington dump the source of his livelihood. “We rely on the dump not only for food but also for other necessities, despite potential health hazards. It is very dirty and on sunny days there is a bad smell, making it difficult to breathe,” he says. Nciniba tells Spotlight he is aware of the health risks. “Even right now I have a recurrent flu. I don’t know whether or not it is Covid-19.”
“Poverty leads us to put our lives in danger,” says Nciniba. “We are working without protective gear to guard us against Covid-19, and no one is providing us with protective gear because we are our own boss. Everyone here is afraid of this deadly virus, but we don’t have a choice but to work with or without them.”
Regulations and survival
Ndamase explains the regulations on municipal landfill sites. “Both municipal landfills are general sites, not hazardous waste sites. Access to both sites is restricted as per permit conditions. No sleeping is allowed on site. Our notice boards clearly state that any person inside the sites seen eating and sleeping after operation times is trespassing.”
Ndamase says at the beginning of lockdown level 5, waste-pickers were made aware of the regulations. “[We] tried so many times to chase them out of the site. However, as the levels were relaxed, people found their way back to the site through the gaps in the fence. Public Health officials are doing their best to educate and create awareness to all communities, including waste-pickers,” she says.
When Spotlight visited both sites recently there were several makeshift shelters made of plastic sheets and wood that people lived in. The shacks appeared to have been there for quite some time, contrary to municipal regulations.
“I came here to collect cardboard and other recyclable material but decided to stay on the site because I can’t afford transport money to travel daily from here to home,” says Asanda Tyala (28) from Uitenhage, mother of a 13-year-old boy and two girls aged 14 and 10. “I collect waste to sell for food so that I can feed my children,” she says. “I used to be concerned about the unbearable smell. The smell doesn’t concern me anymore because I’m used to it. I have been breathing in this stench for three years, having no health problem,” she says. Tyala says on “good days” she used to make R700 a day with her recycling, but since numbers of waste-pickers increased with lockdown, she hardly makes R300 a day.
Backbone of recycling industry
National coordinator of the South African Waste-Pickers Association, Simon Mbata, says waste-pickers are the “backbone of the recycling industry, operating in the informal sector and are self-employed with no one to provide PPE”. “We call on government, private sector and civil society organisations to assist, support, fund and work holistically with waste-pickers during this time and make it easy for waste-pickers to access PPEs,” says Mbata.
“We also call upon national government to make it mandatory for all citizens to separate their waste and phase out [the] mixed waste collection system. We believe that this should be the last generation of waste-pickers working in landfills. We want to see all municipalities building material recovery facilities, run and operated by waste-pickers. All this will go a long way in ensuring that waste-pickers are also protected and practise good hygiene.”
Meanwhile, for most waste-pickers, life remains difficult.
Shelton Tinarwo (44) from Zimbabwe has been working at the Arlington landfill for the last five months. “During the beginning of lockdown, police and municipal security used to chase us away, but we kept coming back until they let us in. It is difficult for us who come from other countries to make a living. Locals always accuse us of taking their bread and butter, but without jobs, we will starve – and poverty knows no nationality.”
*This article was produced by Spotlight – health journalism in the public interest.
A study put people with fatty deposits in their coronary arteries into three groups
Each of these groups could experience a heart attack or another cardiac event because of blocked blood flow
It was found that some people, depending on the group, were more affected by cold weather while others reacted more to warm weather
A growing body of research suggests heart attacks, angina and other heart events increase during winter and summer.
Now, a new study could explain why.
Researchers reviewed an international registry of 1 113 people, the majority from Japan, with acute coronary syndrome. Heart attack is a type of acute coronary syndrome, which occurs when the blood supply to the heart muscle is suddenly decreased or blocked.
Using images of the fatty deposits in participants’ coronary arteries, researchers put people into groups: plaque rupture, plaque erosion and calcified plaque. Each plaque scenario can block blood flow and lead to a heart attack or other cardiac event. But a rupture is more immediate and occurs when the calcified plaque breaks off. Erosion can happen over time.
Cold can constrict blood vessels
“We looked at those three underlying mechanisms to see whether they were different among the different seasons. As expected, we found a significant difference,” said Dr Ik-Kyung Jang, lead author of the study published on 2 July in the Journal of the American Heart Association. Jang is an interventional cardiologist and director of the Cardiology Laboratory of Integrated Physiology and Imaging at Massachusetts General Hospital in Boston.
Even after adjusting for age, sex and other coronary risk factors, Jang and his colleagues found that plaque rupture was highest in the winter and lowest in the summer. In people with plaque rupture, the prevalence of high blood pressure also was higher in the winter. People with plaque erosion or calcified plaque, however, did not tend to have high blood pressure.
One possible explanation for the uptick in wintertime ruptures, Jang said, is that cold temperatures can lead to constriction or narrowing of the blood vessels, and high blood pressure can be a trigger for plaque rupture. Another potential culprit? “Infection, particularly influenza, can result in systemic inflammation, and since plaque rupture is also associated with inflammation, that may also contribute to the higher incidence of acute coronary syndromes in the winter,” he said.
Plaque erosion, on the other hand, was higher in the summer. According to Jang, in hot weather, people are more likely to be dehydrated, which concentrates the blood. This can stress the endothelium, a thin layer of cells that line the blood vessels, causing the erosion.
The increase in winter cardiac events holds true even in milder climates, said Dr Robert Kloner, chief science officer and scientific director of Cardiovascular Research Institute at Huntington Medical Research Institutes in Pasadena, California. He was not involved with the new study.
In a prior study, however, Kloner and his colleagues analysed deaths from coronary heart disease in Los Angeles County between 1985 and 1996. They reported that the death rates were highest in December and January and lowest in the summer and early fall.
Greater indoor pollution
“This is true not only in climates that are known to be cold like the northeast of the US, but also in climates that are milder,” Kloner said. “People get used to a climate and then when it’s even mildly colder, that might be enough to increase cardiac events.”
While more research is needed, Kloner said that lifestyle factors also may explain the increase in plaque rupture during the winter. For example, people tend to eat more fattening, salty foods and overindulge on alcohol during the winter holidays, increasing their risk of heart troubles.
In addition, smoke from fireplaces contributes to greater indoor air pollution, which can contribute to cardiovascular events.
Shovelling snow can increase the heart’s workload, too. “There have been studies showing associations between snow shovelling and blizzards and an increase in cardiac events,” Kloner said.
Jang suggested doctors educate high-risk patients – older people and those with risk factors such as diabetes, obesity, hypertension and high cholesterol – about the risk of cold weather and how they can protect themselves.
“If people take steps to stay warm in the winter and be hydrated in the summer,” Jang said, “we may expect to see less acute coronary syndrome throughout a year.”
