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Thursday, April 25, 2024
Stroke

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A trial suggests that in patients who are no longer responding to metformin, taking a combination of two newer drugs is safe and yields clinical benefits for at least 2 years.

Insulin helps regulate the amount of glucose circulating in the blood. In type 2 diabetes, the body does not produce enough insulin, its cells no longer respond effectively to the hormone, or both.

In the long term, high blood glucose levels can cause a wide range of debilitating and potentially life threatening complications. These include high blood pressure, damage to organs such as the heart and kidneys, nerve damage, and blindness.

According to the Centers for Disease Control and Prevention (CDC), type 2 diabetes affects more than 30 million individuals in the United States and accounts for 90–95% of all cases of diabetes.

Type 2 diabetes used to be called adult-onset diabetes because it mostly affects people over the age of 45. But in recent decades, rates of type 2 diabetes in children, teenagers, and young adults have increased in the U.S.

Lifestyle changes can control or even reverse the condition. Doctors also prescribe drugs to stabilize patients’ blood glucose levels.

The first-line treatment is metformin, but in some patients, the drug’s efficacy can decline over time, necessitating alternative treatments.

Drug combination

A clinical trial called DURATION-8 investigated a combination of two newer drugs — exenatide and dapagliflozin — in patients whose blood glucose levels did not respond to metformin.

Initially, the trial lasted 28 weeks, but it was later extended to 52 weeks. The results suggest that the combination was safe and continued to be more effective than either drug alone.

In addition to stabilizing blood glucose levels, the drug combination was associated with lower blood pressure and body weight.

The researchers report in the journal Diabetes Care that the drug duo remained safe and effective 2 years (104 weeks) after treatment began, following a second extension of the trial.

“Many therapies in diabetes management are short-lived, which is why it is useful to test for long-term effect,” says first author Dr. Serge Jabbour, director of the division of endocrinology and the Diabetes Center at Thomas Jefferson University in Philadelphia, PA.

Exenatide belongs to a class of drugs called glucagon-like peptide-1 receptor agonists, which work by promoting insulin secretion, reducing the release of glucose from the liver, and increasing the feeling of fullness after a meal.

Dapagliflozin belongs to a class called sodium-glucose cotransporter-2 inhibitors, which boost the amount of glucose that is excreted in urine.

“These two classes work synergistically to help control a type 2 diabetes patient’s glucose levels and other measures associated with diabetes,” says Dr. Jabbour. “We can now feel more confident about prescribing these medications long term.”

AstraZeneca, which makes branded versions of both drugs, funded the study. The company also played a role in designing the study, gathering the data, and evaluating it.

Study design

The researchers randomly assigned 695 adults with type 2 diabetes whose blood glucose was not adequately controlled by metformin to three treatment groups:

  • a weekly injection of exenatide and a daily oral dose of dapagliflozin
  • weekly exenatide and daily oral placebo
  • a weekly placebo injection and daily oral dapagliflozin

After 2 years, 431 patients remained in the trial. Most of the participants who dropped out did so because they did not want to sign up to an extension of the trial.

After adjustments for other possible contributing factors, those who received both drugs saw the greatest average reduction in their glycated hemoglobin (HbA1c) levels — a measure of the stability of blood glucose levels — compared with the start of the trial.

In patients who took both drugs, there were also improvements in blood glucose levels after fasting and 2 hours after eating, and reductions in body weight and systolic blood pressure.

The researchers report that patients tolerated well the combination of exenatide and dapagliflozin.

While patients experienced no episodes of major hypoglycemia (dangerously low levels of blood glucose), there were more episodes of minor hypoglycemia in patients who took both drugs compared with the other two experimental groups.

Conclusions

The authors conclude that the clinical benefits of taking both drugs were maintained for 2 years, with “no unexpected safety findings.” They continue:

“Further studies are needed to investigate whether the combination treatment effects observed in DURATION-8 could potentially extend to a reduced incidence of [cardiovascular] and renal events in patients with type 2 diabetes.”

The authors acknowledge that the relatively high proportion of patients who withdrew from the study after 1 year limits the “robustness” of its findings after 2 years.

Finally, they note that their findings may not apply to all patients. Treatment should be tailored to individuals and modified according to how well they progress.

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A study suggests an intensive exercise program boosts cognitive performance and physical fitness in United States Air Force personnel. A nutritional supplement may also have some additional benefits.

While exercise is known to improve health and cognition, combining it with a nutritional supplement that mimics a Mediterranean diet may provide further advantages.

Scientists at the University of Illinois in Urbana-Champaign, Abbott Nutrition, and the U.S. Air Force Research Lab found that volunteers who consumed the supplement before and after training sessions had an edge in some measures of fitness and cognition 3 months later.

However, intensive exercise alone improved strength and endurance more than intensive training with the supplement.

On two cognitive performance measures, both the placebo group and the supplement group showed a slight reduction in performance, while other measures improved.

“The physical and mental health benefits of exercise are well known, but this study demonstrates how optimal nutrition can help boost brain function as well,” says study leader Chris Zwilling, a postdoctoral researcher at the University of Illinois.

“We are excited by the results because they provide critical insights into how simple dietary changes can make a big difference in helping people be as efficient and productive as possible in today’s world,” he adds.

The research appears in the journal Scientific Reports.

Strength and fitness training

The scientists recruited 148 active-duty male and female Air Force personnel from Wright Patterson Air Force Base in Dayton, OH, and randomly assigned them to two groups.

Both groups underwent a 12-week exercise program involving five daily sessions of 45 minutes, including rotating sessions of high-intensity interval training, aerobic fitness, and strength training each week.

One group drank the specially formulated nutritional supplement 30 minutes before and 1 hour after each session, while the second group consumed a placebo drink that looked and tasted the same. The supplement contained 267 calories of energy, while the placebo contained 100 calories.

Neither the researchers nor the participants knew who drank the special supplement and who drank the placebo.

The high-protein supplement contained a wide range of nutrients, including:

  • lutein, a carotenoid vitamin related to beta-carotene and vitamin A found in kale, spinach, avocados, and eggs
  • omega-3 fatty acids, found in oily fish such as mackerel and sardines
  • phospholipids, an essential component of cell membranes
  • beta-hydroxy beta-methylbutyrate, a supplement that helps increase muscle mass and aids recovery after exercise
  • folic acid
  • B vitamins
  • vitamin D

Participants took a series of cognitive and physical fitness tests before and after the exercise program. The cognitive tests assessed their memory, fluid intelligence — the ability to solve novel reasoning problems, executive function, and reaction time.

The exercise-only group had positive improvements in 5 out of 6 physical fitness measures and 4 out of 8 cognitive functioning measures. The research team recorded cognitive functioning increases in:

  • short-term memory
  • episodic memory
  • executive function reaction time
  • fluid intelligence and processing efficiency

The group who also took the supplement had improvements in all six fitness measures and 6 out of 8 cognitive measures. Compared with exercise alone, taking the supplement was associated with significant additional enhancements:

  • working memory increased
  • fluid intelligence reaction time decreased
  • lean muscle mass increased
  • resting heart rate, a measure of physical fitness, decreased

However, some of the figures in the study abstract were inaccurate. The authors have provided updated figures to Medical News Today and the journal.

Furthermore, the figures in the abstract were determined using raw data, which the paper did not provide. There were also some errors in rounding. Therefore, MNT is cautious about the study’s findings while the authors and the journal update the figures.

Working memory

Matt Kuchan, a research fellow and brain health scientist at Abbott and a co-author of the study, was impressed by the improvement in working memory among participants who took the supplement.

Working memory is a finite, temporary information store that predicts an individual’s ability to multitask and is often impaired in stressful situations. For example, it allows a person to remember a telephone number long enough to dial it or write it down.

“This is a really big deal,” says Kuchan. “First, because working memory is hard to improve. And secondly, because it is relevant to everybody.”

Strangely, two measures of cognitive function were slightly worse after the intervention for both the supplement and the placebo group: short-term memory and executive function accuracy.

It could be that these small performance decreases were due to test anxiety or chance.

The investigators say they did not design the study to determine which nutrients improved physical and cognitive performance. They also remain unsure if the enhanced cognition was due to the supplement, improvements in physical fitness, or a combination of both.

The study also took just 3 months, and therefore, it is not certain that real-life health programs could maintain these enhancements.

The research team discovered a link between the supplements and improvements that could not be explained by exercise in only 5 out of the 23 analyzed measures of cognitive health.

In addition, they made no adjustments in the statistical analysis to assess many variables in a single and relatively small study.

They also believe there may have been further benefits by using whole foods to deliver the nutrients, rather than supplements.

However, this would have presented several challenges in designing the study, for example, how to deliver exact quantities of several different nutrients.

The study provides evidence that intensive cardiovascular and resistance training offer rapid improvement in fitness, and in line with previous research, is associated with improvements in some measures of cognition.

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Over the years, scientists have demonstrated an association between red and processed meats and cancer. However, they are still unpicking the mechanisms that drive this relationship.

The authors of a recent study, which appears in BMC Medicine, argue that at least part of the answer might lie in an immune interaction.

Nutrition and dietary habits play pivotal roles in a wide range of health conditions, including type 2 diabetes, obesity, cancer, hypertension, and cardiovascular disease.

Red meats and processed meats have each received a fair amount of attention in this regard. Both have been implicated in cancer risk, but how they exert their influence is up for debate. As the authors of the latest study explain:

“Although various mechanistic explanations have been proposed, [such as a] high energy/fat diet, N-nitroso, nitrates, nitrites, heme iron, [and] compounds produced by gut microbiome or during cooking, none seems to be specific to red meat or dairy.”

A role for antibodies?

The authors point to tentative evidence that N-glycolylneuraminic acid (Neu5Gc) might be a risk factor for colorectal cancer.

Neu5Gc is a carbohydrate, or sugar, present in foods derived from mammals, and it is abundant in red meat and dairy. It occurs at low levels in some fish but is absent from poultry.

Humans cannot synthesize Neu5Gc, but when we consume it, small amounts accumulate on cell surfaces. When immune cells encounter this nonhuman material, it triggers the production of anti-Neu5Gc antibodies. Studies have shown that humans have a wide range of these antibodies.

Scientists have also found evidence that long-term exposure to these antibodies promotes inflammation and cancer in animal models. However, they have yet to identify any clear effect of eating mammalian products on levels of these antibodies.

As these anti-Neu5Gc antibodies travel around the body, they bump into Neu5Gc on cell surfaces, sparking inflammation. Experts believe that this, in turn, exacerbates cancer, because cancer cells tend to have higher levels of Neu5Gc on their surfaces.

In one study, researchers demonstrated an association between levels of circulating Neu5Gc antibodies and colorectal cancer risk. However, the level of antibodies was not associated with red meat intake.

Now, the latest study has set out to unpick the relationship between a person’s diet and their levels of Neu5Gc once and for all.

Diet and Neu5Gc

In the study, a group of scientists — most from Tel Aviv University, in Israel, or the Sorbonne Paris Cité Epidemiology and Statistics Research Center, in Bobigny, France — took data from the NutriNet-Santé survey. This extensive survey conducted in France aims to investigate the complex relationships between nutrition and health.

The authors of the present study took data from 16,149 adults, all of whom had registered a minimum of six dietary records.

Meanwhile, the researchers calculated the amount of Neu5Gc in a wide range of common foods. Using this data, they constructed what they refer to as the “Gcemic index,” which ranks food according to levels of Neu5Gc —specifically, the Neu5Gc content in each food relative to the amount measured in beef.

Next, the researchers analyzed blood samples from 120 participants with at least eighteen 24-hour dietary records; they noted the levels of anti-Neu5Gc antibodies in the serum.

“We found a significant correlation between high consumption of Neu5Gc from red meat and cheeses and increased development of those antibodies that heighten the risk of cancer,” explains corresponding author Dr. Veder Padler-Karavani, of Tel Aviv University.

“For years, there have been efforts to find such a connection, but no one did. Here, for the first time, we were able to find a molecular link thanks to the accuracy of the methods used to measure the antibodies in the blood and the detailed data from the French diet questionnaires.”

Now, combining earlier knowledge and the data provided by the new study, the theory becomes more solid: Consuming mammal products, such as red meat and dairy increases the amount of Neu5Gc on cell surfaces. In turn, this increases the level of circulating anti-Neu5Gc antibodies.

With an increase in these antibodies comes an increase in inflammation, which might raise the risk of exacerbating certain medical conditions, such as cancer.

It is worth noting that the immune response described above is unlikely to be the only link between red meat and cancer.

The authors also mention other factors, including the high fat content in meat and mutagens — chemical compounds that cause irreversible changes in cellular genetic material — such as heterocyclic amine, which is produced when meat is cooked at high temperatures.

In the future, the researchers hope that their Gcemic index will become a tool to assess the amount of Neu5Gc in a person’s diet. This might help design personalized recommendations for at-risk individuals.

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A new study using a global online survey demonstrates that COVID-19 stay-at-home orders resulted in a dramatic increase in unhealthful lifestyle changes.

According to the study — which appeared in the journal Obesity — there were significant increases in sedentary leisure behaviors, declines in physical activity, and increases in anxiety and weight gain, especially in people with obesity.

On the upside, lockdown resulted in substantial improvements in healthful eating.

Since the first reported case of COVID-19 in Wuhan, China, SARS-CoV-2 has spread rapidly worldwide, posing a grave health threat.

On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic, with the United States announcing a national emergency on March 13.

The impact of stay-at-home orders

The U.S. implemented different strategies to limit person-to-person contact in order to mitigate the spread of the virus. Although stay-at-home, quarantine, and social distancing measures diminish transmission of SARS-CoV-2, other health ramifications of these actions are not entirely understood.

The abrupt closures of fitness clubs, restaurants, and places of employment alter eating and physical activity habits. The fear of developing COVID-19, in addition to stay-at-home orders, may provoke added feelings of loneliness and isolation, further exacerbating stress and anxiety.

Stress during a pandemic may result in:

  • anxiety and fear about health, loss of support services, finances, or unemployment
  • sleep disruption or altered sleeping patterns
  • changed eating habits
  • trouble concentrating
  • worsening of chronic health problems, including mental health conditions
  • increased use of alcohol, tobacco, and other substances

Stress associated with altered sleeping patterns, more frequent snacking, and consuming sweet foods may also lead to weight gain.

Researchers at Louisiana State University’s (LSU’s) Pennington Biomedical Research Center designed an innovative online global survey study to quantify changes in physical activity, sedentary behaviors, sleep, mental health, and dietary habits in adults aged 18 and older before and during the initial phase of the COVID-19 lockdown.

The anonymous online survey, accessed through Facebook, the research center’s web page, and an email listserv, ran from April 3, 2020, to May 3, 2020. More than 12,000 individuals looked at the survey, with a total of 7,753 surveys included for analysis.

About 95% of the participants resided in the U.S., United Kingdom, Australia, and Canada. The participants were predominantly white, female, and living in a two-person household, with an average age of 51.

Approximately 32% of the participants had overweight, 34% had obesity, and 32% had a healthy weight. The results of the online survey demonstrated substantial lifestyle changes during the pandemic.

Significant lifestyle behavior changes

Eating out four or more times per week declined by 10%, whereas cooking at home six or more times per week increased by 26% during the pandemic. The validated questionnaire also indicated significant increases in overall healthful eating.

About 44% of the participants reported an increase in unhealthful snacking, while approximately 26% reported increased healthful snacking. The study reported that 36% of the individuals perceived declines in healthful eating, and 21% perceived increases.

A perceived increase in unhealthful eating accompanied trouble falling asleep, decreased physical activity, increased sedentary habits, and nearly twice the reported anxiety levels than in those eating more heathfully.

Sedentary leisure activities increased by 21 minutes on weekdays and 17 minutes on weekends. Physical activity significantly decreased by 18 minutes per week and declined by 112 minutes per week in terms of metabolic equivalents after adjusting for exercise intensity.

The results also showed that sleep onset and wake time increased substantially by 42 minutes and 59 minutes, respectively. Additionally, about 44% of the participants reported worse sleep quality, while 10% experienced improved sleep quality.

As many as 75% of the participants reported being concerned or moderately concerned for their health or their family members’ health (87.5%) due to COVID-19. Reported symptomatic anxiety also significantly increased — by 14% — compared with before the pandemic.

The study results demonstrated incredibly disproportionate changes in health behaviors in individuals with obesity that stemmed from COVID-19 stay-at-home orders.

“Overall, people with obesity improved their diets the most. But they also experienced the sharpest declines in mental health and the highest incidence of weight gain,” says Dr. Leanne Redman, associate executive director for Scientific Education at Pennington Biomedical Research Center.

A total of 24% of the participants with obesity reported symptomatic anxiety compared with 17% for both the individuals with a healthy weight and those with overweight. However, symptomatic anxiety was similar among all three groups before the pandemic.

During lockdown, weight gain occurred in 33% of the individuals with obesity compared with 25% of the participants with a healthy weight and 21% of those with overweight.

Even though the participants with obesity had a lower baseline physical activity than the participants with a healthy weight and the participants with overweight, the change in physical activity was the same across the three groups. The individuals with obesity also had greater sleep onset increases than the people in other two groups, but wake time remained the same.

The self-reported survey study design was a significant limitation due to the possible introduction of recall bias. Another drawback of the study was the lack of diversity of the study population, which primarily comprised older white adult women from similar geographic locations.

Understanding the impact

According to Dr. John Kirwan, executive director of LSU’s Pennington Biomedical Research Center:

“This study is the first to survey thousands of people across the globe on lifestyle behavior changes in response to stay-at-home orders. […] The study demonstrates that chronic diseases like obesity affect our health beyond the physical.”

“Dr. Redman’s study is just one of many initiatives the center launched to help understand COVID-19’s impact and to slow its spread,” he adds.

The lead author of the study, Dr. Emily Flanagan, also notes that the research team would like physicians and scientists to change how they manage patients with obesity by:

  • making mental health screenings more frequent during and following the pandemic
  • staying in contact with patients and study participants, respectively, with the help of remote visits and telehealth to prevent irreversible changes to health that the pandemic may cause

She also suggests that so-called virtual visits could alleviate the concerns patients may have about the safety of traditional, face-to-face visits.

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Stroke is one of the many debilitating diseases today and a leading cause of death and disability worldwide with a prevalence rate of 1.14 per 1000.

A stroke happens when a major blood vessel (artery) which supplies nourishment and oxygen to the brain ruptures or is suddenly blocked. Disrupting this vital supply line to one-half of the brain results in paralysis on the opposite side of the body. Stroke is often preventable but in low and middle-income countries such as Nigeria, where the primary care services are often limited, the burden of stroke mortality is high.

According to World Stroke Organisation (WSO), 90 per cent of strokes are associated with 10 risk factors that can easily be identified: hypertension, exercise, diet, weight, smoking, alcohol, cholesterol, diabetes, depression and stress, and atrial fibrillation (AF, or AFib).

Stroke prevention
Stroke can be prevented in many ways across all boards, from government and policymakers to healthcare professionals to members of the community. Ways to prevent stroke include:

1- Increasing awareness
Despite being the second biggest killer globally, awareness of stroke risk factors and how to manage them is still relatively low. Coordinated global and national campaigns that raise awareness of how to reduce and manage individual stroke risks have the potential to deliver significant gains in stroke prevention.

2- Discovering risk factors for stroke and managing them appropriately

3-Implementing population-wide preventive strategies
Despite clear evidence of the effectiveness of population-wide strategies, there is still not a single country in the world that has implemented these in full on a population level.

4- Build partnerships and advocacy

To create a lasting impact in stroke prevention, we need to build partnerships between healthcare, government, and provide the evidence to support stronger advocacy from Non-Governmental Organisations (NGOs).
5-Modification of lifestyle and maintenance of healthier lifestyle and blood pressure control can significantly reduce the incidence of stroke in the society. A healthy lifestyle includes not smoking, no binge drinking, being physically active, and a healthy diet characterised by adequate fruit and vegetable intake, reduced dietary trans-fat intake, and reduced sodium intake.

Stroke care international (SCI), a charity-based stroke support organisation working to beat stroke in UK and Africa aims to prevent avoidable strokes, promote, recovery, and support life after stroke.
Mission includes:

– Stroke awareness and campaign actions: This encompasses all approaches that are concerned with screening, raising awareness, health education on risk factors, ways to reduce disease risks, and other health promotion activities.

-Health and lifestyle educational programmes that focus on risk reduction. This helps people to understand the link between high blood pressure and stroke, as well as their other stroke risk factors through organising health outreaches and stroke education to various media stations in Nigeria.

-Stroke support services aimed at supporting stroke survivors, family, and carers on their journey to live the best possible life after stroke by creating a positive environment to meet other stroke survivors and share experiences.

Survivors’ rehabilitation
Stroke survivors live with long-term Consequences such as disabilities and often manage their resulting limitations and health status as a chronic condition.

As the population of stroke survivors increases and the number of survivors with a disability and chronic care needs grow, rehabilitation care and therapy play an increasingly important role in integrating survivors back to society.

Rehabilitation is an important part of recovery after a stroke.
It helps patients relearn skills that were lost and regain independence, and improve the quality of their lives.

Stroke affects each person in different ways and survivors may experience a range of physical limitations such as paralysis of one side of the body, difficulty with language and speech, difficulty swallowing, vision problems, and imbalance.

Stroke rehabilitation may include physical, occupational, speech, and recreation therapies.
Physical therapy: Physiotherapy is an integral component of recovery from a stroke as it will improve function, health, and independence. It uses specialised modalities and exercises to help survivors relearn movement and coordination skills they may have lost because of the Stroke.

Goals of physiotherapy involve: restoring mobility, managing motor deficits, preventing and treating complications, community reintegration, improve independence, maximise function, and coordinate continuity of care.

Occupational therapy: Focuses on restoring the ability to perform daily activities, such as eating, drinking, dressing, bathing, reading, and writing.

Speech therapy or cognitive rehabilitation: Speech therapy helps people who have problems producing or understanding speech.

*Gloria Ekeng is a Stroke Nurse Consultant and executive board member of the World Stroke Organisation (WSO)

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Cardiovascular disease (CVD) is the leading cause of death globally, according to the World Health Organisation (WHO) and 17.9 million people die of the ailments yearly, representing 31 per cent of the world’s total mortalities.

In Nigeria, Non-communicable diseases (NCDs) account for 29 per cent of all deaths. CVD, predominantly hypertension is responsible for 11 per cent of all the NCD’s deaths that occurred prematurely in persons below 70 years.

Meanwhile, to mark the World Heart Day (WHD), September 29, experts have harped on the need to raise awareness and mobilise international action against cardiovascular disease.

They also highlighted the imperative to strengthen CVDs’ management in primary healthcare institutions with a view to reducing the high death rate.

Addressing newsmen in Lagos, President, Nigerian Heart Foundation (NHF), Mallam Ismaila Shuaibu, said the initiative was for individuals, government, and the entire heart community to come together to engage in fun activities, increase public education and advocate for universal access to CVD protection, detection, and treatment.

He explained that CVD which comprises of hypertension, heart disease, and stroke are the world’s number one leading cause of death and disability.

Shuaibu noted that as part of measures to reduce the burden of CVD, the foundation is intensifying efforts to raise public awareness about heart disease and their associated risk factors including ways to promote cardiovascular health.

Also, former President, Nigerian Institute of Food Science and Technology, Mrs. Dolapo Coker, said the most important way to fight any ailment is to boost the immune system.

The nutritionist explained that food is the primary healthcare system of any disease urging the general population to take more fruits and vegetables.

Coker continued: “We are blessed in Nigeria because we have these vegetables in abundance. We need to educate the populace not to depend on fast food but on God-given organic food. Everyone can avoid CVD, the basic thing is good nutrition and also to make sure its awareness is heightened.”

She added that the government should lead an awareness campaign to let the masses realise things that are against health.

Coker, however, stated that there is no bad food rather every food must be taken in moderation.

Executive Director, NHF, Dr Kingsley Akinroye said that smoking, tobacco high blood pressure, and obesity are causes of CVD stressing the need for individual and societal behaviour change.

He added that it is vital to make access to healthcare, healthy foods, and a healthy way of life accessible and affordable to all people.

Akinroye said the theme for 2020 World Heart Day, “Use Heart To Fight Cardiovascular Disease” was to unite the global health community to beat cardiovascular disease and also ask individuals, communities, and governments to use the heart to make better choices for society, loved ones and ourselves.

He noted that the call to action is about using our head, influence, and compassion to beat the cardiovascular disease, the world’s number one killer.

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A new study has found a significant rise in people searching Google for anxiety symptoms during the pandemic.

New research found that in the United States, Google searches for ‘worry,’ ‘anxiety,’ and therapeutic techniques to manage worry and anxiety have increased during the pandemic.

The research, featuring as a commentary in the journal Psychological Trauma: Theory, Research, Practice, and Policy, highlights the burden the COVID-19 pandemic has placed not only on people’s physical health but also their mental health.

COVID-19 and mental health

COVID-19 has had a profound effect on people. The world is approaching one million recorded deaths from the disease. And, some of those who recovered from the initial virus effects continue to suffer long-term symptoms that are yet to be fully understood.

Once the knock-on effects of the disease factor in — for example, overwhelmed critical care units prolonging treatment times for people with other serious illnesses — then it is clear that the pandemic has had a devastating effect on people’s health around the world.

However, as well as people’s physical health, it is also becoming clear that the pandemic is significantly affecting their mental health.

Early in the pandemic, there were anecdotal reports that people’s mental health was worsening, including those with pre-existing mental health issues and those whose mental health was normally well. As time has gone on, more research has started to corroborate these reports.

Google Trends

In the present study, the researchers wanted to explore an alternative way of determining the pandemic’s effects on mental health: analyzing Google search requests.

Google Trends allows anyone to see the search terms that people use for various populations, globally and locally. As Dr. Michael Hoerger, Assistant Professor of Psychology and Psychiatry at Tulane University Cancer Center, New Orleans, and his co-authors note:

“Although by no means a ‘window into the soul,’ people’s search terms reflect relatively uncensored desires for information and thus lack many of the biases of traditional self-report surveys.”

Previous health science research has made use of Google Trends data in studies, and the present study’s investigators wanted to see how effective it could be in the context of mental health in the current pandemic.

To do this, they accessed weekly U.S. search terms from April 21, 2019 to April 21, 2020.

Worry and anxiety searches increased

By comparing the pre- and post-pandemic search terms, the researchers were able to identify four relevant themes.

Firstly, following the announcement of the pandemic, search terms related to ‘worry’ increased significantly. These terms included ‘worry,’ ‘worry health,’ ‘panic,’ and ‘hysteria.’

Secondly, people shifted to searching for anxiety symptoms, which spiked after the initial flurry of worry-related search terms.

Thirdly, the researchers did not see a significant increase in other mental health search terms, such as depression, loneliness, suicidal ideation, or substance abuse.

Rather than interpreting this to suggest that these issues did not increase, the authors speculate that people’s searches relating to these issues may occur later, or that they may be better at utilizing self-care techniques concerning these.

Finally, the researchers noticed that not only did people understandably search for more online therapy rather than face-to-face therapy, they also searched for therapy techniques for dealing with anxiety symptoms.

Users did so with search terms such as ‘deep breathing’ and ‘body scan meditation.’

Tip of the iceberg

For Dr. Hoerger, “[o]ur analyses from shortly after the pandemic declaration are the tip of the iceberg.”

“Over time, we should begin to see a greater decline in societal mental health. This will likely include more depression, PTSD, community violence, suicide, and complex bereavement. For each person that dies of COVID, approximately nine close family members are affected, and people will carry that grief for a long time.” – Dr. Michael Hoerger

The researchers suggest that by continuing to track Google Trends data, public health bodies may be able to better identify people’s mental health needs promptly, reducing the pandemic’s psychological effects.

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A new study has explored the link between the Zika and chikungunya arboviruses and neurological or cerebrovascular diseases.

New research has helped clarify the link between the Zika and chikungunya arboviruses — viruses carried by arthropods such as mosquitoes — and neurological complications.

The study also found that a person who has both Zika and chikungunya is more likely to have severe symptoms and more likely to experience a stroke.

The research, appearing in the journal The Lancet Neurology, will help clinicians better treat patients who contract these viruses, which are endemic in various parts of the world.

Arthropods and arboviruses

Arboviruses are carried by mosquitoes, midges, ticks, and sandflies — all of which belong to the phylum Arthropoda and are known as arthropods. When an infected arthropod bites a human, the human may contract the arbovirus.

The Centers for Disease Control and Prevention (CDC) note that more than 130 types of arbovirus can cause disease in humans. Two arboviruses that have recently spread throughout South America are Zika and chikungunya.

In the Americas, both viruses are commonly spread by the same mosquito species, and according to the CDC, both can cause broadly similar symptoms, including joint or muscle pain, a fever, headaches, swelling, and a rash.

While most people recover without needing treatment in a hospital, both types of illness can occasionally cause severe symptoms. Moreover, if contracted during pregnancy, Zika leads to an increased risk of developmental abnormalities and complications, including microcephaly, which affects the development of the head.

In addition to these risks, there is a growing awareness that neurological diseases are linked to Zika and chikungunya.

According to Dr. Maria Lúcia Brito Ferreira, a neurologist and department head at the Hospital da Restauração, in Recife, Brazil, and the lead author of the present study:

“Zika infection most often causes a syndrome of rash and fever without many long-term consequences, but these neurological complications — although rare — can require intensive care support in hospital, often result in disability, and may cause death.”

Arboviruses and neurological disease?

In the present study, the researchers wanted to explore the different ways that arboviruses such as Zika and chikungunya result in neurological diseases. They also wanted to assess whether people who contract two arboviruses tend to develop different diseases or experience a change in disease severity.

To do so, they conducted a 2-year study starting on December 4th, 2014, in Recife during an epidemic of Zika and chikungunya. In addition, the dengue arbovirus, which causes dengue fever and has been linked to neurological complications, is also endemic in the area.

The researchers recruited 201 people who had been admitted to the Hospital da Restauração with neurological issues and who had symptoms suggesting an arbovirus infection. Fifty-four percent of the participants were female, and the average median age was 48.

Laboratory analyses revealed that among these 201 participants, 148, or 74%, had arboviral infections.

Just under half of the 201 participants had a single viral infection — 41 had Zika, 55 had chikungunya, and two had dengue.

A quarter of the participants, or 50, had some signs of two viral infections, and 46 of them had Zika and chikungunya.

Dual viruses made symptoms more severe

The researchers found that a significant number of the participants with a confirmed arboviral infection had symptoms affecting either their central nervous system or peripheral nervous system.

There was a clear split between Zika and chikungunya: of the 55 participants with chikungunya, 26, or 47%, had a disease related to their central nervous system, compared with only six, or 15%, of the 41 participants with Zika.

In contrast, 63% of the participants with Zika had a peripheral nervous system disease, mainly Guillain-Barré syndrome, compared with 16% of the participants with chikungunya.

The researchers also found that the participants who had both Zika and chikungunya infections as well as Guillain-Barré syndrome had more severe symptoms, requiring a longer hospital stay and a greater degree of intensive care.

Finally, the researchers discovered a link between stroke and having two viral infections.

Of the 46 participants with both Zika and chikungunya, eight, or 17%, had a stroke or a transient ischemic attack — sometimes known as a “mini-stroke.” This compares with five, or 6%, of the 96 participants who had only a single viral infection.

Broader implications

As well as contributing new knowledge about Zika and chikungunya, the research has implications for other viral diseases. As Dr. Suzannah Lant, a clinical research fellow at the University of Liverpool and a contributor to the study, explains, “Our study highlights the potential effects of viral infection on the brain, with complications like stroke.”

“This is relevant to Zika and chikungunya, but also to our understanding of other viruses, such as [SARS-CoV-2, the virus behind COVID-19], which is increasingly being linked to neurological complications.”

According to senior study author Prof. Tom Solomon, director of the Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, “Although the world’s attention is currently focused on COVID-19, other viruses that recently emerged, such as Zika and chikungunya, are continuing to circulate and cause problems.”

“We need to understand more about why some viruses trigger stroke, so that we can try and prevent this happening in the future.” – Prof. Tom Solomon

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A study finds that getting enough sleep helps people maintain emotional equilibrium and enjoy the good things in life.

Research shows that a range of health conditions are associated with a lack of sleep. A new study from researchers at the University of British Columbia (UBC) in Vancouver, Canada, investigates the psychological — rather than physical — implications of missed sleep.

The scientists found that after an insufficient night of sleep, people have a reduced capacity for remaining positive when faced with emotionally challenging events. They are also less able to enjoy positive experiences.

The lead author of the study, health psychologist Nancy Sin of UBC, describes how this results in more stressful days for people who do not get enough sleep:

“When people experience something positive, such as getting a hug or spending time in nature, they typically feel happier that day. But we found that when a person sleeps less than their usual amount, they don’t have as much of a boost in positive emotions from their positive events.”

Stress is associated with a range of harmful effects, compounding the damage done by sleep deficits.

The study appears in the journal Health Psychology.

Daily diaries tell a story

“The recommended guideline for a good night’s sleep is at least seven hours, yet one in three adults don’t meet this standard,” says Sin.

To explore the effects of insufficient sleep, Sin and her colleagues analyzed an existing data set of 1,982 United States residents, 57% of whom were female. The participants gave their sociodemographic details and existing chronic conditions to the researchers at the start of the study.

The individuals kept daily diaries. For eight consecutive days, they were interviewed daily via phone calls, during which participants reported the number of hours they had slept the previous night.

Each person also described the events of their day. They recalled problems they had encountered: interpersonal tensions, arguments, feeling of discrimination, and stresses with their work associates and family. They also recalled the good things that happened. In addition, participants reported their emotional responses from that day, both positive and negative.

The pattern that emerged was a lessened ability to remain or feel positive when participants had less sleep. When experiencing stress, they found it harder to maintain emotional equilibrium. And when good things happened, feelings of joy or happiness were muted.

Such days may be more than unpleasant — earlier research, including Sin’s own, has found links between an inability to retain feelings of positivity and inflammation, as well as death.

“A large body of research shows that inadequate sleep increases the risk of mental disorders, chronic health conditions, and premature death. My study adds to this evidence by showing that even minor night-to-night fluctuations in sleep duration can have consequences in how people respond to events in their daily lives.” – Nancy Sin, UBC

The researchers found no evidence that not getting enough sleep increased participants’ negative emotions the following day.

Getting better rest

Previous research has found that individuals with chronic health conditions, including diabetes, cancer, and heart disease, tend to be more emotionally reactive when confronted with stressful events. Considering that getting more sleep could help to prevent this, Sin says she was interested to learn “whether adults with chronic health conditions might gain an even larger benefit from sleep than healthy adults.”

The study’s finding suggests this might be the case, she says.

“For those with chronic health conditions, we found that longer sleep — compared to one’s usual sleep duration — led to better responses to positive experiences on the following day.”

Sin hopes that studies such as hers will convince people to prioritize getting enough sleep as a way to stay healthy and have better days.

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A new study in mice adds to the evidence suggesting that the immune system not only attacks invading pathogens but can also influence mood.

Over the past few years, scientists have discovered some intriguing links between immunity and the mind.

One of the immune signaling molecules, or cytokines, that mediates these links is called interleukin-17a (IL-17a).

IL-17a plays a role in psoriasis, which is an autoimmune skin condition, but it may also contribute to the depression that many people experience. Indeed, a study involving a mouse model of psoriasis found that IL-17a caused depression-like symptoms.

In humans, researchers have also linked the molecule to treatment resistant depression.

Research in mice has even implicated IL-17a in the development of autism.

“The brain and the body are not as separate as people think,” says Prof. Jonathan Kipnis, a neuroscientist at the Washington University School of Medicine in St Louis, MO.

While working at the University of Virginia School of Medicine in Charlottesville, Prof. Kipnis and colleagues found that IL-17a causes anxiety-like behavior in mice.

“We are now looking into whether too much or too little of IL-17a could be linked to anxiety in people,” says Prof. Kipnis.

The scientists have published the results of their mouse study in the journal Nature Immunology. Kalil Alves de Lima, a postdoctoral researcher who is also now at the University of Washington, led the research.

Gamma-delta T cells

Immune cells called gamma-delta T cells produce IL-17a. The cells are present in the meninges, which are the membranes surrounding the brain and spinal cord.

To determine what effect IL-17a might have on behavior, the scientists studied mice whose gamma-delta T cells did not produce any IL-17a and mice who lacked the cells completely.

They put the mice through standard tests of memory, social behavior, foraging, and anxiety. The mice performed just as well as normal mice on all tests apart from two that measure anxiety levels.

In those tests, the mice who lacked gamma-delta T cells or did not produce any IL-17a were more likely to explore open areas. In the wild, this kind of behavior would put them at greater risk of being eaten by predators.

The researchers interpreted this as a sign of reduced anxiety in animals without IL-17a signaling in their central nervous system.

Next, the scientists investigated how the signal affects neurons in their brains. They found receptors for IL-17a on a type of stimulatory nerve cell called a glutamatergic neuron.

When they genetically manipulated the neurons to prevent them from making these receptors, the mice exhibited less anxiety-like behavior.

The gut-brain axis

Previous animal research has revealed a multitude of possible links between bacteria living in the gut and behavior, including anxiety-like behaviors.

This connection is known as the gut-brain axis, and scientists have proposed the immune system as one possible way that messages pass between them.

To investigate the role of IL-17a in the gut-brain axis, Alves de Lima and colleagues injected the mice with lipopolysaccharide. This is a toxin that bacteria produce. It provokes a strong immune reaction.

In response to the injection, gamma-delta T cells in the meninges surrounding the animals’ brains produced more IL-17a.

In another experiment, when the researchers treated the mice with antibiotics to kill the bacteria in their guts, the animals produced less IL-17a.

Together, the results of these experiments suggest that the immune system has evolved not only to fight infection but also to adjust behavior to keep animals safe while they are in a weakened state.

“Selecting special molecules to protect us immunologically and behaviorally at the same time is a smart way to protect against infection. This is a good example of how cytokines, which basically evolved to fight against pathogens, also are acting on the brain and modulating behavior.” – Kalil Alves de Lima

The team is now investigating how gamma-delta T cells in the meninges surrounding the brain can detect the presence of bacteria elsewhere in the body.

The researchers are also looking into exactly how IL-17a signaling in the brain changes behavior.

In their paper, they conclude:

“Our findings provide new insights into the neuroimmune interactions at the meningeal–brain interface and support further research into new therapies for neuropsychiatric conditions.”

Although the physiology of mice and humans is very similar, scientists need to carry out much more research to explore the possible links between the human immune system and mood.

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