Stroke Risk Is Changing With the Climate

Fifi is a vascular neurologist and neuroendovascular surgeon.

The world endured its hottest summer on record in 2024, and the transition to fall brought devastation from multiple hurricanes in the U.S. The growing effects of climate change are widespread and becoming more severe. Now, new research is making it apparent that my field of neurointerventional surgery must confront the growing and deadly link between climate change and an increase in stroke.
Just last month, the latest stroke update from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study in The Lancet Neurology reported that “rises in ambient temperature (including heatwaves) and climate change are associated with increased stroke morbidity and mortality.”
Earlier this year, another study published in Neurology found that, in 2019, more than half a million people died due to strokes that were linked to extreme temperatures (including both extreme highs and lows). From the study, “Globally, low temperature (deaths 474,002, 95% UI 355,077–606,537; DALYs 8,357,198, 95% UI 6,186,217–10,801,911) contributed more to stroke deaths and DALYs [disability-adjusted life years] than high temperature (deaths 48,030, 95% UI 5,630–104,370; DALYs 1,089,329, 95% UI 112,690–2,375,345) in 2019.”
While research on the climate change-stroke connection focuses mostly on extreme temperatures and air pollution, we know that service disruptions due to other extreme weather events — like the hurricanes and flooding that caused so much devastation in the Southeastern U.S. — will ultimately lead to treatment delays and a potential increase in death and disability from stroke. In fact, in preparation for the extreme effects of Hurricane Milton, first responders were forced to suspend answering 911 calls.
As with so many health issues, the poorer a patient is, the more vulnerable they are. In these studies, the connection between climate change and stroke mortality was stronger in low-income countries than high-income countries. Moreover, emerging research at the intersection of environmental justice and medicine is shedding light on comparable injustices being experienced here in the U.S., further exacerbating serious health disparities in stroke care.
Specifically, research released at the Society of NeuroInterventional Surgery’s annual meeting this summer found that worsening air quality and temperature extremes in the U.S. are linked to increased stroke burden, especially among those with lower incomes and a lack of health resources.
Researchers found that stroke prevalence was higher in areas with higher climate vulnerability scores, especially in the Southeast and the Midwest. Across the entire country, stroke incidence was 1.5 times higher in areas with the highest climate vulnerability scores (in the top 10th percentile in the Climate Vulnerability Index) compared to areas with lower scores (in the 50th percentile). Rural areas were especially likely to have high levels of combined climate vulnerability and stroke prevalence.
What this growing body of research makes clear is climate change is altering what it means to be “at risk” for a stroke. And to best serve potential patients, the fields of stroke and neurointerventional medicine and public health need to adapt our approach to stroke care.
Today, much of the public-facing stroke messaging is focused on prevention, and while stroke prevention is important, stroke education cannot end there. Focusing on risk factors alone can leave those who fall outside of the “high-risk” category unprepared. Plus, now we know the risk factors are shifting. Strokes affect people of all ages, including children, as well as those who have a healthy diet and have no family history of stroke.
The authors of the GBD stroke study conclude, “In summary, our study findings continue to point out that currently used stroke prevention strategies are not sufficiently effective to halt, let alone reduce, the fast-growing stroke burden.”
I agree. We need to approach the reduction of the global stroke burden from multiple angles.
A common barrier to better care is that many people are unfamiliar with stroke symptoms. According to a recent omnibus survey, around two-thirds of adults (63%) say they would know if they were having a stroke, but only 16% of adults can correctly identify common stroke symptoms, and around 1 in 10 (11%) get all these common symptoms incorrect.
Healthcare providers need to share the BE FAST acronym with every patient. It is a critical tool to assess stroke symptoms: Balance loss, Eyesight changes, Facial drooping, Arm weakness, Speech difficulty, Time to call 911.
The survey also found that less than half of American adults would call 911 for a stroke. That statistic points to a huge gap in public understanding, one that can be the difference between life and death.
Nearly 2 million brain cells die every minute a severe stroke goes untreated. The longer a patient’s treatment is delayed, the greater the impact of a stroke, including the potential for severe disability and death. Yet, not realizing it’s time-sensitive, too many people drive themselves to the hospital or have a family member or friend drive them instead of calling 911. Our patients need to understand that even one, “mild” symptom of stroke is a reason to call 911.
So many of us feel powerless to mitigate the effects of climate change, but stroke is one place where public education can increase quality of life and survival. As we continue to learn more about the influence of climate change on stroke, we can take action now to reduce stroke death and disability by emphasizing to our patients, our loved ones, and the American public at large that stroke can happen to anyone at any age. Knowing BE FAST and seeking emergency treatment options immediately will save lives and reduce disability.
Johanna Fifi, MD, is a neuroendovascular surgeon at Mount Sinai Hospital in New York City and the president of the Society of NeuroInterventional Surgery. She serves as a professor of Neurosurgery, Neurology, and Radiology at the Icahn School of Medicine at Mount Sinai and is the director of the Pediatric Neuroendovascular Program, associate director of the Cerebrovascular Center, and co-director of the Neuroendovascular Surgery Fellowship Program.

Disclosures
Fifi is a consultant for Medtronic, Cerenovus, Stryker, MIVI, and Microvention. She owns stock in Imperative Care.

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Canadian Teenager Is Country’s First Human Bird Flu Case

A teenager in British Columbia was hospitalized in critical condition with the disease, and officials were working to find out how the person was exposed to the virus.A teenager was hospitalized and in critical condition after contracting bird flu, in what Canadian officials said on Tuesday was the country’s first known case of the virus being transmitted to a human.Health officials in British Columbia were investigating how the teenager came down with the disease despite having no known links to poultry farms, the most common sites where bird flu has been detected in Canada.The virus, called H5N1, is a low risk to the public, health officials said, because it does not spread easily between people. But prolonged outbreaks, such as a cluster in U.S. dairy cattle can increase the chances of the virus mutating and spreading.There have been 46 cases of people contracting the virus in the United States, according to the Centers for Disease Control and Prevention, nearly all of them farm workers. Most cases have been mild.About 36 people who came into contact with the young person in Canada have tested negative for the virus and were offered a preventative course of antiviral medication, Dr. Bonnie Henry, British Columbia’s health officer, said at a news conference on Tuesday. Pets also tested negative.Bird flu, or avian influenza, has not broken out in Canadian dairy farms, but at least two dozen poultry farms have detected the virus since October 2024, officials said.Officials are making painstaking efforts to track down the source of the viral exposure in British Columbia.“There is a very real possibility that we may not ever determine the source, but at this point, we have a number of leads that we’re following,” Dr. Henry said. “We will be tracking down everyone because this is such a rare event.”Officials would not disclose the age or gender of the teenager, but said the person was in critical condition and receiving treatment at the B.C. Children’s Hospital in Vancouver after being admitted on Friday.About a week before that, the teenager went to a hospital emergency room complaining of respiratory symptoms, and had pink eye, fever and a cough. The teenager was sent home at the time and did not attend school before being admitted to the hospital, Dr. Henry said.There has only been one other case, in 2014, of bird flu in a Canadian citizen. Experts say they believe that person contracted the virus during a trip to China, where H5N1 was first discovered about two decades ago. That Canadian later died.British Columbia has warned members of the public to avoid handling dead birds or allowing pets near them.Poultry farmers were also warned to take caution.“People who are raising ducks and chickens and other domestic fowl are advised to keep their flocks indoors, as these birds are spreading their avian flu viruses up and down North America,” said Dr. Brian Ward, a professor at McGill University in Montreal who researches infectious diseases.

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U.S. Overdose Deaths Are Down, Giving Experts Hope for an Enduring Decline

The decline in U.S. drug overdose deaths appears to have continued this year, giving experts hope the nation is seeing sustained improvement in the persistent epidemic.
There were about 97,000 overdose deaths in the 12-month period that ended June 30, according to provisional CDC data released Wednesday. That’s down 14% from the estimated 113,000 for the previous 12-month period.
“This is a pretty stunning and rapid reversal of drug overdose mortality numbers,” said Brandon Marshall, PhD, a Brown University researcher who studies overdose trends.
Overdose death rates began steadily climbing in the 1990s because of opioid painkillers, followed by waves of deaths led by other opioids like heroin and — more recently — illicit fentanyl. Provisional data had indicated a slight decline for 2023, and the tally released Wednesday showed that the downward trend has kept going.
Of course, there have been moments in the last several years when U.S. overdose deaths seemed to have plateaued or even started to go down, only to rise again, Marshall noted.
“This seems to be substantial and sustained,” Marshall said. “I think there’s real reason for hope here.”
Experts aren’t certain about the reasons for the decline, but they cite a combination of possible factors.
One is COVID-19. In the worst days of the pandemic, addiction treatment was hard to get and people were socially isolated — with no one around to help if they overdosed.
“During the pandemic we saw such a meteoric rise in drug overdose deaths that it’s only natural we would see a decrease,” said Farida Ahmad, MPH, of the CDC’s National Center for Health Statistics.
Still, overdose deaths are well above what they were at the beginning of the COVID-19 pandemic.
The recent numbers could represent the fruition of years of efforts to increase the availability of the overdose-reversing drug naloxone (Narcan), and addiction treatments such as buprenorphine, said Erin Winstanley, PhD, a University of Pittsburgh professor who researches drug overdose trends.
Marshall said such efforts likely are being aided by money from settlements of opioid-related lawsuits, brought by state, local, and Native American governments against drugmakers, wholesalers, and pharmacies. Settlement funds have been rolling out to small towns and big cities across the U.S., and some have started spending the money on naloxone and other measures.
Some experts have wondered about changes in the drug supply. Xylazine, a sedative, has been increasingly detected in illegally manufactured fentanyl, and experts are sorting out exactly how it’s affecting overdoses.
In the latest CDC data, overdose death reports are down in 45 states. Increases occurred in Alaska, Nevada, Oregon, Utah, and Washington.
The most dramatic decreases were seen in North Carolina and Ohio, but CDC officials voiced a note of caution. Some jurisdictions have had lags in getting death records to federal statisticians — particularly North Carolina, where death investigations have slowed because of understaffing at the state medical examiner’s office. The CDC made estimates to try to account for incomplete death records, but the decline in some places may ultimately turn out not to be as dramatic as initial numbers suggest.
Another limitation of the provisional data is that it doesn’t detail what’s happening in different groups of people. Recent research noted the overdose deaths in Black and Native Americans have been growing disproportionately larger.
“We really need more data from the CDC to learn whether these declines are being experienced in all racial ethnic subgroups,” Marshall said.

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Novel Weekly Oral HIV Drug Safe in Early Trial of Healthy Volunteers

Data from a phase Ia clinical trial of an oral, long-acting integrase inhibitor (GS-1720) in development for HIV demonstrated promising safety in healthy adults without HIV. The findings were presented at the recent IDWeek annual meeting in Los Angeles.
In this MedPage Today video, Joseph Eron, MD, of the University of North Carolina at Chapel Hill, discusses the findings.
Following is a transcript of his remarks:
We saw pharmacokinetic data on a new long-acting integrase inhibitor. So this is a drug that’s still in development. So this is GS-1720. It’s been studied as single doses in healthy volunteers without HIV infection, and also as a single dose in — actually two doses 1 day apart — in people with HIV. And that’s been presented before. It is very active as two doses given at one time over an 11-day period. But this is the first study that is showing us about multiple doses.
This study is in healthy volunteers who are without living without HIV. And what they showed very clearly is that three different doses of [GS-]1720 had excellent levels given once weekly for 6 weeks and very, very few side effects, very, very few adverse effects, almost all grade 1. So that’s good news. High levels well above the protein-adjusted IC95 [95% inhibitory concentration].
And then at the end of the talk, the presenter actually disclosed that this long-acting integrase inhibitor is being partnered with a pro-drug of lenacapavir [Sunlenca] and given once a week in phase II studies in people living with HIV, including people who are treatment naive. And you might add, well, why aren’t they using once-weekly lenacapavir, because that’s something that’s being studied along with islatravir, and I think it has to do with pill size. I don’t know for sure because I wasn’t able to ask that question, but it’s an exciting opportunity for another potential once-weekly oral treatment for HIV.

Greg Laub is the Senior Director of Video and currently leads the video and podcast production teams. Follow

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1 in 5 Adults Report Anxiety, Depression; New Esketamine Warning; Autism Dx Up 175%

One in five adults said they experienced any symptoms of anxiety or depression in a 2-week period, according to a 2022 CDC survey.
The FDA added a warning to the label of esketamine nasal spray (Spravato), noting that long-term cognitive and memory impairments have been reported with ketamine misuse or abuse.
Ketamine was detected in less than 1% of overdose deaths in the U.S., a 2019-2023 analysis found. (Morbidity and Mortality Weekly Report)
Why did lithium fall out of favor for bipolar disorder? (The Guardian)
Greater depression severity was significantly associated with increased diabetes incidence and elevated HbA1c, fasting glucose, and insulin levels, an analysis of national survey data found. (Scientific Reports)
Over the past 50 years, the prevalence of antipsychotic polypharmacy increased globally and was tied to increased risks of relapse, psychiatric hospitalization, and worse global functioning versus monotherapy. (Lancet Psychiatry)
Investigational emraclidine flopped in two phase II studies, failing to reduce symptom severity in adults with schizophrenia who were experiencing an acute exacerbation of psychotic symptoms, said developer AbbVie.
College students in sexual and gender minority groups were more likely to report depression, a survey study showed. (Journal of American College Health)
Autism spectrum disorder diagnoses increased 175% from 2011 to 2022, and are becoming more prevalent in young adults, according to a cross-sectional study. (JAMA Network Open)
A psychiatrist explains the difference between “normal” anxiety and an anxiety disorder. (Washington Post)
Brief cognitive behavioral therapy by video telehealth reduced suicide attempts among adults with recent suicidal ideation or behavior in a randomized trial. (JAMA Network Open)
BioXcel said a phase III at-home trial testing its investigational drug for agitation associated with bipolar disorders, schizophrenia, and Alzheimer’s dementia is now underway.
The Canadian Research Initiative in Substance Matters released a guideline update for the clinical management of opioid use disorder, recommending buprenorphine and methadone as first-line treatments. (CMAJ)
Increasing alcohol use during the COVID pandemic persisted into 2022, a national cross-sectional study showed. (Annals of Internal Medicine)

Kristen Monaco is a senior staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.

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RSV Severity, Deaths on Par With Flu and COVID

In the years before the introduction of respiratory syncytial virus (RSV) vaccines, the virus was linked with substantial hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths among adults, according to a cross-sectional analysis of CDC data.
Adjusted analysis showed estimated RSV-associated hospitalization rates ranging from 48.9 per 100,000 adults during the 2016-2017 respiratory season to 76.2 per 100,000 in 2017-2018, reported researchers led by Fiona Havers, MD, MHS, of CDC’s National Center for Immunizations and Respiratory Diseases in Atlanta.
Estimated hospitalization rates were highest among adults ages 75 and older, ranging from 244.7 per 100,000 in 2022-2023 to 411.4 per 100,000 in 2017-2018, findings in JAMA Network Open indicated.
In addition, annual estimates of RSV-associated ICU admissions ranged from 24,400 to 34,900 for the 2016-2017 and 2017-2018 seasons, respectively, while estimated annual in-hospital deaths ranged from 4,680 in 2018-2019 to 8,620 in 2017-2018.
“These findings validated RSV as a substantial contributor to respiratory illness and hospitalization among adults, especially older adults,” Havers and colleagues wrote, noting that up to 136,000 estimated annual hospitalizations occurred among those 65 years or older.
Researchers used data from the CDC’s RSV Hospitalization Surveillance Network (RSV-NET) to arrive at their estimates. From the database, they identified a total of 16,575 laboratory-confirmed RSV-associated hospitalizations from the 2016-2017 to the 2022-2023 respiratory virus seasons. To estimate RSV burden, Havers and colleagues used adjustment multipliers to correct for the relatively low proportion of adults who were actually tested for RSV while hospitalized, as well as test sensitivity.
Of note, RSV severity “appeared to be comparable to or possibly more than the severity of influenza and SARS-CoV-2” in hospitalized adults. In the study, about 19% of adults hospitalized with RSV required ICU care and 4.3% died in the hospital. In comparison, CDC data from the 2021-2022 season found that 15.5% of hospitalized adults with COVID-19 required ICU admission and 4.6% died, and 13.3% of patients hospitalized for the flu were admitted to the ICU and 4.6% died, they explained.
Also, estimates of RSV-associated hospitalizations in older adults were comparable to the burden of influenza-associated hospitalizations during milder influenza seasons.
Hospital deaths associated with RSV were highest among those ages 75 or older, at 5.8%. From the 2016-2017 respiratory season through the 2022-2023 seasons, adults 75 and older accounted for 45.6% of the hospitalizations, 38.6% of the ICU admissions, and 58.7% of the in-hospital deaths associated with RSV.
Deaths due to RSV were probably underestimated because the analysis did not include deaths after hospital discharge, Havers and colleagues noted.
The first-ever RSV vaccine (Arexvy) received FDA approval in May 2023, followed by approval of a second vaccine (Abrysvo) in June 2023. An mRNA RSV vaccine (mResvia) was approved earlier this year as well. CDC recommendations now say that all adults ages 75 and older should receive a single dose of an RSV vaccine, as should those ages 60 to 74 years who are at increased risk of severe RSV disease.
“Given the large numbers of potentially vaccine-preventable hospitalizations and deaths associated with RSV, increasing vaccine coverage among adults at highest risk could reduce associated hospitalizations and severe clinical outcomes,” the authors wrote.
Atypical patterns of RSV circulation occurred during the COVID pandemic. Lower hospitalization rates were observed during 2020-2021 and 2021-2022, whereas increased circulation and an earlier peak occurred during 2022-2023.
On average, only 43.5% of the hospitalized adults with acute respiratory illness whose data was included in the RSV-NET catchment were tested for RSV. During 2016-2017, RSV testing was performed in 30.4% of adults ages 18-49 years with acute respiratory illness, 33.1% in those ages 50-64 years, 31.5% for those ages 65-74 years, and just 27.7% of those ages 75 and older. During the 2022-2023 season, these proportions increased to 56.1%, 61.2%, and 61.6% for those age groups, respectively.
Clinicians frequently don’t test for RSV in hospitalized adults with respiratory illness because of limited awareness of RSV as an important pathogen and because results do not generally change disease management, the study authors noted. Importantly, standard tests for RSV are now recognized to have lower sensitivity than previously thought.
The analysis had several limitations, including that RSV-NET data may not be generalizable to the entire country. Also, assumptions used in the adjustment analysis may have overestimated or underestimated the burden of RSV disease.

Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.

Disclosures
The study was funded by grants from the CDC Emerging Infections Program and the Council of State and Territorial Epidemiologists.Havers and co-authors reported relationships with the study funders, state health departments, and other governmental agencies.

Primary Source
JAMA Network Open
Source Reference: Havers FP, et al “Burden of respiratory syncytial virus-associated hospitalizations in US adults, October 2016 to September 2023” JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.44756.

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Alzheimer’s Researcher Placed on Leave; War on Drug Recovery; Lax Coroner Oversight

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
Alzheimer’s Researcher Faces Scrutiny
Berislav Zlokovic, MD, PhD, a prominent Alzheimer’s researcher and the head of a major neuroscience institute at the University of Southern California (USC), was placed on an indefinite leave of absence, according to a Science investigation.
A USC official declined to clarify why Zlokovic was placed on leave, but Science noted that he has faced scrutiny since its 2023 investigation revealed evidence of scientific misconduct.
Science also found that a planned clinical trial for a stroke drug candidate that Zlokovic helped develop was formally canceled by the company that sponsored the $30 million study. The NIH reportedly required USC return nearly $2 million in funding that was meant for the trial as well.
Zlokovic’s leave was announced by Carolyn Meltzer, dean of the USC Keck School of Medicine, in an October 22 email to the school’s faculty, according to the investigation. Zlokovic also stepped down as the head of the Zilkha Neurogenetic Institute, the Department of Physiology & Neuroscience, and as co-director of USC’s federally funded Alzheimer’s Disease Research Center.
The earlier Science investigation cited a large dossier that showed image manipulation in dozens of articles co-authored by Zlokovic. Several of those studies involved an experimental drug that reportedly reduced brain damage in people who suffered ischemic strokes. However, the investigation uncovered evidence that this drug may have an increased risk of death in trial participants.
Science reported that Zlokovic could not be reached for comment about his leave of absence.
Opioid Recovery Community Rejects Addiction Medicines
The addiction recovery community, led by groups like Narcotics Anonymous, has continued to reject addiction medications like buprenorphine or methadone despite evidence of their life-saving potential, according to a STAT investigation.
Thousands of organizations that claim to support those struggling with opioid addiction are very hostile to these effective addiction medications, the investigation found.
Individuals who have participated in Narcotics Anonymous or been residents of detox facilities and rehab centers described a culture that rejected medical consensus around addiction medicine and attempted to silence anyone who dissented, according to STAT.
For example, residents of recovery housing programs have been evicted for taking methadone or buprenorphine, STAT reported. Similarly, individuals seeking to enter rehab and detox facilities are only admitted if they are not taking those medications or if they agree to wean off of them quickly.
Many in the addiction recovery community see methadone or buprenorphine as mind-altering drugs that are no better than heroin or fentanyl. Leaders of addiction recovery support groups will tell individuals taking those medications that they aren’t “clean” yet.
Meanwhile, there is limited evidence that those support groups offer effective recovery support, according to the investigation.
Idaho Lags Behind Nation in Coroner’s Investigations
Due to a lack of regulations and undertrained, publicly elected coroners, Idaho has the nation’s lowest autopsy rate for child deaths attributed to unnatural or unknown causes, according to ProPublica.
While some states hire licensed forensic pathologists to be county medical examiners, Idaho elects coroners who often do not have a medical degree, or even any formal training in the field, ProPublica reported. Although many other states follow this practice, ProPublica found that Idaho also lacks other regulations, such as a professional oversight board, requirements for autopsies for unexpected or unexplained child deaths, or even funding to conduct services like body transportation.
According to the investigation, one of the few existing requirements is that newly elected coroners must attend “coroner’s school” in their first year, and continue to accrue 24 hours of training every 2 years. However, there are no penalties for failing to comply. ProPublica found that 1 in 4 coroners in Idaho have repeatedly fallen short of those requirements.
As a result, just 49% of those unnatural or unknown deaths were autopsied in Idaho from 2018 through 2022, which was far below the national average of 79%, according to a review by the state.
One county coroner profiled in the story, Rick Taylor, reportedly only works part-time despite earning more than $95,000 a year. Taylor has come under scrutiny in the state for failing to properly handle cases, including those involving unexpected or unexplained child deaths.
In one case, he reportedly declined to perform an autopsy on a newborn who was pronounced dead within minutes of arriving at the local hospital. Other officials in the state believed Taylor’s handling of the case fell short of a coroner’s expected responsibilities, ProPublica reported.

Michael DePeau-Wilson is a reporter on MedPage Today’s enterprise & investigative team. He covers psychiatry, long covid, and infectious diseases, among other relevant U.S. clinical news. Follow

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Electronic Symptom Screening in Kids With Cancer Boosts Quality of Care

Symptom screening improved symptom scores among children with cancer compared with usual care, two randomized trials showed.
Among 445 patients in one trial, the mean 8-week Symptom Screening in Pediatrics Tool (SSPedi) score (range 0-60, with higher scores indicating more bothersome symptoms) was 7.9 in patients who underwent symptom screening three times a week compared with 11.4 in the usual care group, with a significant difference in the adjusted mean score in favor of the intervention group (P=0.007), reported Lillian Sung, MD, PhD, of the Hospital for Sick Children in Toronto, and colleagues.
Symptom screening was associated with less bothersome individual symptoms, with statistically significant reductions in 12 of 15 symptoms; the largest differences were for pain, neuropathy, vomiting, and cognitive function, they wrote in JAMA.
In a second study among 345 children receiving ambulatory or inpatient cancer treatment, the SSPedi score at day 5 was 10.2 for patients who underwent symptom screening compared with 12.7 for the usual care group, with a significant difference in the adjusted mean score in favor of the intervention group (P

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Trump’s Age: Is It a Risk?

When president-elect Donald Trump is sworn in for a second term he will become the oldest president ever inaugurated — raising questions as to whether the 78-year-old is at risk of a major health event while in office.
S. Jay Olshansky, PhD, of the University of Illinois Chicago, and colleagues previously wrote a report ahead of the 2020 election assessing the health of both Trump and President Biden, but Olshansky cautioned that there are more unknowns this time around.
“We have reviewed his medical records before, and he does have some risk factors for certain diseases — cardiovascular disease and Alzheimer’s — but we haven’t seen his records in the last 4 years, so we don’t really know if anything has changed,” Olshansky told MedPage Today.
At the time of the 2020 report, Trump was taking rosuvastatin (Crestor) for cholesterol, aspirin for cardiac health, finasteride (Propecia) for hair loss prevention, ivermectin cream for rosacea, as well as a multivitamin, though it’s unknown if he takes the same drugs today. Trump also had COVID in October 2020.
In general, Trump has a 79% likelihood of living through this 4-year term based on the average life expectancy of an American man of his age, Olshansky said. (Biden was also 78 at the time of his inauguration in 2020, but Trump will be 5 months older than Biden was at the time.)
Trump may have some advantages that will put him above that average, said John Rowe, MD, professor of health policy and aging at Columbia University.
“If you want to live a long time and you’re a 78- or 79-year-old male, what you want to do is to be well off financially, have significant educational attainment, which means college or more, be married or have a live-in partner, and not smoke,” Rowe said, noting Trump has all of those things.
Otherwise, Rowe said the first question he asks male patients around Trump’s age is how many times in the past week they have interacted with friends or family.
“Social engagement is the most important variable and isolation is toxic,” he noted, adding that as president, Trump will have one of the most socially connected jobs in the world.
Trump’s former White House physician Rep. Ronny Jackson, MD (R-Texas), has previously said that Trump also enjoys health benefits from a lifetime without drinking or smoking.
In terms of job stress, Olshansky published a paper in JAMA in 2011 that found that American presidents live longer than average, and that all living presidents “have either already exceeded the estimated life span of all U.S. men at their age of inauguration or are likely to do so.” Indeed, former President Jimmy Carter, the oldest living president, recently celebrated his 100th birthday.
“Stress may accelerate the graying of hair and wrinkling of skin, but we don’t die from gray hair and wrinkled skin. So I’m not all that concerned about that,” Olshansky said.
Finally, it’s generally rare for presidents to die due to health conditions while in office. In the past century, only two presidents died from disease: Warren Harding in 1923 from myocardial infarction, and Franklin D. Roosevelt in 1945 from a massive cerebral hemorrhage.
While Trump “has very favorable social determinants of health — higher education, higher income, access to the best medical care in the world” and thus has “a lot going in his favor,” he does have some disadvantages, Olshansky said.
For instance, Trump’s current body mass index isn’t known; nor is his coronary calcium score, which can indicate heart disease risk. Previously, his coronary calcium score was “very high,” Olshansky said, and his diet is “not so favorable.”
And Jackson previously said Trump “would benefit from a diet that is lower in fat and carbohydrates, and from a routine exercise regimen.”
Other factors that could impact health and longevity — like trauma from multiple assassination attempts — are harder to quantify. Jackson issued the only memo about Trump’s injuries from the first assassination attempt and Trump himself has said he did not experience post-traumatic stress disorder or other residual health effects.
Trump has received criticism, including from doctors, for not releasing his medical records during this election season. As of November 2023, his personal physician Bruce Aronwald, DO, has said Trump was in “excellent” health with “exceptional” results on cognitive exams.

Rachael Robertson is a writer on the MedPage Today enterprise and investigative team, also covering OB/GYN news. Her print, data, and audio stories have appeared in Everyday Health, Gizmodo, the Bronx Times, and multiple podcasts. Follow

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Targeted Magnetic Stimulation Slows Alzheimer’s Progression in Phase II Study

A personalized transcranial magnetic stimulation (TMS) protocol, designed to stimulate the precuneus within the default mode network, was well tolerated and significantly slowed clinical decline in patients with mild-to-moderate Alzheimer’s disease, according to data from a small phase II trial presented at the Clinical Trials on Alzheimer’s Disease (CTAD) annual meeting in Madrid.
In this exclusive MedPage Today video, Giacomo Koch, MD, PhD, of the University of Ferrara in Italy, discusses the potential of this investigational approach to improve cognitive and functional outcomes in Alzheimer’s patients.
Following is a transcript of his remarks:
We recently presented at CTAD our latest 52-week trial in which we use personalized, repetitive, transcranial magnetic stimulation to stimulate the precuneus, which is a very important area within the default mode network. The default mode network is one of the first brain networks that is affected, of course, in Alzheimer disease and is important for memory functions. And there is strong evidence showing that a combination of beta-amyloid and tau actually starts in these specific areas of the brain.
So the idea that we developed in the past 10 years or so was to target with noninvasive brain stimulation, repetitive TMS, this network, and specifically the precuneus. And to do so, we developed a novel personalized method that combines neuro-navigation, of course, for precision targeting within the precuneus, and especially a combination of TMS with electroencephalography (EEG) that allows us to have a very clear readout of the stimulation.
So the parameters of stimulation can be adjusted in every patient, and we can have direct evidence that we are engaging the area and the network. So TMS-EEG is very helpful because it provides several [pieces of] information, not only in terms of local activity, but also in terms of oscillation and connectivity. So on the basis of these parameters, we selected in each patient the best spot and the best intensity to engage the brain activity and network activity.
After that, we started the trial, the therapeutic trial, in which the first 2 weeks TMS is applied every day from Monday to Friday, so 10 session in total, we call it a boosting phase. And then we have an intensive phase, and then we have a maintenance phase in which patients are treated every week for the following 50 weeks. So we previously, as mentioned before, investigated the effects of a 6-month trial that were promising. And in this case, we extended the duration of the study up to 1 year, 52 weeks.
And the results are promising. So we have to acknowledge this was a relatively small study in terms of patient enrollment. So we started with 48, but unfortunately we lost some due to the COVID pandemic. And at the end of the 52 weeks, we were able to analyze 32 patients.
But despite this relatively low number, we were happy to see statistical significance in terms of the primary endpoint, the CDR [Clinical Dementia Rating Scale]-Sum of Boxes, that show slowing in progression of the clinical scores there. And this was supported especially by secondary outcomes, and the autonomy of daily living was nearly unchanged after 1 year of therapy. And this is very important for quality of life, patients’ autonomy, and caregivers’ burden.
And also we found the significant effects in terms of ADAS-Cog [Alzheimer’s Disease Assessment Scale-Cognitive Subscale], which is a scale that’s important for assessing memory and cognitive function. And finally, this is also promising, we found an effect on behavioral disturbances as measured by the NPI, Neuropsychiatric Inventory.
So these clinical findings were also supported by neurophysiological evidence that patients that were treated with repetitive TMS and not placebo showed an increase in connectivity within the default mode network. And also we found that there was a correlation among this increase of connectivity and clinical gain as measured by the CDR-Sum of Boxes.

Greg Laub is the Senior Director of Video and currently leads the video and podcast production teams. Follow

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