Publisher Health

New research suggests coaching overweight or obese pregnant women to improve their ability to plan and make progress toward goals may be key to helping them lower the amount of fat in their diet.
Maternal diet quality affects prenatal development and long-term child health outcomes, but the stress that typically increases during pregnancy — often heightened by concern for fetal health and anxiety over impending parenthood — may derail efforts to focus on healthful eating, previous research has shown.
In this new study, researchers at The Ohio State University set out to identify the pathway between stress and total fat consumption, with a broader goal to evaluate an intervention designed to improve the diets of pregnant women who are overweight or obese.
Through a series of questionnaires and statistical analysis, the team found that two thinking-related skills — planning, and execution of those plans — were weakened in women whose stress was high, and those skill gaps were associated with higher total fat intake.
These two skills are known as executive functions, a set of multiple thinking processes that enable people to plan, monitor behavior and execute their goals.
“People with a higher level of stress tend to have a higher intake of fat, too. If stress is high, we’re so stressed out that we’re not thinking about anything — and we don’t care what we eat,” said lead author Mei-Wei Chang, associate professor of nursing at Ohio State.

“That’s why we focused on executive functions as a mediator between stress and diet. And with this baseline data, we have reasons to believe that designing an intervention around executive functions could improve dietary outcomes,” she said. “I would anticipate the results could be similar for nonpregnant women, because it’s all about how people behave.”
The study was published recently in the Journal of Pediatrics, Perinatology and Child Health.
The 70 women enrolled in the study had a pre-pregnancy body mass index of between 25 (scores between 25 and 29.9 are categorized as overweight) and 45 (scores of 30 and higher are categorized as obese).
The participants completed questionnaires assessing both overall perceived stress and pregnancy-related stress, as well as executive functions — specifically focusing on metacognition, or the ability to plan, and behavior regulation, the ability to execute those plans. They also completed two 24-hour dietary recalls of their calorie intake and consumption of total fat, added sugar, and fruits and vegetables.
“We were really interested in the mediation role of executive functions. The mediator is what makes everything happen,” Chang said. “We wanted to know: If we focus an intervention on executive functions, would that carry through to behavior change in dietary intake?

“Weight loss interventions often involve a prescribed diet or meal plan, and you are told to follow it. But that doesn’t lead to behavior change in the long term.”
Statistical modeling showed that higher perceived stress was associated with a worsened ability to plan and monitor behavior, and that pathway was linked to higher total fat intake. Similarly, higher levels of pregnancy-related stress were associated with a lower ability to plan, which in turn was associated with worsened ability to monitor behaviors related to carrying out the plan — and these factors were linked to higher fat consumption.
These pathways suggested that an intervention designed to lower stress would function as a starting point to improve the diet, and enhancing skills through coaching — emphasizing the ability to plan, including being flexible with planning, and behavior monitoring, particularly when making food choices — would be key to changing eating patterns.
“You need to improve executive functions, and you also need to lower stress,” Chang said. She and colleagues are now analyzing data on the effectiveness of an intervention for the study participants that emphasized stress management and boosting executive function to promote healthy eating.
Executive functions are regulated by a specific region of the brain, and strengths or weaknesses in these skill areas are thought to be affected by a variety of physiological factors. Previous research has found that executive function deficits are more likely to occur in women who are overweight or obese than in women whose weight is categorized as normal.
“Executive function is not well-studied, and it is not related to intelligence. But people with low executive function are unable to make detailed plans and stick to them, and that’s how they get into trouble,” Chang said. “Metacognition and behavior regulation must go hand in hand — that way you have a much better chance to control your behaviors, and then you will eat better.”
This work was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Co-authors, all from Ohio State, include Alai Tan, Jonathan Schaffir, Duane Wegener, Brett Worly, Katherine Strafford, Cassandra Sampsell, Kaleena Kemper, Loriana Soma, Maggie Rosen, Amanthi Ranatunga and Michelle Challa.

We’ve long known education is important for many aspects of life, but now a new benefit has been discovered: it can look after your gut health.
Landmark Edith Cowan University (ECU) research has found a better education has a strong genetic correlation and a protective causal association with several gut disorders.
A previous study from ECU’s Centre for Precision Health (CPH) discovered a genetic link between gut health and Alzheimer’s Disease (AD) but couldn’t conclude whether one caused the other.
This study breaks new ground by finding that a higher level of education protects against gut disorders.
CPH Director and study supervisor Professor Simon Laws said these findings build upon the centre’s previous work to provide further evidence of the strong links between the brain and gut, known as the gut-brain axis.
“Gut disorders and Alzheimer’s may not only share a common genetic predisposition but may be similarly influenced by genetic variations underpinning educational attainment,” Professor Laws said.

This large-scale study examined the genetic information of more than 766,000 individuals, with an emphasis on AD, cognitive traits and gut disorders, including peptic ulcer disease (PUD), gastritis-duodenitis, gastroesophageal reflux disease (GERD), irritable bowel syndrome, diverticulosis and inflammatory bowel disease (IBD).
It found higher levels of education and cognitive functioning reduced the risk of gut disorders.
Lead researcher Dr Emmanuel Adewuyi said the findings have significant implications.
“The results support education as a possible avenue for reducing the risk of gut disorders
by, for example, encouraging higher educational attainment or a possible increase in the length of schooling,” he said.

“Hence, policy efforts aimed at increasing educational attainment or cognitive training may contribute to a higher level of intelligence, which could lead to better health outcomes including a reduced risk of gut disorders.”
It goes both ways
ECU’s study further revealed the gut may also influence the brain.
GERD showed evidence of causing a decline in cognitive function across a number of cognitive traits assessed in the study, such as intelligence, cognitive performance, educational attainment and educational qualification.
Although this is the first study to report this finding, the results support recent research reporting an increased incidence of dementia and GERD, which Dr Adewuyi said could help with earlier diagnoses and potential treatments.
“GERD may be a risk factor for cognitive impairment, so it’s important for health workers to look for signs or symptoms of cognitive dysfunction in patients presenting with the gut disorder,” he said.
“This could lead to earlier detection of cognitive decline and therefore earlier interventions aimed at reducing the rate of cognitive decline.
“More studies are needed to investigate whether treatment for, cure or remission of GERD can contribute to a reduced risk of cognitive decline.”
The curious case of IBD
Interestingly, higher levels of education and cognitive function protecting against gut disorders was true of all the disorders examined in the study — but largely with the exception of inflammatory bowel disease.
Further analysis reveals different effects of IBD on cognitive traits and AD at different genomic locations, indicating its relationship depend on effects at specific locations across the genome.
This new understanding may explain the lack of significant genetic correlation of IBD with cognitive traits and AD, and the inconsistency reported in previous observational studies.
Dr Adewuyi said this finding was also important, as it brings a new insight into the relationship of IBD with cognitive traits (and AD), which may shape the direction of future studies.
“For example, some risk genes for AD may be protective against IBD, and vice versa,” he said.
‘Relationship of cognition and Alzheimer’s disease with gastrointestinal tract disorders: a large-scale genetic overlap and Mendelian randomisation analysis’ was published in the International Journal of Molecular Sciences.

Experiencing abuse or neglect as a child can cause multiple mental health problems, finds a new study led by UCL researchers.
The research, published in the American Journal of Psychiatry, seeks to examine the causal effects of childhood maltreatment on mental health by accounting for other genetic and environmental risk factors, such as a family history of mental illness and socioeconomic disadvantage.
The first-of-its-kind research analysed 34 quasi-experimental studies, involving over 54,000 people.
Quasi-experimental studies can better establish cause and effect in observational data, by using specialised samples (eg. identical twins) or innovative statistical techniques to rule out other risk factors. For example, in samples of identical twins, if a maltreated twin has mental health problems but their non-maltreated twin does not, the association cannot be due to genetics or the family environment shared between twins.
Across the 34 studies, researchers found small effects of child maltreatment on a range of mental health problems, including internalising disorders (eg. Depression, anxiety, self-harm, and suicide attempt), externalising disorders (eg. alcohol and drug abuse, ADHD, and conduct problems), and psychosis.
These effects were consistent regardless of the method used or way in which maltreatment and mental health were measured.

The findings suggest that preventing eight cases of child maltreatment would prevent one person from developing mental health problems.
Corresponding author, Dr Jessie Baldwin (UCL Psychology & Language Sciences), said:
“It is well known that child maltreatment is associated with mental health problems, but it was unclear whether this relationship is causal, or is better explained by other risk factors.
“This study provides rigorous evidence to suggest that childhood maltreatment has small causal effects on mental health problems. Although small, these effects of maltreatment could have far-reaching consequences, given that mental health problems predict a range of poor outcomes, such as unemployment, physical health problems and early mortality.
“Interventions that prevent maltreatment are therefore not only essential for child welfare, but could also prevent long-term suffering and financial costs due to mental illness.”
Nevertheless, the researchers also found that part of the overall risk of mental health problems in individuals exposed to maltreatment was due to pre-existing vulnerabilities — which might include other adverse environments (eg. socioeconomic disadvantage) and genetic liability.

Dr Baldwin said: “Our findings also suggest that to minimise risk of mental health problems in individuals exposed to maltreatment, clinicians should address not only the maltreatment experience, but also pre-existing psychiatric risk factors.”
Researchers defined childhood maltreatment as any physical, sexual or emotional abuse or neglect before the age of 18.
The study was funded by Wellcome and is in collaboration with King’s College London, University of Lausanne, Yale University School of Medicine, University of Bristol and NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust.
Study limitations
Each of the quasi-experimental studies analysed may have been subject to potential biases. However, the findings were consistent across studies using different quasi-experimental methods, suggesting that the results are robust.
Additionally, it was not possible to draw firm conclusions about the specific effects of different types of maltreatment, as it is common for different types of abuse/neglect to happen at the same time, and studies rarely account for this.
The lack of available data mean that it was not possible to examine the effects of the timing of maltreatment, the interval between maltreatment and mental health issues, or differences between racial or ethnic groups. Future quasi-experimental research is needed to address these questions.

Teenagers who reported feeling optimism, happiness, self-esteem, belongingness, and feeling loved and wanted were more likely to reach their 20s and 30s in good cardiometabolic health compared to teens with fewer of these positive mental health assets, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.
Previous studies have found that psychological facets of mental well-being, such as optimism and happiness, may be important modifiable factors related to better cardiometabolic health over time. While most of this research was conducted among older adults, this study focused earlier in life and considered a broader measure of cardiometabolic health, which also included indicators of blood sugar levels and inflammation.
“We learned a lot in the last few decades about the impact of discrimination and other social risks youth of color face that may explain their elevated rates of cardiometabolic disease, however, much less attention is paid to the inherent strengths they possess and the ways those strengths may be leveraged to advance health equity,” said lead study author Farah Qureshi, Sc.D., M.H.S., an assistant professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “In this study, we wanted to shift the paradigm in public health beyond the traditional focus on deficits to one that concentrates on resource building.”
Researchers examined data from the National Longitudinal Study of Adolescent Health, which enrolled nearly 3,500 U.S. high schoolers (average age 16 years) in 1994 and were followed for more than two decades. Nearly half were girls, 67% were white youth, 15% were Black teens, 11% were Latino teenagers and 6% reported their race as either Native American, Asian, or “other.” Researchers periodically collected data on the participants’ health and well-being, with the most recent wave of data collection occurring in 2018, when their average age was 38.
Using initial survey responses from when participants were teenagers, researchers identified five mental health assets related to better cardiometabolic health outcomes: optimism, happiness, self-esteem, a sense of belonging and feeling loved. This information was cross-referenced with health data recorded over 3 decades to assess whether teens who had more of these positive assets were more likely to maintain optimal cardiometabolic health in adulthood.
To examine cardiometabolic health in this study, researchers reviewed health measures for seven cardiovascular and metabolic disease risk factors collected during clinic visits when participants were in their late 20s and 30s. The factors included high-density lipoprotein (HDL), or “good” cholesterol; non-HDL cholesterol — calculated as total cholesterol minus HDL cholesterol; systolic blood pressure (top number); diastolic blood pressure (bottom number); hemoglobin A1c, a measure of blood sugar; C-reactive protein, a measure of inflammation; and body mass index, or BMI, the ratio of height to weight to estimate body fat.

The analysis found: Overall, 55% of youth had zero to one positive mental health asset, while 29% had two to three assets and 16% had four to five assets. As young adults, only 12% of participants maintained cardiometabolic health over time, and white youth were more likely to maintain good health later in life compared to Black or Latino youth. Teens with four to five positive mental health assets were 69% more likely to maintain positive cardiometabolic health as young adults. There was also a cumulative effect, with each additional mental health asset conferring a 12% greater likelihood of positive cardiometabolic health. Although psychological assets were found to be protective across all racial and ethnic groups, the largest health benefits were noted among Black youth. Black teens also reported having more positive mental health assets than youth of any other racial or ethnic groups.Despite Black teens having the most assets and deriving the most health benefits from them, racial disparities in cardiometabolic health were still apparent in adulthood. Black individuals were the least likely to maintain good cardiometabolic health over time.
“These somewhat counterintuitive findings were surprising,” Qureshi said. “When we dug deeper, we found that the absence of psychological assets being was particularly health-damaging for Black youth.” She further elaborated that the findings point to the role structural racism plays in shaping cardiometabolic health patterns in the first decades of life: “For Black youth — who face numerous barriers to achieving and sustaining optimal cardiometabolic health in adulthood — not having these additional mental health resources makes a big difference.”
“This work suggests that early investments in youth mental health may be a critical new frontier in the advancement of cardiometabolic health equity,” according to Qureshi.
“We need more large-scale studies to monitor these and other positive mental health factors starting in childhood to understand how these assets may influence health and disease over the life course. This information may help us identify new ways to improve health and reduce disparities,” she said.
Limitations of the study include that there were relatively few participants who were Latino, Asian or Native American and there were variations in blood sample collection methods over time.
Health care professionals measure cardiovascular health with the American Heart Association’s Life’s Essential 8 tool, which measures 4 indicators related to cardiovascular and metabolic health status (blood pressure, cholesterol, blood sugar and body mass index); and 4 behavioral/lifestyle factors (smoking status, physical activity, sleep and diet). According to Life’s Essential 8 data: only 45% of U.S. adolescents have five or more indicators of ideal cardiovascular health, and the percentage declines in adulthood; and there are persistent differences in cardiovascular health levels by self-reported race and ethnicity, and these disparities are larger at younger ages.Co-authors are Anne-Josee Guimond, Ph.D.; Elaine Tsao, M.P.H.; Scott Delaney, Sc.D.; Julia K. Boehm, Ph.D.; and Laura D. Kubzansky, Ph.D.
The National Institutes of Health (NIH) funded this research.

About 20,000 ambulance workers across England and Wales walked out for a second time over pay, with managers warning the impact of this strike is likely to be worse than last month’s stoppage. The health service is in a more precarious position than three weeks ago, according to NHS providers.The government said the strike action was unnecessary, but it had put contingency plans in place. The 14 unions representing health workers on strike called for direct pay talks with ministers.

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I’ve been working steadily for hours but feel as if I haven’t even started. My attention is being pulled from my assigned task — writing this story — by a myriad of what I believe are necessary work interruptions. (OK, a couple were from my cat, who also firmly believes in their necessity.)

My kids and I call days like this “squirrel days” in honor of Dug, the talking dog in (squirrel !!) the 2009 Pixar movie “Up,” who (squirrel !!) was constantly distracted by well, just about (squirrel !!) …

Unfortunately, all too many of us are having “squirrel” days, according to Dr. Gloria Mark, a professor of informatics at the University of California, Irvine, who studies how digital media affects our lives. In her book “Attention Span: A Groundbreaking Way to Restore Balance, Happiness and Productivity,” Mark explains how decades of research have tracked the decline of the ability to focus.

“In 2004, we measured the average attention on a screen to be 2½ minutes,” Mark said. “Some years later, we found attention spans to be about 75 seconds. Now we find people can only pay attention to one screen for an average of 47 seconds.”

Not only do people concentrate for less than a minute on any one screen, Mark said, but when attention is diverted from an active work project, they take about 25 minutes to refocus on that task. (Wait, what??)

“In fact, our research shows it takes 25 minutes, 26 seconds, before we go back to the original working sphere or project,” Mark said.

Why you have a short attention span

How can that be? “If we look at work in terms of switching projects, as opposed to the micro view of switching screens, we find people spend about 10½ minutes in any work project before being interrupted — internally or by someone else — and then switch to another work project,” Mark said.

Yes, but then we go back to the original work, right? Wrong, Mark said. Instead, when we are interrupted on project two, we switch yet again to a different task — call it project three. Unbelievably, her research has shown we are also interrupted on project three and move on to project four.

“And then you go back and pick up the original interrupted project,” Mark said. “But it’s not like you’re interrupted and you do nothing. For over 25 minutes, you’re actually working on other things.”

(At least I can tell my boss that when I miss my deadline.)

“However, there’s also a switch cost,” Mark added. “A switch cost is the time it takes you to reorient back to your work: ‘Where was I? What was I thinking of?’ That additional effort can also lead to errors and stress.”

How to focus

Why is all of this a problem? After all, it’s called multitasking, thought by many to be a highly prized skill for coping with the demands of the information age.

“With the exception of a few rare individuals, there is no such thing as multitasking,” Mark said. “Unless one of the tasks is automatic, like chewing gum or walking, you cannot do two effortful things at the same time.”

For example, she said, you can’t read email and be in a video meeting. When you focus on one thing, you lose the other. “You’re actually switching your attention very quickly between the two,” Mark said. “And when you switch your attention fast, it’s correlated with stress.”

Blood pressure rises. Heart rate speeds up. Psychological measures of stress also show negative outcomes, she said, such as more fatigue and mistakes and less productivity: “The more people multitask, the more errors they make.”

Who did this to us? We did, of course, with the help of tech culprits such as social media, tablets and television. But Mark blames email the most.

“To me, email is probably the worst because it’s become a symbol of work,” she said, adding that her research has found a direct correlation between email and more stress.

“We cut off email for some workers in an organization for one workweek,” she said. “Using heart rate monitors, we found that they became significantly less stressed and were able to focus significantly longer.”

(I find myself pausing to look up flights to Bora Bora. Oh, right. They have email there, too.)

“There’s no way that a person can just completely cut off from technology and work in today’s world,” Mark said. “So let’s learn how to live with it in a way that maintains our positive well-being.”

How to increase your attention span

Regaining your focus requires you to be mindful of how you are using technology, Mark said, a daunting task if you consider the average American spends at least 10 hours a day on screens.

Paradoxically, you can use technology to help, she said. Schedule rote work for the first part of the day when you’re not fully alert, then use technology to block distractions when you’re at your mental best. At night, offload tasks from your brain by writing them down and then put the list away.

Distracted by social media sites? Hide them, Mark said: “Take the icons off your desktop and bury the apps on your phone inside folders, where it takes an extra effort to find them. Leave your phone in another room or put it in a drawer and lock it.”

It’s also important to learn when to take a break. “If you have to read something more than once or if the words are just not registering, it’s time to stop and replenish,” she said.

The best break is a walk in nature: “Just a 20-minute walk in nature can help significantly relax people,” Mark said. “And we found it can help people produce significantly more ideas — it’s called divergent thinking.”

Too cold to walk outside? Do something engaging that takes no mental effort.

“I have a friend who is an MIT professor, and his favorite activity is matching socks,” Mark said. “Another friend likes to iron. Ideas can incubate and then we come back to the hard work, and we see it with fresh eyes.”

The virus spread to nine districts nationwide, infecting hundreds and killing dozens. Seven health workers were among those who died.The World Health Organization on Wednesday declared the latest Ebola epidemic in Uganda over, closing the chapter on a deadly outbreak that lasted nearly four months and killed dozens of people.The outbreak had spread to nine districts, including the capital, Kampala, raising fears of its snowballing across the East African region. It was the worst Ebola outbreak in Uganda in more than two decades, and the second-deadliest in the country’s history, with 142 confirmed cases and 55 deaths, and an additional 22 deaths also linked to the outbreak, according to the W.H.O. Seven of those who died were health workers.The W.H.O. considers an epidemic over when no confirmed or probable cases are reported for 42 days, twice the incubation period for Ebola infections.The response to the outbreak was hampered by delays in identifying and tracing the first case, along with widespread misinformation among the public about the perils and even the existence of the virus.The authorities also initially hesitated to impose a lockdown in the epicenter of the outbreak, in central Uganda, fearing that any restrictions would adversely affect the economy and estrange a population already angry about previous strict Covid shutdowns.The outbreak was caused by the Sudan strain of the virus, which has no approved vaccine or therapeutics. Dr. Matshidiso Moeti, the W.H.O. regional director for Africa, said that the lack of treatment made it challenging to tackle the virus.“Two months ago, it looked as if Ebola would cast a dark shadow over the country well into 2023,” Dr. Moeti said in a statement. “But this win starts off the year on a note of great hope for Africa.”Ebola is a hemorrhagic fever that is transmitted through body contact with sick or dead people or animals. Its symptoms include fever, fatigue and headaches, followed by vomiting, diarrhea, and internal and external bleeding.The virus kills half of those it infects. The worst outbreak recorded spread across West Africa between 2014-16, followed by one in the Democratic Republic of Congo in 2018. While there are existing Ebola vaccines — like the injectable Ervebo vaccine that was crucial to ending the outbreak in Congo — they do not protect against the Sudan strain.Uganda has suffered multiple Ebola outbreaks in the past. The worst was in 2000, killing 224 people, according to the W.H.O.The latest outbreak was first reported on Sept. 20, when a case was confirmed at a hospital in the Mubende district, about 90 miles west of Kampala.The patient, a 24-year-old male, had developed symptoms including high fever, chest pain and convulsions, along with bleeding in the eyes. He had visited multiple health facilities before he was finally isolated and tested for the virus. He died on Sept. 19.For weeks, Ugandan officials dismissed calls to issue restrictions in and beyond the epicenter of the outbreak in the central part of the country. Health experts worried about population movement and the fact that the districts where cases had been reported abutted a major highway connecting them to the capital and to the neighboring Democratic Republic of Congo.It was not until mid-October that President Yoweri Museveni of Uganda imposed an overnight curfew, and stopped movement in and out of Mubende and Kassanda, the two districts identified as the epicenter of the outbreak.But by then, the virus had spread nationwide, including to the capital, and to Jinja, a city on the shores of Lake Victoria. Contacts of Ebola patients were also eluding quarantine, putting more people at risk. The United States, fearing the risk of international spread, began screening air travelers who had visited Uganda.The epidemic was deemed to be under control in late November when the last patient was discharged from hospital. In mid-December, Mr. Museveni lifted the lockdown on Mubende and Kassanda, saying that his country had succeeded in keeping the virus under control.Uganda also received three vaccines from the W.H.O. in December, which were to be deployed in a clinical trial to test their effectiveness against the Sudan strain of the virus. But with no new cases or contacts, the vaccine candidates had come too late.Dr. Jane Ruth Aceng, the Ugandan minister of health, said that communities should continue to be alert and report anyone who showed symptoms.“Uganda is now free of active Ebola transmission,” she said. “But let’s remain vigilant.”

Published5 days agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Lucy WilliamsonBBC Paris correspondentThe UK’s health system is buckling under the weight of staff shortages and a lack of beds. In France, meanwhile, there are more doctors and many more nurses, yet its healthcare system is still in crisis.President Emmanuel Macron has promised to change the way its hospitals are funded, and to free doctors from time-consuming administration, in a bid to break what he called a “sense of endless crisis” in its health service.A series of eye-catching measures over the past few years – such as signing-up bonuses of €50,000 (£44,000) for GPs in under-served areas, and ending a cap on the number of medical students in France – have failed to plug healthcare gaps.The pressure on both hospitals and GPs has continued to mount with a triple-whammy of winter illnesses, leading medical staff to nickname this month “Black January”.After years of Covid, and with inflation biting, many say chronic staff shortages and increasing demands are making their work impossible and threatening the French health system.Some hospitals are reporting up to 90% of their staff on “sick leave protest” at the conditions. And France’s second-largest health union has called an “unlimited walkout” this week, following a fortnight of strikes by French GPs. Julia Venturini, eight years into her medical degree, joined a rally of GPs in Paris last week.”I made this choice [to be a GP] but now I have a lot of questions about my future,” she tells me.”We’re all in the same boat, and the boat is now like the Titanic. When the emergency services go down, the GPs go down, and the hospitals go down – the health system in France is really cracking.” Julia says she and many of her classmates are considering whether to quit the profession entirely, or to try to work abroad.”I’m worried as a future doctor, but I’m worried as a patient too,” she says.I ask her whether she would rather be a patient in France or in the UK.”Ten years ago, I’d have said France,” she replies. “But now in France, it’s so complicated, and if you have money in the UK, you can get care. So, I think I’d rather be rich in the UK, and have good care [there].”The causes of France’s healthcare crisis are complex, but the long-term pressure of an aging population alongside a shortage of medical staff was brought starkly into focus by the Covid pandemic.BBCWe are in a very worrying phase where we regularly alert emergency services [about] people who call saying they are going to commit suicidePauline DubarWorks for a helpline for medical staffFrance has more doctors per head of population than the UK, and many more nurses. But according to the World Health Organization, almost half of French doctors are above the age of 55 and approaching retirement. In the UK, that figure is around 15%.Many younger medics are put off by the growing professional and financial pressures, which are also taking their toll on a workforce exhausted by Covid.Pauline Dubar works for a medical helpline, set up to help staff cracking under the strain. She says calls have more than tripled since the Covid pandemic began.”At the start [of Covid], people were afraid of the unknown, then a weariness set in,” she says. “And today we are in a very worrying phase where we regularly alert emergency services for people who call saying they are going to commit suicide.”The National Order of Nurses estimates that 40% of working nurses want to leave the profession, despite the government allocating an extra €12bn (£10.5bn) a year for hospital workers’ salaries.”The salaries are a little higher than before,” Pauline tells me. “But for a decent salary, you have to work nights and weekends, and that ends up exhausting people in the long term.”Pauline says fewer people are willing to work those kinds of hours now, especially when inflation is cutting into wages, and staff shortages mean more stressful shifts – a vicious cycle.She describes being put in charge of 30 patients herself, as an overnight nurse. And says the lack of minimum staffing numbers outside intensive care units is putting patients and staff in danger.President Macron’s promise to change the way hospitals are funded is designed to ease some of the pressure on staff. Like in the UK, French hospitals are partly funded according to the procedures they carry out, creating an incentive to carry out as many high-paying procedures as possible. Mr Macron says he wants to shift to a funding model based on jointly agreed health objectives, though it’s not clear yet exactly how that would work.And it doesn’t solve the problems faced by GPs. “I work 60 hours a week,” says Patricia Lanco-Saint-Guily, a GP in Toulouse who was out on strike last week. “If I worked less, I couldn’t live. We are upset and tired. I’m 52 years old, and I want to change job.”The vast majority of GPs in France operate as individual private practices, with 70% of each consultation reimbursed to patients by the French state. GPs want a doubling of the consultation fee from €25 to €50. The government has said it is willing to look at an increase, but not one this big.Some GPs are drifting away from the profession, or looking for the rarer, salaried positions in clinics or hospitals, where they are freed from endless paperwork and work limited hours – further reducing the number of GPs available for late night and weekend appointments. President Macron has promised to recruit more medical assistants, and delegate some tasks to pharmacists and nurses, in order to free up more consultation time for GPs.But none of this will directly tackle one of the country’s biggest healthcare problems: large swathes of rural and suburban France known as “medical deserts”, without access to a doctor at all.The French government has resorted to offering €50,000 signing-up bonuses for GPs who commit to the most under-served areas for five years. And the National Assembly has just passed a new law, requiring all fourth-year medical students to complete a year’s internship in a so-called medical desert.But some desperate local authorities are opting for their own solutions.The road into the village of Olliergues, two hours’ drive outside Lyon, winds through the foothills of the Massif Central to a picturesque basin of old stone houses, overlooked by a small château.A large banner, bright blue against the old stone walls, greets all entrants to the village: advertising vacancies for GPs to work at the new clinic here.”We haven’t had a GP since 2018,” Mayor Arnaud Provenchère tells me. “We tried recruiting one, but we simply didn’t get any candidates. No-one wanted to come. GPs are afraid of arriving here alone and being submerged by the demand.”GPs working on a per-consultation basis, as the majority do, say rising inflation and growing paperwork forces them to work very long hours. In a medical desert, those pressures exist alongside acute demand, very little medical support, and limited public services.Fed up with the situation, Mayor Provenchère decided to solve the problem by offering GPs a local government contract, with set working hours, a regular salary and a medical assistant.It’s put a €40,000-a-year hole in the local finances. And it worked: Céline Preux began work here last week.”There were some appointments that really moved me,” she says. “Fragile people, in situations they should not be in. Some are almost in danger: they stopped their thyroid treatment a long time ago, or they’re at risk of acute cardiac events, because they’re not well cared for.”Céline works two days a week at a hospital and says she regularly sees the overflow from medical deserts in the emergency department there.”We see patients come in because they don’t have a GP. These are patients that are hospitalised for many days, sometimes weeks, when they could have had a stabilising treatment.”Guillaume Garot is a Socialist MP leading a cross-party bill to tackle the problem of medical deserts.”Eight million French people live in a medical desert, and six million don’t have an attending doctor,” he says. “It takes six months, on average, to find an appointment in my department of Mayenne; in Paris it takes two hours.”The short-term solution, he believes, is for the government to control where new doctors can practice – channelling them towards areas that aren’t already covered. “[But] the real solution is allowing a generation of young people from working-class backgrounds and rural areas to become doctors,” he says. “Because having grown up in these territories, they will have less difficulty in returning to practice there.”President Macron has promised that 600,000 chronically-ill patients currently living in France without a doctor will have access to one – or to a treatment team – by the end of this year.But the loss of medics, whether from hospital wards or places like Olliergues, is France’s most pressing health problem, and it won’t be easy to cure.More on this storyThe NHS crisis – decades in the making7 JanuaryThe murdered schoolgirl adopted by France’s far right25 October 2022France clamps down on city centre ‘dark stores’8 September 2022

New research from the University of Alabama at Birmingham says the gut microbiome is involved in multiple pathways in the pathogenesis of Parkinson’s disease. The findings, published in Nature Communications, show a wide imbalance in microbiome composition in persons with Parkinson’s disease. The study is the largest microbiome study conducted at the highest resolution.
The investigators employed metagenomics, the study of genetic material recovered directly from the stool microbiome of persons with PD and neurologically healthy control subjects.
“The primary aim of this study was to generate a full, unaltered view of the imbalance in PD gut microbiome,” said Haydeh Payami, Ph.D., professor in the Marnix E. Heersink School of Medicine Department of Neurology and senior author on the study.
The study reports Parkinson’s disease metagenome is indicative of a disease-promoting microbiome.
“We found evidence for multiple mechanisms that we know are linked to PD, but we didn’t know they were happening in the gut also and are orchestrated by the microbiome,” Payami said.
Investigators found an overabundance of opportunistic pathogens and immunogenic components, which suggest infection and inflammation at play, overproduction of toxic molecules, and overabundance of the bacterial product curli. This induces PD pathology and dysregulation of neurotransmitters, including L-dopa. At the same time, there was a shortage of neuroprotective molecules and anti-inflammatory components, which makes recovery difficult.

Payami, who is the John T. and Juanelle D. Strain Endowed Chair in Neurology, and her team enrolled 490 persons with Parkinson’s disease and 234 healthy controls. Just over half of the subjects were male and were predominately older than 50. All were from the Deep South region of the United States, which helped to eliminate confounding by geographic and cultural influence on composition of microbiome.
The researchers studied 257 species of organisms in the microbiome, and of these, analysis indicated 84, more than 30 percent, were associated with Parkinson’s disease.
“Of the 84 PD-associated species, 55 had abnormally high abundance in persons with PD, and 29 were depleted,” Payami said. “We found that over 30 percent of the micro-organisms and bacterial genes and pathways tested have altered abundances in Parkinson’s disease, which indicates a widespread imbalance.”
At one end of the spectrum, Bifidobacterium dentium was elevated by sevenfold, Actinomyces oris by 6.5-fold and Streptococcus mutans by sixfold. At the other end of the spectrum, Roseburia intestinalis was reduced by 7.5-fold and Blautia wexlerae by fivefold. Overall, 36 percent of PD-associated species had higher than twofold change in abundance, reflecting a 100 percent to 750 percent increase or decrease in PD versus the healthy control group.
“This study created a large dataset at the highest resolution currently feasible and made it public with no restriction to promote open science,” Payami said. “It includes extensive metadata on 490 persons with PD, the largest PD cohort with microbiome data, and a unique cohort of 234 neurologically healthy elderly, which can be used in a wide range of studies. We have shown that there is a widespread imbalance in the Parkinson’s metagenome, creating an environment that is permissive for neurodegenerative events and is prohibitive of recovery.”
Parkinson’s disease is a progressively debilitating disorder that affected 4 million individuals in the year 2005 and is projected to double to 8.7 million individuals by the year 2030. Although historically defined as a movement disorder, PD is a multi-systemic disease. It is speculated that PD is caused by various combinations of genetic susceptibility and environmental triggers, although no causative combination has yet been identified. The connection between PD and the gastrointestinal system has long been established.
“This is exciting research, as metagenomics is a new, albeit fast-evolving field, and the resources, methods and tools, while state-of-the-art, are still in development,” Payami said. “Undoubtedly more information will be revealed as we increase the sample size and others also conduct metagenomics studies and share the data. We anticipate that in the near future we will have the tools and the analytic power to use metagenomics as a new approach to study PD heterogeneity, search for biomarkers, delve deeper into the origin and progression of PD sub-phenotypes, and investigate the potential in manipulating the microbiome to prevent, treat and halt the progression of PD.”
Co-authors from the UAB Department of Neurology are Zachary A. Wallen, Ph.D., Guy Twa, Gwendolyn Cohen, Marissa N. Dean, M.D., and David Standaert, M.D., Ph.D. Other co-authors are Ayse Demirkan, Ph.D., University of Surrey, United Kingdom, and Timothy R. Sampson, Ph.D., Emory University.
The research was supported by the U.S. Army Medical Research Material Command, the National Institutes of Health, the Parkinson’s Foundation and Aligning Science Across Parkinson’s through the Michael J. Fox Foundation for Parkinson’s Research.

A Canadian study published in the journal Science elucidates a new molecular mechanism that may cause age-related macular degeneration (AMD).
The research at Hôpital Maisonneuve-Rosement, in Montreal, shows how life stressors such as obesity reprogram immune system cells and make them destructive to the eye as it ages.
“We wanted to know why some people with a genetic predisposition develop AMD while others are spared,” said Université de Montréal ophtalmology professor Przemyslaw (Mike) Sapieha, who led the study by his postdoctoral fellow Dr. Masayuki Hata.
“Although considerable effort has been invested in understanding the genes responsible for AMD, variations and mutations in susceptibility genes only increase the risk of developing the disease, but do not cause it,” Sapieha explained.
“This observation suggests that we must gain a better understanding of how other factors such as environment and lifestyle contribute to disease development.”
AMD is a major cause of irreversible blindness worldwide and affected approximately 196 million people in 2020. It comes in two forms: dry AMD, characterized by the accumulation of fatty deposits at the back of the eye and the death of nerve cells in the eye, and wet AMD, which is characterized by diseased blood vessels that develop in the most sensitive part of the sight-generating tissue, called the macula.Contact with pathogens

It is already known that the immune system in the eye of a person with AMD becomes dysregulated and aggressive. Normally, immune cells keep the eye healthy, but contact with pathogens such as bacteria and viruses can make them go awry.
At the same time, immune cells are also activated when the body is exposed to stressors such as excess fat in obesity, making being overweight the number one non-genetic risk factor for developing AMD, after smoking.
In their study, Sapieha and Hata used obesity as a model to accelerate and exaggerate the stressors experienced by the body throughout life.
They found that transient obesity or a history of obesity leads to persistent changes in the DNA architecture within immune cells, making them more susceptible to producing inflammatory molecules.
“Our findings provide important information about the biology of the immune cells that cause AMD and will allow for the development of more tailored treatments in the future,” said Hata, now an ophthalmology professor at Kyoto University, in Japan.
The researchers hope their discovery will lead other scientists to broaden their interest beyond obesity-related diseases to other diseases characterized by increased neuroinflammation, including Alzheimer’s disease and multiple sclerosis.
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