Publisher Health

Bacterial meningitis is a life-threatening infectious disease of the brain that leaves many survivors with long-lasting neurological impairments. Now, researchers at Karolinska Institutet in Sweden show in a study on rats that the brain’s tool for waste clearance, the glymphatic system, malfunctions during bacterial meningitis, causing a buildup of toxic garbage that damages brain cells. The findings are published in the journal mBio.
“Our study shows that the glymphatic system loses its functionality when an infection occurs in the brain,” says Federico Iovino, associate professor (docent) and group leader at the Department of Neuroscience, Karolinska Institutet and leading author of the study. “Even though we’ve only studied rats so far, we believe it’s possible that the same mechanisms are at play in humans and that the glymphatic system could be a new avenue to explore in the hopes of finding treatments to prevent neurological disabilities caused by bacterial meningitis.”
The glymphatic system was first described in 2013 as a sort of washing-machine that clears waste from the central nervous system, which comprises the brain and the spinal cord. Several neurological diseases, including Alzheimer’s and Parkinson’s disease, have since been associated with its dysfunction.
In this study, the research group of Dr. Federico Iovino and collaborators at the University of Texas Health Science Center at Houston in the U.S. and the University of Southern Santa Catarina in Brazil examined the glymphatic system in rats infected with the bacteria Streptococcus pneumoniae. S. pneumoniae is the leading pathogen causing bacterial meningitis, a potentially deadly infection that in many cases leads to permanent disabilities.
The researchers found higher amounts of bacterial waste products in the brains of rats with meningitis than in a control group. The concentrations were highest in the brain’s cerebrospinal fluid compartments. In contrast, blood tests revealed low levels of bacterial components, indicating the glymphatic system had failed to drain the brain from bacteria and associated rest products. Over time, increased signs of neuroinflammation and neuronal damage were observed, with a corresponding loss of cognitive abilities.
“About half of pneumococcal meningitis survivors suffer from neurological impairments, such as hearing loss, motor and cognitive delay and psychiatric disorders, because of neurons damaged by the infection,” Federico Iovino says. “Since damaged neurons often cannot be repaired or replaced, it is important to find ways to prevent the injury, and the first step in that direction is to understand the molecular mechanisms.”
To further their understanding, the researchers examined brain tissues and cells in detail. They zeroed in on a key fluid transporter, the aquaporin-4 (AQP4)-water channel located at the end-feet of the strings of astrocytes, which are star-shaped cells that act as housekeepers of the glymphatic system.
This water channel normally regulates fluid exchanges between the cerebrospinal fluid compartments and other areas of the brain. But what the researchers found was that during pneumococcal meningitis, the AQP4-water channel lost its natural place and connection with the blood-brain barrier vessel wall. The astrocytic end-feet had detached from the vessel walls after the astrocytes swelled in response to the neuroinflammation caused by the bacterial infection.
“It’s like a snowball effect,” Federico Iovino says. “The infection causes a buildup of toxic bacterial products which activates an immune response that leads to neuroinflammation. The inflammation triggers cellular processes that lead to a detachment of astrocytic end-feet from the blood-brain barrier walls with consequent misplacement and loss of function of the important AQP4-water channel. Combined these events result in a malfunctioning glymphatic system and consequent neuronal damage.”
The study was funded by the Karolinska Institutet Committee for Research, the Karolinska Institutet Research Foundation Grants, the Swedish Research Council, the Bjarne Ahlström Foundation for research in Clinical Neurology, the Clas Groschinsky Foundation, the HKH Crown Princess Lovisa Association for Child Care, the Magnus Bergvall Foundation, the Tore Nilson Foundation, the McGovern Medical School, The University of Texas Health Science Center at Houston, the University of Southern Santa Catarina in Brazil, the Alzheimer’s Association and the National Institutes of Health/National Institute on Aging.
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Inside a living cell, proteins and other molecules are often tightly packed together. These dense clusters can be difficult to image because the fluorescent labels used to make them visible can’t wedge themselves in between the molecules.
MIT researchers have now developed a novel way to overcome this limitation and make those “invisible” molecules visible. Their technique allows them to “de-crowd” the molecules by expanding a cell or tissue sample before labeling the molecules, which makes the molecules more accessible to fluorescent tags.
This method, which builds on a widely used technique known as expansion microscopy previously developed at MIT, should allow scientists to visualize molecules and cellular structures that have never been seen before.
“It’s becoming clear that the expansion process will reveal many new biological discoveries. If biologists and clinicians have been studying a protein in the brain or another biological specimen, and they’re labeling it the regular way, they might be missing entire categories of phenomena,” says Edward Boyden, the Y. Eva Tan Professor in Neurotechnology, a professor of biological engineering and brain and cognitive sciences at MIT, a Howard Hughes Medical Institute investigator, and a member of MIT’s McGovern Institute for Brain Research and Koch Institute for Integrative Cancer Research.
Using this technique, Boyden and his colleagues showed that they could image a nanostructure found in the synapses of neurons. They also imaged the structure of Alzheimer’s-linked amyloid beta plaques in greater detail than has been possible before.
“Our technology, which we named expansion revealing, enables visualization of these nanostructures, which previously remained hidden, using hardware easily available in academic labs,” says Deblina Sarkar, an assistant professor in the Media Lab and one of the lead authors of the study.

Imagine you could take a medicine that prevents the decline that come with age and keeps you healthy. Scientists are trying to find a drug that has these effects. The current most promising anti-ageing drug is Rapamycin, known for its positive effects on life and health span in experimental studies with laboratory animals. To obtain the maximum beneficial effects of the drug, it is often given lifelong. However, even at the low doses used in prevention for age-related decline, negative side effects may occur, and it is always desirable to use the lowest effective dose. A research group at the Max Planck Institute for Biology of Ageing in Cologne, Germany, has now shown in laboratory animals that brief exposure to rapamycin has the same positive effects as lifelong treatment opening new doors for a potential application in humans.
Combating the negative effects of ageing is increasingly becoming the focus of research scientists. Lifestyle changes can improve health of older people, but alone is not sufficient to prevent the ills of older age. Repurposing existing drugs for ‘geroprotection’ is providing an additional weapon in the prevention of age-related decline. The current most promising anti-ageing drug is rapamycin, a cell growth inhibitor and immunosuppressant that is normally used in cancer therapy and after organ transplantations. “At the doses used clinically, rapamycin can have undesirable side-effects, but for the use of the drug in the prevention of age-related decline, these need to be absent or minimal. Therefore, we wanted to find out when and how long we need to give rapamycin in order to achieve the same effects as lifelong treatment,” explains Dr. Paula Juricic, the leading investigator of the study in the department of Prof. Linda Partridge, director at the Max Planck Institute for Biology of Ageing.
Only brief exposure
The scientists have tested different time windows of short-term drug administration in fruit flies and found that a brief window of 2 weeks of rapamycin treatment in young, adult flies protected them against age-related pathology in the intestine and extended their lives. A corresponding short time window, 3 months of treatment starting at 3 months of age in young, adult mice, had similar beneficial effects on the health of the intestine when they were middle-aged.
“These brief drug treatments in early adulthood produced just as strong protection as continuous treatment started at the same time. We also found that the rapamycin treatment had the strongest and best effects when given in early life as compared to middle age. When the flies were treated with rapamycin in late life, on the other hand, it had no effects at all. So, the rapamycin memory is activated primarily in early adulthood,” explains Dr. Thomas Leech, co-author of the paper.
One step closer to applications
“We have found a way to circumvent the need for chronic, long-term rapamycin intake, so it could be more practical to apply in humans,” says Dr. Yu-Xuan Lu, also co-author of the paper. Prof. Linda Partridge, the senior author of the study, comments: “It will be important to discover whether it is possible to achieve the geroprotective effects of rapamycin in mice and in humans with treatment starting later in life, since ideally the period of treatment should be minimized. It may be possible also to use intermittent dosing. This study has opened new doors, but also raised many new questions.”
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Access to paid sick leave is linked to a lower rate of mortality among US working age men and women, according to new research in the American Journal of Preventive Medicine, published by Elsevier. The study shows that laws requiring employers to provide paid sick leave are effective in reducing mortality from suicide and homicide among men and homicide and alcohol-related causes among women. The findings also demonstrate that state laws that preempt local governments from enacting such mandates likely contributed to recent increases in mortality among working adults (up 6% from 2010-2017).
“State preemption laws that protect profits over people may be shortening the lives of working-age Americans,” said co-investigator Jennifer Karas Montez, PhD, Aging Studies Institute and Center for Aging and Policy Studies and Department of Sociology, Syracuse University, Syracuse, NY, USA. “We were surprised by how large the ‘preemption effect’ for paid sick leave mandates turned out to be. We project that mortality could potentially decline by over 5% in large central metro counties currently constrained by preemption laws if they were able to mandate a 40-hour annual paid sick leave requirement.”
The study analyzed data from the US Center for Disease Control and Prevention’s National Vital Statistics System (NVSS) on deaths among adults ages 25-64 by county from 1999-2019. Statistical analyses were used to estimate associations between these death counts and both minimum wage levels and paid sick leave requirements, while accounting for unemployment rates and Medicaid expansion.
The most striking findings are related to paid sick leave requirements: each additional hour of mandated paid sick leave is associated with a significant reduction in mortality due to suicide and homicide for men, and for homicide and alcohol-related deaths for women. The investigators calculated that mortality among their working-age population would have been 7.5% lower in the four counties (Orange County in Florida, and Bexar, Dallas, and Travis Counties in Texas) that attempted to mandate paid leave, only to have their state react by preempting their authority to do so.
The US is one of a few developed countries that has no national paid sick leave policy, forcing millions of workers to choose between going to work while they are ill or staying home without pay and at risk of being fired. The study shows that even before the COVID-19 pandemic, the absence of a paid sick leave requirement has contributed to troubling increasing mortality trends among working-age adults. Lack of paid sick leave increases the odds of economic hardship and involuntary job loss for those who take time off to recover, which, in turn, can elevate the odds of suicide, drug use, and other risky behaviors. It also puts healthy coworkers at risk through exposure to sick colleagues.
Preemption laws, which constrain lower-level governments’ legislative powers, have long been used to harmonize federal, state, and local policymaking or to establish minimum thresholds. The spread and intent of state preemption laws accelerated after 2010 covering new policy domains, such as labor standards, public health, environmental protections, and land use, and defining regulatory ceilings.
“Our study adds to a growing literature pointing to the importance of states’ labor and economic policies on mortality of working-age adults. The consequences of preemption laws stymie local government innovation, constrain opportunities to earn a living wage and take time off of work for medical care without financial repercussions, elevate the risk of death among infants and working age-adults, and contribute to geographic disparities in mortality,” explained lead investigator Douglas A. Wolf, PhD, Aging Studies Institute and Center for Aging and Policy Studies and Department of Public Administration and International Affairs, Syracuse University, Syracuse, NY, USA.
“These findings build on our prior research on the effect of minimum wage preemption laws on infant mortality, adding another policy dimension that addresses working-age mortality and paid sick leave laws — a natural extension of our prior work,” added co-investigator Shannon Monnat, PhD, Aging Studies Institute and Center for Aging and Policy Studies, Department of Sociology, and Lerner Center for Public Health Promotion and Center for Policy Research, Syracuse University, Syracuse, NY, USA.
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Osaka Metropolitan University scientists have developed a simple, rapid method to simultaneously identify multiple food poisoning bacteria, based on color differences in the scattered light by nanometer-scaled organic metal nanohybrid structures (NHs) that bind via antibodies to those bacteria. This method is a promising tool for rapidly detecting bacteria at food manufacturing sites and thereby improving food safety. The findings were published in Analytical Chemistry.
According to the World Health Organization (WHO), every year food poisoning affects 600 million people worldwide — almost 1 in every 10 people — of which 420,000 die. Bacterial tests are conducted to detect food poisoning bacteria at food manufacturing factories, but it takes more than 48 hours to obtain results due to the time required for a bacteria incubation process called culturing. Therefore, there remains a demand for rapid testing methods to eliminate food poisoning accidents.
Responding to this need, the research team led by Professor Hiroshi Shiigi at the Graduate School of Engineering, Osaka Metropolitan University, utilized the optical properties of organic metal NHs — composites consisting of polyaniline particles that encapsulate a large number of metal nanoparticles — to rapidly and simultaneously identify food poisoning-inducing bacteria called enterohemorrhagic Escherichia coli (E. coli O26 and E. coli O157) and Staphylococcus aureus.
The team first found that organic metal NHs produced stronger scattered light than metal nanoparticles of the same size. Since the scattered light of these NHs is stable in the air for a long period of time, they are expected to function as stable and highly sensitive labeling materials. Furthermore, it has been revealed that these NHs exhibit different colors of scattered light (white, red, and blue) depending on the metal elements of the nanoparticles (gold, silver, and copper).
Then the team introduced antibodies that bind specifically to E. coli O26, E. coli O157, and S. aureus into the organic metal NHs and used these NHs as labels to evaluate the binding properties of the antibody-conjugated NHs to specific bacterial species. As a result, E. coli O26, E. coli O157, and S. aureus were observed as white, red, and blue scattered light, respectively, under the microscope. Furthermore, when adding predetermined amounts of E. coli O26, E. coli O157, and S. aureus to rotten meat samples containing various species of bacteria, the team succeeded in using these labels to simultaneously identify each bacterial species added.
This method can identify various types of bacteria by changing the antibodies to be introduced. In addition, since it does not require culturing, bacteria can be rapidly detected within one hour, increasing its practicality as a new testing method.
Professor Shiigi commented, “We aim to establish new detection principles and testing methods through the development of unique nano-biomaterials. Through this development, we hope to contribute not only to food safety and security, but also to the formation of a safe and affluent society in terms of stable supply and quality control of functional foods, medical care, drug discovery, and public health.”
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Entrepreneurs are aiming to put A.I.-powered pet translation tools into our pockets.My cat is a bona fide chatterbox. Momo will meow when she is hungry and when she is full, when she wants to be picked up and when she wants to be put down, when I leave the room or when I enter it, or sometimes for what appears to be no real reason at all.But because she is a cat, she is also uncooperative. So the moment I downloaded MeowTalk Cat Translator, a mobile app that promised to convert Momo’s meows into plain English, she clammed right up. For two days I tried, and failed, to solicit a sound.On Day 3, out of desperation, I decided to pick her up while she was wolfing down her dinner, an interruption guaranteed to elicit a howl of protest. Right on cue, Momo wailed. The app processed the sound, then played an advertisement for Sara Lee, then rendered a translation: “I’m happy!”I was dubious. But MeowTalk provided a more plausible translation about a week later, when I returned from a four-day trip. Upon seeing me, Momo meowed and then purred. “Nice to see you,” the app translated. Then: “Let me rest.” (The ads disappeared after I upgraded to a premium account.)The urge to converse with animals is age-old, long predating the time when smartphones became our best friends. Scientists have taught sign language to great apes, chatted with grey parrots and even tried to teach English to bottlenose dolphins. Pets — with which we share our homes but not a common language — are particularly tempting targets. My TikTok feed brims with videos of Bunny, a sheepadoodle who has learned to press sound buttons that play prerecorded phrases like “outside,” “scritches” and “love you.”MeowTalk is the product of a growing interest in enlisting additional intelligences — machine-learning algorithms — to decode animal communication. The idea is not as far-fetched as it may seem. For example, machine-learning systems, which are able to extract patterns from large data sets, can distinguish between the squeaks that rodents make when they are happy and those that they emit when they are in distress.Applying the same advances to our creature companions has obvious appeal.“We’re trying to understand what cats are saying and give them a voice” Javier Sanchez, a founder of MeowTalk, said. “We want to use this to help people build better and stronger relationships with their cats,” he added.To me, an animal lover in a three-species household — Momo the cranky cat begrudgingly shares space with Watson the overeager dog — the idea of a pet translation app was tantalizing. But even MeowTalk’s creators acknowledge that there are still a few kinks to work out.Making ‘Meowsic’A meow contains multitudes. In the best of feline times — say, when a cat is being fed — meows tend to be short and high-pitched and have rising intonations, according to one recent study, which has not yet been published in a scientific journal. But in the worst of times (trapped in a cat carrier), cats generally make their distress known with long, low-pitched meows that have falling intonations.“They tend to use different types of melody in their meows when they try to signal different things,” said Susanne Schötz, a phonetician at Lund University in Sweden who led the study as part of a research project called Meowsic.And in a 2019 study, Stavros Ntalampiras, a computer scientist at the University of Milan, demonstrated that algorithms could automatically distinguish between the meows that cats made in three situations: when they were being brushed, while waiting for food or after being left alone in a strange environment.MeowTalk, whose founders enlisted Dr. Ntalampiras after the study appeared, expands on this research, using algorithms to identify cat vocalizations made in a variety of contexts.Read More on Artificial IntelligenceMaking Strides: We’re in a golden age of progress in artificial intelligence. It’s time to start taking its potential and risks seriously, our technology columnist writes.Photo Surveillance: Google has an automated tool to detect abusive images of children. But the system can get it wrong, and the consequences are serious.Predicting Shapes: A lab that had in 2020 unveiled technology that could predict the shape of proteins has now released predictions for nearly every protein known to science.Are These People Real?: We created our own artificial-technology system to understand how easy it is for a computer to generate fake faces.The app detects and analyzes cat utterances in real-time, assigning each one a broadly defined “intent,” such as happy, resting, hunting or “mating call.” It then displays a conversational, plain English “translation” of whatever intent it detects, such as Momo’s beleaguered “Let me rest.” (Oddly, none of these translations appear to include “I will chew off your leg if you do not feed me this instant.”)MeowTalkMeowTalkMeowTalk uses the sounds it collects to refine its algorithms and improve its performance, the founders said, and pet owners can provide in-the-moment feedback if the app gets it wrong.In 2021, MeowTalk researchers reported that the software could distinguish among nine intents with 90 percent accuracy overall. But the app was better at identifying some than others, not infrequently confusing “happy” and “pain,” according to the results.And assessing the accuracy of a cat translation app is tricky, said Sergei Dreizin, a MeowTalk founder. “It’s assuming that you actually know what your cat wants,” he said.I found that the app was, as advertised, especially good at detecting purring. (Then again, so am I.) But it’s much harder to determine what the calls in each category mean — if they carry a consistent meaning at all — without actually having a way of, you know, communicating with cats. (Cat-ch-22?)After all, the precise purpose of purring, which cats do in a wide variety of situations, remains elusive. MeowTalk, however, interprets purrs as “resting.”“But to be candid,” Mr. Sanchez said, “it can mean. …” He rephrased. “We don’t know what it means.”At times I found MeowTalk’s grab-bag of conversational translations unsettling. In one moment, Momo sounded like a college acquaintance responding to a tossed-off text message: “Just chilling!” In another, she became a Victorian heroine: “My love, I’m here!” (This spurred my fiancé to begin addressing the cat as “my love,” which was also unsettling.) One afternoon I hoisted Momo off the floor and, when she mewed, glanced at my phone: “Hey baby, let’s go somewhere private!”“Hey baby, let’s go somewhere private!”“A lot of translations are kind of creatively presented to the user,” Dr. Ntalampiras said. “It’s not pure science at this stage.”Dr. Schötz said that over the years she had seen several cat translation products, but that she had yet to find one that truly impressed her. “I’m looking forward to seeing something that really works, because that would be just brilliant,” she said.In the meantime, Mr. Sanchez said he had also heard from users who had found an unexpected use for the app, which stores recordings of the meows it captures: listening to these recordings after their animal had died. It’s a “very magical experience,” he said.Deciphering dogsDogs could soon have their own day. Zoolingua, a start-up based in Arizona, is hoping to create an A.I.-powered dog translator that will analyze canine vocalizations and body language.Dog owners have been overwhelmingly enthusiastic about the concept, said Con Slobodchikoff, the founder and chief executive of Zoolingua, who spent much of his academic career studying prairie dog communication. “Good communication between you and your dog means having a great relationship with your dog,” he said. “And a lot of people want a great relationship with their dog.”(But not everyone, he added: “One small minority says, ‘I don’t think that I really want to know what my dog is trying to communicate to me because maybe my dog doesn’t like me.’”)Still, even sophisticated algorithms may miss critical real-world context and cues, said Alexandra Horowitz, an expert on dog cognition at Barnard College. For instance, much of canine behavior is driven by scent. “How is that going to be translated, when we don’t know the extent of it ourselves?” Dr. Horowitz said in an email.The desire to understand what animals are “saying,” however, does not seem likely to abate. The world can be a lonely place, especially so in the last few years. Finding new ways to connect with other creatures, other species, can be a much needed balm.Personally, I would pay at least two figures for an app that could help me know whether my dog truly needs to go outside or just wants to see if the neighbor has put bread out for the birds. (Maybe what I really need is a canine lie-detection app.) For now, I will simply have to use my own judgment and powers of observation.After all, our pets are already communicating with us all the time, Dr. Horowitz noted. “It’s far more interesting to me to learn my own dog’s communications,” she said, “especially the idiosyncrasies that are formed between particular people and particular animals, than pretend that an app can — presto! — translate it all.”

A six-year analysis of more than 94,000 adults in the U.K. Biobank with no history of heart failure at enrollment has found that engaging in moderate or vigorous physical activity may lower the risk of developing heart failure, according to new research published today in the American Heart Association’s flagship journal Circulation.
The study is one of the first to use objectively measured activity levels to estimate heart failure risk. The results are consistent with previous studies finding that performing 150-300 minutes of moderate exercise or 75-150 minutes of vigorous exercise each week may reduce the incidence of heart attack and stroke.
Heart failure is a chronic, progressive condition that develops when the heart is not capable of pumping sufficient blood to keep up with the body’s needs for blood and oxygen, and it can result in fatigue and difficulty breathing. Heart failure affects more than 6 million adults in the United States, according to the American Heart Association, and more than 86,000 Americans died of heart failure in 2019. The Association recommends adults should engage in at least 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity.
“There are many potential ways that regular physical activity may reduce the risk of developing heart failure,” said Frederick K. Ho, Ph.D., co-lead author of the study and a lecturer in public health at the University of Glasgow in Glasgow, Scotland. “For example, physical activity helps prevent weight gain and related cardiometabolic conditions, such as high blood pressure and Type 2 diabetes, all of which are risk factors for heart failure. Regular physical exercise may also strengthen the heart muscle, which, in turn, may prevent heart failure from developing.”
The investigators analyzed the health records of 94,739 adults aged 37-73 in the U.K. Biobank — a large research database in the United Kingdom that enrolled and collected health information on 500,000 adults who received care through the National Health Service. The participants in the U.K. Biobank were enrolled in the database between 2006 and 2010 across Scotland, England and Wales.
Data for this study was gathered between 2013-2015. During that time period, the subset of 94,739 participants were randomly invited to enroll in the study via the email address they had provided to the U.K. Biobank. Participants were an average age of 56 years at enrollment; 57% were female, and 96.6% were white adults. At the time each participant was invited, enrolled and analyzed, they had not been diagnosed with heart failure or had a heart attack. Each participant wore a wrist accelerometer for seven consecutive days, 24 hours per day, to measure the intensity and duration of physical activity. After enrollment, data was collected through linked hospital and death records.

Around ten percent of the population in high income regions like Europe and the United States has been diagnosed with one or multiple autoimmune disorders. Examples are rheumatoid arthritis, psoriasis, systemic sclerosis, lupus erythematosus and type I diabetes. Although earlier research has suggested associations between some of these disorders and a higher risk of cardiovascular disease, these studies were often too small and limited to selected autoimmune or selected cardiovascular conditions to draw conclusive evidence on the necessity of cardiovascular disease prevention among patients with autoimmune disease.
Until now. At the annual congress of the European Society of Cardiology, held this weekend in Barcelona, an international research team led by KU Leuven presented the outcome of a thorough epidemiological investigation into possible links between nineteen of the most common autoimmune disorders and cardiovascular disease. The results of the study show that patients with autoimmune disease have a substantially higher risk (between 1.4 and 3.6 times depending on which autoimmune condition) of developing cardiovascular disease than people without an autoimmune disorder. This excess risk is comparable to that of type 2 diabetes, a well-known risk factor for cardiovascular disease. The research shows for the first time that cardiovascular risks affect autoimmune disease as a group of disorders, rather than selected disorders individually.
The whole cardiovascular disease spectrum
In the research paper (that will be published in The Lancet) the authors show that the group of nineteen autoimmune disorders they have studied accounts for about 6 percent of cardiovascular events. Importantly, excess cardiovascular risk was visible across the whole cardiovascular disease spectrum, beyond classical coronary heart disease, including infection-related heart disorders, heart inflammation, as well as thromboembolic and degenerative heart disorders, suggesting the implications of autoimmunity on cardiovascular health are likely to be much broader than originally thought. Furthermore, the excess risk was not explained by traditional cardiovascular risk factors such as age, sex, socioeconomic status, blood pressure, BMI, smoking, cholesterol and type 2 diabetes. Another noteworthy finding: the excess risk is particularly high among patients with autoimmune disorders under 55 years and suggests that autoimmune disease is particularly important in causing premature cardiovascular disease, with the potential to result in a disproportionate loss of life years and disability.
The study was based on electronic health records from the United Kingdom’s Clinical Practice Research Datalink (CPRD), a very large database of anonymized patient data from about one-fifth of the current UK population. Among 22 million patient records, the researchers assembled a cohort of patients newly diagnosed with any of the nineteen autoimmune disorders. They then looked at the incidence of twelve cardiovascular outcomes — an unprecedented granularity that was made possible by the very large size of the dataset — in the following years, and they compared it to a matched control group. The risk of developing cardiovascular disease for patients with one or more autoimmune disorders was on average 1.56 times higher than in those without autoimmune disease. They also found that the excess risk rose with the number of different autoimmune disorders in individual patients. Among the disorders with the highest excess risk were systemic sclerosis, Addison’s disease, lupus and type I diabetes.
Need for targeted prevention measures
The results show that action is needed, says Nathalie Conrad, lead author of the study. ‘We see that the excess risk is comparable to that of type 2 diabetes. But although we have specific measures targeted at diabetes patients to lower their risk of developing cardiovascular disease (in terms of prevention and follow-up), we don’t have any similar measures for patients with autoimmune disorders.’ Conrad mentions the European Society of Cardiology guidelines on the prevention of cardiovascular diseases, which don’t yet mention autoimmunity as a cardiovascular risk factor (the guidelines only mention some specific disorders, like lupus) nor do they list any specific prevention measures for patients with autoimmune disease.
Conrad hopes the study will raise awareness among patients with autoimmune disease and clinicians involved in the care of these patients, which will include many different specialties such as cardiologists, rheumatologists, or general practitioners. ‘We need to develop targeted prevention measures for these patients. And we need to do further research that helps us understand why patients with an autoimmune disorder develop more cardiovascular diseases than others, and how we can prevent this from happening.’
Speaking of the pathophysiology, the underlying mechanisms are still poorly understood. Conrad: ‘The general hypothesis is that chronic and systemic inflammation, which is a common denominator in autoimmune disorders, can trigger all sorts of cardiovascular disease. Effects of autoimmune disease on connective tissues, small vessels, and cardiomyocytes, and possibly some of the treatments commonly used to treat autoimmunity are also likely to contribute to patients’ cardiovascular risk. This really needs to be investigated thoroughly.’
Conrad, who owns an engineering degree and a PhD in medical sciences (epidemiology), performed the study during a two-year Marie Curie postdoctoral fellowship at KU Leuven. She worked closely together with Professor Geert Verbeke (KU Leuven), Professor Geert Molenberghs (KU Leuven and Hasselt University) and Professor Jan Verbakel (KU Leuven), who assisted in the bio-statistical and the clinical side of the study. Also part of the team was John McMurray (University of Glasgow, UK), a world-renowned cardiologist. He praises the very broad scope of the research. ‘This population-based study suggests that a much broader range of autoimmune disorders than previously recognized are associated with a variety of different cardiovascular problems.’ The cardiologist further mentions a possible solution in the short term. ‘Some of these problems are potentially preventable using readily available treatments such as statins.’
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Updated Covid vaccines, expected soon after Labor Day, were designed to thwart Omicron variants. But money to distribute them has dried up.Long past the point when pollsters said there were no more Americans willing to be vaccinated against the coronavirus, Coral Garner kept finding them.An organizer of mobile clinics for the Minnesota Department of Health, she arranged to provide vaccines and booster shots to people who had resisted them, setting up in a retrofitted city bus outside a Nigerian church, a Hmong senior center, a Somali mall and dozens of other sites.But even as the United States now prepares for a critical campaign to deliver Omicron-specific booster shots, Ms. Garner’s job no longer exists. In June, her contract position was canceled because the state said funding had dried up.At the very moment a better coronavirus vaccine is expected to finally become available, America’s vaccination program is feeling the effects of a long period of retreat.Local programs to bring shots to the places where Americans gather and the institutions they trust have folded, a consequence in some cases of congressional resistance to more pandemic response spending.The same local health department workers responsible for Covid and flu shots this fall have also, without new staffing, been juggling a monkeypox outbreak and childhood immunization deficits that have left some places susceptible to polio.And some state health officials, citing weak demand for vaccines and increased survival rates of late, said in interviews that they had stopped aggressively pushing coronavirus shots.With the virus killing far fewer people than it once did and many Americans reverting to their prepandemic ways, the country’s no-expenses-spared attitude to saving lives has evolved into a response that has put a greater onus on individuals to protect themselves. In keeping with that approach, many health officials believe the vaccine machinery is in place to meet what they expect, lamentably, to be tepid demand this fall.Tess Holman, held her daughter, Margot Holman, 1, as she received the Covid vaccine at the Mall of America in Bloomington, Minn., in June.Jenn Ackerman for The New York TimesBut others are worried that the country is surrendering a decisive opportunity to stoke that demand and restore the more robust vaccination efforts that lifted last year’s initial rollout.“We are watching the dismantling of the hyperlocal infrastructure that actually brought needles to arms in the most vulnerable communities in the country,” said Stephen Thomas, the director of the Center for Health Equity at the University of Maryland. “To this day, vaccine uptake in the United States is embarrassing.”The Biden administration said some 70,000 sites were prepared to vaccinate people this fall. While 60 percent of those are pharmacies, they also include doctor’s offices, community health centers and rural health clinics.States can also seek money from the Federal Emergency Management Agency for certain vaccination-related expenses, like setting up sites, buying equipment and offering translation or transportation services.Read More on the Coronavirus PandemicHeavy Toll: The average life expectancy of Americans fell precipitously in 2020 and 2021. The decline, largely driven by the pandemic, was particularly pronounced among Indigenous communities.Boosters: An influential panel of expert advisers to the Centers for Disease Control and Prevention recommended updated coronavirus booster shots to the vast majority of Americans, clearing the way for health workers to begin giving people the redesigned shots within days.Paxlovid Study: The Covid-19 medication Paxlovid reduced hospitalizations and deaths in older patients, but made no difference for patients under 65, new research from Israel found.Moderna’s Lawsuits: The vaccine manufacturer sued Pfizer and BioNTech, claiming that its rivals’ Covid-19 shot copied groundbreaking technology that Moderna had developed before the pandemic.Having shifted much of the rollout to private sites, though, states have been promised FEMA reimbursements on a relatively modest $550 million in vaccination spending so far this year. Last year, that figure was $8.5 billion.And while providers are supposed to vaccinate everyone for free, with or without insurance, the federal government ran out of money this spring to offer reimbursements for shots for uninsured people, making it more difficult for them to receive boosters.Sonya Bernstein, a senior policy adviser for the White House Covid response team, said federal spending to support vaccination efforts was being held back by a stalemate in Congress over the administration’s request for billions of dollars in additional pandemic aid. Republicans have said that additional coronavirus spending could be covered with funding already approved by Congress, an assertion that some state health officials say is false.“We are working with less because Congress has not provided us with that funding,” Ms. Bernstein said. “But that has not gotten in the way of our preparations. We’re working day in and day out to make sure states and our partners have the resources and support they need.”The United States is leaning ever more heavily on vaccines to defend against the virus at a time when health officials are pulling back on other preventive measures, like masking, distancing and quarantining.The fall vaccination campaign, which is expected to begin soon after Labor Day, could be crucial. Many Americans have gone months since their last Covid vaccine or infection, allowing immune defenses to wane. More indoor gatherings are on the horizon, and epidemiologists are predicting roughly 100,000 to 165,000 additional Covid deaths by the spring.And, for the first time, the government has bought vaccines that were reformulated in response to the virus’s evolution. Manufacturers may finally have gained on the pathogen: The Omicron subvariant that the updated shots were designed to protect against remains dominant in the United States.But, at the same time, the vaccination campaign is lagging. While two-thirds of Americans have completed the primary vaccine series, only about one-third have received boosters. The country’s per capita booster coverage trails that of some 70 other nations, according to Our World in Data.Some are worried that the country is surrendering a decisive opportunity to stoke demand for and restore the more robust vaccination efforts that lifted last year’s initial rollout.Hannah Beier for The New York TimesPartly as a result, scientists said, Americans this year have died from Covid at a rate 80 percent higher than Canadians and 30 percent higher than residents of the European Union.“We have criticisms of the way the initial vaccine rollout happened, but there was really a very significant effort to get everyone vaccinated,” said Elizabeth Wrigley-Field, a University of Minnesota sociologist, who mentioned mandates, financial rewards and large events. “None of that really exists with boosters.”With Covid deaths having plateaued around 480 a day, policymakers are grappling with whether renewed investments are needed. Some states believe they are not.In Alabama, where one-fifth of residents are boosted, Dr. Burnestine Taylor, the state’s medical officer for disease control and prevention, said officials had pared back health department clinics and become more reliant on pharmacies as demand dropped. The decision to receive additional shots, she said, now fell to individuals.“At this point, we’re not doing a hard push,” Dr. Taylor said. “It’s a personal decision.”Even some more proactive efforts have run into a wall of complacency. In Camden County, N.J., health workers have visited community events and knocked on doors, but they have not encountered as many takers as they had hoped, said Paschal Nwako, the health officer there.But other health workers said that they were still winning converts, if fewer than last year, including those who had been confused about boosters or unable to find clinics with evening availability.In Madison, Wis., Aaron Perry, a former police officer, said that $100 stipends provided by the state have helped draw a dozen or so booster recipients to his health clinic every Friday, many from Black barbershops where he also runs health screening centers.In San Bernardino, Calif., Jacinda Abdul-Mutakabbir, a pharmacist at Loma Linda University, said clinics late this spring could still attract as many as 30 first dose recipients.And in Bismarck, N.D., Renae Moch, the public health director, said organizations like food pantries and homeless shelters still wanted to host regular clinics. But with surge staffing over, workers exhausted and positions harder to fill, she said she could only hold monthly pop-up clinics at a limited number of sites — and none in September, when back-to-school immunizations would consume the staff.Of the hundreds of barbershops nationally that once hosted vaccination events, nine out of 10 are struggling to keep offering shots, said Dr. Thomas, of the University of Maryland, who has helped organize them. In some cases, he said, hospitals or pharmacies that eagerly used to send doses or staff have reported not having the money to partner with barbershops again or being concerned that small turnouts will not make it worth their while.Mike Brown cuts the hair of Michael Venable at the The Shop Spa, a barbershop outside of Washington, D.C. Michael A. McCoy for The New York Times“The health care providers lost interest in us,” said Mike Brown, a barber outside Washington, D.C. “But I don’t think now is the time to give up the fight. People are still dying.”For poorer Americans, the decrease in public vaccination sites could reduce the number who receive shots this fall, experts said.In New York, Emily Gerteis, who arranges shots for people living on the street or in shelters at the Center for Urban Community Services, recalled convincing a patient this summer to be vaccinated. But when she suggested a pharmacy, the patient refused, preferring to hold out for city clinics and their $100 incentives, Ms. Gerteis said.The problem was that those offerings no longer existed. The patient was not vaccinated.“A year ago, there was all this money for advertising, and they were throwing money at vaccines,” said Dr. Zeke McKinney, a physician in Minneapolis who had helped to organize vaccinations at his local barbershop until funding dried up. “Now, it’s like nobody cares.”The White House is still seeking more funding from Congress, which it says is also needed to produce tests and develop next-generation Covid vaccines.For now, some health officials said they were prepared to rev back up shuttered sites in the event demand surged, even if their workers were increasingly depleted. On some days recently, Dr. Mysheika Roberts, the health commissioner in Columbus, Ohio, said she needed to divert two-thirds of her Covid vaccination specialists to monkeypox clinics.“It’s a bit overwhelming for some of our staff members,” she said.Experts said that restoring health workforces and maintaining vaccine outreach could help break a boom-and-bust cycle in public health spending that has especially hurt marginalized Americans. Early investments, for example, helped narrow racial gaps in primary series vaccination rates. But in the booster rollout, considerable racial disparities have re-emerged.The relaxation of federal Covid guidance and the reluctance to incentivize booster shots has not made it any easier to persuade people of the benefits of additional doses, some health officials said.“There’s a lot of messaging from federal sources that things are good and we’re back to normal,” said Dr. Clay Marsh, West Virginia’s Covid czar. “It’s mixed messaging.”Dr. Mysheika Roberts has had to divert two-thirds of her Covid vaccination specialists to monkeypox clinics recently.Maddie McGarvey for The New York TimesHealth experts encouraged making Covid shots a routine part of people’s medical care, including by enlisting more primary care doctors in the rollout. More creative marketing could also help generate demand, said Dr. Kevin Schulman, a Stanford University professor.One example, he said, would be a campaign framed around protecting older relatives at fall or winter holiday gatherings. Despite the scientific uncertainties, he also said the time had to come to promise Americans that they would not be asked back for further Covid vaccines for at least a year — and that, when they were, it would be for an “annual Covid vaccine,” rather than a “booster.”“Marketers spend huge amounts of time trying to figure these things out,” Dr. Schulman said. “Unfortunately, we just haven’t seen effort devoted in that direction.”Ms. Bernstein, the White House adviser, said the administration was regularly surveying people about booster shots and using the results to inform messages it suggested to on-the-ground partners.Ben Weston, Milwaukee County’s chief health policy adviser, said the nation’s underfunded booster campaign had hurt the same vulnerable and often nonwhite residents who have long struggled to gain access to good medical care.“It’s putting up barriers,” he said, “particularly for populations that are more susceptible to those barriers.”

Jonathan Wolfe, the reporter behind the Coronavirus Briefing, now the Virus Briefing, discusses the newsletter’s shift in focus.Times Insider explains who we are and what we do and delivers behind-the-scenes insights into how our journalism comes together.This month, the Coronavirus Briefing newsletter — an account of pandemic news that began in January 2020 — transitioned to the Virus Briefing. The new weekly newsletter, written by Jonathan Wolfe, a Times reporter, expands the briefing’s mission to include updates and expert insight on the varying diseases and pathogens — such as monkeypox and poliovirus — that are spreading across the globe.The Coronavirus Briefing has served as a critical source of pandemic news ever since Covid-19 was a mysterious new illness. More than two years later, it remained committed to providing readers with need-to-know updates. But, as the briefing recently reported, Covid is “here to stay,” according to the Centers for Disease Control and Prevention. The briefing is changing to reflect that outlook, with a greater emphasis on living with the virus instead of preventing infection.In an interview, Mr. Wolfe reflected on more than two years of writing the Coronavirus Briefing and discussed what would change — and what wouldn’t — in the new format. This interview has been edited.How did years of writing the Coronavirus Briefing shape your reporting?It gave me a broader understanding of the range of effects that the virus was having on people. Every issue, we would ask readers to send us a note saying how they were coping with the pandemic — I think we have 20,000 at this point. Readers wrote in with stories of losing businesses, or having sick family members, or how the virus was affecting their mental health. I heard a lot of opinions and stories in real time that I wouldn’t have otherwise. It definitely made me understand the full effects of the virus and its damaging effects on all aspects of life.Will reader engagement continue in the Virus Briefing?Definitely. We really like to engage with our readers; they always have really smart things to offer, and their stories are super interesting.What to Know About the Monkeypox VirusCard 1 of 7What to Know About the Monkeypox VirusWhat is monkeypox?