Publisher Health

Are women who have twins more fertile? While previous studies concluded they are, a detailed analysis of more than 100,000 births from pre-industrial Europe by an international team of scientists shows they are not. The results of the study are now published in the scientific journal Nature Communications.
In humans, twinning usually occurs in about 1-3% of all births. Twinning is found in all populations despite being associated with a much higher risk of natal and postnatal health issues for both the mother and her children than single pregnancies. Given these risks, it seems that natural selection has prevented twinning from becoming more common during evolution. But why then has evolution by natural selection not prevented twinning altogether?
One common explanation has been that survival risks brought by twinning are partly hidden from natural selection because twinning comes with higher fertility. The idea is that women who are more fertile than average are also more likely to release more than one egg when they ovulate — making twinning a marker of high fertility. Many studies analysed demographic data and obtained results consistent with this view.
However, this new study shows that the former analyses have been flawed. “Previous studies are problematic because they cannot tell us whether mothers with twins give birth more often because they are especially fertile, or because giving birth more often increases the chance that one of these births is to twins,” explains principal investigator Alexandre Courtiol from the Leibniz Institute for Zoo and Wildlife Research in Germany.
The new results show that twinners are not unusually fertile. Previous science had mixed up cause and effect. “If a mother gives birth more often, it is more likely that one of these births is to twins — just like you are more likely to win if you buy more lottery tickets, or to be in a car accident if you drive a lot,” adds first author Ian Rickard from Durham University, UK. When the “lottery ticket effect” is taken into account, the authors found that mothers more likely to have twins actually gave birth less often — a result that contradicts previous findings.
To re-examine the relationship between twinning and fertility, the international team of 14 scientists combined large datasets of birth outcomes from several parts of pre-industrial Europe (today’s Finland, Sweden, Norway, Germany and Switzerland). “All these data originate from old parish records that have been meticulously digitised and transcribed,” explains co-author Virpi Lummaa from University of Turku, Finland. “To avoid the statistical trap that plagued former studies, we also had to deploy efficient and carefully calibrated statistical procedures,” adds co-author François Rousset from the Institut des Sciences de l’Evolution in Montpellier, France.
Figuring out what shapes the relationship between twinning and fertility is not only a question of academic interest but also a matter of public health. Indeed, biomedical studies looking for ways to improve female fertility have compared mothers with and without twins. However, co-author Erik Postma from the University of Exeter in the UK points out that, “such study designs ignore the multitude of factors influencing how often a woman gives birth, which will mask any genuine differences in physiology between mothers with and without twins.” In short, comparing groups of mothers with twins to groups of mothers without may hide the effects of twinning and fertility genes where they exist, or create the illusion of these if they do not exist.
“There is still much we do not understand about twinning, but our study suggests that twinning has not been eliminated by natural selection for two reasons. First, twinning is a consequence of double ovulation, which compensates for reproductive ageing and benefits all but the youngest of mothers. Second, when the risk of early mortality of twins is not too high, twinning is associated with larger family sizes although women with twins give birth less often. This is because twin births bring two offspring rather than one,” concludes Courtiol.

Up to three out of every 1,000 infants in the United States are born with profound hearing loss.
Typically, infants with hearing loss are first treated with hearing aids, and if these fail to help them develop early language and speech skills, they then become eligible for cochlear implants at 12 months or older. Cochlear implants — considered the gold standard of treatment — are small, electronic devices surgically placed under the skin that stimulate nerve endings in the ear to provide a sense of sound.
However, some insurance companies have traditionally denied coverage of cochlear implants to deaf children with severe developmental delays (such as low cognitive skills and low adaptive, or learned, behavior), under the belief that the implants will not help them learn to communicate.
Now, a new study from Keck Medicine of USC has found that infants with hearing loss and severe developmental delays are better served with cochlear implants than hearing aids.
“We demonstrated that cochlear implants improve the skills of deaf children with early developmental impairment across the board in every skill tested — cognitive, adaptive behavior, language and auditory” said John Oghalai, MD, an otolaryngologist with Keck Medicine, chair of the USC Caruso Department of Otolaryngology — Head and Neck Surgery and lead author of the study.
In 2010, researchers identified children with severe to profound hearing loss at two large pediatric cochlear implant centers in Texas and California.

An examination of the most credible research to date.Shortly after the Supreme Court draft opinion was leaked that indicated the possible overturning of Roe v. Wade, the American Psychological Association reaffirmed its opinion that restricting abortion was “likely to lead to mental health harms,” a growing concern as some states rush to pass laws that would prohibit abortion.But anti-abortion groups have long argued that abortion is what harms a woman’s mental health, a claim that contradicts credible research.While unwanted pregnancy can produce feelings of distress, regardless of whether a woman has an abortion or not, landmark research known as the Turnaway study found that women who were denied an abortion had more psychological problems in the short term than those who received one, and also experienced more long-term physical and financial problems.What happens to the women who are turned away?When examining how women are affected by abortion restrictions, the Turnaway study — while not without its limitations — is the most comprehensive available, and analyses of its data have been published in numerous peer-reviewed journals.The study recruited nearly 1,000 women at 30 abortion clinics around the country between 2008 and 2010. The researchers then compared the outcomes of those who were denied an abortion (because they were just over the gestational limit in their state) with those who were permitted to have the procedure, and followed both sets of women for five years.The women who were denied abortions were initially more likely to experience higher levels of anxiety, lower life satisfaction and lower self-esteem compared with those who could obtain abortions — distress that “may be a response to being denied an abortion, as well as other social and emotional challenges faced on discovery of unwanted pregnancy and abortion seeking,” the study said.After about six months, however, those differences disappeared. In fact, the mental health of both groups eventually improved, which indicates that the study participants were emotionally resilient, said Diana Greene Foster, a professor in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, and lead investigator of the Turnaway study.“The experience of having an unwanted pregnancy is really disruptive,” she added. But “over time people do better — regardless of whether they got their abortion or not.”The physical and financial harms of being denied an abortion, however, lasted for years. Women who were denied an abortion and gave birth reported more chronic headaches or migraines, joint pain and gestational hypertension compared with those who had an abortion. They also reported more life-threatening complications like eclampsia and postpartum hemorrhage, and burdens that included higher exposure to domestic violence and increased poverty.Ann, a 28-year-old in California who was not part of the Turnaway study, said she didn’t realize she was pregnant until well into the second trimester, shortly after graduating from college. She wanted to have an abortion but just missed the legal cutoff in her state.After speaking with her obstetrician, “I remember going to the bathroom and sobbing,” said Ann, who asked to be referred to by a first name to protect her family’s privacy.During her pregnancy, Ann suffered from severe pre-eclampsia that ended in seizures and an emergency C-section. “I deeply feel like I never want to get pregnant again just because of how traumatic the experience itself was,” she said.Limitations of the Turnaway studyEven though the Turnaway study was rigorous in its design, it cannot be used to generalize for all women seeking abortions — or all experiences with unwanted pregnancy.Turnaway excluded women with a fetal diagnosis or maternal health problems, for example, and most of the women denied abortions were in the second trimester.In addition, the Turnaway study did not include women who never made it to an abortion clinic — in other words, the women who were the most isolated, financially and socially.Some abortion opponents are dismissive of the Turnaway study because of its participation rate. In a 2018 paper published in SAGE Open Medicine, for example, the anti-abortion activist David C. Reardon criticized Turnaway, in part because only about 37 percent of the more than 3,000 women who were asked to participate agreed to do so, and throughout the five-year study some of the women dropped out.Women who anticipate the most difficulty with their abortions may not wish to share their thoughts and feelings about it, he wrote, and may want “to avoid follow-up surveys that may aggravate those negative feelings.”Dr. Foster acknowledged that the subject of abortion or unwanted pregnancy isn’t always easy to talk about, but said there was no evidence that the women in their study skewed toward having rosier views on abortion. And with regard to the participation rate, she added, a study like this is time-consuming — not everyone will want to commit for a five-year period.“We actually take pride in our retention rate,” Dr. Foster said. “We only lost 5 percent of people from survey to survey.”How does abortion affect mental health?Decades of research show that one of the most reliable predictors of mental health after an abortion is the condition of a woman’s mental health before pregnancy.For example, a study led by Julia R. Steinberg, an associate professor at the University of Maryland, College Park, compared women who gave birth to those who had abortions and found that when women’s pre-existing mental health disorders were taken into account, having an abortion was not associated with anxiety, mood, impulse control or eating disorders, nor were abortions predictive of suicidal ideation.Additionally, the Turnaway study found that those who had abortions were no worse off mentally than those who did not, and the procedure did not increase women’s risk for post-traumatic stress.Even so, some anti-abortion groups believe that getting an abortion can be more harmful to a woman’s mental health than being denied one.“Grief and a feeling of not being fully informed is consistent throughout my clients who report having had an abortion,” Robin Atkins, a licensed mental health counselor who leads the mental health section of the American Association of Pro-Life Obstetricians and Gynecologists, said in an email.Among women who have an abortion, an analysis of Turnaway data published in 2020 found that five years post-abortion, 84 percent had either primarily positive emotions or no emotions whatsoever about their abortion decision, while 6 percent expressed primarily negative emotions.The stress of seeking an abortionThe decision to seek an abortion can be emotionally taxing, regardless of whether someone decides to do it or not.An analysis of Turnaway data published in 2020, led by M. Antonia Biggs, an associate professor in the department of obstetrics, gynecology and reproductive sciences​ at the University of California, San Francisco, found that most people considering abortion perceived some stigma — they felt people in their community or people they were close to would look down on them if they knew they had sought an abortion — and this stigma was associated with psychological distress years later.Another of Dr. Biggs’s studies, also published in 2020, surveyed 784 people seeking abortion at four facilities in three U.S. states. The women who encountered logistical problems, like spending time trying to seek care, scheduling an appointment or traveling — as well as those who felt forced to wait to have the abortion or to tell other people about their pregnancy — were more likely to have symptoms of stress, anxiety and depression.Having reproductive autonomy “is extremely important in terms of protecting someone’s mental health and well-being,” Dr. Biggs said.The more women are denied abortions, experts say, the bigger some of these obstacles might become.In 2017, Catherine Sullivan was 17 weeks pregnant when she learned that her baby was missing an X chromosome, the result of a rare genetic disorder called Turner Syndrome.The doctor presented termination as an option. But in Anchorage, where she lived, she could not find a provider who was willing or able to perform the procedure. She began calling clinics in different states and finally located one in Colorado. The cost, $10,000 out of pocket, was out of reach.“I went through five or six weeks of absolute torture,” Ms. Sullivan recalled. Eventually, at 22 weeks, her daughter died in utero and was delivered at a hospital.“I am still working through the PTSD of being denied the choice of how to end my pregnancy,” said Ms. Sullivan, 39. “And I still feel shame about having wanted an abortion for this child that I wanted so much.”Not having the option only caused her “further pain, further anguish, further grief,” she said. “And none of that had to happen.”

A study co-led by the Universities of Oxford, Birmingham and Southampton and the UK Health Security Agency (UKHSA), published in Lancet Oncology today by the UK Coronavirus Cancer Evaluation Project, has found that while COVID-19 vaccination is effective in most cancer patients, the level of protection against COVID-19 infection, hospitalisation and death offered by the vaccine is less than in the general population and vaccine effectiveness wanes more quickly.
Dr Lennard Lee, Department of Oncology, University of Oxford who led the study said: ‘We know that people with cancer have a higher risk of severe COVID-19 disease and that the immune response in cancer patients following COVID-19 vaccination is lower. However, no study has looked at vaccine effectiveness and its waning in cancer patients at a population level. We have undertaken the largest real-world health system evaluation of COVID-19 in cancer patients globally.’
This study analysed 377,194 individuals with active or recent cancer who had received two doses of the COVID-19 vaccine and undergone a SARS-CoV-2 PCR test in England1. The numbers of breakthrough COVID-19 infections and COVID-19-associated hospitalisations and deaths2 in this cohort of cancer patients were compared to a control population without active or recent cancer.
The overall vaccine effectiveness against COVID-19 infection in the general population after two doses of the COVID-19 vaccine over the study period was 69.8% whereas, in the cancer cohort, overall vaccine effectiveness was slightly lower (65.5%). This indicates that COVID-19 vaccination is effective in most cancer patients. However, vaccine effectiveness wanes more quickly in cancer patients. At 3-6 months following the second vaccine dose, vaccine effectiveness reduced by nearly a third from 61.4% in the general population to 47.0% in the cancer cohort.
While the vaccine offers higher protection against COVID-19-associated hospitalisation (83.3%) and death (93.4%) than against breakthrough infections in the cancer cohort, this protection also waned by 3-6 months following the second vaccine dose.
Looking at the differences between people with different types of cancer, vaccine effectiveness is lowest and wanes most quickly in those with the blood cancers lymphoma and leukaemia.
The type of treatment that people with cancer receive also impacts both overall vaccine effectiveness and waning. In cancer patients that were treated in the last 12 months with chemotherapy or radiotherapy, vaccine effectiveness is lower and waned more by 3-6 months than in cancer patients that did not receive these treatments or were treated more than a year ago.
Professor Peter Johnson, Professor of Medical Oncology, University of Southampton commented: ‘This study shows that for some people with cancer, COVID-19 vaccination may give less effective and shorter-lasting protection. This highlights the importance of vaccination booster programmes and rapid access to COVID-19 treatments for people undergoing cancer treatments.’
Helen Rowntree, Director of Research, Services and Engagement at Blood Cancer UK said: ‘For our community, COVID-19 very much has not gone away and many people remain in their homes due to the threat of COVID-19 highlighted in this important study. We know how important the vaccines are for people with blood cancer. This study importantly shows that immunity wanes faster in people with blood cancer, who are entitled to five vaccine doses, and we’d encourage everyone with blood cancer to make sure they are getting these doses.’
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Materials provided by University of Oxford. Note: Content may be edited for style and length.

The Best Emollients for Eczema trial has found that no one type of moisturiser is better than another. This study, the first in the world to directly compare different types of moisturisers, highlights the importance of patient education and choice when deciding which moisturisers to use for children with eczema. The results from the National Institute for Health and Care Research (NIHR) funded study are published in The Lancet Child & Adolescent Health and British Journal of General Practice today.
Moisturisers (also called emollients) are recommended for the one in five children who have eczema (also known as atopic eczema/dermatitis), which causes dry and itchy skin. Over 100 different moisturisers are prescribed in the NHS, costing over £100 million a year. Lack of research in this area means NHS guidelines vary widely in what is recommended, which leads to confusion and waste.
In the study, led by the universities of Bristol, Nottingham and Southampton, 550 children with eczema aged under 12 years were randomised to use one of four types of moisturiser (lotion, cream, gel or ointment) as their main moisturiser for 16 weeks. Parents completed diaries about their child’s eczema for a year, and some were interviewed to gain an in-depth understanding of how they used the moisturisers and what they thought of them. All children also had an independent examination of their skin.
Used alongside other eczema treatments, there was no difference in effectiveness of the four types of moisturiser used in the study. Skin reactions such as itching or redness were common with all moisturiser types. Awareness of the different types of moisturiser was low, and users had different preferences based on how the moisturisers look and feel. For example, some people liked how lotions quickly soaked in whereas others preferred the “barrier” provided by ointments.
Professor Matthew Ridd, a GP and study lead from Centre for Academic Primary Care at the University of Bristol, said: “A study of this type has been long overdue. It has not been in the interest of the manufacturers to directly compare types of moisturiser in the way we have done in this trial. Our findings challenge conventions about how often moisturisers need to be applied, which types are less likely to cause problems and which patients should be recommended certain types. For example, ointments are often suggested for more severe eczema, yet they were found to be no better.”
Hayley, the mother of Abriarna who took part in the trial, said: “The trial helped us find an emollient we had never used before, which has helped keep Abriarna’s skin in good condition for the longest time. Her eczema often requires a different emollient for various purposes, for example, Abriarna has a regular day-to-day moisturiser, which we found through the trial. She then has an emollient for days when her eczema is agitated and then an emollient to wash in as well as to use after handwashing.”
Tiffany Barrett, pharmacist and co-researcher added: “NHS prescribing of moisturisers is determined by locally agreed formularies. These formularies are based on both cost and perceived effectiveness. What this study does is emphasise the importance of having the four main types of moisturisers available on formularies for children with eczema, so that the right product can be used at the right time.”
Professor Hywel Williams, consultant dermatologist and co-researcher at the University of Nottingham, explained: “Along with anti-inflammatory treatments such as topical corticosteroids, emollients are a really key part of treatment for childhood eczema, preventing flares and helping to soothe the skin and improving the quality of life for children and their carers.
“Our study shows that one size does not fit all, and points to the need for doctors to make parents aware of the different emollient types and to help them choose which one is mostly likely to work for them. At last we have evidence that supports the saying, ‘The best moisturisers are the ones the patient will use.'”
Professor Nick Levell, NIHR National Specialty Lead for Dermatology, said: “Around one in five children get eczema and the scratching and sleep loss affects school performance and exhausts children and their parents. This study confirms that parent and patient preference is very important in choosing a moisturiser to treat eczema. Some people prefer ointments, but others like gels, creams or lotions. No one option is best. As reactions to moisturisers are common, it is important that the NHS provides a wide choice to help parents find something that soothes and calms their child’s fiery skin.”
Further work is needed to determine if these findings apply to adolescents and adults with eczema, and people with other dry skin conditions.
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What really is the prognosis for John Fetterman, the Democratic Senate nominee from Pennsylvania who had a stroke on May 13?The 52-year-old lieutenant governor of Pennsylvania clinched his party’s nomination just a few days later, setting up one of the most consequential Senate contests of the midterm elections. But urgent medical questions remain.He was discharged from the hospital, his campaign said on Sunday, and Mr. Fetterman has said doctors assured him that he would make a complete recovery — but the campaign has not said when he will be able to return to campaigning.“I am going to take the time I need now to rest and get to 100 percent so I can go full speed soon and flip this seat blue,” Mr. Fetterman said in a statement on Sunday, adding that he felt “great” but intended to “continue to rest and recover.”With such an important race in the balance, one that could decide the Senate majority, the state of Mr. Fetterman’s health is of intense public interest. Yet, despite repeated requests, his campaign did not make him or his doctors available to discuss his stroke and his medical treatment.And specialists in stroke, heart disease and electrophysiology said that some of the campaign’s public statements do not offer a sufficient explanation for Mr. Fetterman’s described diagnosis or the treatment they say he has received.The stroke, he said in a statement released by his campaign, was caused by a blood clot. He said the clot was the result of atrial fibrillation, a condition in which the upper chambers of the heart beat chaotically and are out of sync with the lower chambers of the heart. The campaign said the clot was successfully removed by doctors at a nearby community hospital, Lancaster General Hospital.On May 17, the day of the primary election, Mr. Fetterman had a pacemaker and a defibrillator implanted in his heart which, his press office said in a statement, “will help protect his heart and address the underlying cause of his stroke, atrial fibrillation (A-fib), by regulating his heart rate and rhythm.” His press office said he is expected to fully recover from his stroke.Medical specialists asked questions about Mr. Fetterman’s treatment with a defibrillator. They say it would make sense only if he has a different condition that puts him at risk of sudden death, like cardiomyopathy — a weakened heart muscle. Such a heart condition may have caused the blood clot. Or, the doctors say the campaign could be correct about afib causing the clot.Thrombectomy, the method likely used to remove the clot, also indicates that Mr. Fetterman experienced more than a tiny stroke, although prompt treatment may have averted damage and saved his brain.“I was just in the hospital for over a week,” Mr. Fetterman said in a statement. “I am aware that this is serious, and I am taking my recovery seriously.”In a brief interview on May 20, Gisele Barreto Fetterman, Mr. Fetterman’s wife, told the story of his stroke, from her perspective.“We had been on the road campaigning,” she said. “We had had breakfast, and he was feeling fine.”The couple got into a car to go to an event at Millersville University when, she said, “the left side of his mouth drooped for just a second.”“I had a gut instinct that something was happening,” Ms. Fetterman said. “I yelled to the trooper, ‘I think he’s having a stroke.’ He said, ‘I’m fine. What are you talking about? I feel fine.’”Gisele Barreto Fetterman, Mr. Fetterman’s wife, spoke at a watch party in Pittsburgh on May 17.Maddie McGarvey for The New York TimesThe state trooper soon drove Mr. Fetterman to Lancaster General Hospital where his treatment began. Ms. Fetterman said it involved going through his groin, which suggests he had a thrombectomy, a procedure in which doctors slide a small plastic tube through the groin, advance it into the brain and then pull the blood clot out using suction or a wire mesh.It was not until two days later that his campaign reported that Mr. Fetterman had been hospitalized with a stroke. Asked about the delay, Ms. Fetterman said, “Less than 48 hours is pretty impressive timing when dealing with sensitive medical issues.”Shortly after that question, Rebecca Katz, a senior adviser in Mr. Fetterman’s campaign, abruptly ended the call with Ms. Fetterman.Medical specialists said that some aspects of the story were difficult to reconcile with their knowledge of stroke treatment.Dr. Lee Schwamm, a stroke specialist at Massachusetts General Hospital and professor of neurology at Harvard Medical School, said doctors do a thrombectomy only when a large artery in the brain is blocked.“You typically wouldn’t do it for someone with just a little bit of facial droop,” he said. Dr. Schwamm wondered if the doctors who examined Mr. Fetterman in the hospital had noticed other symptoms, like a loss of vision on his left side or lack of awareness of his left side, often called “neglect.”“These strokes tend to be very severe,” Dr. Schwamm said. “He is fortunate that he went to a hospital that could treat it.”Pressed about the stroke symptoms as described by Ms. Fetterman, a spokesman for Mr. Fetterman wrote in an email that he “told The Associated Press last week that Gisele ‘noticed that John was not himself, and shortly after he started slurring his speech.’”But what caused the stroke?Ms. Fetterman said her husband knew he had atrial fibrillation, which confers a high risk of stroke, and that he had taken anticoagulants, a standard method of reducing the stroke risk in people with atrial fibrillation, “on and off.”But the treatment with a pacemaker and defibrillator is a puzzle if all he had was atrial fibrillation, medical specialists said.“This doesn’t entirely make sense,” said Dr. Brahmajee Nallamothu, an interventional cardiologist at the University of Michigan.Dr. Elaine Wan, an associate professor of medicine in cardiology and cardiac electrophysiology at Columbia University Medical Center, said defibrillators — which always come with pacemakers — are used to prevent sudden death. They usually are implanted in people with weakened heart muscle, or those who survived an episode in which the heart stopped, or in people with a genetic predisposition for sudden cardiac death.“We would not use it for atrial fibrillation,” Dr. Wan said.Dr. Rajat Deo, an associate professor of medicine and a cardiac electrophysiologist at the University of Pennsylvania’s Perelman School of Medicine, agreed about the use of defibrillators and said he shared Dr. Wan’s suspicion that Mr. Fetterman has a damaged heart.“I think it would be fair to say he has at least two separate issues,” Dr. Deo said of Mr. Fetterman. “One is afib, from which he most likely suffered a stroke that was successfully treated.”He added, “The second issue is that he likely has some underlying cardiac condition that increases his risk for ventricular arrhythmias and thus sudden cardiac death.”The afib could be related to the other condition, Dr. Deo said. Patients with a weakened heart muscle are also at risk of developing atrial fibrillation.On the other hand, Dr. Deo says, Mr. Fetterman’s atrial fibrillation may have nothing to do with his weakened heart. Without more information from his doctors it is impossible to know.Dr. Deo added that if Mr. Fetterman is receiving appropriate state-of-the-art medical therapies and is protected with a defibrillator from sudden cardiac death, “he should do quite well while he continues his campaign.”Experts also raised concerns about the prospects for former Vice President Dick Cheney, who had a defibrillator implanted in 2001. He finished two terms in the White House, including a hard-fought re-election in 2004.And there is time before general election campaigning in Pennsylvania begins in earnest: It is unclear who Mr. Fetterman’s opponent will be, as the Republican race remains too close to call and may head to a recount.But Dr. Wan was less sanguine than Dr. Deo about Mr. Fetterman.“He is at risk for sudden cardiac death,” she said. “For someone on the campaign trail that might raise concerns.”

She worked with President Bill Clinton to to make the disease a public health priority. But her office never achieved the stature or effectiveness that some had hoped for.Kristine Gebbie, a health policy expert who served as the nation’s first AIDS czar in the early 1990s, died on May 17 in Adelaide, Australia. She was 78.The cause was cancer, her daughter Eileen Gebbie said.After serving as the chief health officer for the states of Oregon and Washington and as a member of two national panels, formed by President Ronald Reagan, seeking to cope with the emergent AIDS epidemic, Dr. Gebbie, a nurse, was recruited by President Bill Clinton in June 1993 to fulfill his campaign promise that he would make the disease a public health priority.He named her national AIDS policy coordinator to devise prevention strategies, offer resources to states and communities to establish their own programs, and reconcile the efforts of federal agencies, including the Centers for Disease Control and Prevention, the Public Health Service and the National Institutes of Health.Dr. Gebbie with President Clinton in 1993, when her appointment was announced.C-SPANSeveral more prominent candidates had already rejected the job, and Dr. Gebbie accepted it with no illusions. While the appointment made her a member of the president’s Domestic Policy Council, her office never achieved the stature or effectiveness that AIDS activists had hoped for.“It leads you into just about every complicated human question that you have to deal with,” she told The Los Angeles Times in 1993. “What does human sexuality mean? What is the balance point between an individual’s rights and responsibilities and a community’s rights and responsibilities? What is our responsibility to people at the end of life? At what point do we accept the reality of death and not fight it with everything we have?”She favored supplying clean needles to drug addicts, distributing condoms to sexually active teenagers and incorporating AIDS education into health curriculums, even for young children. Many conservatives opposed those positions, as they had opposed her previous criticisms of the Reagan administration’s proposal for routine testing of applicants for marriage licenses, federal prisoners and certain other groups.“You don’t talk to them about safe sex,” Dr. Gebbie said, “but you teach them that their body is something to take care of, and that viruses can mess it up.”Federal spending on AIDS increased under Dr. Gebbie’s watch, and her appointment was announced in a Rose Garden ceremony, but she did not work from the White House; her office was in a building across the street that also housed a McDonald’s.“My guess,” she told The New York Times in 1993, “is that the choice of me makes clear that this isn’t intended to be somebody who spends all their time outside rousing people up, but somebody who is prepared to spend a lot of time inside making it work.“It’s very clear how many people really did expect miracles,” she added. “When I give what I know are appropriate answers, I know I sound like a bureaucratic stick-in-the-mud: ‘This lady is not worth two bits to us; she talks about coordination and cooperation. Blah!’“But part of my mission,” Dr. Gebbie continued, “is to help people keep their expectations within reality.”Several AIDS activist organizations demanded that she be replaced, and she did not last long in the job; she resigned after 13 months, in July 1994.During Dr. Gebbie’s tenure, President Clinton said in a statement at the time, the federal government had increased funding and other resources “for prevention and research, sped the research and approval process for new drugs and required every federal employee to receive comprehensive workplace education.” He thanked her for giving “this vitally important battle a lift when one was desperately needed and long overdue.”Kristine Elizabeth Moore was born on June 26, 1943, in Sioux City, Iowa, to Thomas Moore, a career officer in the Army, and Irene (Stewart) Moore, who worked for the U.S. Fish and Wildlife Service.She moved from Panama to the Philippines to New Mexico as her father was redeployed in the military; she was also raised for a time by her maternal grandparents in Miles City, Mont. She was inspired by an aunt, Susie Stewart, to enter nursing and worked as a nurse’s aide in high school.She earned her Bachelor of Science degree in nursing from St. Olaf College in Minnesota in 1965, her master’s in community mental health from the University of California, Los Angeles, in 1968, and her doctorate in public health from the University of Michigan in 1995.She served as the Oregon State health administrator from 1978 to 1989 and the Washington State secretary of health from 1989 to 1993.Dr. Gebbie with her second husband, Dr. Lester Nils Wright, in 2014. They retired together in Australia.via Eileen GebbieAs an epidemiologist and an authority on emergency preparedness, she was a member of the AIDS task force for the American Association of State and Territorial Health Officials and was later enlisted by Reagan’s White House AIDS Commission, even though she had criticized the Reagan administration’s response to the epidemic as inadequate.She was a professor of nursing at the Columbia University School of Nursing and director of Columbia’s Center for Health Policy from 1994 to 2000. She was dean of the Hunter-Bellevue School of Nursing from 2008 to 2010.She taught at Flinders University’s Torrens Resilience Initiative and the University of Adelaide Nursing School in Australia, where she had moved with her husband, Lester Nils Wright, a physician, and where they both retired. Dr. Wright died last month.Her first marriage, to Neil Gebbie, ended in divorce. In addition to her daughter Eileen, she is survived by her children from her first marriage, Anna, Sharon and Eric Gebbie; her stepsons, Jason and Nathan Wright; her sister, Sina Ann; 10 grandchildren; and one great-granddaughter.

The United States had more deaths above normal levels during the pandemic than most other wealthy countries, according to data […]

This viral illness is not like Covid, but there is cause for concern. Here’s how experts are thinking about it now.Health officials are tracking more than 100 cases of confirmed or suspected monkeypox that have appeared in countries where the disease does not typically occur, including Australia, Belgium, Canada, France, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, the United Kingdom and the United States.On Sunday, President Biden addressed the highly unusual cases, stating that “it is a concern in the sense that if it were to spread it would be consequential.” After more than two years of living through a pandemic, it is understandable that the news of a new virus spreading across the globe could cause alarm, but health experts say that monkeypox is unlikely to create a scenario similar to that of the coronavirus, even if more cases are found. “As surveillance expands, we do expect that more cases will be seen. But we need to put this into context because it’s not Covid,” Dr. Maria Van Kerkhove, the World Health Organization’s technical lead on Covid-19, said in a live online Q&A on Monday.Monkeypox is not a new virus, and it is not spread in the same way as the coronavirus, so we asked experts for a better understanding of the pathogen — and how the disease it causes is different from Covid-19.How contagious is monkeypox?People typically catch monkeypox by coming into close contact with infected animals. That can be through an animal bite, scratch, bodily fluids, feces or by consuming meat that isn’t cooked enough, said Ellen Carlin, a researcher at Georgetown University who studies zoonotic diseases that are transmitted from animals to humans.Although it was first discovered in laboratory monkeys in 1958, which gives the virus its name, scientists think rodents are the main carriers of monkeypox in the wild. It is primarily found in Central and West Africa, particularly in areas close to tropical rainforests — and rope squirrels, tree squirrels, Gambian pouched rats and dormice have all been identified as potential carriers.“The virus has probably been circulating in these animals for a very, very long time,” Dr. Carlin said. “And for the most part, it has stayed in animal populations.”The first human case of monkeypox was detected in 1970 in the Democratic Republic of Congo. Since then, the virus has periodically caused small outbreaks, though most have been limited to a few hundred cases in 11 African countries.A handful of cases have made it to other continents, brought by travelers or the import of exotic animals that passed the virus to house pets and then to their owners.But human-to-human transmission of monkeypox virus is pretty rare, Dr. Van Kerkhove said. “Transmission is really happening from close physical contact, skin-to-skin contact. So it’s quite different from Covid in that sense.”The virus can also spread by touching or sharing infected items like clothing and bedding, or by the respiratory droplets produced by sneezing or coughing, according to the W.H.O.That may sound eerily familiar because in the early days of the pandemic many experts said that the coronavirus also had little human-to-human transmission beyond respiratory droplets and contaminated surfaces. Later research showed that the coronavirus can spread through much smaller particles called aerosols with the ability to travel distances greater than six feet. But that doesn’t mean the same will turn out to be true for the monkeypox virus, said Luis Sigal, an expert in poxviruses at Thomas Jefferson University in Philadelphia. The coronavirus is a tiny, single-stranded RNA virus, which may have aided its ability to become airborne. The monkeypox virus, however, is made of double-stranded DNA, which means that the virus itself is much larger and heavier and unable to travel as far, Dr. Sigal said.Other routes of monkeypox transmission include from mother to fetus via the placenta or during close contact during and after birth.The majority of cases this year have been in young men, many of whom self-identified as men who have sex with men, though experts are cautious about suggesting that monkeypox transmission may occur through semen or other bodily fluids exchanged during sex. Instead, contact with infected lesions during sex may be a more plausible route. “This is not a gay disease, as some people in social media have attempted to label it,” Dr. Andy Seale, an adviser with the W.H.O.’s H.I.V., Hepatitis and S.T.I.s Program, said during Monday’s Q&A. “Anybody can contract monkeypox through close contact.”What are the symptoms and how bad can a monkeypox infection get?Monkeypox is part of the same family of viruses as smallpox, but it is typically a much more mild condition, according to the Centers for Disease Control and Prevention. On average, symptoms appear within six to 13 days of exposure, but can take up to three weeks. People who get sick commonly experience a fever, headache, back and muscle aches, swollen lymph nodes and general exhaustion.About one to three days after getting a fever, most people also develop a painful rash that is characteristic of poxviruses. It starts with flat red marks that become raised and filled with pus over the course of the next five to seven days. The rash can start on a patient’s face, hands, feet, the inside of their mouth or on their genitals, and progress to the rest of the body. (While chickenpox causes a similar-looking rash, it is not a true poxvirus, but is caused by the unrelated varicella-zoster virus).Once an individual’s pustules scab over, in two to four weeks, they are no longer infectious, said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada.Children and people with underlying immune deficiencies may have more severe cases, but monkeypox is rarely fatal. While one strain found in Central Africa can kill up to 10 percent of infected individuals, estimates suggest that the version of the virus currently circulating has a fatality rate of less than 1 percent.And the easily identifiable rash of monkeypox, as well as its earlier symptoms, could be considered beneficial. “One of the most challenging things about Covid has been that it can be spread asymptomatically or pre-symptomatically, by people who have no idea that they’re infected,” Dr. Rasmussen said. “But with monkeypox it doesn’t appear that there is any pre-symptomatic transmission.”Still, as the recent outbreak of cases has shown, there are plenty of opportunities to transmit monkeypox in the first few days of an infection, when symptoms are non-specific, Dr. Rasmussen said.What to Know About the Monkeypox VirusCard 1 of 5What is monkeypox?

Life-threatening arrhythmias are more common on days with highly polluted air, according to research presented today at Heart Failure 2022, a scientific congress of the European Society of Cardiology (ESC).1 The study was conducted in patients with an implantable cardioverter defibrillator (ICD), enabling the authors to track the occurrence of arrhythmias and delivery of life-saving therapy.
“Our study suggests that people at high risk of ventricular arrhythmias, such as those with an ICD, should check daily pollution levels,” said study author Dr. Alessia Zanni, now working at Maggiore Hospital, Bologna and previously at Piacenza Hospital, Italy. “When particular matter (PM) 2.5 and PM 10 concentrations are high (above 35 μg/m3 and 50 μg/m3, respectively), it would be sensible to stay indoors as much as possible and wear an N95 mask outside, particularly in areas of heavy traffic. An air purifier can be used at home.”
Outdoor air pollution kills an estimated 4.2 million people every year, according to the World Health Organization.2 Nearly one in five cardiovascular disease deaths are due to dirty air, which was ranked the fourth highest risk factor for mortality after high blood pressure, tobacco use and poor diet.3
This study investigated the relationship between air pollution and ventricular arrhythmias in Piacenza, Northern Italy. The European Environment Agency graded the city 307 worst out of 323 cities for annual mean PM2.5 concentrations in 2019 and 2020, with a figure of 20.8 μg/m3.
“We had observed that emergency room visits for arrhythmias in patients with ICDs tended to cluster on days with particularly high air pollution,” noted Dr. Zanni. “We therefore decided to compare the concentration of air pollutants on days when patients had an arrhythmia versus pollution levels on days without an arrhythmia.”
The study included 146 consecutive patients who received an ICD between January 2013 and December 2017. Of those, 93 received an ICD because of heart failure after a heart attack while 53 had a genetic or inflammatory heart condition. Just over half (79 patients) had never experienced a ventricular arrhythmia, and 67 patients had previously had a ventricular arrhythmia.