Publisher Health

In late 2020, Canadian doctors made headlines for “prescribing nature,” or recommended time outdoors based on research that suggests people who spent two or more hours in nature per week improved their health and wellbeing. Knowing this, transdisciplinary researchers from Drexel University investigated how nature relatedness — simply feeling connected with the natural world — benefits dietary diversity and fruit and vegetable intake, in a study recently published the American Journal of Health Promotion.
“Nature relatedness has been associated with better cognitive, psychological and physical health and greater levels of environmental stewardship. Our findings extend this list of benefits to include dietary intake,” said Brandy-Joe Milliron, PhD, an associate professor in Drexel’s College of Nursing and Health Professions and lead author of the publication. “We found people with higher nature relatedness were more likely to report healthful dietary intake, including greater dietary variety and higher fruit and vegetable consumption.”
The research team surveyed over 300 adults in Philadelphia to measure their self-reported connection to nature, including their experience with and perspective of nature, and the foods and beverages they had consumed the previous day to assess their dietary diversity and estimate their daily fruit and vegetable consumption. Survey participants mirrored demographic characteristics (gender, income, education and race) of Philadelphia, as of the 2010 census. The data were collected between May and August 2017. The results of the survey showed that participants with a stronger connection to nature reported a more varied diet and ate more fruits and vegetables.
“This work can impact health promotion practices in two ways,” said Milliron. “First, nature-based health promotion interventions may increase nature relatedness across the lifespan and potentially improve dietary intake. And second, augmenting dietary interventions with nature-based activities may lead to greater improvements in dietary quality.”
The research team added that these findings highlight the potential for leveraging nature-based experiences or interventions such as incorporating green spaces or urban greening into city planning, integrating nature- and park-prescription programs into healthcare practices (similar to the Canadian model) and promoting nature-based experiences in the classroom settings, among many others.
But, the researchers noted, while improving dietary intake through nature-based interventions may be valuable, it is also complex.
“Future research should explore the ways different communities experience and value nature,” said Dane Ward, PhD, assistant teaching professor in the College of Arts and Sciences and co-author of the study. “It needs to include how the intersections of environment, culture, race, history (including connection to land), social cohesion and other social and economic factors influence community identity relative to nature relatedness and dietary intake.”
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A new study finds that the national economic burden of PTSD goes beyond direct health care expenses and exceeds the costs of other common mental health conditions, such as anxiety and depression.
The researchers estimated the cost of PTSD at $232.2 billion for 2018, the latest year for which data were available at the time of the study. They called for increased awareness of PTSD, more effective therapies, and the expansion of evidence-based strategies to “reduce the large clinical and economic burden” of that mental health condition.
The results appeared online in the Journal of Clinical Psychiatry on April 25, 2022.
“The $232 billion annual economic burden of PTSD in the U.S. demonstrated in this study is staggering and fuels the urgency for public and private stakeholders to work together to discover new and better treatments, reduce stigma, improve access to existing treatments, and expand evidence-based recovery and rehabilitation programs,” the researchers write.
Dr. Lori Davis, the associate chief of staff for research at the Tuscaloosa Veterans Affairs Medical Center in Alabama, led the study. She and her team used insurance claims data, academic literature, and government publications to estimate the costs of PTSD in both the U.S. civilian and military populations. The latter cohort included active-duty military and veterans.
Understanding the complex nature of posttraumatic stress disorder, commonly known as PTSD, is one of VA’s most pressing challenges. The agency says many veterans who fought in Vietnam, the Gulf War, and the post-9/11 conflicts in Iraq and Afghanistan have had that mental health condition sometime in their lives.

Efforts by hospitals to protect people from COVID-19 by restricting them from visiting family members in ICUs may have contributed to a significant increase in stress-related disorders, according to a study led by University of Colorado School of Medicine researchers.
The study, published today in JAMA Internal Medicine, reports that nearly two-thirds of those restricted from visiting were suffering from stress-related disorders three months after their family member was hospitalized.
“Our findings suggest that visitation restrictions may have inadvertently contributed to a secondary public health crisis, an epidemic of stress-related disorders among family members of ICU patients,” says Timothy Amass, MD, ScM, assistant professor of medicine at the CU School of Medicine and first author of the article.
Visitation restrictions at hospitals were implemented to prevent the spread of an emerging highly infectious virus and deadly disease at a time when personal protective equipment was in short supply. Hospital and public health officials were also concerned about having enough capacity to provide care.
Amass and his co-authors found that the consequences of those restrictions had an enduring effect on many of the people who weren’t allowed to visit their hospitalized family members. According to the study, having a family member admitted to the ICU with COVID-19 was associated with high levels of symptoms of post-traumatic stress disorder, such as depression and anxiety.
The study authors surveyed people three months after their family member was hospitalized, finding that 64% of the study participants recorded high scores on tests that measure symptoms of post-traumatic stress disorder. That’s more than double from pre-pandemic levels, when about 30% of family members of ICU patients reported stress-related disorders.
To conduct their study, Amass and his colleagues surveyed 330 family members three months after their family members were admitted to the ICU with COVID-19. Those patients were admitted between Feb. 1 and July 31, 2020, in the early days of the pandemic, at eight academic-affiliated and four community-based hospitals in Colorado, Washington, Louisiana, New York, and Massachusetts.
The study authors said restrictions may have fostered distrust between patients’ family members and health care providers. They write, “As the COVID-19 pandemic continues to challenge the ability of family members to build bedside relationships with clinicians, this loss of trust may translate into an increase in stress-related disorders.”
One study participant who was surveyed described their painful experience: “They called us and said, ‘Do you want us to pull the plug?’. . . I said how did it go from coming home to pulling the plug? . . . they say that her mouth was moving and her eyes was moving but they said she was dead. . . .so, they went on and pulled the plug anyway.”
Study authors added that additional studies would be needed to determine any links between visitation restriction policies and factors that caused distrust among family members.
The study lists 41 co-authors. In addition to Amass, authors affiliated with the CU School of Medicine are Hope Cruse; Ying Jin; Trevor Lane, MD; Marc Moss, MD; Ryan Peterson, PhD; Sarah Rhoads, MD; Jin Huang; and Stephanie Yu.
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Materials provided by University of Colorado Anschutz Medical Campus. Original written by Mark Couch. Note: Content may be edited for style and length.

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesHealth officials say there is mounting evidence that a common virus is linked to rare cases of hepatitis that have been occurring in some young children.Globally, there have been 169 cases recorded and one death. In the UK alone, 114 children have become ill and 10 have needed a liver transplant. The UK Health Security Agency (UKHSA) says a strain of adenovirus called F41 is looking like the most probable cause.Most of the children affected are five years old or younger and have had symptoms of gastroenteritis illness – diarrhoea and nausea – followed by jaundice or yellowing of the skin and eyes (a sign that the liver is struggling). Dr Meera Chand, director of clinical and emerging infections at UKHSA, said: “Information gathered through our investigations increasingly suggests that this rise in sudden onset hepatitis in children is linked to adenovirus infection. However, we are thoroughly investigating other potential causes.”Child hepatitis: Why are we seeing an unusual spike?Experts stress that most children who catch adenovirus will not become very unwell. Cases of liver inflammation – known as hepatitis – are extremely rare, but can be very serious. Scientists and clinicians are now investigating whether there has been a change in the genetic make-up of the virus that might trigger liver inflammation more easily.Another possible explanation is that restrictions imposed in the pandemic may have led to young children being first exposed to adenovirus at a slightly later point in their lives, leading to a “more vigorous” immune response in some.Prof Calum Semple, who is an expert in infectious diseases at Liverpool University, said: “Adenovirus virtually disappeared during the Covid outbreak when there was reduced mixing and it has come back in a surge now.”He said other hypotheses are also being explored, including whether a recent Covid infection might be a trigger for the liver problems along with adenovirus. There is no link to the Covid vaccine. None of the currently confirmed cases in under 10 year olds in the UK are known to have been vaccinated.More on this storyRise in childhood hepatitis – what we know so farRelated Internet LinksHepatitis – UKHSAThe BBC is not responsible for the content of external sites.

People could benefit from fully automated personal nutritional advice, as a new research paper shows that an app improved healthy diet in clinical trials.
A paper published in the Journal of Medical Internet Research today (Mon 25 April 22) shows how the eNutri app developed by researchers in human nutrition and biomedical engineering at the University of Reading helped people to eat more healthily. Participants who were given automated personalised nutrition advice improved their healthy diet score by 6% compared to a control group who were given general healthy eating guidance.
Dr Roz Fallaize, Dietitian and Research Fellow at the University of Reading’s Department of Food and Nutritional Science said:
“The research demonstrates that the eNutri technology is effective in helping users to improve their healthy food intake, with a significant improvement in diet quality for the group who had access to automated, personalised nutrition advice.”
“While having a registered nutritionist or dietitian giving personalised dietary advice is ideal, this is often only available to those with health concerns or with the financial resource to pay. There is also growing interest in nutrition apps and web services, but many commercial apps tend to focus on weight loss or calorie counting rather than healthy eating.”
“Nutritional advice should always be focused on healthy, balanced diets and positive relationships with food, and I’m pleased that our study helped people eat better. One exciting aspect of the eNutri system is the potential to offer it to lots of people at low-cost”
Dr Rodrigo Zenun Franco, a PhD graduate from the University of Reading and lead author of the paper said:
“The eNutri app prioritises healthy eating based on evidence and uniquely uses a diet scoring system to provide food-based advice that is tailored to the individual user.”
“We are continuing to develop eNutri to suit specific population groups including those with heart conditions and hope to make this available to the public in the future”
People were either assigned to receive personalised nutrition advice or given general healthy eating advice. Those in the personalised group then had their diets scored according to 11 criteria based on UK dietary guidance. The eNutri app gave an automated assessment of diet quality giving the user a ‘healthy diet score’ out of 100.
The ‘healthy diet score’ includes assessments of intake of fruit, vegetables, wholegrains, red and processed meat, with higher points awarded when users have the recommended intake of these. The personalised advice is then targeted to areas of their diet which they would benefit most from changing.
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Researchers from the Center for Genome Engineering within the Institute for Basic Science developed a new gene-editing platform called transcription activator-like effector-linked deaminases, or TALED. TALEDs are base editors capable of performing A-to-G base conversion in mitochondria. This discovery was a culmination of a decades-long journey to cure human genetic diseases, and TALED can be considered to be the final missing piece of the puzzle in gene-editing technology.
From the identification of the first restriction enzyme in 1968, the invention of polymerase chain reaction (PCR) in 1985, and the demonstration of CRISPR-mediated genome editing in 2013, each new breakthrough discovery in biotechnology further improved our ability to manipulate DNA, the blueprint of life. In particular, the recent development of the CRISPR-Cas system, or “genetic scissors,” has allowed for comprehensive genome editing of living cells. This opened new possibilities for treating previously incurable genetic diseases by editing the mutations out of our genome.
While gene editing was largely successful in the nuclear genome of the cells, however, scientists have been unsuccessful in editing the mitochondria, which also have their own genome. Mitochondria, the so-called “powerhouse of the cells,” are tiny organelles in cells that serve as energy-generating factories. As it is an important organelle for energy metabolism, if the gene is mutated, it causes serious genetic diseases related to energy metabolism.
Director KIM Jin-Soo of the Center for Genome Engineering explained, “There are some extremely nasty hereditary diseases arising due to defects in mitochondrial DNA. For example, Leber hereditary optic neuropathy (LHON), which causes sudden blindness in both eyes, is caused by a simple single point mutation in mitochondrial DNA.” Another mitochondrial gene-related disease includes mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS), which slowly destroys the patient’s brain. Some studies even suggest abnormalities in mitochondrial DNA may also be responsible for degenerative diseases such as Alzheimer’s disease and muscular dystrophy.
The mitochondrial genome is inherited from the maternal line. There are 90 known disease-causing point mutations in mitochondrial DNA, which in total affects at least 1 in 5,000 individuals. Many existing genome editing tools could not be used due to limitations in the method of delivery to mitochondria. For example, the CRISPR-Cas platform is not applicable for editing these mutations in mitochondria, because the guide RNA is unable to enter the organelle itself.
“Another problem is that there is a dearth of animal models of these mitochondrial diseases. This is because it is currently not possible to engineer mitochondrial mutations necessary to create animal models,” Director Kim added. “Lack of animal models makes it very difficult to develop and test therapeutics for these diseases.”
As such, reliable technology to edit mitochondrial DNA is one of the last frontiers of genome engineering that must be explored in order to conquer all known genetic diseases, and the world’s most elite scientists have endeavored for years to make it a reality.

A new study led by Imperial College London finds that drug-resistant mould is spreading from the environment and infecting susceptible people’s lungs.
The researchers found six cases of people infected with a drug-resistant form of a fungi called Aspergillus fumigatus that could be traced back to spores in the environment. Their findings use samples from England, Wales, Scotland and Ireland, and are published in Nature Microbiology.
Aspergillus fumigatus is an environmental mould that can cause fungal lung disease. While people with healthy lungs clear inhaled spores, people with lung conditions or weakened immune systems sometimes cannot, meaning the spores may remain in the lungs causing an infection called aspergillosis. Aspergillosis affects 10-20 million people worldwide. The infection is usually treated with an antifungal drug but emerging resistance to these drugs has been reported.
This resistance has evolved because of the widespread agricultural use of azole fungicides, the researchers say. Azole drugs that work in a similar way are the first-line treatment for patients infected with the Aspergillus fumigatus mould, so the fungus’ exposure to azole fungicides in the environment means it is often in a drug-resistant form even before it even encounters the people it infects.
The researchers call for greater surveillance of Aspergillus fumigatus in the environment and the clinic to help understand the risk it poses.
Senior author, Professor Matthew Fisher, from Imperial’s School of Public Health, says: “Understanding the environmental hotspots and genetic basis of evolving fungal drug resistance needs urgent attention, because resistance is compromising our ability to prevent and treat this disease.”
He adds: “The prevalence of drug-resistant aspergillosis has grown from negligible levels before 1999 to up to 3-40% of cases now across Europe. At the same time, more and more people might be susceptible to Aspergillus fumigatus infection because of growing numbers of people receiving stem cell or solid organ transplants, being on immunosuppressive therapy, or having lung conditions or severe viral respiratory infections.”

Metastatic breast cancer cells abuse macrophages, a type of immune cell, to promote the settlement of cancer metastases in the lungs. The reprogrammed macrophages stimulate blood vessel cells to secrete a cocktail of metastasis-promoting proteins that are part of the so-called metastatic niche. This was demonstrated by scientists from the German Cancer Research Center and the Stem Cell Institute HI-STEM* in mice that had been transplanted with human breast cancer cells. The work enabled the scientists to identify new targets and develop initial concepts to better restrain the metastatic spread of breast cancer.
Cancer spreads within the body as individual cells detach from the primary tumor and travel to distant body regions via the bloodstream or lymphatic system. Before they can grow into a metastasis at a secondary site, they must communicate with their new environment through a variety of molecular interactions. “In order to settle in this new, hostile milieu, the cancer cells corrupt the microenvironment to support their growth,” says Thordur Oskarsson of the German Cancer Research Center (DKFZ) and the stem cell institute HI-STEM. Researchers refer to this as the tumor cells creating a “metastatic niche.”
Blood vessels play a very special role in metastasis. Detached tumor cells prefer to stay in their immediate vicinity. In particular, the interactions of cancer cells with the endothelial cells lining the inside of the vessels are crucial for metastasis, as many studies have already shown. However, the details of this molecular exchange are still largely unknown.
A team led by Oskarsson has now investigated these interactions during metastatic colonization of the lung by breast cancer cells in mice. The researchers first observed that four genes in the lung endothelial cells showed a particularly strong increase in activity three weeks after the onset of metastasis. They encode four proteins that are secreted into the microenvironment (Inhbb, Lama1, Scgb3a1 and Opg**), which both individually and in combination promote the development of lung metastases. Inhbb and Scgb3a1 confer stem cell properties to cancer cells, Opg prevents programmed cell death — apoptosis — and Lama1 supports adhesion-mediated cell survival. Importantly, high expression of these four newly identified niche factors correlates with both shortened relapse-free survival and shortened overall survival of breast cancer patients.
But how do cancer cells get the lung endothelium to produce the metastasis-promoting protein cocktail? To the surprise of the scientists, the cancer cells do not do this job directly themselves, but instead harness a cell type of the innate immune system for this purpose, the macrophages.
“These macrophages, which often reside in the vicinity of the lung blood vessels, are activated by tenascin, an extracellular matrix protein produced by breast cancer cells,” explains Tsunaki Hongu, the first author of the study. Tenascin is involved in disease progression in many cancers. After activation by tenascin, macrophages produce various factors that induce the production of the cancer-promoting protein cocktail in endothelial cells. By eliminating macrophages or their activity, using specific molecular agents, the investigators could show that these cells are crucial for production of the metastasis-promoting protein cocktail.

A new way of using artificial intelligence to predict cancer from patient data without putting personal information at risk has been developed by a team including University of Leeds medical scientists.
Artificial intelligence (AI) can analyse large amounts of data, such as images or trial results, and can identify patterns often undetectable by humans, making it highly valuable in speeding up disease detection, diagnosis and treatment.
However, using the technology in medical settings is controversial because of the risk of accidental data release and many systems are owned and controlled by private companies, giving them access to confidential patient data — and the responsibility for protecting it.
The researchers set out to discover whether a form of AI, called swarm learning, could be used to help computers predict cancer in medical images of patient tissue samples, without releasing the data from hospitals.
Swarm learning trains AI algorithms to detect patterns in data in a local hospital or university, such as genetic changes within images of human tissue. The swarm learning system then sends this newly trained algorithm — but importantly no local data or patient information — to a central computer. There, it is combined with algorithms generated by other hospitals in an identical way to create an optimised algorithm. This is then sent back to the local hospital, where it is reapplied to the original data, improving detection of genetic changes thanks to its more sensitive detection capabilities.
By undertaking this several times, the algorithm can be improved and one created that works on all the data sets. This means that the technique can be applied without the need for any data to be released to third party companies or to be sent between hospitals or across international borders.
The team trained AI algorithms on study data from three groups of patients from Northern Ireland, Germany and the USA. The algorithms were tested on two large sets of data images generated at Leeds, and were found to have successfully learned how to predict the presence of different sub types of cancer in the images.
The research was led by Jakob Nikolas Kather, Visiting Associate Professor at the University of Leeds’ School of Medicine and Researcher at the University Hospital RWTH Aachen. The team included Professors Heike Grabsch and Phil Quirke, and Dr Nick West from the University of Leeds’ School of Medicine.
Dr Kather said: “Based on data from over 5,000 patients, we were able to show that AI models trained with swarm learning can predict clinically relevant genetic changes directly from images of tissue from colon tumors.”
Phil Quirke, Professor of Pathology in the University of Leeds’s School of Medicine, said: “We have shown that swarm learning can be used in medicine to train independent AI algorithms for any image analysis task. This means it is possible to overcome the need for data transfer without institutions having to relinquish secure control of their data.
“Creating an AI system which can perform this task improves our ability to apply AI in the future.”
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Women who were pregnant during the recent Omicron surge were diagnosed with COVID-19 at a much higher rate than during previous phases of the pandemic, but were less likely to develop severe illness, a study by UT Southwestern and Parkland Health scientists found. The research, reported in JAMA, is the first published evidence documenting how the boom in COVID-19 cases late last year and early this year impacted the health of pregnant women.
“Obstetrics never stopped during the pandemic. Women are still having babies and coming in for their prenatal care,” said study leader Emily Adhikari, M.D., Assistant Professor and Maternal-Fetal Medicine specialist at UTSW and Medical Director of Perinatal Infectious Diseases at Parkland Health. “It’s important to understand how this virus behaves in the population we serve.”
Dr. Adhikari explained that respiratory infections, including COVID-19, are as infectious to pregnant women as they are in the general population. However, their effects can be far more severe due to the physiologic changes that occur in pregnancy: While a woman’s lung capacity decreases about 20-30% during later pregnancy, oxygen consumption increases significantly as the fetus grows.
Although previous research, including a study at UTSW, had shown that hospitalizations of pregnant women increased during the Delta wave of COVID-19, no research had yet quantified severity of the Omicron variant in this population.
Toward this end, Dr. Adhikari, along with colleagues in Women and Infants Specialty Health at Parkland and in the Departments of Pathology and Pediatrics at UT Southwestern, gathered data from patients who received prenatal care at Parkland Health, the Dallas County system encompassing a centralized acute care hospital and 10 community-based prenatal clinics. The researchers collected information on positive cases and whether their illness was severe — meaning the patient required supplemental oxygen or higher-level support such as high-flow nasal cannula, mechanical ventilation, or extracorporeal membrane oxygenation (a type of life support that temporarily replaces heart and lung function) — spanning May 17, 2020 to Jan. 29, 2022.
Dr. Adhikari and her colleagues found that 2,641 positive cases were diagnosed during this time period, which covered a pre-Delta phase, the Delta surge, and the Omicron surge. Their analysis showed that during the Delta surge, the case rate was three times higher than during the pre-Delta period. The case rate during the Omicron surge was 10 times higher than the pre-Delta period. However, while Delta cases were about three times more severe than pre-Delta cases, Omicron cases were about 80% less severe, Dr. Adhikari said.
She noted that although vaccination might have played a role in decreasing the severity of illness, this variable was accounted for, suggesting that differences may be due to other factors, such as the behavior of the particular SARS-CoV-2 variant or immunity from prior infection. Because the future of the pandemic remains uncertain, Dr. Adhikari added, vaccination will be key to helping pregnant women stay healthy if the next variant causes more severe illness.
“We’re very lucky that although Omicron caused more cases than Delta, it was a less severe variant. If the same portion of positive patients had ended up on oxygen or ventilators, we would have been overwhelmed,” Dr. Adhikari said. “We have no control over the nature of the next variant, but pregnant women do have control over whether to receive the COVID-19 vaccine, which has been proven to help prevent severe illness and spread.”
Other researchers who contributed to this study include Jeffrey A. SoRelle, Jessica Morse, Jessica Pruszynski, and Catherine Y. Spong, all of UT Southwestern; and Lorre MacDonald of Parkland Health.
Dr. SoRelle is the inventor of the genotyping PCR tests for variants and is entitled to income from their use.
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Materials provided by UT Southwestern Medical Center. Note: Content may be edited for style and length.