Publisher Health

Among firefighters, the risk of having an irregular heart rhythm, known as atrial fibrillation (AFib), increases with the number of fires they respond to, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.
Compared with people in other occupations, firefighters are known to have a disproportionately high risk of heart disease, and almost half of fatalities in on-duty firefighters result from sudden cardiac death — when the heart suddenly stops beating and pumping blood to vital organs. An increased risk of an irregular heart rhythm or arrhythmias from the ventricles, the bottom chambers of the heart, has been documented in firefighters, however, prior to this study, little was known about AFib, which is an arrhythmia involving the top chambers of the heart. According to the American Heart Association, AFib is the most common type of irregular heartbeat with at least 2.7 million people living with it in the United States. People with AFib have an increased risk of blood clots, heart failure, stroke and other heart complications.
“A few years ago, I treated a local firefighter for atrial fibrillation, and he felt dramatically better with the treatment, so he referred other firefighters to me for care, all with AFib. I decided to methodically examine AFib in the firefighter population, as it may shed light into the cause of atrial fibrillation in non-firefighters as well,” said Paari Dominic, M.D., senior author of the study, the director of clinical cardiac electrophysiology and associate professor of medicine and molecular and cellular physiology at LSU Health Shreveport in Louisiana.
Participants were recruited through five professional firefighter organizations. The study was conducted from 2018-19 among active firefighters throughout the U.S. They completed a survey about their occupational exposure (number of fires fought per year) and about their history of heart disease. Of the 10,860 firefighters who completed the survey (93.5% male, and 95.5% were age 60 or younger), 2.9% of the men and 0.9% of the women reported a diagnosis of AFib.
“Among adults in the general population younger than age 60, there is a 0.1-1.0% prevalence of having AFib. However, among our study population, 2.5% of firefighters ages 60 or younger had AFib,” Dominic said. “Of the few respondents who were 61 or older, 8.2% reported a diagnosis of AFib.”
When occupational exposure was factored in, the researchers found a direct and significant relationship between the number of fires fought and the risk of developing AFib. The analysis found: 2% of those who fought 0-5 fires per year developed AFib; 2.3% of those who fought 6-10 fires per year developed AFib; 2.7% of those who fought 11-20 fires per year developed AFib; 3% of those who fought 21-30 fires per year developed AFib; and 4.5% of those who fought 31 or more fires per year developed AFib.After adjusting for multiple risk factors for AFib, such as high blood pressure and smoking, researchers found a 14% increased risk of atrial fibrillation for every additional 5 fires fought annually.

In a study of children born after a pregnancy of less than 24 weeks, nearly all (96 percent) proved to have any of the diagnoses studied. According to the study, lead from the University of Gothenburg, neuropsychiatric and somatic diagnoses are prevalent as these extremely preterm infants grow into adulthood.
The findings are now published in the scientific journal Acta Paediatrica. The study was based on data in national registers and hospital journals on almost every child born in Sweden in 2007-2018, before the 24th week of gestation, who survived after birth up to what would have been full term (40 weeks).
Altogether, the study comprises 399 children. At follow-up, they were aged 2 to 13 years.
More than half need habilitation
Among these children born before 24 weeks of pregnancy, 75 percent had neuropsychiatric impairments, such as some degree of development disorder (40 percent); Attention-Deficit/Hyperactivity Disorder, ADHD (30 percent); and Autism (24 percent). 55 percent required habilitation support. 88 percent had other medical diagnoses, such as Asthma (63 percent) or postnatal growth restriction (39 percent). 17 percent had Cerebral Paresis.Major support needs
The study shows the marked need for special support for the most immature children, born extremely preterm, and highlights the need for long-term habilitation.

Living your best life at 35, ignoring cholesterol and glucose levels, may impact your chances of getting Alzheimer’s disease (AD) later in life. According to researchers from Boston University School of Medicine (BUSM), lower HDL (high-density cholesterol) and high triglyceride levels measured in blood as early as age 35 are associated with a higher incidence of AD several decades later in life. They also found that high blood glucose measured between ages 51-60 is associated with risk of AD in the future.
“While our findings confirm other studies that linked cholesterol and glucose levels measured in blood with future risk of Alzheimer’s disease, we have shown for the first time that these associations extend much earlier in life than previously thought,” explains senior author Lindsay A. Farrer, PhD, chief of biomedical genetics at BUSM.
The researchers believe that although high LDL has been consistently associated with AD risk in many previous studies, the link between HDL and AD was inconclusive, perhaps because most studies examining these relationships were conducted in persons who were 55 years and older at baseline.
This study was conducted using data obtained from participants of the Framingham Heart Study who were examined in approximately four-year intervals throughout most of their adult lives. Correlations of AD with multiple known risk factors for cardiovascular disease and diabetes (including HDL, LDL, triglycerides, glucose, blood pressure, smoking, and body mass index) were measured at each exam and during three age periods during adulthood (35-50, 51-60, 61-70).
The researchers found that lower HDL (the good cholesterol) is predictive of AD in early (35-50 years) and middle (51-60 years) adulthood and that high glucose in the blood (a precursor of diabetes) during mid-adulthood is also predictive of AD “These findings show for the first time that cardiovascular risk factors, including HDL which has not been consistently reported as a strong risk factor for AD, contribute to future risk of AD starting as early as age 35,” says first and corresponding authorXiaoling Zhang, MD, PhD, assistant professor of medicine at BUSM.
According to the researchers, careful management of these factors starting in early adulthood can lower one’s risk of cardiovascular disease and diabetes, as well as Alzheimer’s.”Intervention targeting cholesterol and glucose management starting in early adulthood can help maximize cognitive health in later life,” adds Farrer.
Farrer also points out, “the unique design and mission of the Framingham Heart Study, which is a multi-generation, community-based, prospective study of health that began in 1948, allowed us to link Alzheimer’s to risk factors for heart disease and diabetes measured much earlier in life than possible in most other studies of cognitive decline and dementia.”
These findings appear online in the journal Alzheimers & Dementia: The Journal of the Alzheimer’s Association.
This work was supported by the Framingham Heart Study’s National Heart, Lung, and Blood Institute contract N01-HC-25195; the Wing-Tat Lee Foundation and Evans Center for Interdisciplinary Biomedical Research at Boston University School of Medicine; National Institutes of Health grants U19-AG068753, RF1-AG057519, 2R01-AG048927, U01-AG062602, R01-NS017950, R01-AG016495, R01-AG008122, R01-AG033040; R01-AG049810, RF1-AG054156, RF1-AG062109; and VMF-14-318524 from the Alzheimer’s Association.

A team led by engineers at the University of California San Diego has developed a device that is a first step to enabling noninvasive, ultrasound-based therapies for the brain. For example, ultrasound waves are currently being used in clinical trials to treat epilepsy. 
Current approaches are focusing ultrasound waves to reach their specific target in the brain.  But this has proven difficult, as ultrasound tends to bounce around within the skull, which leads to some areas of the brain being over-exposed while others are not exposed enough. In worst-case scenarios, this can cause hemorrhage and overheating in brain tissue. 
“We can’t modify the inside of the skull,” said senior author Professor James Friend, in the Department of Mechanical and Aerospace Engineering at the University of California San Diego. “The only thing we could do was to change how the device that produces the sound works.”
Researchers tried a different approach: diffusing ultrasound waves instead of focusing them. They accomplished  this by placing a microscale diffuser on the transducer that produces the ultrasound waves. The device is built based on the Schroeder diffuser–the best sound diffuser mathematical models can provide. This is the same math that is used to design concert halls so that every audience member can hear music perfectly. 
The team details their research in the Feb. 16 issue of Advanced NanoBiomed Research. 
The ultrasound waves are applied to cells that have been engineered to be more responsive to ultrasound stimuli by researchers at the Salk Institute. The cells are exposed to an adenovirus that causes them to form an ion channel called TRPA1 that is sensitive to ultrasound. 
“By using a targeted approach for this delivery, we can use uniformly distributed ultrasound instead of focused ultrasound,” Friend said.

Children of mothers with clinical depression are at three times greater risk to develop depression themselves than are their low-risk peers. Researchers are working to understand the neural underpinnings of the risk, and some studies have shown altered brain processing of reward in at-risk children as young as 6. An outstanding question remains as to whether children with a maternal history of depression have a biological predisposition to blunted neural reward responding or whether it depends more on social factors. Now, new work finds those dampened responses depended on maternal feedback, suggesting the latter.
The study appears in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier.
Researchers have long observed changes in brain activity associated with depression in adults, particularly in a brain area called the ventral striatum (VS), which is associated with motivation, pleasure, and goal-directed behaviors. Similarly, several studies have shown striatal responses to rewarding experiences are blunted in adolescent children of depressed parents, which predicts later development of depression. However, more recent work shows that these brain changes can emerge long before the teenage years, when the risk for depression typically increases.
For the current study, lead author Judith Morgan, PhD, at the University of Pittsburgh, Pennsylvania, USA, recruited 49 children aged 6 to 8 without a history of psychiatric illness. Half the kids’ mothers had a history of clinical depression, and half had no psychiatric history. To measure reward-related brain activity, children played a video game in which they guessed which of two doors contained a hidden token while they underwent functional magnetic resonance imaging (fMRI).
Depression may disrupt parents’ capacity for emotional socialization, a process by which kids learn from their parents’ reactions to their emotional responses. Positive socialization responses include acknowledgment, imitation, and elaboration, whereas negative or emotionally dampening parental responses may be dismissive, invalidating, or punitive.
Mothers participating in the study completed an extensive questionnaire designed to measure parental emotional socialization by presenting a dozen situational vignettes of children’s displays of positive emotions and collecting parents’ reactions to them. Strikingly, children with a maternal history of depression were more likely to have reduced reward-related brain activity in the VS, but only if their mothers reported less enthusiastic and more dampening responses to their children’s positive emotions, the researchers found.
“In our study, mothers’ own history of depression by itself was not related to altered brain responses to reward in early school-age children,” said Dr. Morgan. “Instead, this history had an influence on children’s brain responses only in combination with mothers’ parenting behavior, such as the ability to acknowledge, imitate, or elaborate on their child’s positive emotions.”
“This is hopeful news as interventions geared at coaching parents to encourage positive emotions in their children may have a powerful impact on child reward-related development, especially for families of children who may be at greater risk because of a family history of depression,” Dr. Morgan added.
Cameron Carter, MD, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, said,
“This important work provides a great example of how clinical neuroscience can reveal neural mechanisms underlying depression and discover new links that may explain why one person has depression and another does not. These links take us beyond clinical observation and therapy alone to open new avenues (such as parenting interventions) for prevention that can promote resilience and wellness.”
Story Source:
Materials provided by Elsevier. Note: Content may be edited for style and length.

Just as a water filtration system acts to filter contaminants from the water you drink, your kidneys act to filter waste and excess fluid from your blood. In chronic kidney disease (CKD), kidney function is impaired over time, and the resultant build-up of excess fluid and waste has harmful repercussions on overall body function. Researchers in Japan conducted a study of real-world data from patients with CKD to evaluate the impact of a commonly prescribed medication on disease outcome.
In a study published in Hypertension, researchers from Osaka University have demonstrated an association between the use of mineralocorticoid receptor antagonists (MRAs), a class of medicines that acts by suppressing the action of the steroid hormone aldosterone, and an improved renal prognosis in individuals with CKD.
As CKD progresses, the initiation of renal replacement therapy (RRT), which includes dialysis and kidney transplantation, may be necessary for life support in kidney failure. MRAs, which include spironolactone, eplerenone, and potassium canrenoate, are commonly used to reduce swelling, blood pressure, and urine protein levels in people with CKD. However, the association between MRA treatment and the initiation of RRT has not been fully explored in a real-world population, which spurred the research team from Osaka University to undertake a large-scale retrospective study of MRA use in people with CKD.
“We conducted a retrospective analysis of clinical data from over 3100 individuals with CKD,” says lead author Tatsufumi Oka. “We evaluated MRA treatment in various populations of people with CKD, including those with diabetes, heart disease, and severely impaired renal function.”
The research team employed a marginal structural model to analyze the association between MRA use and the initiation of RRT across multiple patient subgroups.
“Our analysis showed that MRA use was associated with a 28% lower rate of RRT initiation and a 24% lower rate of the combined outcomes of RRT initiation and death,” says senior author Jun-Ya Kaimori.
The research team observed a reduced risk for RRT initiation across various subgroups of people with CKD, including those with and without diabetes and those with severely impaired renal function. These findings highlight the association of MRA use and improved renal outcomes in a real-world population of CKD patients with varying health backgrounds. Overall, this study supports the use of MRAs in treatment plans for various groups of people with CKD who are not undergoing dialysis.
Story Source:
Materials provided by Osaka University. Note: Content may be edited for style and length.

The coronavirus was expected to devastate the continent, but higher-income and better-prepared countries appear to have fared far worse.KAMAKWIE, Sierra Leone — There are no Covid fears here.The district’s Covid-19 response center has registered just 11 cases since the start of the pandemic, and no deaths. At the regional hospital, the wards are packed — with malaria patients. The door to the Covid isolation ward is bolted shut and overgrown with weeds. People cram together for weddings, soccer matches, concerts, with no masks in sight.Sierra Leone, a nation of eight million on the coast of Western Africa, feels like a land inexplicably spared as a plague passed overhead. What has happened — or hasn’t happened — here and in much of sub-Saharan Africa is a great mystery of the pandemic.The low rate of coronavirus infections, hospitalizations and deaths in West and Central Africa is the focus of a debate that has divided scientists on the continent and beyond. Have the sick or dead simply not been counted? If Covid has in fact done less damage here, why is that? If it has been just as vicious, how have we missed it?The answers “are relevant not just to us, but have implications for the greater public good,” said Austin Demby, Sierra Leone’s health minister, in an interview in Freetown, the capital.The assertion that Covid isn’t as big a threat in Africa has sparked debate about whether the African Union’s push to vaccinate 70 percent of Africans against the virus this year is the best use of health care resources, given that the devastation from other pathogens, such as malaria, appears to be much higher.In the first months of the pandemic, there was fear that Covid might eviscerate Africa, tearing through countries with health systems as weak as Sierra Leone’s, where there are just three doctors for every 100,000 people, according to the World Health Organization. The high prevalence of malaria, H.I.V., tuberculosis and malnutrition was seen as kindling for disaster.That has not happened. The first iteration of the virus that raced around the world had comparatively minimal impact here. The Beta variant ravaged South Africa, as did Delta and Omicron, yet much of the rest of the continent did not record similar death tolls.Into Year Three of the pandemic, new research shows there is no longer any question of whether Covid has spread widely in Africa. It has.Studies that tested blood samples for antibodies to SARS-CoV-2, the official name for the virus that causes Covid, show that about two-thirds of the population in most sub-Saharan countries do indeed have those antibodies. Since only 14 percent of the population has received any kind of Covid vaccination, the antibodies are overwhelmingly from infection.A busy morning at the fish market at Man of War Bay in Freetown, Sierra Leone’s capital.Finbarr O’Reilly for The New York TimesFudia Kamara, 25, sat with her son Kabba Kargbo, 3, in the hospital in Kamakwie, Sierra Leone. Like nearly all the children in the pediatric ward, he had malaria.Finbarr O’Reilly for The New York TimesA new W.H.O.-led analysis, not yet peer-reviewed, synthesized surveys from across the continent and found that 65 percent of Africans had been infected by the third quarter of 2021, higher than the rate in many parts of the world. Just 4 percent of Africans had been vaccinated when these data were gathered.So the virus is in Africa. Is it killing fewer people?Some speculation has focused on the relative youth of Africans. Their median age is 19 years, compared with 43 in Europe and 38 in the United States. Nearly two-thirds of the population in sub-Saharan Africa is under 25, and only 3 percent is 65 or older. That means far fewer people, comparatively, have lived long enough to develop the health issues (cardiovascular disease, diabetes, chronic respiratory disease and cancer) that can sharply increase the risk of severe disease and death from Covid. Young people infected by the coronavirus are often asymptomatic, which could account for the low number of reported cases.Plenty of other hypotheses have been floated. High temperatures and the fact that much of life is spent outdoors could be preventing spread. Or the low population density in many areas, or limited public transportation infrastructure. Perhaps exposure to other pathogens, including coronaviruses and deadly infections such as Lassa fever and Ebola, has somehow offered protection.Since Covid tore through South and Southeast Asia last year, it has become harder to accept these theories. After all, the population of India is young, too (with a median age of 28), and temperatures in the country are also relatively high. But researchers have found that the Delta variant caused millions of deaths in India, far more than the 400,000 officially reported. And rates of infection with malaria and other coronaviruses are high in places, including India, that have also seen high Covid fatality rates. So are Covid deaths in Africa simply not counted?Most global Covid trackers register no cases in Sierra Leone because testing for the virus here is effectively nonexistent. With no testing, there are no cases to report. A research project at Njala University in Sierra Leone has found that 78 percent of people have antibodies for this coronavirus. Yet Sierra Leone has reported only 125 Covid deaths since the start of the pandemic.Most people die in their homes, not in hospitals, either because they can’t reach a medical facility or because their families take them home to die. Many deaths are never registered with civil authorities.This pattern is common across sub-Saharan Africa. A recent survey by the United Nations Economic Commission for Africa found that official registration systems captured only one in three deaths.Nurses at a hospital in Neave, South Africa, moved a patient who died of Covid to a temporary morgue in November 2020. South Africa is the only country in sub-Saharan Africa to record high Covid infection and death rates.Samantha Reinders for The New York TimesPreparing a Covid vaccine in the town of Kathantha Yimbo in Sierra Leone. The lack of reported Covid cases in the country is raising questions about whether resources should be directed at more urgent problems.Finbarr O’Reilly for The New York TimesThe one sub-Saharan country where almost every death is counted is South Africa. And it’s clear from the data that Covid has killed a great many people in that country, far more than the reported virus deaths. Excess mortality data show that between May 2020 and September 2021, some 250,000 more people died from natural causes than was predicted for that time period, based on the pattern in previous years. Surges in death rates match those in Covid cases, suggesting the virus was the culprit.Dr. Lawrence Mwananyanda, a Boston University epidemiologist and special adviser to the president of Zambia, said he had no doubt that the impact in Zambia had been just as severe as in South Africa, but that Zambian deaths simply had not been captured by a much weaker registration system. Zambia, a country of more than 18 million people, has reported 4,000 Covid-19 deaths.“If that is happening in South Africa, why should it be different here?” he said. In fact, he added, South Africa has a much stronger health system, which ought to mean a lower death rate, rather than a higher one.A research team he led found that during Zambia’s Delta wave, 87 percent of bodies in hospital morgues were infected with Covid. “The morgue was full. Nothing else is different — what is different is that we just have very poor data.”The Economist, which has been tracking excess deaths throughout the pandemic, shows similar rates of death across Africa. Sondre Solstad, who runs the Africa model, said that there had been between one million and 2.9 million excess deaths on the continent during the pandemic.“It would be beautiful if Africans were spared, but they aren’t,” he said.But many scientists tracking the pandemic on the ground disagree. It’s not possible that hundreds of thousands or even millions of Covid deaths could have gone unnoticed, they say.“We have not seen massive burials in Africa. If that had happened, we’d have seen it,” said Dr. Thierno Baldé, who runs the W.H.O.’s Covid emergency response in Africa.“A death in Africa never goes unrecorded, as much as we are poor at record-keeping,” said Dr. Abdhalah Ziraba, an epidemiologist at the African Population and Health Research Center in Nairobi, Kenya. “There is a funeral, an announcement: A burial is never done within a week because it is a big event. For someone sitting in New York hypothesizing that they were unrecorded — well, we may not have the accurate numbers, but the perception is palpable. In the media, in your social circle, you know if there are deaths.”Dr. Demby, the Sierra Leone health minister, who is an epidemiologist by training, agreed. “We haven’t had overflowing hospitals. We haven’t,” he said. “There is no evidence that excess deaths are occurring.”Which could be keeping the death rate lower?Abu Kamara tended to his mother, Ramatu Sesay, in the hospital at Kamakwie, Sierra Leone. The hospital wards contain cancer and malaria patients, but none with Covid.Finbarr O’Reilly for The New York TimesA path leading to the community graveyard in Mabin. Many Sierra Leoneans who die are laid to rest in small village burial grounds and not included in official records.Finbarr O’Reilly for The New York TimesWhile health surveillance is weak, he acknowledged, Sierra Leoneans have the recent, terrible experience of Ebola, which killed 4,000 people here in 2014-16. Since then, he said, citizens have been on alert for an infectious agent that could be killing people in their communities. They would not continue to pack into events if that were the case, he said.Dr. Salim Abdool Karim, who is on the African Centers for Disease Control and Prevention Covid task force and who was part of the research team tracking excess deaths in South Africa, believes the death toll continentwide is probably consistent with that of his country. There is simply no reason that Gambians or Ethiopians would be less vulnerable to Covid than South Africans, he said.But he also said it was clear that large numbers of people were not turning up in the hospital with respiratory distress. The young population is clearly a key factor, he said, while some older people who die of strokes and other Covid-induced causes are not being identified as coronavirus deaths. Many are not making it to the hospital at all, and their deaths are not registered. But others are not falling ill at rates seen elsewhere, and that’s a mystery that needs unraveling.“It’s hugely relevant to things as basic as vaccine development and treatment,” said Dr. Prabhat Jha, who heads the Centre for Global Health Research in Toronto and is leading work to analyze causes of death in Sierra Leone.Researchers working with Dr. Jha are using novel methods — such as looking for any increase in revenue from obituaries at radio stations in Sierra Leonean towns over the past two years — to try to see if deaths could have risen unnoticed, but he said it was clear there had been no tide of desperately sick people.Some organizations working on the Covid vaccination effort say the lower rates of illness and death should be driving a rethinking of policy. John Johnson, vaccination adviser for Doctors Without Borders, said that vaccinating 70 percent of Africans made sense a year ago when it seemed like vaccines might provide long-term immunity and make it possible to end Covid-19 transmission. But now that it’s clear that protection wanes, collective immunity no longer looks achievable. And so an immunization strategy that focuses on protecting just the most vulnerable would arguably be a better use of resources in a place such as Sierra Leone.“Is this the most important thing to try to carry out in countries where there are much bigger problems with malaria, with polio, with measles, with cholera, with meningitis, with malnutrition? Is this what we want to spend our resources on in those countries?” he asked. “Because at this point, it’s not for those people: It’s to try to prevent new variants.”And new variants of Covid pose the greatest risk in places with older populations and high levels of comorbidities such as obesity, he said.Other experts cautioned that the virus remained an unpredictable foe and that scaling back efforts to vaccinate sub-Saharan Africans could yet lead to tragedy.“We can’t get complacent and assume Africa can’t go the way of India,” Dr. Jha said.A new variant as infectious as Omicron but more lethal than Delta could yet emerge, he warned, leaving Africans vulnerable unless vaccination rates increased significantly.“We should really avoid the hubris that all Africa is safe,” he said.

The pandemic is not the only reason.Last June, researchers from Texas Children’s Hospital and Baylor College of Medicine documented six unusual cases in the journal Movement Disorders. The subjects were teenage girls between 13 and 16 who had started having “abrupt-onset tic-like movements.” The tics were puzzling because Tourette’s syndrome and other tic disorders — characterized by involuntary and repeated movements or sounds — are far more common among boys and tend to first appear in early childhood with small movements; the girls’ movements, though, were large, accompanied by vocalizations and had other unique traits. Among them: The girls all described having watched TikTok videos of tics before their symptoms began, suggesting the potential spread of a social contagion.Indeed, the C.D.C. last month reported a pronounced increase in similar tics based on evidence from a source never before used to assess specific mental-health conditions among the nation’s children: emergency-room data. For girls ages 12 to 17, the proportion of visits to the E.R. for tics nearly tripled during the pandemic as of January 2022. Visits also doubled for eating disorders, and there were increases related to anxiety, trauma and stress and obsessive-compulsive disorders.These findings, particularly the rise in what have been called TikTok tics, have received considerable media coverage. But “equally striking,” says the lead author, Lakshmi Radhakrishnan, a health scientist at the C.D.C., is the marked but less widely discussed decrease in mental-​health visits by adolescent boys.Why do girls appear to be struggling? Are boys faring better? Or are their problems more likely to be overlooked? The numbers can’t answer questions like these. “No single, comprehensive surveillance system for children’s mental health in the United States exists,” the C.D.C. noted in a supplementary report. The current surveys that keep tabs on various aspects of mental health in children are too slow to capture swift changes amid a national crisis. And though rapid surveys have evaluated the pandemic’s impact on the mental health of adults, fewer have considered how children are doing. “A lot of times kids aren’t the first in line,” says Daniel Dickstein, the associate chief and director of research at McLean Hospital’s child and adolescent psychiatry division. And, he points out, if more children were getting adequate mental-health care earlier, fewer would end up in the E.R., a venue that is not set up for ongoing treatment of psychiatric conditions.Illustration by Ori ToorEmergency-room data has been monitored for almost two decades by the C.D.C. as part of a response to 9/11 and a congressional mandate to track health measures in the event of disease outbreaks or other public-health emergencies. Though mental-health data from the E.R. has not been a specific focus for the C.D.C. over the years, it has now enabled the agency to produce a report that is meant, Radhakrishnan says, to raise awareness among parents, physicians and mental-health organizations.This is especially important for emerging conditions in order to reduce misdiagnoses. For the tics many adolescent girls are having, for example, “we would want to treat looking at anxiety and depression,” says John Piacentini, an expert in tic disorders and director of the Child Anxiety Resilience Education Support Center at the University of California, Los Angeles. Those conditions can increase the vulnerability of children to developing tics and eating disorders. Hence doctors should use great care in prescribing medications for tics because Tourette’s syndrome and other movement disorders — and kids can have more than one — often involve different neurological pathways.“With the social isolation and lack of social connection, I think that hit girls harder than boys,” Piacentini says. “Girls tend to socialize in different ways.” If, as experts believe, the tics that many of them have experienced during the pandemic mirror behavior they saw online, it may be an unintentional way of trying to make connections during what for many has been a period of loneliness. “I think it’s a little beyond their control,” he says of the tics. “I don’t think most kids are doing this for attention.”It would be easy to blame the pandemic for changes in mental health that have been observed since March 2020. But in December, when the surgeon general noted a “mental-health crisis” among young people, he made clear that rising numbers of children and young adults were struggling with anxiety and depression before Covid-19. Between 2013 and 2019, A.D.H.D. and anxiety were the most common mental disorders among those 3 to 17 years old, with each condition affecting roughly one in 11 children, according to the C.D.C. More than one in five 12- to 17-year-olds experienced a major depressive episode. Yet in 2019, fewer than 15 percent of children between the ages of 5 and 17 received some kind of mental-​health treatment. “Pre-Covid we had a mental-health crisis,” says John T. Walkup, chairman of the psychiatry and behavioral-health department at Lurie Children’s Hospital of Chicago. “The biggest misconception is that Covid makes people mentally ill. From my point of view, Covid unmasked people who have underlying vulnerabilities.”Unfortunately, that means letting go of the popular notion that a return to “normal” for children — in-​person schooling, no more masks — will reverse those trends. In fact, such measures may compound the stress many students already feel, says Lisa Fortuna, the U.C.S.F. chief of psychiatry at Zuckerberg San Francisco General Hospital. And an estimated 200,000 children in the U.S. who lost a parent or guardian to Covid-19 may need additional support. Screening for depression and anxiety at schools and pediatricians’ offices will be crucial, because the symptoms associated with those conditions are easier to manage and do less damage when addressed early. For adolescents, substance abuse, eating disorders and thoughts of suicide can be complications of both anxiety and depression.In preadolescent children, Fortuna says, depression may reveal itself as touchiness and irritability rather than sadness. For all ages, a withdrawal from routine activities is a warning sign, as is excessive worry. Symptoms vary greatly, but in general, depressed girls may become withdrawn, whereas boys may fight or act out, incurring the label of behavior problem rather than, say, mood disorder. “Clinically, I’m seeing a lot of young men presenting with depressive symptoms,” Fortuna says. That’s despite the decrease in male visits to the E.R. that the C.D.C. found. “They are still there,” she says. “They might not be as loudly presenting.”Opening a dialogue with children about how they are feeling and listening without judgment are critical. “I would encourage parents to talk to kids and ask them, ‘Are you feeling sad?’” says Anita Everett, director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration. “We encourage people to also ask about suicide,” she adds. Doing so won’t plant the idea. If there’s a problem, don’t ignore it and hope it will go away. “Some sort of path forward is important,” Everett says.That path may well be arduous. A recent survey in Annals of Family Medicine found that 85 percent of primary-care practices are having difficulty accessing evidence-based mental-health care for children. Nationally, Fortuna says, some children are waiting six months to a year for help. She suggests first seeking advice from a primary-care doctor or school counselor. The SAMHSA website includes a treatment locator, and churches and other community groups can be valuable resources. Everett urges caregivers to ensure that weapons, especially guns, and medications and other dangerous substances are well secured in any home where a child will be. And, she says, parents should look for support for themselves. Perhaps it’s helpful — as well as tragic — to know that finding others whose children are struggling, and who are struggling themselves, won’t be difficult.If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.Kim Tingley is a contributing writer for the magazine.

Measuring blood oxygen levels at home is a safe way for people with COVID-19 to spot signs that their health could be deteriorating, and they may need emergency and hospital care, new research led by Imperial College London has found.
Pulse oximeters are widely available, low-cost devices that shine light through a person’s finger to assess their blood oxygen saturation. Evidence has shown that a fall in blood oxygen levels is a critical indicator that a COVID-19 patient’s health is deteriorating and they may need closer monitoring and urgent treatment.
Led by Imperial’s Institute of Global Health Innovation, the study carried out the first extensive evidence review of pulse oximetry and its potential in home monitoring for people with COVID-19.
The research, published in Lancet Digital Health, examined 13 studies involving almost 3,000 participants across five countries*, most of which were carried out during the first pandemic wave.
The scientists found that with medical guidance, home pulse oximetry can act as a safety net, reducing unnecessary emergency and hospital admissions for patients who can safely stay at home, while spotting early signs of deterioration and escalating care in those who need it. This would help to save stretched resources, and reduce further potential spread of the virus from contact in health settings.
However, the researchers note a lack of research on darker skinned patients, for whom oximetry may be less accurate than in white people.

Investigators from Cedars-Sinai have created an artificial intelligence-enabled tool that may make it easier to predict if a person will have a heart attack.
The tool, described in The Lancet Digital Health, accurately predicted which patients would experience a heart attack in five years based on the amount and composition of plaque in arteries that supply blood to the heart.
Plaque buildup can cause arteries to narrow, which makes it difficult for blood to get to the heart, increasing the likelihood of a heart attack. A medical test called a coronary computed tomography angiography (CTA) takes 3D images of the heart and arteries and can give doctors an estimate of how much a patient’s arteries have narrowed. Until now, however, there has not been a simple, automated and rapid way to measure the plaque visible in the CTA images.
“Coronary plaque is often not measured because there is not a fully automated way to do it,” said Damini Dey, PhD, director of the quantitative image analysis lab in the Biomedical Imaging Research Institute at Cedars-Sinai and senior author of the study. “When it is measured, it takes an expert at least 25 to 30 minutes, but now we can use this program to quantify plaque from CTA images in five to six seconds.”
Dey and colleagues analyzed CTA images from 1,196 people who underwent a coronary CTA at 11 sites in Australia, Germany, Japan, Scotland and the United States. The investigators trained the AI algorithm to measure plaque by having it learn from coronary CTA images, from 921 people, that already had been analyzed by trained doctors.
The algorithm works by first outlining the coronary arteries in 3D images, then identifying the blood and plaque deposits within the coronary arteries. Investigators found the tool’s measurements corresponded with plaque amounts seen in coronary CTAs. They also matched results with images taken by two invasive tests considered to be highly accurate in assessing coronary artery plaque and narrowing: intravascular ultrasound and catheter-based coronary angiography.
Finally, the investigators discovered that measurements made by the AI algorithm from CTA images accurately predicted heart attack risk within five years for 1,611 people who were part of a multicenter trial called the SCOT-HEART trial.
“More studies are needed, but it’s possible we may be able to predict if and how soon a person is likely to have a heart attack based on the amount and composition of the plaque imaged with this standard test,” said Dey, who is also professor of Biomedical Sciences at Cedars-Sinai.
Dey and colleagues are continuing to study how well their AI algorithm quantifies plaque deposits in patients who undergo coronary CTA.
Funding: The study was funded by the National Heart, Lung, and Blood Institute under award number 1R01HL148787-01A1.
Story Source:
Materials provided by Cedars-Sinai Medical Center. Note: Content may be edited for style and length.