Publisher Health

The period after hospital discharge is a high-risk time for people who use illicit opioids such as heroin, according to new research publishing October 5th in the open access journal PLOS Medicine. Fatal opioid overdoses are four times more likely in the first two days after hospital discharge than at other times, and people who use illicit drugs need extra support when being discharged from hospital.
The number of deaths related to opioids, such as heroin, is increasing in England. Hospital patients who use drugs often report undertreated pain and opioid withdrawal and may leave hospital to use illegal drugs. Dan Lewer of University College London and colleagues examined whether hospital admission and discharge are associated with increased risk of fatal drug overdoses, hoping to understand if these times present opportunities to support individuals who use illicit drugs.
They studied opioid-related deaths in England in people aged 18-64 using 2010-2019 data from a national database. A total of 13,609 deaths occurred in that period, with 236 (1.7%) following drug use while admitted to hospital:a risk that was smaller or lower than periods not in hospital or recently discharged. 1,088 (8%) deaths occurred in the 14 days after hospital discharge, particularly during the first two days, which is an increase over other periods. Patients who were admitted to hospital for psychiatric admissions, who left the hospital against medical advice or who had stays of seven days or more were at greater risk.
The team concludes that with 1 in 14 opioid-related deaths in England occurring in the two weeks after hospital discharge, interventions such as treatment to prevent withdrawal or overdose response training could save lives. “We don’t want patients needing to treat their own withdrawal or pain and end up overdosing in the bathroom,” says co-author Thomas Brothers, who specializes in addiction medicine. “Hospitals can do more to support this patient group, by giving medicines such as methadone, safer consumption spaces, take-home naloxone kits, and improving training.”
Lewer adds, “Drug related deaths are a public health crisis in the UK. We can cut the number of deaths by supporting people at the most difficult times. This study shows that hospital discharge is one of those critical moments.”
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Living with a food allergy can greatly impact a child’s everyday life — from limiting participation in social activities to being treated differently by peers. While previous research indicates many kids experience food allergy-related bullying, a new study in the Journal of Pediatric Psychology found that offering kids with food allergies a multi-question assessment gives a more accurate picture of the size and scope of the problem.
When asked a simple “yes” or “no” question about food allergy-related bullying, 17% of kids said they’d been bullied, teased or harassed about their food allergy. But when asked to reply to a multi-item list of victimization behaviors, that number jumped to 31%. Furthermore, Children’s National Hospital researchers found that only 12% of parents reported being aware of it. The reported bullying ranged from verbal teasing or criticism to more overt acts such as an allergen being waved in their face or intentionally put in their food. Researchers say identifying accurate assessment methods for this problem are critical so children can get the help they need.
“Food allergy-related bullying can have a negative impact on a child’s quality of life. By using a more comprehensive assessment, we found that children with food allergies were bullied more than originally reported and parents may be in the dark about it,” says Linda Herbert, Ph.D., director of the Psychosocial Clinical and Research Program in the Division of Allergy and Immunology at Children’s National and one of the study’s researcher.
“The results of this study demonstrate a need for greater food allergy education and awareness of food allergy-related bullying among communities and schools where food allergy-related bullying is most likely to occur,” Herbert adds.
The study looked at food allergy-related bullying among a diverse patient population and evaluated parent-child disagreement and bullying assessment methods. It included 121 children and 121 primary caregivers who completed questionnaires. The children ranged in age from 9 to 15-years-old and were diagnosed by an allergist with at least one of the top eight IgE-mediated food allergies — peanut, tree nut, cow’s milk, egg, wheat, soy, shellfish and fish.
Of the 41 youth who reported food allergy-related bullying: 51% reported experiencing overt physical acts such as an allergen being waved in their face, thrown at them or intentionally put in their food. 66% reported bullying experiences that are categorized as non-physical overt victimization acts including verbal teasing, remarks or criticisms about their allergy and verbal threats or intimidation. Eight reported relational bullying, such as rumors being spread, people speaking behind their back and being intentionally ignored or excluded due to their food allergy.The researchers also note that food allergy bullying perpetrators included, but were not limited to, classmates and other students, and bullying most commonly occurred at school.
The authors found that only 12% of parents reported that their child had been bullied because of their food allergy and of those, 93% said their child had reported the bullying to them. Some parents reported they had been made fun of or teased themselves because of concerns about their child’s food allergy.
“It’s important to find ways for children to open up about food allergy-related bullying,” Herbert says. “Asking additional specific questions about peer experiences during clinic appointments will hopefully get children and caregivers the help and support they need.”
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Women with undiagnosed endometriosis will have difficulty falling pregnant without IVF, according to a University of Queensland study.
UQ School of Public Health researcher, Dr Katrina Moss, said women whose endometriosis went undiagnosed until after they began fertility treatment ended up doing more cycles, used treatments that aren’t recommended, and were less likely to have a baby.
“By contrast, our study found women who were diagnosed with endometriosis before fertility treatment experienced the same outcomes as those without the condition,” Dr Moss said.
In Australia, 1 in 9 women are diagnosed with endometriosis and 40 per cent of these experience infertility.
Dr Moss said Australian women can wait between 4 and 11 years before being diagnosed with endometriosis, and delayed diagnosis reduced the chances of fertility treatments being successful.
“In our national study of 1322 women, 35 per cent of participants had endometriosis and one-third of those weren’t diagnosed until after they started their fertility treatment,” Dr Moss said.

The arrival of vaccines and declining Covid-19 cases in the first half of 2021 coincided with an easing of symptoms of anxiety and depression across the United States, according to survey data released on Tuesday by the Centers for Disease Control and Prevention.But symptoms remained much more common in June 2021, the end of the survey period, than before the pandemic, and could be on the rise again because of the summer surge in cases of the Delta variant, C.D.C. scientists said.The agency relied on a biweekly online survey conducted from August 2020 to June 2021. Researchers analyzed 1.5 million responses over that period about the severity of symptoms of anxiety or depression.From August to December 2020, symptoms of anxiety rose by 13 percent and symptoms of depression by 15 percent, the surveys found. But from December to June 2021, that trend reversed: Symptoms of anxiety decreased by 27 percent and of depression by 25 percent.The C.D.C. said that there was a strong correlation between the average number of daily Covid-19 cases and the severity of respondents’ anxiety and depression.Noting that some parts of the population had been harder hit by the virus than others, the agency said those same groups may be at higher risk for psychological ill effects from Covid-19 and that good access to mental health services was critical. Other research has indicated that people with low incomes were at higher risk of depression during the pandemic.The national trends were mirrored in most states, with anxiety and depression peaking in December 2020 or January 2021, when U.S. cases, hospitalizations and deaths all peaked. States that experienced steeper increases in symptoms last year also showed larger reductions in the first half of 2021.Mississippi was among the states with the largest increases in anxiety and depression scores by percentage in the second half of 2020. New York, on the other hand, experienced both the smallest rise in anxiety scores in late 2020 and the smallest drop in the first half of this year.

Ellume, an Australian company that makes a widely available at-home coronavirus test, has recalled nearly 200,000 test kits because of concerns about a higher-than-expected rate of false positives. That represents about 5.6 percent of the approximately 3.5 million test kits Ellume has shipped to the United States.The company, which detected the problem in mid-September, traced the issue to variations in the quality of one of the raw materials used in the test kit, Dr. Sean Parsons, Ellume’s chief executive, said in a phone interview. He declined to specify the material in question, citing a desire not to publicly disclose precisely how the test kits work.Approximately 427,000 test kits, including some provided to the U.S. Department of Defense, were affected by the problem, Dr. Parsons said. Roughly half have already been used, he said, yielding about 42,000 positive results. As many as a quarter of those positives may have been inaccurate, Dr. Parsons said, although he stressed that it would be difficult to determine exactly how many. “I’m very sorry that this has happened,” Dr. Parsons said. “We’re all about chasing accuracy, and to have these false positives is disappointing.”The issue did not affect all Ellume test kits or the reliability of negative results, the company said.Ellume’s test is a rapid antigen test, designed to detect pieces of the virus in the nose. Users swab their nostrils, insert the swab into a dropper of fluid and then add the fluid to a Bluetooth-connected analyzer. Results are transmitted to a smart phone app in 15 minutes. Last December, it became the first over-the-counter, completely at-home test to receive an emergency use authorization from the U.S. Food and Drug Administration.The company has asked retailers to remove the tests from shelves and is in the process of notifying consumers, Dr. Parsons said.Consumers who have one of the affected tests can request a replacement online. People who try to use one of the affected test kits will be notified in the app that the test has been recalled. “It really won’t be possible to use any of those tests now,” Dr. Parsons said.He added that the company had put “extra controls” in place to prevent the same problem from cropping up again in the future.“We are doing everything possible to get known, good product into the hands of consumers in the U.S.,” Dr. Parsons said.The recall comes as demand for testing has soared, and consumers have complained that at-home test kits are hard to find. On Monday, the F.D.A. authorized a new at-home antigen test, ACON Laboratories’ Flowflex. The authorization “is expected to double rapid at-home testing capacity in the U.S. over the next several weeks,” Dr. Jeffrey E. Shuren, who directs the F.D.A.’s Center for Devices and Radiological Health, said in a statement. “By year’s end, the manufacturer plans to produce more than 100 million tests per month, and this number will rise to 200 million per month by February 2022.”

It is still elusive to what extent interactions between different cell types of the heart influence the normal heart rhythm and possibly trigger life-threatening arrhythmias. A new measurement method developed at the University of Bern combines for the first time optical and electrical recording of cardiac ventricular activation which, in conjunction with optogenetics, will permit finding comprehensive answers to these questions.
The normal function of the heart is based on a pacemaker that generates electrical impulses (‘action potentials’) which spread rapidly throughout the heart muscle where they trigger the contraction leading to the heartbeat. In the past, it was assumed that the propagation of action potentials was controlled exclusively by cardiac muscle cells. However, recent findings suggest that other cell types of the heart, such as connective tissue cells (‘fibroblasts’) and macrophages, may additionally affect action potential propagation and, thus, play a significant role in determining cardiac function. These findings were obtained using a new method called optogenetics that uses light to control the electrical behavior of defined cell types like fibroblasts thereby permitting the assessment of their involvement in the cardiac activation process.
To enable comprehensive optogenetic studies with hearts, researchers led by Stephan Rohr of the Department of Physiology at the University of Bern developed a new experimental system called ‘Panoramic Opto-Electrical Measurement and Stimulation (POEMS)’ system. The POEMS system is the first to allow simultaneous optical and electrical measurements and stimulation extending over the entire ventricular surface of mouse hearts. Results obtained with the system are expected to open new perspectives in the study of normal cardiac function and the investigation of mechanisms causing cardiac arrhythmias. The study describing the system was published in the journal Nature Communications.
Connective tissue cells as a cause of cardiac arrhythmias?
Cell culture experiments have previously shown that cardiac muscle cells communicate with activated cardiac fibroblasts by means of electrical signals and that this interaction leads to cardiac arrhythmias. However, it is still unknown whether this mechanism is also operational in intact hearts because conventional electrophysiological methods are not suited to investigate this question.
The lack of suitable experimental approaches is overcome these days by optogenetics that permits a direct interrogation of the presence and functional consequences of cellular interactions between muscle and non-muscle cells of the heart. Presence of direct electrical communication can be assessed by letting specific cell types like fibroblasts express so-called “optogenetic voltage reporters.” On the other hand, the functional consequences of such coupling can be investigated by expressing ‘optogenetic voltage actuators’ in these cells and by observing the effects of light-activation on whole heart electrophysiology. Presently, conducting optogenetic experiments is complex and equipment intensive. In addition, it is not possible to combine electrode-based experiments with optical studies, which severely limits the range of possible experiments.
POEMS system creates new possibilities
“With our POEMS system, all of these disadvantages have been overcome, as the entire surface of the ventricles is covered with a combination of optical and electrical measurement and stimulation sites, which allows free combinations of both modalities,” explains Professor Stephan Rohr, lead author of the study. The core of the new POEMS system consists of a cup fitting the size of mouse hearts with its inner surface being lined by 294 optical fibers and 64 electrodes. All optical fibers and electrodes can be individually configured as measurement and stimulation sites thereby permitting a precise tailoring of individual experiments to the specific requirements of the optogenetic reporter and actuator used in a given experiment.
Simultaneous optical and electrical panoramic measurements of cardiac activation using stimulated mouse hearts expressing optogenetic voltage reporters demonstrated that the POEMS system provides, irrespective of the measurement modality, congruent and highly accurate measurements of ventricular action potential propagation with differences between optically and electrically determined activation times less than a millisecond. Going beyond, the POEMS system was designed with the goal to enable straightforward and efficient experimentation. “With our ‘drop&go’ approach, experiments can be started immediately after the isolated mouse is placed in the measurement container,” says co-author of the study Michael Rieger, who developed the system together with other members of the Department of Physiology. The gentle treatment of the hearts increasing the success rate of experiments as well as the increased information content provided by the POEMS system is also relevant with regards to the 3R principles (replace, reduce, refine) because the number of animal experiments needed to answer a given question can be substantially reduced.
“With the POEMS system in place, we are presently investigating the burning question of whether cardiac arrhythmias can also be caused by non-muscle cells such as activated connective tissue cells,” says Stephan Rohr. If this should be the case, it would open up new avenues for the treatment of cardiac arrhythmias as cell types different from muscle cells may become targets for anti-arrhythmic therapies.
The study was supported by the Swiss National Science Foundation SNSF.
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To prevent the spread of COVID-19 indoors, the two metres physical distancing guideline is not enough without masks, according to researchers from Quebec, Illinois, and Texas. However, wearing a mask indoors can reduce the contamination range of airborne particles by about 67 percent.
“Mask mandates and good ventilation are critically important to curb the spread of more contagious strains of COVID-19, especially during the flu season and winter months as more people socialize indoors,” says Saad Akhtar, a former doctoral student under the supervision of Professor Agus Sasmito at McGill University.
While most public health guidelines recommend physical distancing of two metres for people from different households, the researchers say distancing alone is not enough to prevent the spread of COVID-19. In a study published in Building and Environment, the researchers found that when people are unmasked, more than 70 percent of airborne particles pass the two metres threshold within the 30 seconds. By contrast, less than 1 percent of particles cross the two-metre mark if masks are worn.
Simulating coughing dynamics
Building on models used by scientists to study the flow of liquids and gasses, the team from McGill University, Université de Sherbrooke, Texas A&M University, and Northern Illinois University, developed a computer program to accurately simulate coughing dynamics in indoor spaces.
While ventilation, a person’s posture, and mask-wearing impacted the spread of the bio-contaminants significantly, the impact of age and gender was marginal, the researchers found.
Coughing is one of the main sources of spread of airborne viruses from symptomatic individuals. “This study advances the understanding of how infectious particles can spread from a source to its surroundings and can help policymakers and governments make informed decisions about guidelines for masks and distancing in indoor settings,” says Akhtar.
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Materials provided by McGill University. Note: Content may be edited for style and length.

Huntington’s disease is a fatal condition involving the death of brain cells, typically striking in midlife. But new findings suggest the disease process starts decades earlier. Although symptoms emerge in adulthood, researchers have been able to detect the earliest effects of Huntington’s in the first two weeks of human embryonic development. 
The findings recast Huntington’s, often considered a neurodegenerative condition, as a developmental disease, and point to new approaches for finding treatments for a disease that currently has no cure or therapies.
“When the patient goes to the doctor, that’s when the last dominoes have fallen. But the first domino is pushed in the developmental phase,” says Ali Brivanlou, head of the Laboratory of Synthetic Embryology at Rockefeller University, who published the findings in the journal Development. “Knowing this trajectory, we may be able to block the progression of the disease.”
Early beginnings
Huntington’s is caused by mutations in a single gene, Huntingtin, resulting in the production of an unusually long protein. The gene is expressed in the fertilized egg and subsequently in every cell of the body, but its functions are not entirely known. A bigger mystery is why the defective gene appears to be detrimental only to neurons in specific parts of the brain.
Previously researchers in the Brivanlou lab found evidence that abnormalities due to Huntingtin mutation arise decades before the neurons start to perish: In the first stages of the brain development in the embryo, when uniform cells are becoming specific brain cell types and forming structures. Introducing the Huntington’s mutation in these developing cells led to abnormal neurons and structures.

Researchers working with primary care patients in China have discovered that a simple questionnaire and airflow measurement test could identify adults suffering with undiagnosed chronic obstructive pulmonary disease (COPD), a new study funded by the National Institute for Health Research (NIHR) reveals.
COPD is a long-term condition characterised by persistent breathing problems. Nearly one-third of the 3.2 million annual global deaths it causes are from China, where the disease ranks among the top three leading causes of death.
Some 90 percent of the estimated 100 million sufferers in China are undiagnosed. The study shows the Chinese symptom-based questionnaire (C-SBQ) combined with microspirometry — measuring how much air a patient can breathe out in one forced breath — could provide the most efficient way of identifying patients needing treatment for COPD.
An international research team, led by experts at the University of Birmingham, published its findings today in BMJ Open.
Co Author Professor Peymané Adab, from the University of Birmingham’s Institute of Applied Health Research, commented: “COPD is a global killer and we’re working with partners in China to improve ways of identifying those people who have the disease, but don’t realise it.
“COPD develops slowly, resulting in delays in symptom recognition and high rates of underdiagnosis. Simple screening tests can help identify undiagnosed COPD within China’s primary care network — the first step in providing people with early treatment and potentially saving lives and reducing the burden on the country’s healthcare system.”
Study participants were recruited from one urban and one rural community health centre (CHC) in each of four municipalities: Beijing, Chengdu, Guangzhou and Shenyang. Residents aged 40 years and above attending CHCs for any reason were invited to participate.

Just because you’ve solved a standing chemistry challenge doesn’t mean you can’t make it better. Rice University scientists had that in mind when they set out to improve their technique to make a common building block for drugs.
Rice chemist Julian West and graduate student Yen-Chu Lu found that an Earth-abundant salt of manganese further simplifies the process of synthesizing fluoroketones, precursor molecules for drug design and manufacture.
The complex method required catalysts of expensive silver until the West lab figured out how to replace it with a cerium-based compound. That in turn led the researchers to eye manganese as a next-level catalyst.
The lab reported its results in the American Chemical Society journal ACS Catalysis.
Attaching negatively charged fluorine atoms to ketones, biological compounds with a variety of structures, helps direct the functional groups toward desired reactions when used in anticancer and other compounds, West said. He noted in the previous study that replacing hydrogen atoms with fluorines “is like armor plating at that position” and helps drugs last longer in the body.
Manganese has several advantages over cerium, West said, and not just for its easy availability and low cost.