Publisher Health

Pain distribution as reported on a body map, on its own, can be used to assign patients to distinct subgroups that are associated with differences in pain intensity, pain quality, pain impact and clinically-relevant three-month outcomes, according to a new study published this week in the open-access journal PLOS ONE by Benedict Alter of University of Pittsburgh, US, and colleagues.
In clinical practice, the bodily distribution of chronic pain is often used in conjunction with other signs and symptoms to diagnose and treat patients. Recent work on fibromyalgia has revealed that clinical pain syndromes thought to be distinct entities may share clinically-relevant features, especially regarding the impact of pain distribution on outcomes. However patterns of pain distribution have not been previously examined in a systematic way as predictors of pain characteristics or outcomes.
In the new study, researchers analyzed data on 21,658 patients seen at the seven pain management clinics of the University of Pittsburgh between 2016 and 2019. All patients completed a pain body map, in which areas of pain are selected on two side-by-side drawings of the front and back of the body, with 74 possible regions of pain. Other information on patients’ pain, health, and outcomes was available in the electronic medical record. Patients were 83% white, 60% female, 22% insured by Medicaid and 10% had at least one comorbidity.
Data from all patients revealed 9 distinct groupings of pain distribution. Demographic and medical characteristics, pain intensity, pain impact, and neuropathic pain quality all varied significantly across cluster subgroups. For instance, the pain intensity of the “Neck and Shoulder” group was less than that of “Lower Back Pain below knee” and “Neck, Shoulder and Lower Back Pain,” while the group with the highest pain intensity consisted of patients with widespread heavy pain, also associated with low physical function, high anxiety and depression and high sleep disturbance. In a subset of 7,138 patients who completed 3-month follow-up questionnaires, subgroups predicted the likelihood of improvement in pain and physical function; those in the “Abdominal Pain” group were the most improved, with 49% self-reporting clinically significant improvements, while those in the “Neck, Shoulder and Lower Back Pain” group were the least improved, with only 37% reporting improvements. The authors conclude that algorithmic clustering by pain distribution may, in the future, be an important facet of the personalization of pain management.
The authors add: “Using an algorithmic approach, we found that how a patient reports the bodily distribution of their chronic pain affects nearly all aspects of the pain experience, including what happens three months later. This emphasizes that chronic pain is a disease process and suggests that this facet of the chronic pain phenotype will be important for future developments in diagnosis and personalized pain management.”
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WHO chief says it would allow at least 10% of the population in every country to be vaccinated.

All 16 and 17-year-olds in the UK will start being offered Covid jabs within weeks, it has been announced.The Joint Committee on Vaccine and Immunisation updated their advice on Wednesday; England, Scotland, Wales and Northern Ireland have all said they will begin to roll it out.We asked 16 and 17-year-olds on Weston-super-Mare seafront if they would get the vaccine.Read more: Jabs for 16 and 17-year-olds to start within weeks

A new study identifies DNA signatures associated with risk for cardiovascular disease, a discovery that could lead to opportunities for clinical intervention years before symptoms manifest. Based on analyses of data from five large heart cohort studies of diverse populations, the findings are published in the journal JAMA Cardiology.
“The science is rapidly advancing in the area of epigenetics — modifications to our DNA that are often environmentally driven and have the potential to serve as early warning sign for disease,” says Ana Navas-Acien, MD, PhD, the study’s first author and professor of environmental health sciences at Columbia University Mailman School of Public Health. “In this study, we harness the country’s best clinical data on heart disease from diverse populations to begin to unlock the specific epigenetic changes involved the complex biology that leads to disease. Ultimately, we hope the research will allow us to identify and prevent disease before the worst damage takes place, although developing appropriate DNA methylation tests is still years away.”
The researchers began their analysis with data from the Strong Heart Study, the largest study of cardiovascular disease in American Indians, conducted in partnership with communities across the Great Plains and the Southwest since 1988. They analyzed blood samples to identify specific locations on DNA where methylation activity was associated with incidents of coronary heart disease, including heart attack and coronary deaths (methylation can change the activity of a DNA segment without changing the genetic sequence).
“The use of high-dimensional statistical methods allowed us to study methylation in hundreds of thousands specific locations in the DNA at the same time” says Arce Domingo-Relloso, MSc, data scientist and study co-author leading the statistical analyses for this project.
The researchers then took the same approach with four other major heart disease cohorts: Atherosclerosis Risk in Communities (divided into Black and white cohorts due to differences in timing and laboratory methods), Framingham Heart Study, and Women’s Health Initiative. In all, they examined more than 400,000 DNA locations and 1,894 coronary heart disease events.
In the initial analysis of Strong Heart data, they identified 506 epigenetic marks linked to cardiovascular risk. Of these, 33 were also linked to cardiovascular risk in three or more of the other cohorts, although some of these sites were associated with higher risk of disease in one cohort but with lower risk of disease in other cohorts. Among the 33 methylation sites are those previously linked to cardiovascular risk and smoking, as well as novel sites that the researchers say are worthy of future investigation. Further analysis of the commonalities between the 33 marks found that many of them are connected with EGFR gene, which is involved in cell growth and cell survival.
“The overlap of these methylation sites across diverse cohorts supports the idea of interconnected biological pathways for cardiovascular risk,” says Yuling Hong, MD, PhD, chief of the epidemiology branch within the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute. “The more we understand about early risk for cardiovascular disease the better we may be able to prevent illness, particularly in populations such as American Indians with relatively high risk for heart disease.”
The study’s senior author is Shelley A. Cole, PhD, of the Texas Biomedical Research Institute. A full list of authors is available on the journal’s article page.
The Strong Heart Study was supported by grants for the National Heart, Lung, and Blood Institute (NHLBI) (contract numbers: 75N92019D00027, 75N92019D00028, 75N92019D00029, 75N92019D00030) and previous grants (HL090863, HL109315, HL109301, HL109284, HL109282, HL109319) and cooperative agreements (HL41642, HL41652, HL41654, HL65520, HL65521) and by the National Institute of Environmental Health Sciences (ES021367, ES025216, ES010349, ES009089). The Framingham Heart Study acknowledges the support of contracts NO1-HC-25195, HHSN268201500001I and 75N92019D00031 from the NHLBI and grant supplement HL092577-06S1 for this research. The Women’s Health Initiative is funded by the NHLBI, National Institutes of Health (NIH), and U.S. Department of Health and Human Services (HHS) through contracts N268201600018C, N268201600001C, N268201600002C, N268201600003C, and N268201600004C. The Atherosclerosis Risk in Communities study has been funded in whole or in part with funds from the NHLBI, NIH, HHS (contract numbers HHSN268201700001I, HHSN268201700002I, N268201700003I, N268201700004I, N268201700005I). Funding was also supported by 5RC2HL102419 and NS087541. Investigator-specific funding is available on the journal’s article page. Navas-Acien and several other authors receive funding from the NHLBI and NIEHS.

Researchers at UT Southwestern announced successful results of a clinical trial for a commonly prescribed weight-loss drug called liraglutide. In adults who are overweight or have obesity combined with high cardiovascular risk, once-daily liraglutide combined with lifestyle interventions significantly lowered two types of fat that have been associated with risk to heart health: visceral fat and ectopic fat.
“Our study used the latest imaging technology to evaluate different fat components in the body. The main finding was a significant decrease in visceral fat in patients without diabetes but who were overweight or had obesity. These results show the potential of liraglutide treatment for significantly lowering the risk of chronic disease in this population,” said Parag Joshi, M.D., preventive cardiologist, Assistant Professor of Cardiology, and senior author of the study published in The Lancet Diabetes & Endocrinology.
Visceral fat is stored within the abdominal cavity around important internal organs, such as the liver, pancreas, and intestines. Ectopic fat is stored in tissues that normally contain small amounts of fat, such as the liver, skeletal muscle, heart, and pancreas.
The 185 study participants were given a once-daily injection of liraglutide over 40 weeks of treatment. The relative effects of liraglutide on fat reduction were two-fold greater in the abdominal tissues and six-fold greater in the liver than seen on overall body weight. The treatment effect was consistent across race/ethnicity and BMI categories, and among those with or without baseline prediabetes. Liraglutide also reduced fasting blood glucose and inflammation in this trial population without diabetes, the majority of whom had normal blood sugar levels at baseline.
In a 2016 study led by UTSW investigators called the Leader trial, the rate of the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke among patients with type 2 diabetes was lower in those treated with liraglutide than with placebo. “Our findings help add a possible mechanism for why there is a benefit of liraglutide on cardiovascular outcomes while also showing its benefits in people without diabetes,” said Dr. Joshi.
According to the researchers, obesity affects an estimated 1 in every 4 adults and 1 in every 5 youths, leading to substantial risk of cardiovascular disease and mortality. “Excess visceral fat and ectopic (e.g., liver) fat are central to the development of type 2 diabetes and cardiovascular disease,” said Dr. Joshi. “It remains challenging to identify those at highest risk, in order to offer them treatment in addition to lifestyle changes such as diet and exercise.”
The study was funded by an investigator-initiated grant from Novo Nordisk.
Other UT Southwestern researchers who contributed to the study include Colby R. Ayers, Bienka Lewis, Robert Oslica, Susan Rodder, and Ambarish Pandey.
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Fewer than one in 20 children with symptomatic COVID-19 experienced symptoms lasting longer than 4 weeks, and almost all children have fully recovered by 8 weeks, a new study has found.
In a study published today in Lancet Child and Adolescent Health, researchers at King’s College London looked at daily health reports logged in the ZOE COVID Symptom Study app between March 2020 and February 2021 by parents or carers on behalf of more than 250,000 children aged 5-17, with nearly 7,000 having symptoms consistent with COVID-19 and a positive test.
The team previously analysed data from adults using the ZOE COVID Symptom Study, and showed that around one in 7 adults experienced COVID-19 symptoms lasting 4 weeks, while one in 20 were ill for 8 weeks or longer.
For this analysis, the team focused on the period from September 2020 through to February 2021. This coincided with the reopening of schools in the autumn and the peak of the winter wave when there was widespread availability of COVID testing.
During this time, 1,734 children were reported who had a clear start and end point to their symptoms and a positive COVID PCR test, enabling the researchers to determine their duration of illness with some allowance for symptoms reoccurring.
On average, the illness lasted for 5 days in younger children (5 to 11 years old) and 7 days in older children aged 12 to 17. Fewer than one in 20 (4.4%) experienced symptoms for 4 weeks or more, while only one in fifty (1.8%) had symptoms lasting more than 8 weeks.

A new mathematical model for predicting infectious disease outbreaks incorporates fear — both of disease and of vaccines — to better understand how pandemics can occur in multiple waves of infections, like those we are seeing with COVID-19. The “Triple Contagion” model of disease and fears, developed by researchers at NYU School of Global Public Health, is published in the Journal of The Royal Society Interface.
Human behaviors like social distancing (which suppresses spread) and vaccine refusal (which promotes it) have shaped the dynamics of epidemics for centuries. Yet, traditional epidemic models have overwhelmingly ignored human behavior and the fears that drive it.
“Emotions like fear can override rational behavior and prompt unconstructive behavioral change,” said Joshua Epstein, professor of epidemiology at NYU School of Global Public Health, founding director of the NYU Agent-Based Modeling Laboratory, and the study’s lead author. “Fear of a contagious disease can shift how susceptible individuals behave; they may take action to protect themselves, but abandon those actions prematurely as fear decays.”
For instance, the fear of catching a virus like SARS-CoV-2 can cause healthy people to self-isolate at home or wear masks, suppressing spread. But, because spread is reduced, the fear can evaporate — leading people to stop isolating or wearing masks too early, when there are still many infected people circulating. This pours fuel — in the form of susceptible people — onto the embers, and a new wave explodes.
Likewise, fear of COVID-19 has motivated millions of people to get vaccinated. But as vaccines suppress spread and with it the fear of disease, people may fear the vaccine more than they do the infection and forego vaccination, again producing disease resurgence.
For the first time, the “Triple Contagion” model couples these psychological dynamics to the disease dynamics, uncovering new behavioral mechanisms for pandemic persistence and successive waves of infection.

A KAIST immunology research team found that a specific subtype of macrophages that originated from blood monocytes plays a key role in the hyper-inflammatory response in SARS-CoV-2 infected lungs, by performing single-cell RNA sequencing of bronchoalveolar lavage fluid cells. This study provides new insights for understanding dynamic changes in immune responses to COVID-19.
In the early phase of COVID-19, SARS-CoV-2 infected lung tissue and the immediate defense system is activated. This early and fast response is called ‘innate immunity,’ provided by immune cells residing in lungs. Macrophages are major cell types of the innate immune system of the lungs, and newly differentiated macrophages originating from the bloodstream also contribute to early defenses against viruses.
Professor Su-Hyung Park and his collaborators investigated the quantitative and qualitative evaluation of immune responses in the lungs of SARS-CoV-2 infected ferrets. To overcome the limitations of research using patient-originated specimens, the researchers used a ferret infection model to obtain SARS-CoV-2 infected lungs sequentially with a defined time interval.
The researchers analyzed the 10 subtypes of macrophages during the five-day course of SARS-CoV-2 infection, and found that infiltrating macrophages originating from activated monocytes in the blood were key players for viral clearance as well as damaged lung tissue. Moreover, they found that the differentiation process of these inflammatory macrophages resembled the immune responses in the lung tissue of severe COVID-19 patients.
Currently, the research team is conducting a follow-up study to identify the dynamic changes in immune responses during the use of immunosuppressive agents to control hyper-inflammatory response called ‘cytokine storm’ in patients with COVID-19.
Dr. Jeong Seok Lee, the chief medical officer at Genome Insight Inc., explained, “Our analysis will enhance the understanding of the early features of COVID-19 immunity and provide a scientific background for the more precise use of immunosuppressive agents targeting specific macrophage subtypes.”
“This study is the first longitudinal study using sequentially obtained immune cells originating from SARS-CoV-2 infected lungs. The research describes the innate immune response to COVID-19 using single cell transcriptome data and enhances our understanding of the two phases of inflammatory responses,” Professor Park said.
This work was supported by the Ministry of Health and Welfare and KAIST, and was published in Nature Communications on July 28.
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Physical activity does the brain good. For example, it fosters its ability to change and adapt.
The dual beneficial effect of physical activity in depression is confirmed by a study at the University Clinic for Psychiatry and Psychotherapy at Ruhr-Universität Bochum (RUB) at the Ostwestfalen-Lippe campus: physical activity not only reduces depressive symptoms. It also increases the brain’s ability to change, which is necessary for adaptation and learning processes.
“The results show how important seemingly simple things like physical activity are in treating and preventing illnesses such as depression,” says study leader associate professor Dr. Karin Rosenkranz.
The study was published on 9 June 2021 in the journal Frontiers in Psychiatry.
Exercise programme promotes motivation and togetherness
People with depression often withdraw and are physically inactive. To investigate the effect of physical activity, Karin Rosenkranz’s working group enlisted 41 people, who were undergoing treatment at the hospital, for the study. The participants were each assigned to one of two groups, one of which completed a three-week exercise programme. The programme, which was developed by the sports science team from the University of Bielefeld led by Professor Thomas Schack, was varied, contained fun elements, and did not take the form of a competition or test, but instead required teamwork from the participants. “This specifically promoted motivation and social togetherness while breaking down a fear of challenges and negative experiences with physical activity — such as school PE lessons,” explains Karin Rosenkranz. The other group took part in a control programme without physical activity.
The study team ascertained the severity of the depressive symptoms, such as a loss of drive and interest, lack of motivation and negative feelings, both before and after the programme. The brain’s ability to change, known as neuroplasticity, was also measured. It can be determined externally with the help of transcranial magnetic stimulation. “The ability to change is important for all of the brain’s learning and adaptation processes,” explains Karin Rosenkranz.
Ability to change increased — symptoms decreased
The results show that the brain’s ability to change is lower in people with depression than in healthy people. Following the programme with physical activity, this ability to change increased significantly and achieved the same values as healthy people. At the same time, depressive symptoms decreased in the group. “The more the ability to change increased, the more clearly the clinical symptoms decreased,” summarises Karin Rosenkranz. These changes were not so pronounced in the group who took part in the control programme. “This shows that physical activity has an effect on symptoms and the brain’s ability to change. We cannot say to what extent the change in symptoms and the brain’s ability to change are causally linked based on this data,” says the doctor, referring to the limitations. “It is known that physical activity does the brain good, as it, for instance, promotes the formation of neuron connections. This could certainly also play a role here.”
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Materials provided by Ruhr-University Bochum. Original written by Meike Drießen. Note: Content may be edited for style and length.

Eating more nutritious, plant-based foods is heart-healthy at any age, according to two research studies published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.
In two separate studies analyzing different measures of healthy plant food consumption, researchers found that both young adults and postmenopausal women had fewer heart attacks and were less likely to develop cardiovascular disease when they ate more healthy plant foods.
The American Heart Association Diet and Lifestyle Recommendations suggest an overall healthy dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes and non-tropical vegetable oils. It also advises limited consumption of saturated fat, trans fat, sodium, red meat, sweets and sugary drinks.
One study, titled “A Plant-Centered Diet and Risk of Incident Cardiovascular Disease during Young to Middle Adulthood,” evaluated whether long-term consumption of a plant-centered diet and a shift toward a plant-centered diet starting in young adulthood are associated with a lower risk of cardiovascular disease in midlife.
“Earlier research was focused on single nutrients or single foods, yet there is little data about a plant-centered diet and the long-term risk of cardiovascular disease,” said Yuni Choi, Ph.D., lead author of the young adult study and a postdoctoral researcher in the division of epidemiology and community health at the University of Minnesota School of Public Health in Minneapolis.
Choi and colleagues examined diet and the occurrence of heart disease in 4,946 adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants were 18- to 30-years-old at the time of enrollment (1985-1986) in this study and were free of cardiovascular disease at that time. Participants included 2,509 Black adults and 2,437 white adults (54.9% women overall) who were also analyzed by education level (equivalent to more than high school vs. high school or less). Participants had eight follow-up exams from 1987-88 to 2015-16 that included lab tests, physical measurements, medical histories and assessment of lifestyle factors. Unlike randomized controlled trials, participants were not instructed to eat certain things and were not told their scores on the diet measures, so the researchers could collect unbiased, long-term habitual diet data.