Publisher Health

A third of children and adolescents develop a mental health problem after a concussion, which could persist for several years post-injury, according to a new literature review.
The research, led by the Murdoch Children’s Research Institute (MCRI) and published in the British Journal of Sports Medicine, found mental health should be evaluated as part of standard pediatric concussion assessment and management.
MCRI researcher and Monash University PhD candidate Alice Gornall said despite many post-concussion and mental health symptoms overlapping, the relationship between delayed recovery and mental health had remained poorly understood until this literature review.
The review of 69 articles published between 1980 to June 2020, involved almost 90,000 children, aged 0-18 years, from nine countries including Australia, US, Canada and New Zealand, who had a concussion. Falls (42.3 per cent) and sporting injuries (29.5 per cent) were the most common cause of injury, followed by car accidents (15.5 per cent).
It found up to 36.7 per cent experienced significantly high levels of internalising problems such as withdrawing, anxiety, depression and post-traumatic stress and 20 per cent externalising problems such as aggression, attention problems and hyperactivity after concussion compared with healthy children or children who sustained other injuries such as an arm fracture.
Pre-existing mental health problems were a strong predictor of post-concussion mental health issues. The review stated 29 per cent of children with a pre-injury mental health diagnoses received a new mental health diagnosis post-concussion. Up to 26 per cent without prior mental health problems went onto develop symptoms.

A new, rapid screening approach uses CRISPR/Cas9 technology to identify immune system-related genes that play a crucial role in repairing zebrafish spinal cord injuries. Marcus Keatinge and Themistoklis Tsarouchas of the University of Edinburgh, U.K., and colleagues present these findings in the open-access journal PLOS Genetics.
In humans and other mammals, severed spinal-cord nerve connections do not heal, so a spinal cord injury may lead to permanent paralysis. In contrast, zebrafish are capable of recovering from spinal cord injury in a process that involves inflammation controlled by macrophages — a type of immune system cell. However, the precise process by which macrophages aid spinal cord regeneration in zebrafish remains mysterious.
To help clarify this process, Keatinge, Tsarouchas and colleagues developed a new method for rapidly identifying macrophage-related genes that are involved in zebrafish spinal cord regeneration. The strategy employs CRISPR/Cas9 technology, which enables researchers to target and disrupt specific genes, thereby revealing their function. Molecules known as synthetic RNA Oligo CRISPR guide RNAs (sCrRNAs) enable this gene-specific targeting.
The researchers applied the new method to study spinal cord regeneration in larval zebrafish. Key to the method was a prescreening step in which they tested over 350 sCrRNAs that target genes already known to potentially play an important role in inflammation-related spinal cord regeneration. Introducing these sCrRNAs to the zebrafish enabled identification 10 genes that, when disrupted, impaired recovery from spinal cord injury.
Further analysis narrowed the list to four genes that appear to be crucial for repair of severed spinal nerve connections, validating the novel method. One gene in particular, tgfb1, appears to play an essential signaling role in controlling inflammation during the recovery process.
The new method and findings could help deepen understanding of spinal cord regeneration in zebrafish. The researchers also say the method could be adapted to screen for genes that play important roles in other biological processes, as well.
The authors add, “Zebrafish can fully regenerate their spinal cords after injury. Using a new and very rapid screening platform, we discover genes of the immune system that are essential for regeneration. We envision our findings to lead to new insights into the inability of mammals to regenerate and our versatile screening platform to be adapted to other disease or injury models in zebrafish.”
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In recent weeks, people who oppose Covid vaccinations have spread a claim that is not only false but defies the rules of biology: that being near someone who has received a vaccine can disrupt a woman’s menstrual cycle or cause a miscarriage.The idea, promoted on social media by accounts with hundreds of thousands of followers, is that vaccinated people might shed vaccine material, affecting people around them as though it were secondhand smoke. This month, a private school in Florida told employees that if they got vaccinated, they could not interact with students because “we have at least three women with menstrual cycles impacted after having spent time with a vaccinated person.”In reality, it is impossible to experience any effects from being near a vaccinated person, because none of the vaccine ingredients are capable of leaving the body they were injected into.The vaccines currently authorized for use in the United States instruct your cells to make a version of the spike protein found on the coronavirus, so your immune system can learn to recognize it. Different vaccines use different vehicles to deliver the instructions — for Moderna and Pfizer, messenger RNA, or mRNA; for Johnson & Johnson, an adenovirus genetically modified to be inactive and harmless — but the instructions are similar.“It’s not like it’s a piece of the virus or it does things that the virus does — it’s just a protein that’s the same shape,” said Emily Martin, an infectious disease epidemiologist at the University of Michigan School of Public Health. “Transferring anything from the vaccine from one person to another is not possible. It’s just not biologically possible.”Microorganisms spread from person to person by replicating. The vaccine ingredients and the protein can’t replicate, which means they can’t spread. They don’t even spread through your own body, much less to anybody else’s.“They’re injected into your arm, and that’s where they stay,” Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said of the vaccines. “mRNA is taken up by your muscle cells near the site of injection, the cells use it to make that protein, the immune system learns about the spike protein and gets rid of those cells. It’s not something that circulates.”It’s also not something that sticks around. Messenger RNA is extremely fragile, which is one reason we’ve never had an mRNA-based vaccine before: It took a long time for scientists to figure out how to keep it intact for even the brief period needed to deliver its instructions. It disintegrates within a couple days of vaccination.Vaccinated people can’t shed anything because “there’s nothing to be shedding,” said Dr. Céline Gounder, an infectious disease specialist at Bellevue Hospital Center and a member of President Biden’s transition advisory team on the coronavirus. “The people who shed virus are people who have Covid. So if you want to prevent yourself or others from shedding virus, the best way to do that is to get vaccinated so you don’t get Covid.”This brings us to the reports of women having abnormal periods after being near vaccinated people. Because one person’s vaccine can’t affect anybody else, it is impossible for these two events to be connected. Many things, like stress and infections, can disrupt menstrual cycles.The shedding claims are “a conspiracy that has been created to weaken trust in a series of vaccines that have been demonstrated in clinical trials to be safe and effective,” Dr. Christopher M. Zahn, vice president of practice activities at the American College of Obstetricians and Gynecologists, said in a statement. “Such conspiracies and false narratives are dangerous and have nothing to do with science.”Some women have expressed a related concern that getting vaccinated themselves could affect their menstrual cycles. Unlike secondhand effects, this is theoretically possible, and research is ongoing — but anecdotal reports could be explained by other factors, and no study has found a connection between the vaccine and menstrual changes.“There’s no evidence that the vaccine affects your menstrual cycle in any way,” Dr. Gounder said. “That’s like saying just because I got vaccinated today, we’re going to have a full moon tonight.”

In one of the first studies of its kind, medical and engineering researchers have shown wearable devices that continuously monitor blood sugar provide new insights into the progression of Type 2 diabetes among at-risk Hispanic/Latino adults.
The findings by researchers from Sansum Diabetes Research Institute (SDRI) and Rice University are available online this week in EClinicalMedicine, an open-access clinical journal published by The Lancet.
“The fresh look at the glucose data sheds new light on disease progression, which could have a direct impact on better management,” said Rice study co-author Ashutosh Sabharwal, professor and department chair in electrical and computer engineering and founder of Rice’s Scalable Health Labs. “An important aspect of our analysis is that the results are clinically interpretable and point to new directions for improved Type 2 diabetes care.”
The study builds on SDRI’s groundbreaking research to address Type 2 diabetes in underserved Hispanic/Latino communities. SDRI’s Farming for Life initiative assesses the physical and mental health benefits of providing medical prescriptions for locally sourced fresh vegetables to people with or at risk of Type 2 diabetes, with a focus on the Hispanic/Latino community. SDRI recently added a digital health technology called continuous glucose monitoring to this research.
Continuous glucose monitors track blood sugar levels around-the-clock and allow trends in blood glucose to be displayed and analyzed over time. The devices typically consist of two parts, a small electrode sensor affixed to the skin with an adhesive patch and a receiver that gathers data from the sensor.
“We found that the use of this technology is both feasible and acceptable for this population, predominantly Mexican American adults,” said study co-author David Kerr, SDRI’s director of research and innovation. “The results also provided new insights into measurable differences in the glucose profiles for individuals at risk of as well as with noninsulin-treated Type 2 diabetes. These findings could facilitate novel therapeutic approaches to reduce the risk of progression of Type 2 diabetes for this underserved population.”
Sabharwal, who is also a co-investigator of the Precise Advanced Technologies and Health Systems for Underserved Populations (PATHS-UP) engineering research center, said, “The collaboration with SDRI aligns with our mission to use technology as an important building block to reduce health care disparities.”
“We are excited about the application of digital health technologies for underserved populations as a way to eliminate health disparities and improve health equity,” Kerr said. “This opens up potential for a larger number of collaborations to support SDRI’s evolving focus on precision nutrition and also the expanded use of digital health technologies for both the prevention and management of all forms of diabetes.”
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Materials provided by Rice University. Original written by Jade Boyd. Note: Content may be edited for style and length.

Land productivity could be greatly increased by combining sheep grazing and solar energy production on the same land, according to new research by Oregon State University scientists.
This is believed to be the first study to investigate livestock production under agrivoltaic systems, where solar energy production is combined with agricultural production, such as planting agricultural crops or grazing animals.
The researchers compared lamb growth and pasture production in pastures with solar panels and traditional open pastures. They found less overall but higher quality forage in the solar pastures and that lambs raised in each pasture type gained similar amounts of weight. The solar panels, of course, provide value in terms of energy production, which increases the overall productivity of the land.
Solar panels also benefit the welfare of the lambs by providing shade, which allows the animals to preserve energy. Also lamb grazing alleviates the need to manage plant growth under the solar panels through herbicides or regular mowing, which require extra labor and costs.
“The results from the study support the benefits of agrivoltaics as a sustainable agricultural system,” said Alyssa Andrew, a master’s student at Oregon State who is the lead author of the paper published in Frontier in Sustainable Food Systems.
Solar photovoltaic installation in the U.S. has increased by an average of 48% per year over the past decade, and current capacity is expected to double again over the next five years, the researchers say.

The Mayo Clinic data scientists who developed highly accurate computer modeling to predict trends for COVID-19 cases nationwide have new research that shows how important a high rate of vaccination is to reducing case numbers and controlling the pandemic.
Vaccination is making a striking difference in Minnesota and keeping the current level of positive cases from becoming an emergency that overwhelms ICUs and leads to more illness and death, according to a study published in Mayo Clinic Proceedings. The study, entitled “Quantifying the Importance of COVID-19 Vaccination to Our Future Outlook,” outlines how Mayo’s COVID-19 predictive modeling can assess future trends based on the pace of vaccination, and how vaccination trends are crucial to the future course of the pandemic.
The Mayo researchers estimate that a peak of more than 800 patients would be in hospital ICUs in Minnesota this spring if no vaccines had been developed. The projections take into account new variants of the SARS-CoV-2 virus as well as current public health measures and masking standards.
The predicted ICU census levels would be more than double the number of Minnesota COVID-19 patients who were hospitalized in ICUs on Dec. 1, at the height of the most recent surge last year.
“It is difficult to untangle how much of this elevated rate of spread right now is due to new variants as opposed to changes in social behavior,” the authors say, but “regardless of the reason, the absence of vaccinations in the current environment would have been likely to result in by far the largest surge to date.”
If Minnesota had achieved vaccination of 75% of the population by early April, the study estimates that the 7-day average of cases per 100,000 residents, the number of COVID-19 patients hospitalized and the number in ICUs would plummet by early July. “According to the model, this level of vaccination would completely suppress the growth (even in the face of the recent elevated spread rate) and immediately drive cases and hospitalizations down to very low levels,” the authors say.
The Mayo Clinic study was led by Curtis Storlie, Ph.D., and Sean Dowdy, M.D., whose team developed the computer model for forecasting COVID-19’s impact on hospital usage that has helped guide Mayo’s response to the pandemic. Mayo Clinic’s predictive modeling also has been shared with Minnesota public health leadership to help inform critical decisions over the past year.
Mayo Clinic’s forecasting of COVID-19 trends nationally is available online at the Mayo Clinic COVID-19 Resource Center (https://www.mayoclinic.org/coronavirus-covid-19). The Coronavirus Map tracking tool has county-by-county information on COVID-19 cases and trends nationwide.
When the pandemic emerged last year, Mayo Clinic data scientists developed predictive modeling to assess when and where COVID-19 hot spots would occur. The model accurately predicted the timing and magnitude of COVID-19 case and hospitalization surges, which enabled Mayo Clinic to prepare and assure it could provide the best care while keeping patients and staff safe.
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Materials provided by Mayo Clinic. Original written by Jay Furst. Note: Content may be edited for style and length.

In a new resource for the scientific community, published today in Nature Biotechnology, researchers in the lab of Neville Sanjana, PhD, at the New York Genome Center (NYGC) and New York University (NYU) developed CRISPR-sciATAC, a novel integrative genetic screening platform that jointly captures CRISPR gene perturbations and single-cell chromatin accessibility genome-wide. With this technology, they profile changes in genome organization and create a large-scale atlas of how loss of individual chromatin-altering enzymes impacts the human genome. The new method harnesses the programmability of the gene editing system CRISPR to knock-out nearly all chromatin-related genes in parallel, offering researchers deeper insights into the role of DNA accessibility in cancer and in rare diseases involving chromatin.
Recent advances in single-cell technologies have given scientists the ability to profile chromatin, the complex of DNA and proteins that resides within the nucleus of individual cells. Chromatin is often called the “gatekeeper” of the genome because its proteins act as packaging elements for the DNA, either promoting or refusing access to it. This controls gene expression processes in the cell, such as turning on or off specific genes. Changes in the chromatin landscape have been linked to diverse human traits and diseases, most notably cancer.
In an initial demonstration of CRISPR-sciATAC, the Sanjana Lab team designed a CRISPR library to target 20 chromatin-modifying genes that are commonly mutated in different cancers, including breast, colon, lung and brain cancers. Many of these enzymes act as tumor suppressors and their loss results in global changes in chromatin accessibility. For example, the group showed that loss of the gene EZH2, which encodes a histone methytransferase, resulted in an increase in gene expression across several previously silenced developmental genes.
“The scale of CRISPR-sciATAC makes this dataset very unique. Here, in a uniform genetic background, we have accessibility data capturing the impact of every chromatin-related gene. This provides a detailed map between each gene and how its loss impacts genome organization with single-cell resolution,” said Dr. Noa Liscovitch-Brauer, a postdoctoral fellow in Sanjana’s lab at the New York Genome Center and NYU and the study’s co-first author.
In total, the team targeted more than 100 chromatin-related genes and developed a “chromatin atlas” that charts how the genome changes in response to loss of these proteins. The atlas shows that different subunits within each of the 17 chromatin remodeling complexes targeted can have different effects on genome accessibility. Surprisingly, nearly all of these complexes have subunits where loss triggers increased accessibility and other subunits with the opposite effect. Overall, the greatest disruption in transcription factor binding sites, which are important functional elements in the genome, was observed after loss of AT-rich interactive domain-containing protein 1A (ARID1A), a member of the BAF complex. Mutations in BAF complex proteins are estimated to be involved in 1 out of every 5 cancers.
In addition to the CRISPR-sciATAC method, the team also developed a suite of computational methods to map the dynamic movements of the nucleosomes, which are the protein clusters that DNA is wrapped around. When there are more nucleosomes, the DNA is tightly wound and less available to bind transcription factors. This is exactly what the team found at specifical transcription factor binding sites involved in cell proliferation after CRISPR knock-out of ARID1A. When targeting a different chromatin-modifying enzyme, these same sites underwent an expansion in nucleosome spacing, demonstrating the dynamics of nucleosome positioning at specific sites in the genome. The CRISPR-sciATAC method allowed the team to systematically explore this genome plasticity for multiple chromatin-modifying enzymes and transcription factor binding sites.
“We really focused on making CRISPR-sciATAC an accessible technique — we wanted it to be something that any lab could do. We produced most of the key enzymes in-house and used simple methods for single-cell isolation that do not require microfluidics or single-cell kits,” said Dr. Antonino Montalbano, a former postdoctoral fellow in Sanjana’s lab at the New York Genome Center and NYU and the study’s co-first author.
To develop the CRISPR-sciATAC technology, the researchers used a mix of human and mouse cells to create a tagging/identification process that allowed them to split and barcode the nuclei of cells as well as capture the single-guide RNAs required for CRISPR targeting. The work builds off prior single-cell combinatorial indexing ATAC-seq (sciATAC-seq) work from Dr. Jay Shendure at the University of Washington and other groups developing new single-cell genomics methods. CRISPR-sciATAC also uses an unique, easy-to purify transposase that was developed in the NYGC’s Innovation Technology Lab. A key technical hurdle was optimizing experimental conditions to simultaneously capture the CRISPR guide RNAs and genome fragments for accessibility profiling while also keeping the nuclear envelope of each cell intact.
“Integrating chromatin accessibility profiling into the genome-wide CRISPR screens provides a new lens for us to understand gene regulation,” said Dr. Sanjana, Core Faculty Member, NYGC, Assistant Professor of Biology, NYU, and Assistant Professor of Neuroscience and Physiology, NYU Grossman School of Medicine, the study’s senior author. “With CRISPR-sciATAC, we have a comprehensive view into how specific chromatin-modifying enzymes and complexes change accessibility and orchestrate the interactions that control gene expression. Chromatin sets the stage for gene expression, and here we can measure the impact of different mutations on chromatin rapidly. We hope this atlas will be a broadly useful resource for the community and that CRISPR-sciATAC will be used to produce similar atlases in other biological systems and disease contexts.”
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Nearly half of adults in the United States have hypertension, a condition that raises the risk for heart disease and stroke, which are leading causes of death in the U. S.
At Baylor College of Medicine, Dr. David J. Durgan and his colleagues are dedicated to better understand hypertension, in particular the emerging evidence suggesting that disruption of the gut microbiota, known as gut dysbiosis, can have adverse effects on blood pressure.
“Previous studies from our lab have shown that the composition of the gut microbiota in animal models of hypertension, such as the SHRSP (spontaneously hypertensive stroke-prone rat) model, is different from that in animals with normal blood pressure,” said Durgan, assistant professor of anesthesiology at Baylor.
The researchers also have shown that transplanting dysbiotic gut microbiota from a hypertensive animal into a normotensive (having a healthy blood pressure) one results in the recipient developing high blood pressure.
“This result told us that gut dysbiosis is not just a consequence of hypertension, but is actually involved in causing it,” Durgan said. “This ground work led to the current study in which we proposed to answer two questions. First, can we manipulate the dysbiotic microbiota to either prevent or relieve hypertension? Second, how are the gut microbes influencing the animal’s blood pressure?”
Can manipulating the gut microbiota regulate blood pressure?
To answer the first question, Durgan and his colleagues drew on previous research showing that fasting was both one of the major drivers of the composition of the gut microbiota and a promoter of beneficial cardiovascular effects. These studies, however, had not provided evidence connecting the microbiota and blood pressure.

After the C.D.C. issued new guidelines, people are figuring out how to proceed. Some want to keep their face coverings on: “It saves me having to put on sunscreen.”Mark Rasch hopped on his bike Tuesday in Bethesda, Md., pedaled off for an afternoon ride, and realized he forgot his mask. As he turned back for it, news came on the radio over his earbuds: The Centers for Disease Control and Prevention said masks were no longer required outdoors for fully vaccinated people unless they were in a crowd.Mr. Rasch, a lawyer, rode on, naked from nose to chin for the first time in a year. He reached nearby Georgetown and found he was nearly alone in that almost everyone else there remained masked.“I wondered if there was a store I could go into without wearing a mask to buy a mask?” he said. Instead, he went home, and told his wife: “Nothing is changing, but it’s happening quickly.”It’s springtime of the pandemic. After the trauma of the last year, the quarantined are emerging into sunlight, and beginning to navigate travel, classrooms and restaurants. And they are discovering that when it comes to returning to the old ways, many feel out of sorts. Do they shake hands? Hug? With or without a mask?It’s a confusion exacerbated by changing rules, state and federal, that vary by congressional district or even neighborhood, all while the very real threat of infection remains, in some places more than others.Many states and cities are scrambling to incorporate the agency’s new counsel into their own rules. New York has ended its curfew. In California, where masks remain recommended, the authorities are looking to reconcile the clash of cues.“We have reviewed and support the C.D.C.’s new masking recommendations and are working quickly to align California’s guidance with these common sense guidelines,” Dr. Tomás Aragón, the director of the California Department of Public Health, said in a statement.Visitors to the Lincoln Memorial in Washington on Tuesday, the day the C.D.C. updated its outdoor mask guidance.Erin Schaff/The New York TimesDr. Susan Huang, of the University of California, Irvine, Medical School, explained the conflicted psychology as a function of rapidly changing risk, and the difference in tolerance individuals have for risk. At present, she said, most places have a foundation of people vaccinated but are not near the 80 percent that marks herd immunity — with no children inoculated.“We’re between the darkness and the light,” Dr. Huang said. She likened the psychology around masks and other behavior to the different approaches people take to changing their wardrobes at the end of winter: People who are more risk averse continue to wear winter clothes on 50 degree days, where bigger risk takers opt for shorts.“Eventually,” she said, “everyone will be wearing shorts.”It seems that this psychology may come to define the way the pandemic ebbs, revolving less around public dictate than personal comfort after a stark trauma. For many, the jurisdictional battle is internal, with head and heart clashing over the right personal policy.“I have hugged friends but in a very clumsy body posture,” said Shirley Lin, who lives in Fremont, Calif., where she works on business development at a mobile game company. “The bear hugs with the joyful scream will not be seen for a long, long time.”Her partner lost his mother to Covid-19. She died in August in St. Petersburg, Russia, at age 68. Ms. Lin, scarred, is dubious that the risk has passed. “I don’t think we can slack off on the proper social distancing and masking,” she said. But “we are much more optimistic.”Masks have also become so much more than mere barrier between germs and lungs. They can keep that too-chatty neighbor at bay or help the introvert hide in plain sight. And vanity? Goodbye to that.“It saves me having to put on sunscreen and wear lipstick,” said Sara J. Becker, an associate professor at the Brown University School of Public Health.Children in Fort Greene Park in Brooklyn on Tuesday. The U.S. is still a ways away from reaching herd immunity, and children have yet to be inoculated.Stephanie Keith for The New York TimesShe recently had an awkward transitional moment when she, her husband and two children went to an outdoor fire pit with vaccinated neighbors.“Someone offered me their hand, and I gave my elbow,” Ms. Becker said. She was “not quite ready for handshakes or hugs,” she explained, though “pre-Covid, I was definitely a hugger.”So was Dr. Shervin Assari, but he’s abstaining — at least for now, particularly after the last few weeks. His mother, who lives in Tehran, was just released from the hospital there after a dangerous bout with Covid-19, and Dr. Assari feels chastened anew.“I had an abstract idea about the risk, and now I really see the risk,” said Dr. Assari, who lives in Lakewood, Calif. He’s “half-vaccinated,” he said, “and terribly scared of Covid-19.”Dr. Assari, a public health expert, is trying to modulate his own behavior given the three different worlds he’s trying to navigate: in the working-class neighborhood where he lives in South Los Angeles; his daughter’s elementary school; and the historically Black medical school, Charles Drew University of Medicine and Science, where he teaches family medicine.Each differs in culture. Most residents of his neighborhood wear masks, but also seem to him respectful of individual choice. The elementary school maintains rigid standards with daily checklists to make sure no one is sick or at risk.And at the medical school, people religiously wear masks, even as the school roils with mistrust of the vaccination, despite the fact it trains doctors, nurses and others in the field.An unmasked cyclist in Charlotte on Tuesday.Travis Dove for The New York Times“It’s shocking — it’s very deep mistrust, not just moderate,” Dr. Assari said. The skepticism of the medical establishment was centuries in the making, and he doubts it will end soon. But, he said, the mistrust in the Black community is different from that of conservatives: Vaccination may be slow among both groups, but white conservatives may be quicker to rip off their masks, if they wore them at all.“There’s none of that Tucker Carlson stuff here,” he said. Mr. Carlson, a talk-show host on Fox News, said on a recent show that having children wear a mask outside should “be illegal” and that “your response should be no different than seeing someone beat a kid at Walmart” and to call the police.(Dr. Anthony Fauci, the president’s chief medical adviser for Covid, promptly shot back on CNN: “I think that’s self-evident that that’s bizarre.”)In San Francisco, Huntley Barad, a retired entrepreneur, ventured out with his wife this week, and they took their first walk without masks in more than a year.“We walked down the Great Highway,” he said. “We’re ready to poke our heads out from underneath our rock, and perhaps find a restaurant with a nice outdoor table setup — on a warmish night if possible.”But he said that their plans for a date night weren’t firm, much like the conflicting guidance and behavior of a nation itself.“Nothing definite yet.”

Researchers at Karolinska Institutet and the Public Health Agency of Sweden have studied newborn babies whose mothers tested positive for SARS-CoV-2 during pregnancy or childbirth. The results show that although babies born of test-positive mothers are more likely to be born early, extremely few were infected with COVID-19. The study, published in JAMA, supports the Swedish recommendation not to separate mother and baby after delivery.
The population-based study comprised 92 per cent of all neonates — almost 90,000 births — in Sweden during the first year of the pandemic (11 March 2020 to 31 January 2021), making it one of the largest datasets in the field to date.
The results show a slightly higher level of morbidity in neonates whose mothers tested positive for SARS-CoV-2, including an increased risk of respiratory disorders, which were largely due to the higher number of preterm births in this group. No direct correlation between maternal infection and neonatal respiratory infection or pneumonia could be observed.
A total of 2,323 babies were born to SARS-CoV-2-positive mothers, of whom about one third were tested close to or just after childbirth. Only 21 (0.9 per cent) of the babies of these women tested positive for the virus at some point during the newborn period (the first 28 days), the majority without displaying any symptoms; a few babies were treated for other reasons than COVID-19.
The study supports the Swedish recommendation that babies born of women who have tested positive for SARS-CoV-2 while pregnant or during delivery do not need to be routinely separated from their mothers at birth. In many countries such a precautionary measure is taken despite the lack of supporting evidence.
“Separating a newborn baby from its mother is a serious intervention with negative consequences for the health of both mother and baby that must be weighed against the possible benefits,” says Mikael Norman, professor of paediatrics at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and one of the researchers leading the study. “Our study suggests that mother and baby can be cared for together and that nursing can be recommended without danger to the baby’s health. This is good news for all pregnant women, their babies and postnatal and neonatal staff.”
The study was made possible through daily reports to three Swedish registries: the National Quality Register for Pregnancy, the National Quality Register for Neonatal Care, and the Communicable Diseases Register (SmiNet). SmiNet is a system for reporting communicable diseases used jointly by the Public Health Agency of Sweden and the regional communicable diseases units to surveille the 60-plus notifiable diseases that must be reported in accordance with the Communicable Diseases Act.
“By cross-referencing the three registries we’ve been able to monitor and report outcomes for the neonates in real time during both the first and second waves of COVID-19,” says Professor Norman.
The study was financed by the Swedish Society of Medicine, NordForsk, Region Stockholm (ALF funding) and the Childhood Foundation of the Swedish Order of Freemasons in Stockholm. Co-author Jonas F. Ludvigsson leads a study on behalf of the Swedish IBD quality register (SWIBREG), which has received funding from Janssen. No other potential conflicts of interest have been reported.
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