Publisher Health

Middle-age and older people living in more disadvantaged neighborhoods — areas with higher poverty levels and fewer educational and employment opportunities — had more brain shrinkage on brain scans and showed faster decline on cognitive tests than people living in neighborhoods with fewer disadvantages, according to a study published in the April 14, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology. Researchers say such brain aging may be a sign of the earliest stages of dementia.
“Worldwide, dementia is a major cause of illness and a devastating diagnosis,” said study author Amy J. H. Kind M.D., Ph.D., of the University of Wisconsin School of Medicine and Public Health in Madison. “There are currently no treatments to cure the disease, so identifying possible modifiable risk factors is important. Compelling evidence exists that the social, economic, cultural and physical conditions in which humans live may affect health. We wanted to determine if these neighborhood conditions increase the risk for the neurodegeneration and cognitive decline associated with the earliest stages of Alzheimer’s disease and dementia.”
For the study, researchers identified 601 people from two larger studies of Wisconsin residents. Participants had an average age of 59 and no thinking or memory problems at the start of the study, although 69% had a family history of dementia. They were followed for 10 years.
Participants had an initial MRI brain scan and then additional scans every three to five years. With each scan, researchers measured brain volume in areas of the brain linked to the development of Alzheimer’s dementia. Participants also took thinking and memory tests every two years, including tests that measured processing speed, mental flexibility and executive function.
Researchers used the residential address of each participant and a measure called the Area Deprivation Index to determine if each participant lived in an advantaged or disadvantaged neighborhood. Neighborhoods in the index are determined by census areas of 1,500 residents. The index incorporates information on the socioeconomic conditions of each neighborhood and its residents, ranking neighborhoods based on 17 indicators including income, employment, education and housing quality.
Of all participants, 19 people lived in the 20% most disadvantaged neighborhoods in their state and 582 people lived in the 80% of all other neighborhoods in their state. People in the first group were then matched one to four to people in the second group for race, sex, age and education and compared.
At the start of the study, there was no difference in brain volume between people living in the most disadvantaged neighborhoods and those in other neighborhoods. But at the end, researchers found brain shrinkage in areas of the brain associated with dementia in people in the most disadvantaged neighborhoods, while there was no shrinkage in the other group. Researchers also found a higher rate of decline on tests that measure risk of Alzheimer’s disease.
“Our findings suggest that increased vigilance by healthcare providers for early signs of dementia may be particularly important in this vulnerable population,” said Kind. “Some possible causes of these brain changes may include air pollution, lack of access to healthy food and healthcare and stressful life events. Further research into possible social and biological pathways may help physicians, researchers and policymakers identify effective avenues for prevention and intervention in Alzheimer’s disease and related dementia.”
Limitations of the study included a small number of participants from highly disadvantaged neighborhoods and a limited geographic setting. Future studies should involve larger and more diverse groups of people over longer periods of time.
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The prevalence of intellectual disabilities, which means difficulties with learning and understanding new things, is roughly 1-2% in the population. People with a severe intellectual disability need help from others in daily activities throughout their lives.
Such disabilities can be caused by genetic changes or external factors. According to estimates, roughly 2,500 genes underlie intellectual disability, of which approximately half remain unidentified.
In recent years, the diagnostics for intellectual disabilities have improved thanks to advancements in techniques that make it possible to sequence the entire genome. These techniques can also help to identify causes of intellectual disability not found in other medical examinations and tests. Exome sequencing, that is, the sequencing of the protein-coding regions of genes in the genome, enables the identification of new pathogenic gene variants as well. Identifying genes is a prerequisite for identifying disease mechanisms and developing treatments.
The study conducted at the University of Helsinki utilised exome sequencing to determine the potential genetic background of intellectual disability. The study participants included Finnish families with family members with delayed cognitive development for which no clear cause had been identified. The results were recently published in the Human Genetics journal.
It was found that in 64% of the study participants the cause of their developmental disorder was a known intellectual disability gene. The majority of these variants, 75%, was the result of random mutations taking place during fetal development (de novo), and variants not found in the parents’ genome. An inherited mutation was identified in no more than a quarter of the pathogenic genes studied. More large-scale structural variants, which are usually not inherited, were found in only 8% of the families.
“Based on our findings, the risk of recurrence of intellectual disability in the next child of individual families is usually low,” says Docent Irma Järvelä. According to Järvelä, this is a significant and relieving piece of information for many families.

There are many variants of “goblet cells” in the intestines and they seem to have different functions, according to a new study from the University of Gothenburg. The study indicates that defects in goblet cells of a particular type may be a factor contributing to ulcerative colitis, an inflammatory bowel disease.
The entire inside of our intestines is covered by a thin layer of mucus that protects the fragile mucous membrane (mucosa) from bacteria and other microorganisms. If the microorganisms repeatedly come into contact with the intestinal mucosa, inflammation and even cell changes may result. These increase the risk of intestinal cancer. In a healthy colon, the mucus layer is up to a millimeter thick. This layer, which undergoes complete renewal hourly, is formed from cells of a special type, known as goblet cells.
Many different goblet cells
In the present study, now published in the journal Science, the scientists separated goblet cells from other cells and investigated which proteins each individual goblet cell expresses. There proved to be many different subtypes of these cells, and goblet cells’ functions turned out to vary more than researchers have previously realized.
“We believe this is important knowledge that may enable us to influence the protective function of the gut in the future. The system that maintains the protective intestinal mucus layer seems to be able to change its functions, and we could utilize this capacity by reprogramming the layer with various signals, for example by using new drugs,” says Malin Johansson, Associate Professor at Sahlgrenska Academy, University of Gothenburg, who led the research behind the present study.
Connected with ulcerative colitis
The most impermeable part of the mucus layer is formed by glands in the gut. In particular, the research team studied one of the specific types of goblet cells, found on the outermost surface of the mucosa. These goblet cells provide another type of mucus, which contributes to the protection of the gut but allows certain nutrients to pass through.
“If the function of these specific cells is impaired, we see that unprotected cell surfaces arise. These lead to inflammation, both in studies on mice and in samples from patients with ulcerative colitis,” Johansson says.
Appear to cause damage to mucosal protection
In the study, these specific goblet cells seemed to be repelled by the mucosa earlier than normal in patients with ulcerative colitis. Accordingly, the cells became fewer.
“To our surprise, we were able to observe this both in patients with active ulcerative colitis and in those who were temporarily asymptomatic. This indicates that premature rejection of the particular goblet cells we’ve been studying damages the mucus protection and that this is a contributing cause of inflammatory bowel disease. It could also be a partial explanation for these patients’ elevated cancer risk,” Johansson says.
There are some 30,000 people in Sweden with ulcerative colitis, which is a chronic but intermittent inflammatory bowel disease.
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A simple dietary supplement reduces behavioral symptoms in mice with a genetic mutation that causes schizophrenia. After additional experiments, including visualizing the fluorescently stained dancing edge of immature brain cells, researchers concluded that the supplement likely protects proteins that build neurons’ cellular skeletons.
The supplement betaine was first isolated from sugar beets and is often associated with sweetness or umami flavor. Healthy levels of betaine come from both external food sources and internal synthesis in the body. Betaine supplements are already used clinically to treat the metabolic disease homocystinuria.
“I don’t encourage anyone to take betaine for no reason, if a doctor has not recommended it. But, we know this drug is already used clinically, so repurposing it to treat schizophrenia should be safe,” said Project Professor Nobutaka Hirokawa, M.D., Ph.D., from the University of Tokyo Graduate School of Medicine who led the recent research project. Hirokawa has been a member of the Japan Academy, a national honorary organization recognizing scientific achievement, since 2004 and received a Person of Cultural Merit award from the Japanese government in 2013.
Schizophrenia is estimated to affect about 1 in 100 people globally and is one of the top 15 leading causes of disability worldwide.
“There are treatments for schizophrenia, but they have side effects and unfortunately there is still no effective drug for patients to take that we can explain biochemically why it works,” explained Hirokawa.
Genetic studies of people diagnosed with schizophrenia have found possible links between the disease and variations in the kinesin family 3b (kif3b) gene as well as another gene involved in the body’s internal synthesis of betaine.

A new study led by researchers at Johns Hopkins and the University of Pennsylvania uses computer modeling to suggest that eviction bans authorized during the COVID-19 pandemic reduced the infection rate and not only protected those who would have lost their housing but also entire communities from the spread of infections.
With widespread job loss in the U.S. during the pandemic, many state and local governments temporarily halted evictions last spring, and just as these protections were about to expire in September, the Centers for Disease Control and Prevention (CDC) declared a national eviction ban.
However, the order is only extended a few months at a time and is under constant challenge in the court system, including debates about whether such measures control infection transmission.
The research team aimed to study if eviction bans help control the spread of SARS-CoV-2, the virus that causes COVID-19, explains Alison Hill, Ph.D., an assistant professor of biomedical engineering at Johns Hopkins.
In a bid to document the potential impact, Hill and Michael Levy, Ph.D., of the University of Pennsylvania, teamed up with experts in housing policy from the University of Illinois Urbana-Champaign. Hill and Levy specialize in using mathematical models to study how infections spread.
A report on the research was published April 15 in Nature Communications.

SharecloseShare pageCopy linkAbout sharingIndia has been added to a “red list” of countries from which most travel to UK is banned amid concerns over a new Covid variant, Health Secretary Matt Hancock says.From 04:00 BST on Friday 23 April, international visitors who have travelled from India in the last 10 days will be refused entry.British or Irish passport holders, or people with UK residence rights, will be allowed in but must quarantine in a government-approved hotel for 10 days.This breaking news story is being updated and more details will be published shortly. Please refresh the page for the fullest version.You can receive Breaking News on a smartphone or tablet via the BBC News App. You can also follow @BBCBreaking on Twitter to get the latest alerts.

By setting routines for myself, I was able to shield myself from chaos. Then the pandemic happened. I set out to get them back on track.This article is part of a series on resilience in troubled times — what we can learn about it from history and personal experiences.I was laid off in December. I can’t say I wasn’t anticipating it. Everything was falling apart everywhere, including the media world. But when it happened, the first thing I worried about — before questions of how I’d make money or what I’d do about insurance — was if I’d lose the routine that I had developed, lost, and then worked so hard to get back.We all had our routines before the pandemic, and so many of them were upended. Just about any personal routine, if it wasn’t halted outright, changed somehow, from the mundane to the essential. The older man I used to see slowly savoring an espresso every day at the coffee shop had to take it in a to-go cup and drink it outside. Until lockdown, a friend had gone uptown to see his parents every Sunday morning, but had to stop. Children stopped going to school and much of the work force stopped going to offices. Trying to maintain a routine was difficult enough with the world feeling as if it was going to pieces; trying to set new ones without any clear indication of what the future held felt downright impossible.Life is a series of routines. We go to sleep, we wake, we work, we play. But for some, routines and rituals help us function against the chaos of the world, and in many cases, our minds. Some minds just aren’t made for routines; that’s why I’ve had to work extra hard and discipline myself to live and work a certain way.I grew up constantly uncertain, thanks to an unstable home life as a child, parents who moved around a lot and, starting at 16, being without a home of my own. The trauma from those experiences began to prey on me, it wore me down and mingled with my diagnoses of A.D.H.D., depression and obsessive-compulsive personality disorder, making it almost impossible for me to concentrate, work, and generally be productive and happy on a daily basis.At some point, by chance, I started to realize that the more I implemented boundaries and schedules — waking and eating and meditating at specific times, working out, writing down the next day’s schedule — the more I started to feel not only some control, but also happiness. By setting routines for myself, I was able to shield myself from chaos.“It helps you feel like you’re in control,” Charles Duhigg, who wrote “The Power of Habit,” said in an interview. “It helps you remember how to do things that — maybe because of your A.D.H.D. — you’d forget because of short-term memory.” In his book, Mr. Duhigg explores the sort of ouroboros — the ancient symbol of a snake eating its own tail — I was performing on myself. I needed some sort of cue, a routine and then a reward. I hadn’t thought of rewards as part of the process, but they are essential.For me, I thought the reward was peace of mind. What I didn’t realize was I was also giving myself other little trophies: If I went to the gym five days every week, there was a little voice in my head that would say “You’ve earned two slices of pizza.” When I’d clean the house on Sunday morning, I’d always crack open a beer by afternoon. And sometimes you aren’t even conscious of the rewards you’re giving yourself for routine, and I find those are the most important ones. With those rewards, I’m being good to yourself, telling myself I did something, so I earned something.“You’re forcing yourself to anticipate rewards,” Mr. Duhigg said. “All of that is really good.”For Esmé Weijun Wang, author of the essay collection “The Collected Schizophrenias,” “Routines and rituals are a core part of maintaining my mental health,” she told me. Ms. Wang’s routines include “my analog planner, where I journal, manage my appointments and jot down tasks — that, along with an array of other notebooks and binders, organize things in a way that help life to feel less overwhelming.”Equally important — and perhaps more challenging — is maintaining your routines. So, while writing down appointments is important, reminding myself to wake up at a certain time, to meditate, my 1 p.m. work and phone break are the acts of reminding myself where the calm waters are going to be in what could turn out to be a rough sea.“When you change a habit in your life that you previously found to be important,” Mr. Duhigg said, “you just need to be cognizant of how you change that habit deliberately.”But sometimes, outside forces overwhelm the ability to maintain. After five years of consistent routines, the pandemic hit. The first day working from home, my routine fell apart. We were told it would be a week, then two, then next month, then late summer, then maybe after Thanksgiving. Sooner or later we’d go back to the office, maybe. I started sleeping in later; when the gym closed, I had to figure out a new way to work out; and as every little thing I’d considered part of a normal day for me started to go away, I didn’t realize how depressed I was.By the time I started lifting myself out of my depression, realizing that I was going to have to learn to adapt, it was autumn. There was still no office or gym or place I could go to safely see people in person and talk to them. I avoided my therapist for months because I felt awkward doing sessions on Zoom. I’d skip morning meditation from time to time. I’d would open and eat a bag of chips in a few minutes. It was the kind of spiraling I thought I had figured out how to correct.Then, one morning, I pulled out one of my old journals to see what I’d done right in the past. I had notes about what in my routine worked and what didn’t, how drinking coffee at certain times made me feel more anxious or how checking Twitter before 8 a.m. almost always put me in a bad mood. I had left myself little reminders in case I got lost.One day, I went to walk my dog and for no reason whatsoever and decided that the soundtrack that morning would be Brian Eno’s “Ambient 1/Music for Airports,” an album the composer wrote and recorded to help calm anxious travelers. I told myself I’d walk for the duration of the first track — 17 minutes and 22 seconds — before going home. I was doing something I did every morning, but as I turned a corner, I realized I was also setting myself up for the day, and felt a comfort I hadn’t felt in months. Mr. Eno’s wordless, drifting tape loops of piano rhythms simply served as the background noise to my unplanned walking meditation — and a reminder of how necessary it was.That was when I started putting my routine back together. Within a week, I was back on some sort of normal schedule of when I woke up, when I walked the dog, when I let myself look at Instagram. I was getting to as comfortable a spot as one could be in during a pandemic. Then I got the Slack message that I was needed in a meeting with an H.R. person. I knew what was coming next.Obviously I was feeling all of those things one feels when they lose a job. It hurt. My finances were going to take a hit. The one main channel of communication I had with anybody besides my wife was cut off. But I realized there was nothing I could do besides pick myself up and start making out my schedule for the next day. Tomorrow, and every single day after that, my routine and rituals were in my hands only. And nobody could take that from me.Jason Diamond’s most recent book is “The Sprawl.”

Gender-affirming hormone therapy (GAHT) was associated with blood pressure changes in both transgender men and women, according to new research published today in Hypertension, an American Heart Association journal. Given the higher burden of heart attack, stroke and other cardiovascular conditions among transgender men and women, blood pressure screening and monitoring are important, especially after beginning hormone therapies.
Although doctors have prescribed gender-affirming hormone therapy to transgender men and women for more than 25 years, researchers and health care professionals know little about rates of hypertension and how the effects on blood pressure change over time. Previous research has shown that transgender men were almost five times as likely to report having a heart attack compared to cisgender women. Conversely, transgender women were more than two-and-a-half times more likely to have reported a heart attack than cisgender women, yet they did not have a significant increase in heart attack incidence when compared with cisgender men. However, a systematic review conducted in 2020 found most of the studies examining gender-affirming hormones and blood pressure had sample sizes that were too small to detect statistically significant differences in blood pressure.
“There are many important gaps in our knowledge about the effects of hormone therapy for transgender people. This study examined the time course and magnitude of the effects of gender-affirming hormones on blood pressure,” said senior study author Michael S. Irwig, M.D., an associate professor of medicine at Harvard Medical School and director of transgender medicine at Beth Israel Deaconess Medical Center in Boston.
To conduct the largest and longest observational study of its kind, the researchers followed 470 patients who began GAHT at a medical center in the Washington, D.C. area from 1/1/2007 to 6/1/2015. Participants were all at least 17 years old and non-cisgender. Of the 470 patients, 247 were transfeminine and 223 were transmasculine. About 27% of the participants were non-white, and 16% self-identified as Latinx. Researchers measured each patient’s blood pressure before beginning GAHT to establish a baseline and continued measurements at subsequent clinical visits for up to 57 months.
The study found: Within two to four months of beginning hormone therapy, transgender women saw an average decrease of 4.0 mm Hg in their systolic blood pressure, but transgender men saw an average increase of 2.6 mm Hg. The prevalence of stage 2 hypertension (at least 140/90 mm Hg) dropped from 19% to 10% in the transfeminine group within two to four months of beginning hormone therapy. The use of testosterone in transgender men could lead to an increased risk for heart attack or stroke if they also have untreated high blood pressure.In addition, the results indicated that some patients experienced different blood pressure effects compared to the majority of those with the same gender identity. Some transgender women and transgender men saw blood pressure rates trend in the opposite direction of their peers. The study authors highlight this is an area that requires further research, noting individuals taking the same medication may react in different ways.
The study has several limitations. Most patients were on the same formulation of intramuscular testosterone or oral estrogen, so the effects of other formulations need further study. Additionally, the study did not have a large enough sample to detect statistically significant changes in blood pressure measures among Black or Latinx patients.
Monitoring blood pressure and other preventive screening measures are particularly important in transgender and LBGTQ communities. A 2020 Scientific Statement from the American Heart Association indicates transgender adults had lower physical activity levels than their cisgender counterparts, and transgender women may be at increased risk for cardiovascular disease due to behavioral and clinical factors (such as the use of gender-affirming hormones like estrogen). The statement indicates that it is paramount to include LGBTQ health in clinical training and licensure requirements for health care professionals in order to better address cardiovascular health disparities in the LGBTQ community.
Study co-authors are Katherine Banks, M.D.; Mabel Kyinn, M.D.; Shalem Y. Leemaqz, Ph.D.; Eleanor Sarkodie, M.P.H.; Deborah Goldstein, M.D.
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SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesIndia’s capital Delhi has announced a week-long lockdown after a record spike in cases overwhelmed the city’s healthcare system.Government offices and essential services, such as hospitals, pharmacies and grocers, will be open during the lockdown which starts on Monday. The city had imposed a weekend curfew but reported its highest single-day spike so far on Sunday – 24, 462 cases. India has been reeling from a deadly second wave since the start of April.”I have always been against lockdowns, but this one will help us amplify the number of hospital beds in Delhi,” Chief Minister Arvind Kejriwal said in a press conference on Monday. He also appealed to the city’s migrant workers not to leave – last year’s national lockdown saw millions of them heading back to their villages after they found themselves unemployed and running out of money. “This was a difficult decision to take but we had no other option left,” Mr Kejriwal said. “I know when lockdowns are announced, daily-wage workers suffer and lose their jobs. But I appeal to them to not leave Delhi, it’s a short lockdown and we will take care of you.Lockdown rules:Religious places are allowed to open but cannot accept visitors.Only 50 people will be allowed at weddings and up to 20 people at funerals.Malls, cinemas, restaurants, public parks, gyms, spas will remain closed during the lockdown.All social, political and religious gatherings have been banned.Sporting events without spectators are allowed.Public transport like buses and the Metro will function with up to 50 per cent seating capacity.Students appearing for examinations with valid documents will be allowed to travel.Home delivery and takeaway of food by restaurants will be allowed.People travelling for Covid-19 vaccinations or testing will be allowed if they have valid documents. How India failed to prevent a deadly second wave’Think about ICU workers before you party”Covid lockdown will make us beg for food again’India has been reporting more than 200,000 cases daily since 15 April – this is well past its peak last year, when it was averaging around 93,000 cases a day. Deaths too have been rising. India confirmed 1,620 deaths from the virus on Sunday. On Monday UK Prime Minister Boris Johnson cancelled a planned trip to India in view of the situation. Mr Johnson and India’s Prime Minister Narendra Modi will speak later this month to “launch ambitious plans for the future partnership”, a statement said.image copyrightGetty ImagesMaharashtra, which has India’s financial hub Mumbai as its capital, remains the worst-hit state, accounting for a nearly a third of India’s more than 1.9 million active cases. But Delhi is the worst-hit city, confirming more cases daily than Mumbai in recent days. Hospitals are struggling to accommodate Covid positive patients in Delhi and other badly hit cities such as Mumbai, Lucknow and Ahmedabad. Several states have been reporting an acute shortage of beds in Covid wards and ICUs. Even test results are being delayed because of overwhelming demand, which, doctors say, is leading to people not getting diagnosed and treated in time. Experts say the Indian government ignored warnings of a second wave and did little to prevent it or even contain it – they point to cricket matches attended by unmasked crowds, massive election rallies that appeared to flout basic Covid safety rules and a huge Hindu festival where millions congregated on the banks of the Ganges river earlier this month to take a holy dip. Buoyed by a sharp dip in case numbers and the start of the vaccination drive, India began the year on what appeared to be a normal note. But things soon took a turn for the worse as people began leaving home more, wearing masks less and socialising in larger groups. The entry of variants and a lag in the vaccination drive only drove up infections further, experts say.Within weeks, India shot to the top of the world’s Covid chart, recording more cases daily than any other country.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesHealthy young people who have had Covid-19 are being asked to volunteer for a trial that will deliberately expose them to the pandemic virus. The experts behind the study, beginning this month, want to see how the immune system copes second time round. The ultimate aim is to design better treatments and vaccines.Up to 64 people aged 18-30 will spend 17 days in a quarantine unit at a hospital suite and have numerous tests, including lung scans. They will be re-exposed to the virus, the original strain from Wuhan, China, in a “safe and controlled environment” while the medical team monitors their health.Develop symptomsThe first phase of this study, funded by the Wellcome Trust, will aim to establish the lowest dose of virus that can take hold and start replicating but produce few or no symptoms.This dose will then be used to infect participants in the second phase of the study, expected to start in the summer.Volunteers who develop symptoms will be given an antibody treatment to help them fight off the infection. They will be discharged only when they are no longer contagious. Anti-viral therapiesChief investigator Prof Helen McShane, from the University of Oxford, said: “Challenge studies tell us things that other studies cannot because, unlike natural infection, they are tightly controlled. “When we reinfect these participants, we will know exactly how their immune system has reacted to the first Covid infection, exactly when the second infection occurs, and exactly how much virus they got. “As well as enhancing our basic understanding, this may help us to design tests that can accurately predict whether people are protected.”Prof Lawrence Young, of Warwick University, said: “Human challenge studies have a long history of being able to generate important information about infections under strictly controlled conditions as well as allow the efficacy of vaccination to be accurately assessed.”They will significantly improve our understanding of the dynamics of virus infection and of the immune response as well as provide valuable information to help with the ongoing design of vaccines and the development of anti-viral therapies.”OXFORD JAB: What is the Oxford-AstraZeneca vaccine?SYMPTOMS: What are they and how to guard against them?TREATMENTS: What progress are we making to help people?VACCINE: When will I get the jab?COVID IMMUNITY: Can you catch it twice?