Publisher Health

A new study by researchers at the Leverhulme Centre for Demographic Science (LCDS) and Princeton University reveals that US working-age adults are dying at higher rates than their peers in high-income countries; the UK is also falling behind. The study is published today in the International Journal of Epidemiology.
Using annual mortality data from the World Health Organization Mortality Database, the study compared trends in midlife mortality for adults aged 25-64 years between 1990 and 2019 across 15 major causes of death in 18 high-income countries, including the US and UK, and seven Central and Eastern European countries.
Over the past three decades, the study found that most of these countries have experienced significant declines in midlife mortality from all possible causes of death, known as all-cause mortality. US improvements, however, were slower and interrupted by recent periods of stalling and reversals, depending on age and sex. As a result, by 2019, the US saw all-cause mortality rates that were 2.5 times higher than the average of other high-income countries studied.
Worsening midlife mortality in the US was driven by several causes of death, including highly preventable ones such as transport accidents, homicide, suicide and drug overdoses. For example, drug-related deaths in the US increased up to 10-fold (depending on sex and age group combination) between 2000 and 2019, diverging tremendously from other countries.
Dr Katarzyna Doniec, corresponding author of the study and Postdoctoral Researcher at LCDS and the Demographic Science Unit said, ‘Over the past three decades midlife mortality in the US has worsened significantly compared to other high-income countries, and for the younger 25 to 44 year old age-group in 2019 it even surpassed midlife mortality rates for Central and Eastern European countries. This is surprising, given that not so long ago some of these countries experienced high levels of working-age mortality, resulting from the post-socialist crisis of the 1990s.’
The study highlights the health disadvantage of younger US females aged 25-44 years old who were the only group across the 25 countries studied to experience higher mortality rates in 2019 than in 1990.
The UK is also falling behind its high-income peers with midlife mortality increasing for people aged 45-54, and death rates among 25-54 year olds stagnating instead of improving. Midlife mortality among 25-44 year olds also rose in Canada since 2013 alongside small increases for males of the same age range in Poland and Sweden, although these increases were far smaller than in the US.
While the UK performed relatively well on external causes of death such as suicide, homicide and traffic accidents, this was countered by stalling improvements in cardiovascular disease and cancer, and increasing drug deaths. The study also found that by 2019 younger females (25-44 year olds) in the UK fared worse than all high-income peers, except the US, and even some of the Central and Eastern European countries.
Professor Jennifer Dowd, lead author and Deputy Director of LCDS and the Demographic Science Unit said, ‘Our study adds to the evidence that UK mortality is increasingly diverging from its high-income peers, especially for younger women. The causes of this worsening health will be important to understand going forward.’
The study concludes that mortality declines witnessed in other high-income countries imply significant room for mortality improvement in both the US and UK. The study did not cover the years of the COVID-19 pandemic, when the life expectancy gap between the US and high-income countries widened further.

The use of water contaminated with higher than recommended levels of arsenic could pose a serious health risk to millions, a new study from the University of Sheffield has found.
New research from academics at the Institute for Sustainable Food at the University of Sheffield has found countries that do not adhere to the current World Health Organisation (WHO) recommended limits on the levels of arsenic in water are putting around 32 per cent of the global population — particularly those from low and middle-income countries — at risk of serious health issues.
Many countries worldwide still use the outdated WHO limit (50 µg L-1 or parts per billion) for inorganic arsenic in water introduced in 1963, including several Asian countries such as China, Bangladesh, Pakistan, Cambodia, Thailand, Myanmar, and Nepal, where rice is the main staple food.
Long-term exposure to arsenic in water used for drinking, food preparation or irrigation of crops can cause a range of health issues affecting every organ in the body, such as cancer, diabetes and pulmonary and cardiovascular diseases.
The new study, a first of its kind, compared how using different methods to cook common rice types with water contaminated with arsenic affected the amount absorbed into the food.
White and parboiled rice are more commonly consumed in the West and Asia, and this research found that these types accumulate more arsenic than brown rice when cooked with arsenic-spiked water. However, using arsenic-safe water removes arsenic from these rice types.
Research lead Dr Manoj Menon, from the University of Sheffield’s Institute for Sustainable Food and the Department of Geography, said: “Both rice and drinking water in the UK are regulated for arsenic, but further afield in Asia and Africa, there is often very little or no regulation to current WHO standards. We know that as many as 40 countries in the world allow more than 10 parts per billion in drinking water, and 19 countries have no evidence of any regulations.

“Rice is one of the major cereal crops in the world, contributing to the dietary energy and nutrition of more than half of the world’s population. We already know that rice has more arsenic than other cereals, and the risk is exacerbated if we cook rice with arsenic-contaminated water above the WHO recommended limit.
“That is why it is vitally important that countries worldwide work to adopt the latest WHO recommendations to ensure arsenic exposure is minimised as much as possible to protect the public.”
The study tested varying levels of inorganic arsenic in the cooking water, including 10 and 50 µg L-1 and arsenic-safe tap water from the UK ( which contains less than 0.2 parts per billion) as a control.
Dr Menon said: “India has a huge population that was affected by an arsenic problem, and a few years ago it adopted 10 parts per billion as its standard, setting a good example for the other countries that are yet to adopt this.
“Obviously, for people in countries where rice is a staple food, consumption is higher and the health risk also increases, such as in many parts of Asia. People in the UK may only consume around 5kg of rice annually, but the average global consumption is 57kg, and even higher at 85kg across Asia.
“In this study, we evaluated the exposure risks to the Bangladesh population-the highest per capita rice consumers in the world at approximately 170 kg per person, and found that nearly all age groups are at significant risk. Policymakers in those countries with high rice consumption rates urgently need to develop measures to supply arsenic-safe water for domestic use.”
Previous studies by the team found that the way rice is cooked is also meaningful in reducing arsenic loading, with certain methods able to remove more than half of the naturally occurring arsenic within rice grains. So, the study tested white and brown rice against two of the most commonly used cooking methods, using excess water (EW) and parboiled and absorbed (PBA).

This new research found that if there is no access to arsenic-safe water, the best way to cook rice is using the EW method, which is drained off when done (like pasta or noodles) to reduce the risks.
Dr Menon added: “One of the United Nations (UN) Sustainable Development Goals for good health and wellbeing is for everyone to have access to clean water and sanitation. This cannot happen without regulations being implemented in countries where limits or water testing are not currently in place.
“There are genuine concerns for rice consumers about consuming arsenic, but our successive studies have shown there are ways we can try to minimise our risk of exposure. Even in countries where there may be higher levels of inorganic arsenic in water supplies, where possible, this includes selecting varieties of rice that don’t absorb as much arsenic and using cooking methods that remove as much arsenic from the water and grains as possible.”

Published27 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Penny TaylorBy Sharon BarbourHealth Correspondent, BBC Look NorthNeuroferritinopathy is a rare brain condition that traps people in their bodies and seems to largely affect descendants of one family. As a university launches a drugs trial in a hope of reversing its effects, the BBC spoke to the family of four sisters diagnosed with the disease.Liz Taylor was a fit 38-year-old when she found out she was going to lose her ability to walk, talk and even eat.She had pain in her hands which, after weeks of tests, doctors in Newcastle told her was a neurological disease for which there was no cure.”I remember when she ran upstairs crying,” her daughter Penny, who is now also 38, recalls.Liz’s husband James, 62, has had to watch helplessly as his wife’s health deteriorated.Now aged 59, Liz is trapped in her own body.Her mind is still fully active but James can only communicate with her by reading the expressions in her eyes.The following years brought more devastating news for the family as each of Liz’s three sisters were diagnosed with the same condition. It turned out it was a genetic disease no-one in the family from Rochdale, Greater Manchester, knew anything about. Image source, Family handoutScientists believe there are only about 100 patients in the world with the condition, and the majority come from the same family line in Cumbria. Often misdiagnosed as Parkinson’s or Huntington’s disease, scientists discovered it was in fact a new condition and named it neuroferritinopathy, as it is caused by a build-up of iron in the brain.They found a genetic fault meant the iron was getting into the brain, but could not get out.’Living in a shell’A trial at Cambridge University will test if an existing drug can be repurposed to draw out the iron, and halt, reverse or possibly even “cure” some patients. It offers a glimmer of hope for Liz and her sisters, including 61-year-old Heather Gartside.Image source, Family handoutHer husband Stephen, 59, says she too can understand everything going on in the world around her, but cannot communicate. She can barely move and can no longer talk. “We’d seen Elizabeth deteriorate, and we just knew that it was going to be life-changing,” says Stephen, who is now his wife’s devoted carer.He asks her if she can help him find the words to describe how hard it is, but she cannot answer. Looking at Liz, James says: “It must be frustrating to live in that shell.” The disease was only discovered by scientists in Newcastle after they saw an increasing number of patients from Cumbria. Image source, Getty ImagesProfessor Sir John Burn, from Newcastle University, who named the disease, discovered almost all known cases were likely to be descended from the same ancestor. He traced it back to the 18th Century in Cockermouth, Cumbria, and families with the surname Fletcher.Investigations have also taken place to see if they could have shared common ancestry with Fletcher Christian (Fletcher being his surname), known for leading the mutiny on the Bounty in April 1789, given he was also from the region, but that evidence remains unclear.’A potential cure’Now, nearly 25 years since the condition was recognised, neurology professor Patrick Chinnery from the University of Cambridge is about to start a year-long trial of an existing drug, deferiprone, which he hopes will be able to “pull out the iron from the brain” and halt the disease in its tracks. “Scans show where the iron is collecting in the brain, and in people who’ve inherited this genetic change it’s really marked,” Prof Chinnery says, adding: “It can take 40 years before people start to get symptoms.” Image source, Family handoutAfter patients have had symptoms for 10 years, the excess iron is “clearly causing damage to the brain itself and the supporting tissue has been destroyed”, Prof Chinnery explains. “Our primary aim is to stop the disease in its tracks, and it might lead to some reversing of the problems.”The trial was approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) in February.It is being supported by the LifeArc Rare Diseases Translational Challenge, which has contributed £750,000 towards it.”Drug repurposing trials are an increasingly effective way of taking treatments that have already approved and applying them to new conditions and diseases,” says Dr Catriona Crombie, from LifeArc.If the trial is successful, Prof Chinnery says all doctors may be able to give it to people before they develop any symptoms at all. He says, for these patients, that means “a potential cure”.He also says it could pave the way for treating other conditions linked to the build-up of iron in the brain “If we can show in this condition that reducing iron stops the nerve cells being damaged, it is not a big jump to suggest a similar approach might be helpful in Parkinson’s disease or Alzheimer’s disease,” he adds.’I try not to think about it’The trial of deferiprone brings hope where there was none, that an effective treatment may be possible. Liz’s daughter Penny helps look after many in her family but does not know if she has the disease.”I try not to think about it,” she says, adding: “If you think about it, then I believe it’ll come on faster.” She says she worries about building her hopes up about the trial success, but adds for her and her family “it would mean everything”.Heather’s husband Stephen agrees, adding: “If it slows it down – that’s a win, she’s not going to deteriorate. If it can cure it – fantastic, absolutely wonderful.”It just means so much, doesn’t it?” Stephen says, looking at his wife. Follow BBC Cumbria on Facebook, X (formerly Twitter), and Instagram. Send your story ideas to northeastandcumbria@bbc.co.uk.More on this storyNew drug trial hopes to slow Parkinson’s diseasePublished22 February’My NHS hell waiting for surgery and information’Published29 October 2023New breast cancer screening pod opens in GatesheadPublished17 March 2023Related Internet LinksNewcastle UniversityUniversity of CambridgeLifeArcThe BBC is not responsible for the content of external sites.

Published6 minutes agoShareclose panelShare pageCopy linkAbout sharingBy Zoe KleinmanTechnology editorAn AI tool tested by an NHS hospital trust successfully identified tiny signs of breast cancer in 11 women which had been missed by human doctors.The tool, called Mia, was piloted alongside NHS clinicians and analysed the mammograms of over 10,000 women.Most of them were cancer-free, but it successfully flagged all of those with symptoms, as well as an extra 11 the doctors did not identify.At their earliest stages, cancers can be extremely small and hard to spot.The BBC saw Mia in action at NHS Grampian, where we were shown tumours that were practically invisible to the human eye. But, depending on their type, they can grow and spread rapidly. Barbara was one of the 11 patients whose cancer was flagged by Mia but had not been spotted on her scan when it was studied by the hospital radiologists. Because her 6mm tumour was caught so early she had an operation but only needed five days of radiotherapy. Breast cancer patients with tumours which are smaller than 15mm when discovered have a 90% survival rate over the following five years.Barbara said she was pleased the treatment was much less invasive than that of her sister and mother, who had previously also battled the disease.She told me she met a relative who expressed sympathy that Barbara had “the Big C”.”I said, ‘it’s not a big C, it’s a very little one’,” she said.Without the AI tool’s assistance, Barbara’s cancer would potentially not have been spotted until her next routine mammogram three years later. She had not experienced any noticeable symptoms.Because it works instantly, tools like Mia also have the potential to reduce the waiting time for results from 14 days down to three, claims its developer Kheiron.None of the cases in the trial were analysed by Mia alone – each had a human review as well. Currently two radiologists look at each individual scan, but the hope is that one of them could one day be replaced by the tool, effectively halving the workload for each pair.Of the 10,889 women who participated in the trial, only 81 did not want the AI tool to review their scans, said Dr Gerald Lip, clinical director of breast screening in the north west of Scotland and the doctor who led the project.AI tools are generally pretty good at spotting symptoms of a specific disease, if they are trained on enough data to enable them to be identified. This means feeding the programme with as many different anonymised images of those symptoms as possible, from as diverse a range of people as possible. Getting hold of this data can be difficult because of patient confidentiality and privacy concerns.Sarah Kerruish, Chief Strategy Officer of Kheiron Medical, said it took six years to build and train Mia, which is run on cloud computing power from Microsoft, and it was trained on “millions” of mammograms from “women all over the world”.”I think the most important thing I’ve learned is that when you’re developing AI for a healthcare situation, you have to build in inclusivity from day one,” she said.Breast cancer doctors look at around 5,000 breast scans per year on average, and can view 100 in a single session.”There is an element of fatigue,” said Dr Lip.”You get disruptions, someone’s coming in, someone’s chatting in the background. There are lots of things that can probably throw you off your regular routine as well. And in those days when you have been distracted, you go, ‘how on earth did I miss that?’ It does happen.”I asked him whether he was worried that tools like Mia might one day take away his job altogether.He said he believed it the tech could one day free him up to spend more time with patients.”I see Mia as a friend and an augmentation to my practice,” Dr Lip said.Mia isn’t perfect. It had no access to any patient history so, for example, it would flag cysts which had already been identified by previous scans and designated harmless.Also, because of current health regulation, the machine learning element of the AI tool was disabled – so it could not learn on the job, and evolve during its use. Every time it was updated it had to undergo a new review.The Mia trial is just one early test, by one product in one location. The University of Aberdeen independently validated the research, but the results of the evaluation have not yet been peer reviewed. The Royal College of Radiologists say the tech has potential.”These results are encouraging and help to highlight the exciting potential AI presents for diagnostics. There is no question that real-life clinical radiologists are essential and irreplaceable, but a clinical radiologist using insights from validated AI tools will increasingly be a formidable force in patient care.” said Dr Katharine Halliday, President of the Royal College of Radiologists. Dr Julie Sharp, head of health information at Cancer Research UK said the increasing number of cancer cases diagnosed each year meant technological innovation would be “vital” to help improve NHS services and reduce pressure on its staff.”More research will be needed to find the best ways to use this technology to improve outcomes for cancer patients,” she added.There are other healthcare-related AI trials going on around the UK, including an AI tool by a firm called Presymptom Health which is analysing blood samples looking for signs of sepsis before symptoms emerge – but many are still in early stages without published results.More on this storyHospitals using AI to diagnose prostate cancerPublished1 day agoAI offers huge promise on breast cancer screeningPublished2 August 2023Scientists excited by potential of AI cancer toolPublished1 November 2023

Published15 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, SWNSBy Michael BuchananSocial affairs correspondent, BBC NewsA group representing hundreds of clinicians has applied to contribute to the Lucy Letby inquiry, to challenge NHS culture around whistleblowing.Their experiences of raising concerns should inform the inquiry, they say. Letby murdered seven babies and attempted to murder another six while working at the Countess of Chester NHS trust between June 2015 and June 2016. The public inquiry is examining how the nurse was able to murder and how the hospital handled concerns about her. “The evidence of this group relating to how whistleblowers are treated, not just at one trust but across the UK, is of huge significance,” Rachel di Clemente, of Hudgell Solicitors, acting for the clinicians, said. ‘Unethical practices’The group, NHS Whistleblowers, comprising healthcare professionals across the UK, including current and former doctors, midwives and nurses, has written to Lady Justice Thirlwall’s inquiry, asking for them to be formally included as core participants. The inquiry has stated it will consider NHS culture. And the group says “a culture detrimental to patient safety” is evident across the health service.”NHS staff who have bravely spoken up about patient-safety concerns or unethical practices deserve to have their voices heard,” Dr Matt Kneale, who co-chairs Doctors’ Association UK, which is part of the group, said.Several doctors at the Countess of Chester Hospital told BBC News senior management at the trust had failed to investigate allegations against Letby for months and tried to silence their concerns. At one point, the doctors were ordered to write an apology to Letby, now 34, and told to stop making allegations against her. NHS Whistleblowers, which also includes groups NMCWatch and Justice for Doctors, said it had more than 1,600 members, who could show how whistleblowers were commonly subject to “victimisation and persecution” and referred to medical regulators as a direct consequence of raising concerns. Letby appeal bid to be heard by judges in April”Our members could not be better placed to understand the challenges, complexities and potentially career- and, tragically, sometimes life-destroying risks involved when speaking truth to power within the healthcare system,” Dr Martyn Pitman, sacked by the Royal Hampshire County Hospital after raising concerns about maternity care, said.The inquiry can compel witnesses to give evidence. Its hearings, in Chester, are unlikely to start until the autumn. Letby is facing a retrial on an attempted murder charge relating to one baby. A hearing to decide if she can appeal against her conviction will also be held next month. Representatives for the inquiry said they could not comment on applications to participate but confirmed it would consider NHS culture and the effectiveness of management and governance structures.

Published34 minutes agoShareclose panelShare pageCopy linkAbout sharingBy Tulip MazumdarGlobal health correspondentWorking in extreme heat can double the risk of stillbirth and miscarriage for pregnant women, according to new research from India. The study found that the risks to mothers-to-be are significantly higher than previously thought. Researchers say hotter summers can affect not only women in tropical climates, but also in countries such as the UK.They want specific health advice for working pregnant women globally.Eight hundred pregnant women in the southern Indian state of Tamil Nadu took part in the study, which was started in 2017 by the Sri Ramachandra Institute of Higher Education and Research (SRIHER) in Chennai. About half of those who took part worked in jobs where they were exposed to high levels of heat, such as agriculture, brick kilns and salt flats. The others worked in cooler environments, such as schools and hospitals, although some workers were also exposed to very high levels of heat in those jobs too.There is no universal threshold for what level of heat is considered to be too hot for the human body.”[The impact of heat] is relative to what you’re used to and what your body’s used to,” says Prof Jane Hirst, one of the scientists who contributed to the study.In the lush green fields of Tiruvannamalai, I meet Sumathy, one of the pregnant women who took part.She removes her thick gloves and stretches out her fingers. She has been picking cucumbers for the past two hours.”My hands burn in this heat,” she tells me, gently caressing her fingertips.Summer hasn’t even started yet, but already it is about 30 degrees here today and feeling hotter with the humidity.Sumathy has to protect her hands from the constant stabbing of the tiny spikes on the cucumbers, but the gloves make her sweat profusely.”My face burns too,” she says.She comes to the cucumber farm before and after her main job, working as a cook in a school, and is paid about 200 rupees or just under £2 for her efforts.India’s Mothers: Bearing the HeatThe BBC’s global health correspondent Tulip Mazumdar reports from southern India on new research suggesting heat can double the risk of stillbirth and miscarriage.Watch on BBC iPlayer (UK only)Sumathy was one of the first recruits. Her baby was also one of the first in the study to die.”I used to feel so exhausted being pregnant and working in the heat,” she says.One day, as Sumathy was dropping off her husband’s lunch, she suddenly started feeling very unwell. That evening, she went to see a doctor who told her she had suffered a miscarriage 12 weeks into her pregnancy. “My husband would lay me down on his lap and console me. I don’t know what I would have done without him,” she says.Sumathy talks about her husband with so much love but has had to learn to live without him. He recently died, and she is now the main breadwinner for the family.Sumathy will never know for sure if working in the heat during her pregnancy had anything to do with her losing her first child. But overall, the study found that women who worked in similar conditions as her were twice as likely to suffer a stillbirth or miscarriage than those working in cooler environments.Important for women all over the worldThe pregnant women in the study in India really are “at the forefront of experiencing climate change,” says Prof Hirst, who is a UK-based consultant obstetrician, and Professor of Global Women’s Health at medical research organisation The George Institute.Earth’s average temperature is projected to rise by nearly three degrees by the end of the century, compared with pre-industrial times, and the World Health Organization (WHO) is warning of “an existential threat to all of us” with pregnant women facing “some of the gravest consequences”.Previous studies have shown about a 15% rise in the risk of premature birth and stillbirth during heatwaves, but these have generally been conducted in high-income countries such as the US and Australia. The latest findings from India are particularly stark and worrying, says Prof Hirst, and have wider implications. “The UK is getting hotter summers, and while it’s not as hot as India, these adverse effects [on pregnancies] can be seen at much lower temperatures in more temperate climates, such as the UK.” However, she adds, they do need to be “kept in perspective”. Even with a doubling of risk, experiencing baby loss is still going to be a “rare event for most women”.There is currently no official international advice for pregnant working women in the heat. The main guidance that does exist for hot-weather working, is based on studies involving a man in the US military in the 1960s and 70s, weighing 70-75kg and with 20% body fat. Prof Hirst hopes this study, and further research, will change that. In the meantime, she says pregnant women working in the heat can protect themselves by:Avoiding prolonged periods in the heatTaking regular shade breaks if working outdoors on hot daysAvoiding exercising or sunbathing for long periods in the hottest part of the dayKeeping hydrated with waterFor the study in India, the researchers used what is called the wet-bulb-globe-temperature (WBGT), which measures the effects of temperature, humidity, wind speed and radiant heat on human bodies.WBGT readings are often lower than the temperatures you might see forecast on the TV or a weather app.The safe heat threshold for people doing heavy work is 27.5C WBGT, according to the US Occupational Safety and Health Administration. ‘No choice but to work out in the sun’ India is predicted to become one of the first countries in the world where temperatures will top the safe limit for healthy people who are simply resting in the shade, according to a recent study from the University of Cambridge.The number of hot days and hot nights (when the body struggles to recover from daytime heat) is also projected to double or even quadruple in India by 2050.In the sugarcane fields of Tiruvannamalai, Rekha Shanmugam, a former nurse and the SRIHER study’s lead researcher, is measuring the daytime heat.Around us, a couple of dozen workers – about half of them women – hack down thick stems of cane with small machetes. “These women often have no choice but to work out in the sun – they need the money,” says Ms Shanmugam.She pours water into a gauge and presses various buttons. It shows a WBGT temperature of 29.5C – that’s above the safe threshold for doing this type of physically demanding work in the heat.”If the workers continue for prolonged periods in this level of heat, they are more prone to heat-related illnesses, and it’s especially concerning for pregnant women,” she tells me. Sandhiya, 28, tells me she has no choice but to do this type of back-breaking work for which she gets paid about 600 rupees, just under £6 a day. She has two young children and an extended family to feed. Sandhiya also took part in the study – and lost her first child six months into her pregnancy.She had to take several months off work to recover and says she is still paying off the debts she racked up during that time.”All my desires centre around my children,” Sandhiya tells me. “I want them to study well and get good jobs. They shouldn’t end up toiling here in the fields like me.”The problem of peeingThe mechanisms around how and why heat impacts pregnant women and their growing babies in this troubling way are not well understood.A previous study in The Gambia found high temperatures could raise foetal heart rate and slow blood flow through the umbilical cord.One theory is that when the mother gets too hot, blood could be diverted away from the foetus, to help cool the mother down.Ms Shanmugam thinks a lack of toilets may also be playing a part.She says a previous study found many women didn’t want to squat in an open field to relieve themselves and so would avoid drinking water, developing urinary problems as a result. “They worry about insects and snakes in the bushes, or men peeping to look at them,” she says.”They often don’t feel safe, so they’ll just hold it in for the whole day and then finally go to the toilet when they get home.”Finding solutions The findings of the study in Tamil Nadu are being taken very seriously, says Dr TS Selbavinayagam, the state’s director for public health.”We already offer financial compensation to pregnant women, but maybe we need to look at options for giving alternative employment too,” he says. The state government offers poorer women 18,000 rupees (£170) when they reach 12 weeks of pregnancy, to try to ease some of their financial pressures. However, much of the power to protect these low-paid workers rests with workplace bosses.On the outskirts of Chennai, Thillai Bhasker – a brick-kiln owner – has erected giant steel roofs with special heat-protective coatings on them, to provide his workers with much-needed shade. “Business owners should be smart enough to know how to retain the employees,” he says. “If you take care of them, they will take care of you.”He also told us he was planning to build women-only toilets. Some organisations are also offering education sessions on the simple steps women can take to better protect themselves in the heat. Insulated bottles are also being made available to keep drinking water cool.Sumathy had no choice but to continue to work in extreme heat when she became pregnant again within a couple of years of her miscarriage. But she got specific advice from doctors and the SRIHER researchers on how to better protect herself. Sumathy gave birth to a healthy daughter and son. Tonight – after her long shift – she will return home to them. Exhausted, anxious, but so grateful they are there.Follow @TulipMazumdar on XIf you are affected by any of the issues raised in this story, support and advice isavailable via the BBC Action Line.

Artificial intelligence can spot COVID-19 in lung ultrasound images much like facial recognition software can spot a face in a crowd, new research shows.
The findings boost AI-driven medical diagnostics and bring health care professionals closer to being able to quickly diagnose patients with COVID-19 and other pulmonary diseases with algorithms that comb through ultrasound images to identify signs of disease.
The findings, newly published in Communications Medicine, culminate an effort that started early in the pandemic when clinicians needed tools to rapidly assess legions of patients in overwhelmed emergency rooms.
“We developed this automated detection tool to help doctors in emergency settings with high caseloads of patients who need to be diagnosed quickly and accurately, such as in the earlier stages of the pandemic,” said senior author Muyinatu Bell, the John C. Malone Associate Professor of Electrical and Computer Engineering, Biomedical Engineering, and Computer Science at Johns Hopkins University. “Potentially, we want to have wireless devices that patients can use at home to monitor progression of COVID-19, too.”
The tool also holds potential for developing wearables that track such illnesses as congestive heart failure, which can lead to fluid overload in patients’ lungs, not unlike COVID-19, said co-author Tiffany Fong, an assistant professor of emergency medicine at Johns Hopkins Medicine.
“What we are doing here with AI tools is the next big frontier for point of care,” Fong said. “An ideal use case would be wearable ultrasound patches that monitor fluid buildup and let patients know when they need a medication adjustment or when they need to see a doctor.”
The AI analyzes ultrasound lung images to spot features known as B-lines, which appear as bright, vertical abnormalities and indicate inflammation in patients with pulmonary complications. It combines computer-generated images with real ultrasounds of patients — including some who sought care at Johns Hopkins.

“We had to model the physics of ultrasound and acoustic wave propagation well enough in order to get believable simulated images,” Bell said. “Then we had to take it a step further to train our computer models to use these simulated data to reliably interpret real scans from patients with affected lungs.”
Early in the pandemic, scientists struggled to use artificial intelligence to assess COVID-19 indicators in lung ultrasound images because of a lack of patient data and because they were only beginning to understand how the disease manifests in the body, Bell said.
Her team developed software that can learn from a mix of real and simulated data and then discern abnormalities in ultrasound scans that indicate a person has contracted COVID-19. The tool is a deep neural network, a type of AI designed to behave like the interconnected neurons that enable the brain to recognize patterns, understand speech, and achieve other complex tasks.
“Early in the pandemic, we didn’t have enough ultrasound images of COVID-19 patients to develop and test our algorithms, and as a result our deep neural networks never reached peak performance,” said first author Lingyi Zhao, who developed the software while a postdoctoral fellow in Bell’s lab and is now working at Novateur Research Solutions. “Now, we are proving that with computer-generated datasets we still can achieve a high degree of accuracy in evaluating and detecting these COVID-19 features.”
The team’s code and data are publicly available here: https://gitlab.com/pulselab/covid19

SARS-CoV-2, the virus that causes COVID-19, can damage the heart even without directly infecting the heart tissue, a National Institutes of Health-supported study has found. The research, published in the journal Circulation, specifically looked at damage to the hearts of people with SARS-CoV2-associated acute respiratory distress syndrome (ARDS), a serious lung condition that can be fatal. But researchers said the findings could have relevance to organs beyond the heart and also to viruses other than SARS-CoV-2.
Scientists have long known that COVID-19 increases the risk of heart attack, stroke, and Long COVID, and prior imaging research has shown that over 50% of people who get COVID-19 experience some inflammation or damage to the heart. What scientists did not know is whether the damage occurs because the virus infects the heart tissue itself, or because of systemic inflammation triggered by the body’s well-known immune response to the virus.
“This was a critical question and finding the answer opens up a whole new understanding of the link between this serious lung injury and the kind of inflammation that can lead to cardiovascular complications,” said Michelle Olive, Ph.D., associate director of the Basic and Early Translational Research Program at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH. “The research also suggests that suppressing the inflammation through treatments might help minimize these complications.”
To reach their findings, the researchers focused on immune cells known as cardiac macrophages, which normally perform a critical role in keeping the tissue healthy but can turn inflammatory in response to injury such as heart attack or heart failure. The researchers analyzed heart tissue specimens from 21 patients who died from SARS-CoV-2-associated ARDS and compared them with specimens from 33 patients who died from non-COVID-19 causes. They also infected mice with SARS-CoV-2 to follow what happened to the macrophages after infection.
In both humans and mice, they found the SARS-CoV-2 infection increased the total number of cardiac macrophages and also caused them to shift from their normal routine and become inflammatory.
When macrophages are no longer doing their normal jobs, which includes sustaining the metabolism of the heart and clearing out harmful bacteria or other foreign agents, they weaken the heart and the rest of the body, said Matthias Nahrendorf, M.D., Ph.D., professor of Radiology at Harvard Medical School and senior author on the study.
The researchers then designed a study in mice to test whether the response they observed happened because SARS-CoV-2 was infecting the heart directly, or because the SARS-CoV-2 infection in the lungs was severe enough to render the heart macrophages more inflammatory. This study mimicked the lung inflammation signals, but without the presence of the actual virus. The result: even in the absence of a virus, the mice showed immune responses strong enough to produce the same heart macrophage shift the researchers observed both in the patients who died of COVID-19 and the mice infected with SARS-CoV-2 infection.

“What this study shows is that after a COVID infection, the immune system can inflict remote damage on other organs by triggering serious inflammation throughout the body — and this is in addition to damage the virus itself has directly inflicted on the lung tissue,” said Nahrendorf. “These findings can also be applied more generally, as our results suggest that any severe infection can send shockwaves through the whole body.”
The research team also found that blocking the immune response with a neutralizing antibody in the mice stopped the flow of inflammatory cardiac macrophages and preserved cardiac function. While they have yet to test this in humans, Nahrendorf said a treatment like this could be used as a preventive measure to help COVID-19 patients with pre-existing conditions, or people who are likely to have more severe outcomes from SARS-CoV-2 associated ARDS.
Study: Grune J, Bajpai G, Ocak PT, et al. Virus-induced ARDS causes cardiomyopathy through eliciting inflammatory responses in the heart. Circulation. 2024. doi:10.1161/CIRCULATIONAHA.123.066433.
Funding: This study was supported by NHLBI grants: HL139598, HL142494, HL155097, and HL149647.

The largest living animal, the blue whale (Balaenoptera musculus) which averages about 27 metres in length, has slowly recovered from whaling only to face the rising challenges of global warming, pollution, disrupted food sources, shipping, and other human threats.
In a major new study, Flinders University has taken a stock of the number, distribution and genetic characteristics of blue whale populations around the world and found the greatest differences among the eastern Pacific, Antarctic subspecies and pygmy subspecies of the eastern Indian and western Pacific.
“Each of these groups need to be conserved to maintain biodiversity in the species, and there are indications that natural selection in different environments contributed to driving genetic differences between the high-level groups,” says study first author Dr Catherine Attard in a newly published article in Animal Conservation.
“Within these regions, there were differences between the eastern North and eastern South Pacific, and among the eastern Indian Ocean, the western South Pacific and the northern Indian Ocean but no differences in the Antarctic group,” she says.
The study found no evidence of inbreeding, which is good news for the potential recovery of subspecies and populations. However, challenges remain for this endangered species.
The recovery of baleen whales including endangered blue whales is now threatened by multiple human sources, including underwater noise, changing availability of food driven by human-induced effects on ocean productivity, environmental contaminants, ship collision and entanglement in fishing gear.
“Our findings build on decades of work to improve the management of endangered blue whales under the International Whaling Commission,” says Dr Attard.

The estimated migration rates were 1%-4% among each of the high-level groups, with both migrant individuals (i.e. movement without necessarily interbreeding) and hybrids (i.e. interbreeding) among the high-level groups.
Piecing together the whale population structures, the researchers found an unexpected similarity between the eastern South Pacific and eastern North Pacific blue whales, which suggests they are part of the same subspecies, rather than their current classification as separate subspecies.
“This finding was unexpected given that blue whale populations are thought to have opposite breeding seasons when their populations exist on either side of the equator,” adds senior author Associate Professor Luciana Möller, from the Molecular Ecology Lab and Cetacean Ecology, Behaviour and Evolution Lab at Flinders University.
“While eastern Indian and western Pacific blue whales have the lowest genetic diversity of the high-level hierarchical groups, which is likely due to climate-induced diversification rather than anthropogenic impacts, our study identified the eastern Indian Ocean, western South Pacific Ocean and potentially western Indian Ocean as different populations within the Indo-western Pacific,” says Associate Professor Möller.
As well as generating the largest global genomic dataset to date for blue whales, the study incorporated information from recent satellite tagging, acoustics and stable isotopes research to link the genetic results to blue whale population calls and typical migratory and breeding patterns.
Another coauthor, Matthew Flinders Professor Luciano Beheregaray, who founded the Molecular Ecology Lab at Flinders University in 2009, adds: “Genomics is a vital tool that has unparalleled power to determine population differentiation, connectivity, and other characteristics to inform the conservation management of biodiversity.

“Whole-genome population studies and comparisons with environmental conditions are needed to better understand adaptations in blue whales and other baleen whales. Localised depletion of blue whales could occur if these threats are concentrated in areas containing populations with limited connectivity to animals in surrounding regions.
“Thus, describing the spatio-temporal patterns of population differences within a species and their geographic boundaries can inform management decisions on the timing and location of human activities to minimise impacts on these wide-ranging whale species.”
While blue whales became protected from commercial whaling in 1966, the International Whaling Commission (IWC) implemented a global moratorium 20 years later.
The Flinders University-based research group calls on the IWC to use the findings to refine the stock delineations of blue whales for conservation and management purposes.
“We recommend that national management bodies minimise human activities that can impact these management groups when the blue whales are within their jurisdiction,” researchers conclude.

Researchers have incorporated a swept illumination source into an open-top light-sheet microscope to enable improved optical sectioning over a larger area of view. The advance makes the technique more practical for nondestructive 3D pathology.
3D pathology is being explored as an alternative to traditional slide-based histology because it can provide detailed 3D insights into pathological structures and cellular interactions without altering the tissue. This approach makes it possible to analyze complex 3D tissue structures and to image thick tissues, which is not possible with slide-based methods.
The researchers used their improved open-top light-sheet microscope to capture images of densely labeled clinical specimens, showing its potential for nondestructive 3D pathology. Kevin W. Bishop from the University of Washington will detail the work at Optica’s Biophotonics Congress being held in Fort Lauderdale, Florida, 07 — 10 April 2024.
For certain diseases, like prostate cancer, it can be challenging to determine which patients need aggressive treatment and which patients do not. 3D information could ultimately help clinicians better determine the best course of treatment for each patient.
Open-top light-sheet microscopy is used to rapidly acquire 3D images of fluorescently labeled tissues that have been treated in a way that makes them transparent or translucent. The typical setup uses a fixed thin sheet of light to illuminate and image the sample from below, much like a flatbed document scanner. This enables high-resolution imaging of large areas at much faster speeds than are possible with other 3D imaging approaches (e.g. confocal microscopy).
Although many types of labels can be used with this microscopy technique, 3D pathology samples typically use dyes that mimic the hematoxylin and eosin (H&E) staining used in traditional histology slides. Because this type of staining is much denser than highly targeted stains, the microscope’s optical-sectioning capability — its ability to visualize a thin slice within a 3D sample — becomes key to achieving good image quality.
Although better sectioning is possible by using a higher illumination numerical aperture, this creates a shorter depth of focus that reduces the system’s usable field of view. To overcome this challenge, the researchers developed a new open-top light-sheet microscope that incorporates an axially swept illumination arm.
Compared to their previous microscope design with a fixed light sheet, the new system quadrupled the field of view and doubled the optical sectioning ability without compromising volumetric imaging speed. The researchers demonstrated its usefulness by imaging a densely labeled cleared mouse kidney. They also acquired other datasets from clinical tissues to further show that the optimized system can deliver the image quality and field of view necessary for 3D pathology studies.
“We plan to use this platform to run large-scale clinical studies that will help us understand where 3D pathology can have the greatest clinical impact,” said Bishop.