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Here’s how to confront your fears and seek out new perspectives this year — no therapist required.The start of the new year often brings lofty ambitions.It’s 2024 — time to exercise and eat better, says a nagging voice, somewhere deep in your brain. What about learning to knit?It’s enough to make anyone feel anxious.For those who already struggle with anxiety, these heightened expectations can be even more distressing. Especially because research suggests that many of us don’t complete our New Year’s resolutions.So we asked several psychologists for resolutions specifically tailored to people with anxious tendencies. And we broke them down into bite-size steps so you can notch your successes along the way.But don’t feel pressure to tackle these tips just because it’s January.“It’s OK to take stock of your life at any moment and say, ‘Hey, what can I do differently?’” said Regine Galanti, a psychologist and author in Cedarhurst, N.Y., who specializes in treating people with anxiety disorders. “It’s about changing our lives to look the way we want.”1. Resolve to confront one of your fears.Research suggests that directly confronting the things that make us anxious can help break a pattern of fear and avoidance.You can do this with a therapist — a process clinicians call exposure therapy — or you can do it on your own.Start by asking yourself: “How is feeling anxious keeping me from the life I want?” or “What would my life look like if I were calmer?” Dr. Galanti said.For example, you might answer: “I would travel more often if I were less worried” or “I would speak up more often if I weren’t so anxious.”Then, instead of waiting to feel more relaxed, chart out steps you can take now to reach your goal.Dr. Galanti suggested breaking down your fear into several smaller components that are easier to face and creating a plan of action to help you stay accountable and keep track of your progress.If you are afraid of speaking in public, for instance, you can start by jotting down notes for a toast. Next, practice it out loud. Then try saying it in front of two friends.You can work up to speaking in front of a small group. “It’s like climbing a ladder,” Dr. Galanti said. “I can’t jump to the top.”Some people may need to do each step several times before moving on to the next one, she added.Gradually, each new task will start to feel easier. If you get stuck, “try to avoid white-knuckling things,” Dr. Galanti said. Instead, break down that step into smaller ones.2. Resolve to focus on your values instead of your anxiety.It may sound counterintuitive, but telling yourself to be less anxious is “a signal to your brain to focus on anxiety more,” Dr. Galanti said.Having some anxiety is part of being human — so it is fruitless to try to banish the feeling entirely. “It’s more like, ‘If I feel anxious, then what?’” she added.So rather than focusing on your anxiety, think instead about the personal traits that you value. Total serenity probably won’t make the cut.“Does anybody really want their tombstone to say, ‘He was calm’?” said David Tolin, director of the Anxiety Disorders Center at the Institute of Living in Hartford, Conn.How do you want to be remembered? As a caring spouse? A loyal friend? A hard worker? After you have pinpointed the characteristics you value, he said, do something meaningful to embody them.For example, if being generous is important, consider volunteering in your community, even if you are anxious to step outside your comfort zone.3. Resolve to seek a different perspective.Imagine a man having an argument with his wife. He begins to worry that she doesn’t love him anymore and becomes convinced that she secretly wants a divorce.Catastrophizing — becoming consumed by fear that a situation carries more risk than it actually does — is associated with anxiety disorders.Angela Neal-Barnett, a professor of psychological sciences at Kent State University, suggested thinking about what you worried about last year. It’s likely that the worst-case scenario didn’t happen. Maybe the amount of worry you devoted to a particular problem wasn’t worth it. Or perhaps you surprised yourself by successfully navigating a tough situation. What was the most important thing you learned?Write down your observations so that you can refer back to them if excessive worry or dread start to resurface.Another strategy is to approach a trusted and less anxious friend and ask what they would do.4. Resolve to take care of yourself.This doesn’t necessarily mean luxuries like massages or a personal trainer, the experts said, but the basics: Are you getting enough sleep? Are you eating nutritious food? Are you moving?Dr. Neal-Barnett recommends filling in the blank: “When I am anxious or fearful, my go-to self-care routine is …” The list might include relaxing things like calling a friend, practicing deep breathing or taking a walk outside and getting some fresh air.“Anxious people have a really hard time resting,” Dr. Neal-Barnett said, but it is “one of the best things you can do.”

Published17 minutes agoShareclose panelShare pageCopy linkAbout sharingBy Catherine Burns, Laura Foster and Alison BenjaminHealth Correspondent, Health Reporter and BBC VerifyA former midwife has told the BBC she quit because she could not live with herself if she provided poor care.Hannah Williams says staff shortages meant she kept patients safe, but sometimes only “by the skin of her teeth”.BBC Verify analysis shows that the number of full-time equivalent midwife posts in England has gone up by 7% in the last decade.In comparison, the overall NHS workforce has increased by 34%.The country has a shortage of about 2,500 midwives, and maternity units are struggling with safety concerns. BBC research has also found that some trusts have more than one in five midwife jobs unfilled. The Royal College of Midwives says staffing is the “most important issue” and the gap needs to close.Maternity units are places where miracles can happen every day. We witnessed one at Croydon University Hospital, after meeting a nervous Nicole D’Cruze on the labour ward.She was about to have a planned caesarean section and allowed us to film the surgery.It was the perfect illustration of excellent NHS care – with the surgeon, anaesthetist, midwife and the rest of the surgical team working in harmony.As baby Zenia gave her first cry, a single tear, of joy and relief, rolled down her mum’s face. But not every family gets such a positive start.Safety issuesIn November, we reported that 67% of units in England were not consistently meeting safety standards.To put that in context, this means maternity had the worst safety ratings of all hospital services inspected by regulator the Care Quality Commission. Since then, there has been a slight decline. Now seven in 10 units are not always safe enough. ‘Privilege’Phoebe Isaac and Hannah are two midwives with a lot in common.If you ask them to describe the moment a baby is born, their answers are almost identical, even down to their body language.Their eyes light up and they use the exact same word – “privilege”. Phoebe, 22, qualified last summer and wants this to be her job for life.But at 35, Hannah walked away from the job she used to love.Together, they sum up both the problem – and the possible solutions – to the shortage of midwives: recruitment and retention. Dream job”The future of midwifery” is how her boss described Phoebe, who says she has got her dream career and feels very well-supported as a newly-qualified midwife. But the Croydon unit is working hard to fill a high number of empty midwife posts. This time last year, there were 40 full-time vacancies. The plan is to cut that down to 20 by March, partly by recruiting new starters like Phoebe.Still though, the team has to use agency staff to plug rota gaps and keep mothers and babies safe.’I miss it but I mourn it’Hannah worked in a maternity unit in a different part of the country and is keen to stress that she – and other midwives – always do their best.But she says they were often so short-staffed that she had to look after too many mothers and babies at the same time. She thinks she always managed to keep them safe, but looks close to tears as she says: “I walked away from it because I couldn’t live with myself if I provided unsafe care for someone because the staff numbers were unsafe.”I miss it. But I also mourn it, because I don’t see it improving.”Midwife shortagesThe number of babies being born is falling – but births are becoming more complex. Ten years ago, 13% of deliveries were caesarean sections, but now it is 23%.This means mums and babies need longer stays in hospital and more care from midwives. Gill Walton, chief executive of the Royal College of Midwives (RCM), says the “huge gaps in midwifery staffing levels” are an historic issue because maternity services are often not prioritised. She says: “What we’re asking for is not to be at the back of the queue, not to be overlooked.”It is a tricky balance to train enough new midwives and retain those already in the job.The RCM is worried about a vicious circle – staffing shortages mean existing midwives have to work harder, which can lead to them burning out and deciding to resign. “We do need more midwives, and we need to keep the ones we’ve got. Being a midwife is probably one of the best professions in the world. And we really need to look after them,” Gill says.Posts unfilledWe did a Freedom of Information (FOI) request to 106 trusts with maternity units.We asked how many full-time midwife posts they were budgeted to have in the summer of 2023 – and how many of those jobs were vacant.On average, 11% of midwife jobs were empty – which translates to 25 unfilled posts per trust. Several trusts had shortages of more than 20%, with the highest at 35%.Similar FOI requests to Wales and Northern Ireland showed that staffing there is less of an issue than in England, with averages of 6% and 9% of empty midwife posts respectively. Scotland’s figures suggest a smaller gap of 4%, but it records workforce data differently to the other nations.’Things are already improving’Plans to train and hire more midwives are under way – and starting to have an impact. The government wants to increase the number of midwives in training by 13% between 2021-22 and 2024/-5. The Department of Health and Social Care says it has invested £165m a year to improve maternity and neonatal care – and that will soon go up to £186m. England’s Chief Midwifery Officer Kate Brintworth is optimistic for the future.She says: “Things already are improving. We’ve got 700 more midwives in post. Our retention rates are improving, staff are starting to feel that things are feeling better.”Additional reporting by Vicki Loader and Elena Bailey More on this storyMost maternity units not safe enough – regulatorPublished16 November 2023Related Internet LinksRoyal College of MidwivesThe BBC is not responsible for the content of external sites.

Measuring airborne grass allergen levels instead of pollen counts will be more beneficial for hay fever sufferers as new research shows grass allergen levels are more consistently associated with hay fever symptoms than grass pollen counts.
The research, published today in The Journal of Allergy and Clinical Immunology and led by King’s College London and Imperial College London, shows for the first time that measuring airborne allergen levels will help people with hay fever better control their symptoms.
1 in 4 adults in the UK suffer from hay fever from late-March to September. Symptoms include a runny or blocked nose, sneezing and coughing and itchy, red or watery eyes. Hay fever can make lung conditions such as asthma worse, causing wheezing and breathing difficulties which can lead to hospitalisation.
Many people with hay fever monitor peak pollen times to manage their symptoms. In the UK, pollen grains are manually measured to find the daily pollen count. But authors of this study say measuring allergen levels instead will be more accurate as each pollen grain can release a different amount of allergen each day, and it is the allergens in the air that are primarily responsible for causing hay fever symptoms. Currently, there is no regular monitoring of allergen levels in the UK or elsewhere.
Authors collected daily symptom and medication scores from adult participants in an allergy clinical trial as well as daily counts of asthma hospital admissions in London. They measured grass pollen counts and but also sampled air for the grass pollen Phl p 5 grass allergen protein in the same location at King’s College London over the same time period.
First author Dr. Elaine Fuertes, from Imperial College London, said: “Grass pollen is the most common hay fever trigger. In this study, we measured grass allergen (Phl p 5) levels and found this was more consistently associated with allergic respiratory symptoms than grass pollen counts.”
Senior author Professor Stephen Till, from King’s College London, said: “High pollen season can be serious for people who suffer with hay fever, and can trigger severe asthma attacks in those who are allergic to grass pollen. This study shows there is a superior way of measuring pollen allergens in the air than the traditional pollen count. Monitoring grass allergen instead of grass pollen counts gives results that are more consistently linked to patients’ symptoms and could allow people with serious allergies to be better prepared during the pollen season.”
Research is ongoing to see whether regular measurement of allergen levels can become the standard in the UK, and whether there are other environmental factors, such as meteorological factors including temperature, wind, humidity, and air pollutants, that influence how much allergen each pollen grain releases.

Women with autoimmune disease are more likely to suffer from depression during pregnancy and after childbirth; conversely, women with a history of perinatal depression are at higher risk of developing autoimmune disease, a new study from Karolinska Institutet published in the journal Molecular Psychiatry reports.
In autoimmune disease, the immune system mistakenly attacks the body’s own healthy tissue. Some of the most common autoimmune diseases are gluten intolerance (coeliac disease), autoimmune thyroiditis, rheumatoid arthritis, type 1 diabetes, and multiple sclerosis (MS).
In the present study, researchers used data from the Swedish Medical Birth Register and identified all women who had given birth in Sweden between 2001 and 2013. Out of the resulting group of approximately 815,000 women and 1.3 million pregnancies, just over 55,000 women had been diagnosed with depression during their pregnancy or within a year after delivery.
The researchers then compared the incidence of 41 autoimmune diseases in women with and without perinatal depression, controlling for familial factors such as genes and childhood environment by also including the affected women’s sisters.
Strongest association for MS
The results reveal a bidirectional association between perinatal depression and autoimmune thyroiditis, psoriasis, MS, ulcerative colitis, and coeliac disease. Overall, women with autoimmune disease were 30 per cent more likely to suffer perinatal depression. Conversely, women with perinatal depression were 30 per cent more likely to develop a subsequent autoimmune disease.
The association was strongest for the neurological disease MS, for which the risk was double in both directions. It was also strongest in women who had not had a previous psychiatric diagnosis.

“Our study suggests that there’s an immunological mechanism behind perinatal depression and that autoimmune diseases should be seen as a risk factor for this kind of depression,” says the study’s first author Emma Bränn, researcher at the Institute of Environmental Medicine at Karolinska Institutet.
Can have serious consequences
The researchers will now continue to examine the long-term effects of depression during pregnancy and in the first year following childbirth.
“Depression during this sensitive period can have serious consequences for both the mother and the baby,” says Dr Bränn. “We hope that our results will help decision-makers to steer funding towards maternal healthcare so that more women can get help and support in time.”
Since this was an observational study, no conclusions on causality can be drawn.
The study was financed by Karolinska Institutet, Forte (the Swedish Research Council for Health, Working Life and Welfare), the Swedish Research Councill and the Icelandic Research Fund. The researchers report no conflicts of interest.

Published2 hours agoShareclose panelShare pageCopy linkAbout sharingBy Archana ShuklaIndia Business CorrespondentScores of patients quietly fill a modest tin shed which serves as a waiting area at a cancer hospital in Silchar, in north-eastern India.Over the last few months, Cachar Cancer Centre in the state of Assam has seen an unusually high number of patients from nearby towns and villages. The reason: a quiet revolution that is making cancer drugs more affordable.The hospital is part of the National Cancer Grid, a group of treatment centres that have clubbed together to bulk buy drugs and bring down costs by more than 85%.It is a modest start but, literally, a lifesaver for some of the country’s poorest people.Expensive, protracted treatments often put families under immense financial strain or are simply out of reach. For example, breast cancer treatments can extend for over 10 cycles and cost more than $6,000 (£4,719). In a country where the average monthly salary is less than $700, that is beyond many household budgets.Baby Nandi, 58, is waiting for her next chemotherapy session at the Cachar hospital clinic. Previously, she had to travel 2,000km (1,242 miles) for breast cancer treatment. The drugs alone cost $650 for one treatment cycle. She needed six cycles. Along with the travel and accommodation costs, her family’s finances were pushed to the brink.Thanks to the new initiative, those drugs are now available in her home city, Silchar, at a third of the cost.Baby’s husband Narayan Nandi said: “We don’t have so much money at a go. I had to sell land and borrow from my relatives to take her to Chennai. At least now we can afford her full treatment and be home.”Nearly two million cancer cases are reported a year in India, but consultancy firm EY says that the actual figure could be up to three times as high.Most people in India have to pay for healthcare themselves. Even for those with insurance or on government schemes, cancer care costs are often not fully covered.Amal Chandra, the owner of a small shop in rural Assam, knows the problem well. Last year his wife’s government health card, which covered $1,800 of health expenses, expired midway through her breast cancer treatment. “I had to borrow $250 to pay for her remaining chemotherapy injections,” he told the BBC. Amal and his wife are now back at the hospital as her cancer has returned but at least now the whole cost of her treatment is covered after the prices of drugs was brought down.A major issue is that most of India’s cancer patients live in towns and rural areas, while the bulk of healthcare resources are in larger cities. This means that patients, like Mrs Nandi, and their families face the added burden of having to travel long distances to access treatment.Healthcare experts say that getting cancer drugs to these parts of the country is one of the healthcare system’s biggest problems. Cachar Cancer Hospital, the only facility of its kind in India’s North-eastern hills, is trying to meet that challenge.It treats 5,000 new patients a year and manages the ongoing treatment of another 25,000 people, who are mainly low-paid workers unable to afford the cost of cancer treatment and travel.The intense pressure this puts on the not-for-profit organisation’s funding means it faces a budget deficit of more than $20,000 a month.Oncologist Dr Ravi Kannan, who leads the hospital’s operations, told the BBC that the initiative to cut cancer drug prices has helped him to buy quality medicines and treat more patients for free.It has also helped hospitals in smaller towns avoid another serious problem – running out of cancer drugs. Previously, drug supplies outside large urban centres were erratic due to the low numbers of patients and limited funds. “Now smaller hospitals don’t have to get into the negotiation table at all. The price is already decided and comes with a commitment to supply to all hospitals at par,” Dr Kannan said.The initiative to bulk-buy drugs is led by the country’s largest cancer centre, Tata Memorial Hospital (TMH) in Mumbai. The initial list had 40 common off-patent generic drugs, covering 80% of their pharmacy costs, saving the group $170m.The success of the scheme has attracted interest from hospitals and state governments across the country. The next round will expand to over 100 drugs, while broader cancer care purchases like supplies, diagnostics and equipment are also being considered. However, more expensive patented treatments are currently not part of the plan.”I think what pharmaceutical companies need to understand is in a market like India, unless you bring costs down, you’re not going to get the volumes and it’s a chicken and the egg phenomenon,” according to Dr C S Pramesh, Director of TMH and the Convenor of National Cancer Grid.Dr Pramesh also says that with around 70% of global cancer deaths projected to be in lower and middle income countries, like India, initiatives similar to the National Cancer Grid could be key to helping patients around the world.More on this storyCan vaccines help India triumph against TB?Published5 days agoIndia bans anti-cold drug combination for childrenPublished21 December 2023

Ethanol — the compound found in alcoholic beverages — interferes with the normal functioning of a long list of biological molecules, but how each of these interactions contributes to the behavioral effects of alcohol is not fully understood. A guiding, but elusive, goal of researchers is to identify the protein (or proteins) to which ethanol binds that makes some people vulnerable to excessive drinking. Solving this question would point the way to effective therapies for alcohol use disorder, which affects more than 10% of the U.S. adult population and is responsible for a myriad of health and societal issues.
Previous studies identified one such molecule, a protein widely expressed in the brain, called the BK channel. Ethanol can directly interact with a component of BK channels, known as the α subunit, to facilitate their opening. However, scientists at Scripps Research found that this interaction may not drive behaviors related to alcohol abuse as much as previously thought. Their study, appearing in the journal Molecular Psychiatry on December 22, 2023, demonstrates that preventing ethanol from interacting with the BK α subunit does not reduce or increase the motivation to consume alcohol in mice.
The relationship between the BK α subunit and ethanol had previously been explored in vitro, ex vivo and in live invertebrates. Previous studies suggested that the BK α subunit was involved in an animal’s response to alcohol exposure, but there was a gap in understanding its role in mammals, particularly for the control of alcohol drinking.
“Knowing what a molecule does from in vitro experiments really doesn’t tell you much about what the behavioral consequences of that action might be,” says senior author Candice Contet, PhD, associate professor in the Department of Molecular Medicine at Scripps Research. “Things get complicated in vivo, because there are many layers of modulation that may occur in a cell-type specific manner. Moreover, the initial effect often changes with repeated or prolonged exposure to alcohol. We thus sought to determine whether the ability of ethanol to alter BK channel activity was in any way influencing the motivation to drink alcohol.”
Tackling this question didn’t lend itself well to conventional pharmacological testing: blocking BK channels with a drug causes tremors, which then interfere with drinking behavior. However, Contet’s collaborator Alex Dopico, MD, PhD, of the University of Tennessee, had identified a residue in the mouse BK α subunit that is required for ethanol to activate BK channels but is dispensable for normal BK channel activity, as shown in frog eggs. In the new study, Contet and her colleagues leveraged this discovery to unlock the significance of ethanol’s interaction with BK channels for alcohol drinking in mice.
Accordingly, the team tested mice that had a mutation in this particular BK α subunit residue. First, they found that the mutation prevented alcohol from altering the firing properties of neurons in the medial habenula, a brain region with high levels of BK channels, thereby demonstrating that it also confers resistance to ethanol in mouse brain cells, not just in frog eggs. At the behavioral level, the mice harboring the mutation did not display any anomalies when compared to control littermates. Notably, they exhibited the standard signs of intoxication upon alcohol injection, such as loss of balance and hypothermia, and they consumed the same amount of alcohol when tested under various conditions of moderate or excessive drinking.
“The lack of effect of the mutation was surprising, especially in light of our previous results showing that other BK channel subunits, β1 and β4, influence alcohol intake escalation in the same model of alcohol dependence,” says Contet. “However, these negative results, which were replicated in multiple cohorts and both sexes, are just as important as positive ones, because they encourage the field to study other targets rather than focusing on the wrong culprit.”
While the study does not point to a critical role of the BK α subunit in the motivation to drink alcohol or several physiological responses related to ethanol intoxication and withdrawal, the group will continue to explore whether the molecular target plays a role in other aspects of alcohol use disorder.
“Ethanol is highly pleiotropic. Beyond its reinforcing effects, it alters the functioning of multiple organs and cell types,” Contet says. “It is likely that ethanol’s interaction with BK channels contribute to some of these effects, but we’ve only explored the tip of the iceberg so far; the next challenge will be to find the right experimental readout.”
This work was supported by funding from the National Institutes of Health (AA020913, AA006420, AA026685, AA027636, AA027372, AA020889, AA010422, AA021491, AA013498, AA011560, AA007456)

Children and adolescents who received one of the main COVID-19 vaccines were significantly protected from the illness and showed no increased signs of cardiac complications compared to young people who were not vaccinated, according to a new real-world study led by researchers from the Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia (CHOP). When the Delta variant rose to prominence, the study showed that vaccinated young people were 98 percent less likely to be infected than their unvaccinated peers, and data indicated that the vaccine’s effectiveness decline slightly when the Omicron variant became dominant. The paper was published today in Annals of Internal Medicine.
In their analysis of 250,000 patients with around half of them received at least one dose of the BNT162b2 vaccine (the vaccine produced by a collaboration between Pfizer and BioNTech), the researchers — led by Yong Chen, PhD, and Jeffrey Morris, PhD, both professors of Biostatistics at the Perelman School of Medicine, and Christopher Forrest, MD, PhD, a professor of Pediatrics at CHOP and Penn — covered the periods in which the Delta and Omicron variants became dominant, in mid-2021 and 2022, respectively.
While previous clinical trials established that the vaccines provided strong protection against infection for children and adolescents, limited evidence of the vaccine’s performance existed beyond controlled settings. So, the researchers conducted one of the largest COVID-19 vaccine studies of children and adolescents in the United States with the assistance of data from electronic health records gleaned from a national network of pediatric medical centers, known as PEDSnet.
“Our study has longer follow-up than any previous study, which enabled us to evaluate the real-world, long-term durability of vaccine protection against Delta and Omicron variants,” said Chen. “Further, it covered a diverse representation of U.S. pediatric populations from primary care, specialty care, emergency department, testing centers, and inpatient settings.”
One of the main ideas behind the work, as stated by the study’s first authors — Qiong Wu, PhD, a postdoctoral research fellow at Penn Medicine and Jiayi Tong, a PhD candidate in Biostatistics at Penn — was to help address under-reporting in vaccine status to give a clearer picture of its effects.
Yet, infection prevention wasn’t the study’s only area of focus. The researchers also explored potential effects on risk of heart conditions.
“We found no indication of increased cardiac risks during either variant phase,” said Morris.

During the period of time in which the Delta variant of the SARS-CoV-2 virus emerged and became dominant, the researchers found that adolescents (defined as patients who were 12-to 20-years old) who received the vaccine were approximately 98 percent less likely to be infected or have severe disease compared to those who did not receive it, with no evidence of increased cardiac complications or significant waning infection protection over the subsequent four months.
Vaccination proved strongly protective against the Omicron wave, albeit at a lower magnitude than during Delta. Among adolescents, those who were vaccinated were roughly 86 percent less likely to be infected compared to unvaccinated peers, and their protection against severe illness and ICU admission was similarly high, being approximately 85 and 91 percent less likely, respectively, than the unvaccinated.
Among children, (those who were 5-to-11 years old at the time of vaccination during Omicron), the protection against infection was 74 percent better than unvaccinated peers. Their comparative protection against severe illness and ICU admission stood at 76 and 85 percent, respectively.
During the Omicron wave, the data showed some reduction in effectiveness in the four months following vaccination, while the vaccinated actually had a lower risk of cardiac complications during this time period.
In a follow-up study, the researchers are conducting further work to characterize the direct and indirect impacts of vaccination on outcomes tied to Long COVID, the phenomenon in which symptoms related to the illness linger for months or even years.
Additionally, the researchers believe even longer-term work is needed to better understand how well the vaccines continue to protect their recipients.
“Children and adolescents were the last age group to be enrolled in COVID-19 vaccine clinical trials. Although the pandemic has been declared over, the risk of COVID-19 is present throughout U.S. communities,” Forrest said. “Thus, more information is needed on effectiveness of vaccination delivered to children and adolescents during more recent time periods.”
This research was funded, in part, by the National Institutes of Health (OT2HL161847-01, 1R01LM012607, 1R01AI130460, 1R01AG073435, 1R56AG074604, 1R01LM013519, 1R56AG069880, 1R01AG077820, 1U01TR003709) and the Patient-Centered Outcomes Research Institute’s Project Program Awards (ME-2019C3-18315 and ME-2018C3-14899).

A study of seriously ill patients from academic medical centers across the country has found that nearly a quarter had a delayed or missed diagnosis.
All the patients had either been transferred to the intensive care unit (ICU) after being admitted or died in the hospital. The researchers concluded that three-quarters of these diagnostic errors contributed to temporary or permanent harm, and that diagnostic errors played a role in about one in 15 of the deaths.
The most common errors identified in the study involved delayed rather than missed diagnoses, for example because a specialist was consulted too late or an alternate diagnosis was not considered soon enough, or because of problems ordering the correct test and interpreting the results.
Using statistical methods, they estimated that eliminating these problems with assessment and testing would reduce the risk for diagnostic errors by approximately 40%.
The study represents the largest assessment of diagnostic errors in which physicians reviewed each medical record. It appears Jan. 8, 2024, in JAMA Internal Medicine.
Academic medical centers often see the most challenging cases, and the data can help them increase patient safety by coaching physicians, improving communication between healthcare teams and patients, and developing more accurate diagnostic tools and techniques.
“Our study is similar to studies from the ’90s describing the prevalence and impact of common patient safety events, such as medication errors, studies which catalyzed the patient safety movement,” the paper’s first author, Andrew Auerbach, MD, MPH, a professor in the UCSF in the Division of Hospital Medicine, said in reference to the groundbreaking 1999 Institute of Medicine report, “To Err is Human.” “We hope our work provides a similar call to action to academic medical centers, researchers and policymakers.”
The data may also be useful in designing artificial intelligence (AI) that can summarize lengthy medical records, suggest alternative diagnoses when patients fail to improve and ensure that the correct tests are ordered.

A national collaboration to improve safety
The study involved the 29 academic medical centers that are participating in the Hospital Medicine ReEngineering Network, a quality improvement collaborative that includes Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Johns Hopkins Hospital, Massachusetts General Hospital, the Mayo Clinic, UCSF Medical Center, Yale New Haven Hospital and Zuckerberg San Francisco General Hospital and Trauma Center.
While the study centered on some of the most respected medical centers in the country, the authors cautioned that the results may not generalize to all acute care hospitals.
The research was drawn from a pool of more than 24,000 hospitalized adults who were transferred to the ICU on their second hospital day or died in the hospital between Jan. 1, 2019, and Dec. 31, 2019. Patients who had been transferred to the ICU from the emergency department were excluded to eliminate cases that had been misdiagnosed there.
The researchers randomly selected cases from this large pool, settling on a final group of 2,428. The patients were extremely ill, and three-quarters (1,863) died in the hospital. The physicians first examined every chart for the presence or absence of diagnostic errors, then evaluated whether the mistake had caused harm. Two physicians who had been trained to identify errors reviewed each record, and a third was on hand to settle any disagreements.
Of the reviewed cases, 550 patients, or 23%, experienced a diagnostic error. The errors caused temporary or permanent injury or death in 436 of those patients. The researchers concluded that diagnostic error was a contributing factor in 121 of the deaths.

“We know diagnostic errors are dangerous, and hospitals are obviously interested in reducing their frequency, but it’s much harder to do this when we don’t know what’s causing these errors or what their direct impact is on individual patients,” said senior author Jeffrey L. Schnipper, MD, MPH, of the Brigham’s Division of General Internal Medicine and Primary Care. “We found that diagnostic errors can largely be attributed to either errors in testing, or errors in assessing patients, and this knowledge gives us new opportunities to solve these problems.”
How AI can help physicians
The researchers say the study highlights the need to improve clinician training, evaluate physician workloads and develop more accurate diagnostic tools and techniques. This could include using AI to evaluate patients, select the most appropriate tests and reduce delays, although care must be taken to ensure the models are performing correctly without introducing errors or widening health disparities.
“In the end, helping physicians become better diagnosticians means coaching and training physicians, and helping physicians clearly explain diagnoses to patients,” Auerbach said. “I suspect AI will help with many tasks, but we still have work to improve communication between patients and healthcare team members to fully advance the field.”
This study was supported by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ). Since 2019, AHRQ has received dedicated funding from Congress to support diagnostic excellence. This includes 10 Diagnostic Safety Centers of Excellence funded in 2022, one of which was awarded to UCSF.
Preventing diagnostic errors is also the focus of UCSF’s new Coordinating Center for Diagnostic Excellence.
Authors: Additional UCSF co-authors include Tiffany M. Lee, Colin C. Hubbard, PhD, Sumant R. Ranji, MD, Armond M. Esmaili, MD, Peter Barish, MD, Cynthia Fenton, MD, and Molly Kantor, MD.
Funding: The Agency for Healthcare Research and Quality (R01HS027369).

In recent years, research has begun to reveal that the lines of communication between the body’s organs are key regulators of aging. When these lines are open, the body’s organs and systems work well together. But with age, communication lines deteriorate, and organs don’t get the molecular and electrical messages they need to function properly.
A new study from Washington University School of Medicine in St. Louis identifies, in mice, a critical communication pathway connecting the brain and the body’s fat tissue in a feedback loop that appears central to energy production throughout the body. The research suggests that the gradual deterioration of this feedback loop contributes to the increasing health problems that are typical of natural aging.
The study — published Jan. 8 in the journal Cell Metabolism — has implications for developing future interventions that could maintain the feedback loop longer and slow the effects of advancing age.
The researchers identified a specific set of neurons in the brain’s hypothalamus that, when active, sends signals to the body’s fat tissue to release energy. Using genetic and molecular methods, the researchers studied mice that were programmed to have this communication pathway constantly open after they reached a certain age. The scientists found that these mice were more physically active, showed signs of delayed aging, and lived longer than mice in which this same communication pathway gradually slowed down as part of normal aging.
“We demonstrated a way to delay aging and extend healthy life spans in mice by manipulating an important part of the brain,” said senior author Shin-ichiro Imai, MD, PhD, the Theodore and Bertha Bryan Distinguished Professor in Environmental Medicine and a professor in the Department of Developmental Biology at Washington University. “Showing this effect in a mammal is an important contribution to the field; past work demonstrating an extension of life span in this way has been conducted in less complex organisms, such as worms and fruit flies.”
These specific neurons, in a part of the brain called the dorsomedial hypothalamus, produce an important protein — Ppp1r17. When this protein is present in the nucleus, the neurons are active and stimulate the sympathetic nervous system, which governs the body’s fight or flight response.
The fight or flight response is well known for having broad effects throughout the body, including causing increased heart rate and slowed digestion. As part of this response, the researchers found that the neurons in the hypothalamus set off a chain of events that triggers neurons that govern white adipose tissue — a type of fat tissue — stored under the skin and in the abdominal area. The activated fat tissue releases fatty acids into the bloodstream that can be used to fuel physical activity. The activated fat tissue also releases another important protein — an enzyme called eNAMPT — which returns to the hypothalamus and allows the brain to produce fuel for its functions.

This feedback loop is critical for fueling the body and the brain, but it slows down over time. With age, the researchers found that the protein Ppp1r17 tends to leave the nucleus of the neurons, and when that happens, the neurons in the hypothalamus send weaker signals. With less use, the nervous system wiring throughout the white adipose tissue gradually retracts, and what was once a dense network of interconnecting nerves becomes sparse. The fat tissues no longer receive as many signals to release fatty acids and eNAMPT, which leads to fat accumulation, weight gain and less energy to fuel the brain and other tissues.
The researchers, including first author Kyohei Tokizane, PhD, a staff scientist and a former postdoctoral researcher in Imai’s lab, found that when they used genetic methods in old mice to keep Ppp1r17 in the nucleus of the neurons in the hypothalamus, the mice were more physically active — with increased wheel-running — and lived longer than control mice. They also used a technique to directly activate these specific neurons in the hypothalamus of old mice, and they observed similar anti-aging effects.
On average, the high end of the life span of a typical laboratory mouse is about 900 to 1,000 days, or about 2.5 years. In this study, all of the control mice that had aged normally died by 1,000 days of age. Those that underwent interventions to maintain the brain-fat tissue feedback loop lived 60 to 70 days longer than control mice. That translates into an increase in life span of about 7%. In people, a 7% increase in a 75-year life span translates to about five more years. The mice receiving the interventions also were more active and looked younger — with thicker and shinier coats — at later ages, suggesting more time with better health as well.
Imai and his team are continuing to investigate ways to maintain the feedback loop between the hypothalamus and the fat tissue. One route they are studying involves supplementing mice with eNAMPT, the enzyme produced by the fat tissue that returns to the brain and fuels the hypothalamus, among other tissues. When released by the fat tissue into the bloodstream, the enzyme is packaged inside compartments called extracellular vesicles, which can be collected and isolated from blood.
“We can envision a possible anti-aging therapy that involves delivering eNAMPT in various ways,” Imai said. “We already have shown that administering eNAMPT in extracellular vesicles increases cellular energy levels in the hypothalamus and extends life span in mice. We look forward to continuing our work investigating ways to maintain this central feedback loop between the brain and the body’s fat tissues in ways that we hope will extend health and life span.”

It’s long been established that secondhand smoke is a detriment to health and linked to cancer.
Now, researchers are looking more closely at thirdhand smoke, which is the presence of toxic tobacco by-products that remain on surfaces such as furniture, décor, walls and floors.
In a new study, published in the Journal of Exposure Science & Environmental Epidemiology, researchers tested the surfaces in smoking households where children reside and found troubling results, says Ashley Merianos, a tobacco researcher at the University of Cincinnati who led the study.
Researchers found nicotine on surfaces in all of the children’s homes and detected the presence of a tobacco-specific carcinogen (called NNK) in nearly half of the homes, she says.
The study reported that the NNK levels on surfaces and vacuumed dust were similar, which Merianos says indicates that surfaces and dust can be similar reservoirs and sources of thirdhand smoke exposure for children.
“This is critically important and concerning, since NNK is considered the most potent carcinogen for tobacco-induced cancers,” says Merianos, an associate professor in UC’s School of Human Services.
Additional findings include: Children living in lower-income households had higher levels of NNK and nicotine found on home surfaces. Children living in homes that did not ban indoor smoking had higher levels of NNK and nicotine found on surfaces.Merianos says that NNK and nicotine were still detected in homes with voluntary indoor smoking bans, which highlights the persistence of thirdhand smoke pollutants on surfaces in children’s homes.

“This research highlights that home smoking bans do not fully protect children and their families from the dangers of tobacco,” she adds.
Merianos is a prolific researcher and has extensive training and experience in the epidemiology and prevention of substance use with an emphasis on tobacco, as well as quantitative statistical methods and clinical and translational research in the pediatric health care setting.
She is also a research affiliate member of Cincinnati Children’s Hospital Medical Center, the Thirdhand Smoke Research Consortium and the American Academy of Pediatrics Tobacco Consortium.