Publisher Health

In a new study, researchers at Uppsala University have investigated how junk food affects sleep. Healthy participants consumed an unhealthier as well as a healthier diet in a randomised order. After the unhealthier diet, the quality of the participants’ deep sleep had deteriorated, compared with those who had followed the healthier diet. The results have been published in the journal Obesity.
Several epidemiological studies have shown that what we eat is associated with changes in our sleep. However, few studies have investigated how diet itself directly affects sleep. One way to do that is to have the same participant consume different diets in a randomised order.
“Both poor diet and poor sleep increase the risk of several public health conditions. As what we eat is so important for our health, we thought it would be interesting to investigate whether some of the health effects of different diets could involve changes to our sleep. In this context, so-called intervention studies have so far been lacking; studies designed to allow the mechanistic effect of different diets on sleep to be isolated,” says Jonathan Cedernaes, Physician and Associate Professor in Medical Cell Biology at Uppsala University.
Previous epidemiological studies have shown that diets with greater sugar content, for example, are linked to poorer sleep. Yet sleep is an interplay of different physiological states, as Cedernaes explains:
“For example, deep sleep can be affected by what we eat. But no study had previously investigated what happens if we consume an unhealthy diet and then compared it to quality of sleep after that same person follows a healthy diet. What is exciting in this context is that sleep is very dynamic. Our sleep consists of different stages with different functions, such as deep sleep which regulates hormonal release, for example. Furthermore, each sleep stage is hallmarked by different types of electrical activity in the brain. This regulates aspects such as how restorative sleep is, and differs across different brain regions. But the depth or integrity of the sleep stages can also be negatively affected by factors such as insomnia and ageing. Previously, it has not been investigated whether similar changes in our sleep stages can occur after exposure to different diets.”
Each study session involved several days of monitoring in a sleep laboratory. Therefore, only 15 individuals were included in the study. A total of 15 healthy normal-weight young men participated in two sessions. Participants were first screened for aspects such as their sleep habits, which had to be normal and within the recommended range (an average of seven to nine hours of sleep per night).
In random order, the participants were given both a healthier diet and an unhealthier diet. The two diets contained the same number of calories, adjusted to each individual’s daily requirements. Among other things, the unhealthier diet contained a higher content of sugar and saturated fat and more processed food items. The meals of each diet had to be consumed at individually adjusted times, which were matched across the two dietary conditions. Each diet was consumed for a week, while the participants’ sleep, activity and meal schedules were monitored at an individual level.
After each diet, the participants were examined in a sleep laboratory. There, they were first allowed to sleep a normal night, while their brain activity was measured to monitor their sleep. The participants were then kept awake in the sleep laboratory, before being allowed to catch up on sleep. Their sleep was recorded in this case, too.
“What we saw was that the participants slept for the same amount of time when they consumed the two diets. This was the case both while they were following the diets, as well as after they had switched to another, identical diet. In addition, across the two diets, the participants spent the same amount of time in the different sleep stages. But we were particularly interested in investigating the properties of their deep sleep. Specifically, we looked at slow-wave activity, a measure that can reflect how restorative deep sleep is. Intriguingly, we saw that deep sleep exhibited less slow-wave activity when the participants had eaten junk food, compared with consumption of healthier food. This effect also lasted into a second night, once we had switched the participants to an identical diet. Essentially, the unhealthy diet resulted in shallower deep sleep. Of note, similar changes in sleep occur with ageing and in conditions such as insomnia. It can be hypothesised, from a sleep perspective, that greater importance should potentially be attached to diet in such conditions,” explains Cedernaes.
The researchers do not currently know how long-lasting the sleep effects of the unhealthier diet may be. The study did not investigate whether the shallower deep sleep may alter functions that are regulated by deep sleep, for example.
“It would also be interesting to conduct functional tests, for example to see whether memory function can be affected. This is regulated to a large extent by sleep. And it would be equally interesting to understand how long-lasting the observed effects may be. Currently, we do not know which substances in the unhealthier diet worsened the depth of deep sleep. As in our case, unhealthy diets often contain both higher proportions of saturated fat and sugar and a lower proportion of dietary fibre. It would be interesting to investigate whether there is a particular molecular factor that plays a greater role. Our dietary intervention was also quite short, and both the sugar and fat content could have been higher. It is possible that an even unhealthier diet would have had more pronounced effects on sleep,” notes Cedernaes.

Researchers at the Francis Crick Institute have identified three 4,000-year-old British cases of Yersinia pestis, the bacteria causing the plague — the oldest evidence of the plague in Britain to date, reported in a paper published today in Nature Communications.
Working with the University of Oxford, the Levens Local History Group and the Wells and Mendip Museum, the team identified two cases of Yersinia pestis in human remains found in a mass burial in Charterhouse Warren in Somerset and one in a ring cairn monument in Levens in Cumbria.
They took small skeletal samples from 34 individuals across the two sites, screening for the presence of Yersinia pestis in teeth. This technique is performed in a specialist clean room facility where they drill into the tooth and extract dental pulp, which can trap DNA remnants of infectious diseases.
They then analysed the DNA and identified three cases of Yersinia pestis in two children estimated to be aged between 10-12 years old when they died, and one woman aged between 35-45. Radiocarbon dating was used to show it’s likely the three people lived at roughly the same time.
The plague has previously been identified in several individuals from Eurasia between 5,000 and 2,500 years before present (BP), a period spanning the Late Neolithic and Bronze Age (termed LNBA), but hadn’t been seen before in Britain at this point in time. The wide geographic spread suggests that this strain of the plague may have been easily transmitted.
This strain of the plague — the LNBA lineage — was likely brought into Central and Western Europe around 4,800 BP by humans expanding into Eurasia, and now this research suggests that it extended to Britain.

Using genome sequencing, the researchers showed that this strain of the Yersinia pestis looks very similar to the strain identified in Eurasia at the same time.
The individuals identified all lacked the yapC and ymt genes, which are seen in later strains of plague, the latter of which is known to play an important role in plague transmission via fleas. This information has previously suggested that this strain of the plague was not transmitted via fleas, unlike later plague strains such as the one that caused the Black Death.
Because pathogenic DNA — DNA from bacteria, protozoa, or viruses which cause disease — degrades very quickly in samples which might be incomplete or eroded, it’s also possible that other individuals at these burial sites may have been infected with the same strain of plague.
The Charterhouse Warren site is rare as it doesn’t match other funeral sites from the time period — the individuals buried there appear to have died from trauma. The researchers speculate that the mass burial wasn’t due to an outbreak of plague but individuals may have been infected at the time they died.
Pooja Swali, first author and PhD student at the Crick, said, “The ability to detect ancient pathogens from degraded samples, from thousands of years ago, is incredible. These genomes can inform us of the spread and evolutionary changes of pathogens in the past, and hopefully help us understand which genes may be important in the spread of infectious diseases. We see that this Yersinia pestis lineage, including genomes from this study, loses genes over time, a pattern that has emerged with later epidemics caused by the same pathogen.”
Pontus Skoglund, group leader of the Ancient Genomics Laboratory at the Crick, said, “This research is a new piece of the puzzle in our understanding of the ancient genomic record of pathogens and humans, and how we co-evolved.
“We understand the huge impact of many historical plague outbreaks, such as the Black Death, on human societies and health, but ancient DNA can document infectious disease much further into the past. Future research will do more to understand how our genomes responded to such diseases in the past, and the evolutionary arms race with the pathogens themselves, which can help us to understand the impact of diseases in the present or in the future.”

The disgraced founder of the blood testing start-up Theranos, who was convicted of fraud, is expected to report to a minimum-security prison in Texas.Elizabeth Holmes, the disgraced entrepreneur who was convicted of defrauding investors at her failed blood testing start-up Theranos, is expected to report to a federal prison in Texas on Tuesday to begin her 11-year, three-month sentence.Ms. Holmes is expected to report to FPC Bryan, a minimum-security prison camp for women located roughly 90 minutes from Houston. Its 655 inmates are required to work in the cafeteria or in a manufacturing facility, where pay starts at $1.15 an hour, according to the prison’s handbook. Before starting work at the factory, Ms. Holmes may take a test to assess her strengths in areas such as business, clerical, numerical, logic, mechanical and “social.” Inmates can also enroll in a “Lean Six Sigma” training program to learn about efficiency.“We try to help our ladies obtain work in the factory which focuses on their strengths so they may develop additional marketable skills,” the prison’s handbook says.Ms. Holmes, 39, was found guilty last year of four counts of wire fraud and conspiracy for falsely claiming that Theranos’s blood tests could detect a variety of ailments with just a few drops of blood. She and her former business partner, Ramesh Balwani, must together pay $452 million in restitution to investors who were defrauded. Ms. Holmes has appealed her case, though her requests to remain out of prison during the appeal have been denied.Ms. Holmes founded Theranos in 2003 after dropping out of Stanford University at age 19. The company raised $950 million in funding, making her a billionaire on paper. Theranos collapsed in 2018. Ms. Holmes and Mr. Balwani were indicted that year.The pair were tried separately. Mr. Balwani was convicted on 12 counts of fraud and is serving a nearly 13-year sentence in a federal prison in San Pedro, Calif. He has also appealed his case.Ms. Holmes’s sentence was meant to send a message to others in Silicon Valley: There are consequences when ambitious start-up founders take an ethos known as “fake it till you make it” — when entrepreneurs speak ambitiously about what their companies can do, even if the companies can’t yet do those things — too far. Despite the tech industry’s long history of stretching the rules, as entrepreneurs invent new businesses and disrupt old ones, few have ever gone to prison for lying.Since her conviction, Ms. Holmes has been living in a rental home in San Diego near the family of Billy Evans, who is the father of her two children. During her trial, held in San Jose, Calif., Ms. Holmes and Mr. Evans lived in a home on the grounds of Green Gables, a $135 million estate in the wealthy town of Woodside.Their two young children, William and Invicta, will be able to conduct video calls with Ms. Holmes and visit her on weekends and federal holidays. Phone calls are limited to 15 minutes each, with a total of 300 minutes per month.At FPC Bryan, Ms. Holmes, known for wearing black turtlenecks to mimic Steve Jobs while running Theranos, and, during her trial, sporting heels, sheath dresses and a diaper bag, will wear prison-issued khaki pants and shirts in pastel green, gray, or white with athletic shoes that must not exceed $100 in value.She will not have any internet access but can buy a radio ($31.75) or MP3 player ($88.40) from the commissary. All music must be “non-explicit,” according to the prison’s handbook.FPC Bryan offers leisure activities including music programs, “table games” and movies, according to its handbook. Arts and crafts are available, including beading, knitting, paper art, crochet and ceramics. A crochet needle costs $1.30 and yarn is $3.55 at FPC Bryan’s commissary, according to the handbook.Inmates are allowed to access an outdoor “recreation yard pavilion” but must return to their dorms for head counts that occur five times every 24 hours.Counterfeiting or forging documents and conducting a business are against the rules. Ms. Holmes admitted to falsifying pharmaceutical reports to solicit investors while testifying in her trial.Other inmates at the prison camp include Jen Shah, a “Real Housewives of Salt Lake City” star who is serving a five-and-a-half year sentence for wire fraud related to telemarketing. In a blog post from March about her first few days in prison, Ms. Shah described difficulty operating the phone system, which uses account numbers, and noted that not many people were nice. Breakfast was instant oatmeal, an apple and a slice of wheat bread with jelly, she wrote.Lea Fastow, a former executive for the collapsed energy company Enron, was incarcerated for tax fraud at FPC Bryan for 11 months in the mid-2000s. Jenna Ryan, a participant in the Jan. 6 attack on the U.S. Capitol, spent 60 days there. And Michelle Janavs, daughter of the Hot Pocket co-founder, served five months for her association with the “Operation Varsity Blues” college admissions scandal.Three inmates escaped FPC Bryan in 2017. One of them, Edith Lara, who was serving time for drug charges, has not been found, according to the Bureau of Prisons website.

Polygenic risk scores could help patients understand whether they really need early treatment for heart disease.Katie Elkins has a family history of heart disease on both sides of the family, and she was worried. Her father had a heart attack this year on Easter morning at the age of 53 — the same age his mother was when she had one.Ms. Elkins’s primary care doctor ordered a blood test, which revealed that her LDL cholesterol level was 160. That is high for someone at her age of 34. The doctor referred her to Dr. Daniel Rader, at the University of Pennsylvania, who specializes in preventive cardiology.The question for Dr. Rader was: Should Ms. Elkins start taking a cholesterol-lowering statin? The guidelines say she is too young — the treatment is typically reserved for people at least age 40. But high cholesterol levels damage blood vessels slowly, over a period of decades. Was her risk high enough to intervene early?To find out, Dr. Rader suggested Ms. Elkins take a new genetic test, known as a polygenic risk score. It looks at a collection of thousands of genetic variants. Each variant contributes little on its own to heart disease risk, but the variants together might point to those who are likely to have heart attacks.Cardiologists hope to use such tests, which cost about $150 and are not typically covered by health insurance, to identify people most likely to have heart attacks long before they have them. Some doctors envision testing children as part of routine pediatric care.“There’s a real unmet need to identify high-risk people very early in life,” said Dr. Nicholas Marston, a cardiologist at Brigham and Women’s Hospital in Boston. He has studied polygenic risk scores and has also been involved in trials for pharmaceutical companies that make cholesterol medicines. “We know the solution to preventing heart disease is getting your bad cholesterol as low as possible for as long as possible.”Those at high risk would be treated aggressively. But the test may also spare some patients, including possibly Ms. Elkins, from unnecessary treatment if their risk turns out to be low.Dr. Rader said Ms. Elkins’s LDL level could put her at risk for a heart attack — but probably not for at least a couple of decades. But a heart attack at any age is life-altering and can have severe effects, even with advances in medicine. So the question of how to protect young people whose risk may manifest years later is pressing.(Dr. Rader, who has no financial interests in polygenic risk tests, is on the scientific advisory boards of Alnylam and Novartis, which have commercial interests in inclisiran, an LDL-lowering drug.)Despite the high hopes for the new tests, there are many questions.Some critics say that a focus on treating younger people is misplaced because they may not comply with taking a statin or another drug for the rest of their lives. It can be difficult for young people to focus on possible threats to their health decades in the future, and some of Dr. Rader’s patients have put off even getting polygenic risk tests after he recommends them.The real need, these critics say, is with the huge group of older people who need cholesterol-lowering treatment but are not getting it, or who are abandoning their prescriptions. In one study, about 40 percent of people 65 and older who had a heart attack and need lipid-lowering medications for the rest of their lives stop taking statins within two years.Others, like Dr. Rita F. Redberg, a cardiologist at the University of California, San Francisco, the editor at JAMA Internal Medicine and a critic of the overuse of statins, is concerned that polygenic risk scores could introduce new problems.“There is a lot of downside to labeling people with a disease,” she said.The label, she added, “inexorably leads to tests and a search for treatments.” And, she said, “because the person, who now has become a ‘patient,’ is asymptomatic, more tests and possible treatments in most cases will not make the person feel any better.”People can go from thinking of themselves as healthy to thinking of themselves as someone with a disease. “Now, whenever they experience the common aches, pains and twinges of life, they wonder if it is because they have this ‘disease,’” Dr. Redberg said. “And they may then go to the doctor or even emergency room for things they would not have previously. And that also will lead to more tests and procedures, with their attendant risk of harms.”Others, while enthusiastic about the prospects for polygenic risk scores, say that doctors need to know more about how effective early intervention might be.Dr. Iftikhar Kullo of the Mayo Clinic in Rochester, Minn., asked, “Do you actually improve long-term outcomes” by using the tests and acting on them?Suppose your young patient has a score indicating a heart attack is likely, perhaps a few decades or more later. If that patient starts taking a statin right away, as opposed to in midlife, will a heart attack be prevented?Kori Green, who had severe chest pain last year and discovered that one of her arteries was almost completely blocked, took a genetic test, which did not find her at risk.Dumebi Malaika Menakaya for The New York TimesDr. Sadiya Sana Khan of Northwestern University emphasized the need for more research. She has a new study showing that, in middle-aged to older adults, CT scans of the heart, which can show the buildup of plaque, are better than genetics in predicting risk. But that leaves a question about how to manage risk in young people, who almost never have visible plaque on a CT scan, even if they are at greater danger for a heart attack later in life.“We need more studies that focus on younger people with follow-up over several decades,” she said. If risk scores in young adults predict a greater likelihood of a heart attack, she asked, will that prediction be borne out when the people are older, at ages when heart attacks are more likely? Or will those with high risk scores instead be needlessly worried about their hearts?One hint comes from a recent study by Dr. Marston and his colleagues. They used data from hundreds of thousands of people in Britain and Japan whose genetic material and clinical outcomes are available to researchers.By doing the genetic tests and looking at 10 years of data on the subjects’ health, he and his colleagues asked if those with high risk scores were in fact more likely to have a heart attack. They were — but only if the people were younger than 50. In older people, the cumulative effect of traditional risk factors — like smoking, LDL levels and diabetes — were so powerful that they dominated the risk picture.Dr. Rader and his colleagues in preventive cardiology at Penn are proceeding with the assumption that the risk scores can help them make treatment decisions for patients when it is not clear whether or how aggressively to lower their LDL levels. These people typically are between the ages of 20 and 50 in whom traditional risk assessments are not helpful.They also include patients who are reluctant to take statins any sooner than absolutely necessary.Such was the situation for Sally Thompson, another patient of Dr. Rader.Ms. Thompson, in her late 40s, has an LDL cholesterol level of 160 milligrams per deciliter, not high enough to make a statin imperative. But her doctor said it was advisable. She has no family history of heart disease. She said she would prefer to postpone starting a statin because she already is taking seven drugs for other chronic conditions.She agreed to have the genetic test and take a statin, if it showed her risk is high. It was — in the 70th percentile — and she was persuaded.Other preventive cardiology experts are not yet ready to use the tests to make most treatment decisions.Dr. Marston, for example, so far is only ordering the test for young people who had a heart attack at an early age and are trying to understand why.Even then, polygenic risk scores do not always provide answers.Kori Green, 39, had severe chest pain last year and discovered that one of her coronary arteries was almost completely blocked. The news came as a complete surprise. “I am an avid skier and have a healthy diet,” she said. Neither of her parents have heart disease.The genetic test Dr. Marston suggested did not solve the mystery of why her artery was blocked.“What’s really unfortunate is we still don’t know how this happened,” Ms. Green said.But polygenic risk scores are not going away. At Geisinger, a medical care system in Pennsylvania, researchers are mapping out strategies for introducing them, including clinical trial planning.“I predict it will be part of routine care,” Dr. Christa Martin, Geisinger’s chief scientific officer, said. “We will treat it no differently than cholesterol screening or screening for diabetes.”

Published26 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, ReutersBy John Sudworth & Simon MaybinBBC NewsThe possibility the Covid virus leaked from a laboratory should not be ruled out, a former top Chinese government scientist has told BBC News.As head of China’s Centre for Disease Control (CDC), Prof George Gao played a key role in the pandemic response and efforts to trace its origins.China’s government dismisses any suggestion the disease may have originated in a Wuhan laboratory.But Prof Gao is less forthright.In an interview for the BBC Radio 4 podcast Fever: The Hunt for Covid’s Origin, Prof Gao says: “You can always suspect anything. That’s science. Don’t rule out anything.”A world-leading virologist and immunologist, Prof Gao is now vice-president of the National Natural Science Foundation of China after retiring from the CDC last year. In a possible sign that the Chinese government may have taken the lab leak theory more seriously than its official statements suggest, Prof Gao also tells the BBC some kind of formal investigation into the Wuhan Institute of Virology (WIV) was carried out.”The government organised something,” he says, but adds that it did not involve his own department, the China CDC. We asked him to clarify whether that meant another branch of government carried out a formal search of the WIV – one of China’s top national laboratories, known to have spent years studying coronaviruses. “Yeah,” he replies, “that lab was double-checked by the experts in the field.”It’s the first such acknowledgement that some kind of official investigation took place, but while Prof Gao says he has not seen the result, he has “heard” that the lab was given a clean bill of health.”I think their conclusion is that they are following all the protocols. They haven’t found [any] wrongdoing.”More from John Sudworth on CovidJul 2020: Wuhan, city of silenceDec 2020: Wuhan scientist would ‘welcome’ visit probing lab leak theoryMarch 2023: Toxic debate over lab leak theory hampers searchThe virus that causes Covid, it is almost certain, once came from bats.But how it got from bats to us is a far more controversial question, and from the start there were two main possibilities.One is that the virus spread naturally from bats to humans, perhaps via other animals. Many scientists say the weight of evidence suggests that is the most likely scenario.But other scientists say there is not enough evidence to rule out the main alternative possibility – that the virus infected someone involved in research which was designed to better understand the threat of viruses emerging from nature.Those two alternatives now find themselves at the heart of a geopolitical stand-off, a swirling mass of conspiracy theories, and one of the most politicised and toxic scientific debates of our time.In the new BBC podcast we shed light on this difficult, but vitally important, question through interviews with some of the leading scientists from all sides of the debate – as well as on-the-ground reporting, from the streets of Wuhan to the inside of a high-security laboratory in the US.Image source, Getty ImagesA Singapore-based scientist, Prof Wang Linfa, was visiting the Wuhan Institute of Virology (WIV), where he is an honorary professor, in January 2020, just as the coronavirus outbreak was taking hold. He tells the BBC a colleague at the WIV had been worried about the possibility of a lab leak, but that she was able to dismiss it.Prof Wang is a professor of emerging infectious diseases at the Duke-NUS Medical School in Singapore, and collaborates regularly with Prof Shi Zhengli, a professor with the same speciality at the WIV. Long-standing friends, they are two of the world’s top experts on bat coronaviruses – earning themselves the nicknames Batman and Batwoman.Prof Wang says Prof Shi told him she “lost sleep for a day or two” because she worried about the possibility that “there’s a sample in her lab that she did not know of, but has a virus, contaminated something, and got out”.But he says that she checked her samples and found they contained no evidence of the virus that causes Covid or any other virus close enough to have caused the outbreak.He also says there’s “zero chance” that Prof Shi or anyone in her team was hiding the fact that they had found evidence of a lab leak because they were behaving like nothing happened, including going out for dinner, and planning a karaoke session.Now-declassified US intelligence suggests that several researchers at the WIV became sick in autumn 2019 with symptoms “consistent with both Covid-19 and common seasonal illnesses”.But Prof Wang tells us that he suggested Prof Shi take blood samples from her team to see if they had Covid antibodies in January 2020. He says she followed his advice and all the tests were negative. Image source, Getty ImagesProf Wang is one of a group of scientists who believe that the evidence overwhelmingly suggests that the virus passed to humans in a Wuhan market.The Huanan Seafood Market – which sold much more than its name suggests, including wild mammals – was connected to many of the early cases, people who worked or shopped there.Although China has shown a marked lack of transparency, those scientists say there is now enough information, such as the data on those early cases and the environmental sampling in that market, to rule out a lab leak.In fact, such claims of certainty have been there from the start, most notably in a March 2020 paper which has become one of the most read and most controversial scientific papers of the internet age.”The Proximal Origin of Sars-Cov-2″ was written by some of the most eminent scientists in the field of virology and emerging disease, and it concluded: “We do not believe that any type of laboratory-based scenario is plausible.”It helped to bolster the idea – that quickly became prevalent in much of the media coverage – that the lab leak was a conspiracy theory.But one of the paper’s authors has told the podcast that he now has doubts about the strength of that earlier conclusion.Ian Lipkin, a professor of epidemiology at Columbia University in New York, has long-experience tracking diseases around the world, including in China, where he has built strong contacts.He was also the scientific adviser on the Hollywood blockbuster Contagion.Prof Lipkin now says ruling out any lab-based scenario in the paper was putting it too strongly.While he continues to believe that the market remains the most plausible explanation for where Covid came from, and does not believe the virus was deliberately engineered, he does not feel all laboratory or research scenarios can yet be excluded. And he volunteers a theory of his own, pointing to another Wuhan laboratory – run by the Wuhan Centre for Disease Control – located just a few hundred metres away from the Huanan Seafood Market. It was known to be involved in the collection of thousands of blood and faecal samples from wild bats, research that was sometimes done without wearing proper protective equipment, according to Chinese news reports – a clear infection risk.”The people who work there could have become infected while they’re in a cave collecting bats,” Prof Lipkin says, adding that he was not aware of the lab and its work when he co-wrote the March 2020 paper.Prof Lipkin says that further analysis pointing to the Huanan Seafood Market as the origin of the virus – including recent research focused on evidence of raccoon dogs at the market – does not resolve the origin question.The virus, he says, could have “originated outside of the market and been amplified in the market”.On the surface, Prof Gao’s comments about not ruling out a lab leak appear seriously at odds with China’s publicly stated position.Risky even.”The so-called ‘lab leak’ is a lie created by anti-China forces. It is politically motivated and has no scientific basis,” reads a statement provided by the Chinese embassy in the UK.But looked at another way, there may be more common ground than it seems.In its propaganda, the Chinese government has been pushing a strange, unsubstantiated third theory of its own.The virus, it says, didn’t come from the lab or the market but may have been brought into the country on frozen food packaging.The Chinese government says it rules out both the lab and the market – and Prof Gao’s comments could simply be seen as the more scientific version of that position, because he rules out neither. Both are based on that idea of a lack of evidence.”We really don’t know where the virus came from… the question is still open,” Prof Gao tells the BBC.Scientists dispute – sometimes bitterly – whether the question really is still open. But, outside China at least, there is broad agreement on one thing: China has not done enough to look for evidence or share it.Though it may seem like a simple question, it’s anything but.Where did Covid come from? For every life lost, for everyone who’s suffered and for those who continue to suffer, the answer matters. The Fever: The Hunt for Covid’s Origin podcast is available on BBC Sounds.More on this storyHave we found the ‘animal origin’ of Covid?Published25 MarchChinese scientists publish long-awaited Covid dataPublished7 AprilChina should be honest on Covid origin, says US envoyPublished28 February

Engineers at the University of California San Diego have developed a simple, low-cost clip that uses a smartphone’s camera and flash to monitor blood pressure at the user’s fingertip. The clip works with a custom smartphone app and currently costs about 80 cents to make. The researchers estimate that the cost could be as low as 10 cents apiece when manufactured at scale.
The technology was published May 29 in Scientific Reports.
Researchers say it could help make regular blood pressure monitoring easy, affordable and accessible to people in resource-poor communities. It could benefit older adults and pregnant women, for example, in managing conditions such as hypertension.
“We’ve created an inexpensive solution to lower the barrier to blood pressure monitoring,” said study first author Yinan (Tom) Xuan, an electrical and computer engineering Ph.D. student at UC San Diego.
“Because of their low cost, these clips could be handed out to anyone who needs them but cannot go to a clinic regularly,” said study senior author Edward Wang, a professor of electrical and computer engineering at UC San Diego and director of the Digital Health Lab. “A blood pressure monitoring clip could be given to you at your checkup, much like how you get a pack of floss and toothbrush at your dental visit.”
Another key advantage of the clip is that it does not need to be calibrated to a cuff.

“This is what distinguishes our device from other blood pressure monitors,” said Wang. Other cuffless systems being developed for smartwatches and smartphones, he explained, require obtaining a separate set of measurements with a cuff so that their models can be tuned to fit these measurements.
“Our is a calibration-free system, meaning you can just use our device without touching another blood pressure monitor to get a trustworthy blood pressure reading.”
To measure blood pressure, the user simply presses on the clip with a fingertip. A custom smartphone app guides the user on how hard and long to press during the measurement.
The clip is a 3D-printed plastic attachment that fits over a smartphone’s camera and flash. It features an optical design similar to that of a pinhole camera. When the user presses on the clip, the smartphone’s flash lights up the fingertip. That light is then projected through a pinhole-sized channel to the camera as an image of a red circle. A spring inside the clip allows the user to press with different levels of force. The harder the user presses, the bigger the red circle appears on the camera.
The smartphone app extracts two main pieces of information from the red circle. By looking at the size of the circle, the app can measure the amount of pressure that the user’s fingertip applies. And by looking at the brightness of the circle, the app can measure the volume of blood going in and out of the fingertip. An algorithm converts this information into systolic and diastolic blood pressure readings.

The researchers tested the clip on 24 volunteers from the UC San Diego Medical Center. Results were comparable to those taken by a blood pressure cuff.
“Using a standard blood pressure cuff can be awkward to put on correctly, and this solution has the potential to make it easier for older adults to self-monitor blood pressure,” said study co-author and medical collaborator Alison Moore, chief of the Division of Geriatrics in the Department of Medicine at UC San Diego School of Medicine.
While the team has only proven the solution on a single smartphone model, the clip’s current design theoretically should work on other phone models, said Xuan.
Wang and one of his lab members, Colin Barry, a co-author on the paper who is an electrical and computer engineering student at UC San Diego, co-founded a company, Billion Labs Inc., to refine and commercialize the technology.
Next steps include making the technology more user friendly, especially for older adults; testing its accuracy across different skin tones; and creating a more universal design.
Paper: “Ultra-low-cost Mechanical Smartphone Attachment for No-Calibration Blood Pressure Measurement.” Co-authors include Jessica De Souza, Jessica Wen and Nick Antipa, all at UC San Diego.
This work is supported by the National Institute of Aging Massachusetts AI and Technology Center for Connected Care in Aging and Alzheimer’s Disease (MassAITC P30AG073107 Subaward 23-016677 N 00), the Altman Clinical and Translational Research Institute Galvanizing Engineering in Medicine (GEM) Awards, and a Google Research Scholar Award.
Disclosures: Edward Wang and Colin Barry are co-founders of and have a financial interest in Billion Labs Inc. Wang is also the CEO of Billion Labs Inc. The other authors declare that they have no competing interests. The terms of this arrangement have been reviewed and approved by the University of California San Diego in accordance with its conflict-of-interest policies.

A large-scale study led by researchers at Columbia and Brigham and Women’s Hospital/Harvard is the first to establish that a diet low in flavanols — nutrients found in certain fruits and vegetables — drives age-related memory loss.
The study found that flavanol intake among older adults tracks with scores on tests designed to detect memory loss due to normal aging and that replenishing these bioactive dietary components in mildly flavanol-deficient adults over age 60 improves performance on these tests.
“The improvement among study participants with low-flavanol diets was substantial and raises the possibility of using flavanol-rich diets or supplements to improve cognitive function in older adults,” says Adam Brickman, PhD, professor of neuropsychology at Columbia University Vagelos College of Physicians and Surgeons and co-leader of the study.
The finding also supports the emerging idea that the aging brain requires specific nutrients for optimal health, just as the developing brain requires specific nutrients for proper development.
“The identification of nutrients critical for the proper development of an infant’s nervous system was a crowning achievement of 20th century nutrition science,” says the study’s senior author, Scott Small, MD, the Boris and Rose Katz Professor of Neurology at Columbia University Vagelos College of Physicians and Surgeons.
“In this century, as we are living longer research is starting to reveal that different nutrients are needed to fortify our aging minds. Our study, which relies on biomarkers of flavanol consumption, can be used as a template by other researchers to identify additional, necessary nutrients.”
Age-related memory loss linked to changes in hippocampus

The current study builds on over 15 years of research in Small’s lab linking age-related memory loss to changes in the dentate gyrus, a specific area within the brain’s hippocampus — a region that is vital for learning new memories — and showing that flavanols improved function in this brain region.
Additional research, in mice, found that flavanols — particularly a bioactive substance in flavanols called epicatechin — improved memory by enhancing the growth of neurons and blood vessels and in the hippocampus.
Next, Small’s team tested flavanol supplements in people. One small study confirmed that the dentate gyrus is linked to cognitive aging. A second, larger trial showed that flavanols improved memory by acting selectively on this brain region and had the most impact on those starting out with a poor-quality diet.
In the new study, the Columbia team collaborated with researchers at Brigham and Women’s Hospital studying the effects of flavanols and multivitamins in COSMOS (COcoa Supplements and Multivitamin Outcomes Study). The current study, COSMOS-Web, was designed to test the impact of flavanols in a much larger group and explore whether flavanol deficiency drives cognitive aging in this area of the brain.
Study methods
More than 3,500 healthy older adults were randomly assigned to receive a daily flavanol supplement (in pill form) or placebo pill for three years. The active supplement contained 500 mg of flavanols, including 80 mg epicatechins, an amount that adults are advised to get from food.

At the beginning of the study, all participants completed a survey that assessed the quality of their diet, including foods known to be high in flavanols. Participants then performed a series of web-based activities in their own homes, designed and validated by Brickman, to assess the types of short-term memory governed by the hippocampus. The tests were repeated after years one, two, and three. Most of the participants identified themselves as non-Hispanic and white.
More than a third of the participants also supplied urine samples that allowed researchers to measure a biomarker for dietary flavanol levels, developed by co-study authors at Reading University in the UK, before and during the study. The biomarker gave the researchers a more precise way to determine if flavanol levels corresponded to performance on the cognitive tests and ensure that participants were sticking to their assigned regimen (compliance was high throughout the study). Flavanol levels varied moderately, though no participants were severely flavanol-deficient.
People with mild flavanol deficiency benefited from flavanol supplement
Memory scores improved only slightly for the entire group taking the daily flavanol supplement, most of whom were already eating a healthy diet with plenty of flavanols.
But at the end of the first year of taking the flavanol supplement, participants who reported consuming a poorer diet and had lower baseline levels of flavanols saw their memory scores increase by an average of 10.5% compared to placebo and 16% compared to their memory at baseline. Annual cognitive testing showed the improvement observed at one year was sustained for at least two more years.
The results strongly suggest that flavanol deficiency is a driver of age-related memory loss, the researchers say, because flavanol consumption correlated with memory scores and flavanol supplements improved memory in flavanol-deficient adults.
The findings of the new study are consistent with those of a recent study, which found that flavanol supplements did not improve memory in a group of people with a range of baseline flavanol levels. The previous study did not look at the effects of flavanol supplements on people with low and high flavanol levels separately.
“What both studies show is that flavanols have no effect on people who don’t have a flavanol deficiency,” Small says.
It’s also possible that the memory tests used in the previous study did not assess memory processes in the area of the hippocampus affected by flavanols. In the new study, flavanols only improved memory processes governed by the hippocampus and did not improve memory mediated by other areas of the brain.
Next steps
“We cannot yet definitively conclude that low dietary intake of flavanols alone causes poor memory performance, because we did not conduct the opposite experiment: depleting flavanol in people who are not deficient,” Small says, adding that such an experiment might be considered unethical.
The next step needed to confirm flavanols’ effect on the brain, Small says, is a clinical trial to restore flavanol levels in adults with severe flavanol deficiency.
“Age-related memory decline is thought to occur sooner or later in nearly everyone, though there is a great amount of variability,” says Small. “If some of this variance is partly due to differences in dietary consumption of flavanols, then we would see an even more dramatic improvement in memory in people who replenish dietary flavanols when they’re in their 40s and 50s.”

More than 200 others could be at risk from a fungal meningitis outbreak that has been traced to two clinics in Matamoros, Mexico, where people traveled for cosmetic surgeries, health officials said.Two people in the United States have died with probable cases of fungal meningitis and more than 200 others are at risk after an outbreak of the infection among patients who had surgery in Matamoros, Mexico, the Centers for Disease Control and Prevention said on Friday.At least 220 people in the United States who were treated at two clinics in Matamoros this year could be at risk after having epidural anesthesia, which is injected near the spinal column, the C.D.C. said. The people at risk traveled from the United States to the Mexican clinics for surgical procedures that included liposuction, Brazilian butt lifts and breast augmentation.The C.D.C. said that as of Friday two people had died who had been classified as having probable cases of fungal meningitis. There were 11 more probable cases of the infection, based on spinal tap results, and 14 suspected cases, based on symptoms consistent with meningitis, the C.D.C. said.Health authorities in the United States and Mexico have asked the World Health Organization to issue an emergency declaration in response to the outbreak.The two clinics linked to the infections are River Side Surgical Center and Clinica K-3 in Matamoros, and both closed on May 13, the C.D.C. said.People who had epidural anesthesia at these clinics should go to their nearest health center, urgent care facility or emergency room as soon as possible to be tested for meningitis, even if they do not have symptoms, health officials said.It can take weeks for meningitis symptoms to appear, and once they do, they can quickly become severe and life-threatening, the C.D.C. said. Symptoms may include sensitivity to light, a stiff neck, fever, vomiting and confusion. Fungal meningitis infections are not contagious or transmitted person to person.The C.D.C. said that anyone who has planned an elective procedure involving an epidural injection of an anesthetic in Matamoros should cancel the surgery and related travel “until there is evidence that there is no longer a risk of infection at these clinics.”According to the C.D.C., millions of people in the United States travel to another country for medical care each year, a practice known as medical tourism. The most common procedures people seek on those trips include dental care, surgery, cosmetic surgery, fertility treatments, organ and tissue transplantation, and cancer treatment.The C.D.C. said Mexico’s Ministry of Health provided it with a list of 221 U.S. residents who might be at risk for meningitis because they were listed as having had a surgical procedure at one of the two clinics this year.Dallas Smith, a C.D.C. epidemiologist, said in a webinar for scientists and medical providers on Friday that 205 of those exposed were women and 16 were men. The median age of the patients was 32, and 178 of them were from Texas.Dr. Smith said the outbreak was similar to a fungal meningitis outbreak that started in November 2022 in Durango, Mexico, where more than 1,400 patients were possibly exposed through contaminated epidural anesthesia. In that outbreak, 80 people were found to have meningitis and 39 of them died, he said.“The outbreak that we’re experiencing now is pretty similar, and it has the capacity to have this high mortality rate and just devastate families and communities,” Dr. Smith said.He said that Mexican and United States authorities had submitted a request for a public health emergency of international concern to the W.H.O. because the outbreak had exposed people in Mexico, the United States, Canada and Colombia.This declaration is meant to accelerate international collaboration, funding and treatment development in response to a disease. The W.H.O. declared Covid-19 an emergency in January 2020 and lifted the designation this month.The C.D.C. said it was working with Mexico’s Ministry of Health and local health departments in 24 U.S. states and the District of Columbia to respond to the outbreak and to contact people who officials know had surgery at the clinics.C.D.C. officials found that six of the 221 people potentially exposed to the infection did not have epidural anesthesia and are not considered at risk. The agency also found five other people who were not in the initial group of 221, meaning at least 220 people in the United States were potentially exposed.Health officials are trying to determine which organism or organisms caused the outbreak and whether any other clinics were involved.Mexico’s Ministry of Health said on Thursday that an estimated 547 people had surgery at the two clinics between Jan. 1 and May 13.

Recent research shows that most pregnancy-related deaths occur in the year after a baby is born. The discovery is changing how doctors care for new mothers.Sherri Willis-Prater’s baby boy was 2 months old, and she was about to return to her job at a school cafeteria in Chicago. But as she walked up the short flight of stairs to her kitchen one evening, she nearly collapsed, gasping for breath.At the hospital, Ms. Willis-Prater, who was 42 at the time, was connected to a ventilator that pumped air into her lungs. Her heart, doctors said, was operating at less than 20 percent of its capacity. She had developed a rare form of heart failure that emerges after pregnancy.The diagnosis was the last thing she expected to hear. After giving birth, Ms. Willis-Prater thought “I made it across the finish line,” she recalled in an interview. “I don’t have to worry about anything anymore.”Most people think of labor and birth as the most dangerous part of pregnancy. But new scientific research is challenging this assumption, finding that substantial risks persist for a full year after birth itself. The deadliest time for mothers is actually after the baby is born.And for each woman who dies, an estimated 50 to 100 women experience severe complications that may leave them with lifelong health problems. The numbers are growing as more American women become heavier, and hypertension and diabetes become more common.More women are also postponing childbearing until later in life, so they are more likely to start pregnancy with chronic medical conditions that can lead to complications.The new figures come amid a troubling rise in deaths of pregnant women and new mothers in the United States, which has the highest maternal mortality rate in the industrialized world. The figures soared during the pandemic, to 32.9 deaths for every 100,000 live births in 2021, up from 20.1 per 100,000 in 2019. Rates for Black and Native American women are two to three times higher than those for white women.But those figures reflect a traditional definition of maternal mortality, deaths that occur during gestation or up to six weeks after birth.A fuller extent of the problem came to light in September, when the Centers for Disease Control and Prevention took a more expansive look at mothers’ deaths, analyzing them for a full year after childbirth and including deaths resulting from mental health conditions.Based on data provided by 36 states on 1,018 pregnancy-related deaths from 2017 to 2019, the C.D.C. concluded that about a third of them occurred during pregnancy or on the day of delivery, and roughly another third before the baby turned six weeks old. A full 30 percent occurred from that point until the baby’s first birthday, a period that had not been a focus of maternal mortality research.The data have led to calls for closer follow-up care and more support for new mothers during what has been called the “fourth trimester,” with special attention given to vulnerable women.“Our approach to birth has been that the baby is the candy and the mom’s the wrapper, and once the baby is out of the wrapper we cast it aside,” said Dr. Alison Stuebe, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine. “We need to recognize that the wrapper is a person — moms are getting really sick and dying.”After giving birth, Sherri Willis-Prater recalled thinking, “I don’t have to worry about anything anymore.” But she was diagnosed with heart failure shortly afterward. Anjali Pinto for The New York TimesThe leading causes of maternal mortality among white and Hispanic women are mental health conditions that lead to suicide or fatal overdoses. Among Asian women, the leading cause is hemorrhage.Among Black women like Ms. Willis-Prater, heart conditions were the leading cause of death. High blood pressure, a predisposing factor, is more common among Black women, and they more often have poor access to health care, a legacy of both poverty and racism.The risk of later maternal death — from six weeks to a year after delivery — is 3.5 times higher among Black women, compared with that among white women.Medical practice is often slow to change. But the numbers are accelerating revisions to Medicaid, the health plan that covers low-income Americans, including more than 40 percent of pregnant women in the United States.Thirty-three states and Washington, D.C., have extended Medicaid coverage for new mothers to a full year after childbirth, so women are insured while recovering from pregnancy, and eight other states plan to do so, according to the Kaiser Family Foundation.Three states, including Texas, are extending only limited coverage, and six — including Arkansas, which has had one of the nation’s highest maternal mortality rates — have no plans to extend Medicaid coverage, according to the foundation.Other initiatives include a new law in New Jersey that requires emergency room doctors to ask women of childbearing age about their pregnancy history. Some illnesses that bring women to the hospital may be more quickly diagnosed if physicians know that they are new mothers.In North Carolina, health providers earn a $150 bonus if a patient comes in for a postpartum visit. Historically, nearly half of new mothers have missed postpartum checkups.Doctors are now advised to see new mothers within three weeks of childbirth, rather than wait for the six-week checkup that was once standard.“Now it’s ‘I’ll see you in two weeks, right? And yes, you are definitely coming,’” said Dr. Tamika Auguste, a co-author, along with Dr. Stuebe, of new guidance about postpartum care from the American College of Obstetricians and Gynecologists.New mothers with medical conditions like hypertension should be seen even sooner, Dr. Auguste said.Even more important, however, is that physicians and other providers listen when women express concerns, and pay special attention when Black and Native American women say something is wrong.“There’s no more ‘Oh sweetie, you’re fine,’” Dr. Auguste said. “There’s no more of that to be had. There’s ‘Let’s see if we can get you in to see us today or tomorrow.’”Pregnancy has been called “nature’s cardiac stress test” because of its strains on a woman’s heart and circulatory system. Lea Suzuki/The San Francisco Chronicle, via Getty ImagesMultiple RisksMany doctors refer to pregnancy as “nature’s cardiac stress test.” The condition strains a woman’s heart and circulatory system: Blood volume increases up to 50 percent, the heart works harder, and the heart rate goes up.Elevations in blood pressure can affect other vital organs and leave a woman at greater risk for cardiovascular disease during the pregnancy or even decades later, said Dr. Rachel Bond, a cardiologist and system director of the women’s heart health program at Dignity Health in Chandler, Ariz.“We tell women, ‘You went through your first stress test — either you pass or fail,’” Dr. Bond said. “Failure doesn’t necessarily mean you’ll have heart disease, but it means that we as clinicians need to treat you more aggressively.”Once the baby is born, the uterus shrinks, and blood pressure may rise, which can prompt a stroke.New mothers also are more likely to experience life-threatening blood clots and infections. At the same time, hormonal changes may lead to mood fluctuations. Some of these are transient, but more severe, longer-lasting postpartum depression may also develop.Though most women survive pregnancy-related complications after childbirth, prompt medical care is critical.Deidre Winzy, a 28-year-old medical assistant in New Orleans, already had high blood pressure when she became pregnant with her third child. Doctors gave her a blood pressure cuff to use at home, along with Babyscripts, a remote monitoring system that sent readings to her midwife.Ms. Winzy was induced two and a half weeks early after being diagnosed with pre-eclampsia, a dangerous hypertensive condition. But three weeks after the delivery, she woke up in the middle of the night feeling disoriented and dizzy. She called a friend for help, her speech slurring.Medics thought she was having a panic attack and at first did not want to take her to the hospital. In fact, she was having a stroke. “I made it there just in time,” Ms. Winzy recalled. “If I hadn’t, I might have been paralyzed for the rest of my life.”Ms. Winzy now struggles with short-term memory loss and weakness, but she is able to work. Still, as a single mother of three, she worries.“My biggest fear is me not being here for my kids,” Ms. Winzy said. “What if I have another stroke and it paralyzes me permanently or kills me? It’s terrifying.”Aryana Jacobs, holding her son Caleb, as her husband, Brendan Hurley, looked on. Her first pregnancy was uneventful, but she had a family history of hypertension and kept a blood pressure cuff at home.Shuran Huang for The New York TimesAmong white women, mental health conditions are responsible for 35 percent of pregnancy-related deaths, according to C.D.C. data. Among Hispanic women, the figure is 24 percent. Pre-existing anxiety or depression may leave women vulnerable to postpartum depression, as can a difficult pregnancy or having a sick baby.The stress of parenting may set off a relapse for someone in recovery from a substance use disorder, said Katayune Kaeni, a psychologist and board chairwoman of Postpartum Support International.Karen Bullock, 39, who lives outside Peoria, Ill., had a difficult pregnancy and a traumatic preterm delivery, and she struggled to breastfeed.“Nothing came naturally,” she said. “I wasn’t happy when the baby was born — I was scared. Every time I looked at him, I would think, I don’t know what to do with you.” Ms. Bullock was eventually diagnosed with postpartum depression and began taking medication. Complications can surprise even women who had trouble-free pregnancies. After a cesarean section, Aryana Jacobs, a 34-year-old health technology analyst in Washington, D.C., was told that her blood pressure was fluctuating. At home, Ms. Jacobs checked it with a blood pressure cuff she kept because of a family history of hypertension. Within days, the reading had reached 170/110.She went to the hospital and was treated for pre-eclampsia — which usually develops during pregnancy, not afterward.“I wish every new mother was sent home with a box of chocolates and a blood pressure cuff to emphasize that you, as a mother, are still a patient,” Ms. Jacobs said. “Your body is recovering from something massive.”

New mothers are at risk for up to a year, research has shown. But the first six weeks are the most perilous.After a woman gives birth, the baby’s well-being usually becomes the focus of family attention, and the mother’s health often recedes as a priority. Many busy new mothers don’t make it to their postpartum visit with an obstetrician or midwife, even though recent medical guidelines say they should do so within three weeks of the delivery.But new research has highlighted the frequency with which serious pregnancy-related medical complications emerge after childbirth — often well after the mother is discharged from the hospital.Here’s what you need to know.When are postpartum complications most likely to occur?The first six weeks after delivery are the most dangerous; women and their partners or support teams should be particularly vigilant during the first week. But complications related to pregnancy can emerge up to a year after childbearing.“That whole first year is a vulnerable time,” said Dr. Cheryl Franklin, an assistant professor of obstetrics and gynecology at Morehouse School of Medicine in Atlanta.Who is at greatest risk?Black women are almost twice as likely as white women to have serious complications during the postpartum period. Native American women are at even higher risk of complications, both during and after pregnancy.But all mothers who are 35 and older are more likely to experience complications after being discharged from the hospital, regardless of race and ethnicity. Women who had a cesarean section and those who had a stillbirth also have higher odds of complications, as do obese women and those with underlying conditions like heart disease. Women in the South have higher complication rates than those in the Northeast.What are the most common warning signs?A number of symptoms after childbearing may indicate very serious medical complications and should prompt women to seek care immediately. They include:a headache that doesn’t go away or gets worse;dizziness or fainting;changes in vision;a fever of 100.4 degrees or higher;extreme swelling of the face or hands;trouble breathing;chest pain or fast-beating heart;severe nausea and vomiting;severe belly pain;severe swelling and redness or pain in an arm or leg;heavy vaginal bleeding or discharge;and overwhelming fatigue.If you can’t reach your usual health provider, go to the emergency room and make sure you say you were pregnant within the last year.The C.D.C. offers a useful quiz that helps familiarize women with the warning signs during and after pregnancy.Is a difficult pregnancy or delivery more likely than an uneventful one to prompt postpartum complications?Yes — but anyone can develop a medical complication after childbearing, even someone who had a smooth and easy pregnancy.Some medical conditions that emerge during pregnancy, like hypertensive disorders and diabetes, may increase the risks during the postpartum period, and require close follow-up and monitoring. Women with hypertension or a family history of it may want to have a cuff at home to track their blood pressure, or to use a remote blood pressure monitoring program.Certain birth outcomes also raise red flags. Cesarean sections may lead to infections and potentially life-threatening blood clots. Having a preterm birth, or having a baby who is small for his or her gestational age, should prompt close monitoring of the mother’s health in addition to the baby’s.A traumatic birthing experience may lead to depression, anxiety and post-traumatic stress disorder, said Katayune Kaeni, a psychologist. All women should be screened for depression during their postpartum checkups.Are there precautions I can take to lessen my risk?If you are not pregnant and are planning a pregnancy, schedule a preconception visit with your doctor and your partner, if you have one (that person’s medical history may also be significant).“Optimize your health prior to pregnancy, with heart-healthy nutrition, fitness, cancer screenings and immunizations,” Dr. Franklin said. “Optimize chronic conditions such as high blood pressure, diabetes, obesity and cardiovascular disease, and understand your family history and your own risk factors.”Once you are pregnant, start prenatal care early and don’t skip appointments.After childbirth, make sure to go back to your OB-GYN or midwife for checkups, preferably within the first two to three weeks after being discharged from the hospital. If you had difficulty during your pregnancy, or you have underlying conditions like hypertension, diabetes or obesity, talk to your provider about an earlier check-in, more frequent calls or visits and transitioning to doctors who can manage your postnatal care.If you have concerns, call your doctor. If providers dismiss your concerns but you don’t feel right, go to an emergency room.Is it normal to feel weepy immediately after childbirth? What psychological symptoms should prompt immediate medical care?Some new mothers may feel sad after childbearing, but this is usually a transient phenomenon. Seek help if feelings of sadness and hopelessness continue, or you think that you aren’t a good mother, or feel you have no control over your life and are constantly worried.Get help immediately if you have thoughts of hurting yourself or your baby, or if intrusive thoughts pop into your head and you can’t get rid of them. Your regular health provider should be able to provide a referral; you can get more information at Postpartum Support International.