Anytime, babytime


Women who are trying to get pregnant are advised to have sex on or around ovulation. But two new studies suggest that having sex at any point during a woman's cycle can cause changes in the immune system that increase the likelihood of getting pregnant.

According to the lead researcher, this is the first study to show that sexual activity even during ‘non-fertile’ periods “may cause the body to promote types of immunity that support conception”.

The studies were based on healthy premenopausal women, half of whom abstained from sex while the other half was sexually active.

Women who were sexually active had significantly higher levels of type 2 helper T cells, which help the body accept changes associated with pregnancy, during the luteal phase—when the uterine lining thickens in preparation for pregnancy. Higher levels of type 1 helper T cells, which act as the body's defence against illness or disease, were found during the follicular phase—when the ovaries’ follicles are maturing.

Helper T cells have a crucial role in the body's immune response, activating cells that destroy microbes invading the body.

"The female body needs to navigate a tricky dilemma. In order to protect itself, the body needs to defend against foreign invaders. But if it applies that logic to sperm or a fetus, then pregnancy can't occur. The shifts in immunity that women experience may be a response to this problem.”

The findings are published in the journals Fertility and Sterility and Physiology and Behavior.


Heart in a drop of blood

A more sensitive blood test developed by researchers at Edinburgh University can rule out a heart attack in two-thirds of people who come to the emergency department with a chest pain, avoiding unnecessary hospital admissions and cutting costs.

One of the most common causes for hospital admissions globally is chest pain. A protein called troponin is released when the heart muscles become damaged. Higher blood levels of troponin suggest a possible heart attack. Identifying a patient with heart attack requires multiple blood tests to assess troponin levels and lengthy stay.

The new blood test is more sensitive than the existing one. It can detect far lower blood levels of troponin.

The findings, published in the journal The Lancet, was based on 6,304 people who came to an emergency room with chest pain. The researchers assessed blood troponin levels in these patients and assessed their risk for heart attack or death from a heart condition within 30 days.

The study found that 61 per cent of the patients with a troponin level below 5ng/L (nanograms per liter of blood) did not have a heart attack and could have been discharged early. Even a year later, these patients had a three times lower risk of heart attack and cardiac death than those with higher troponin levels.

Based on this, the researchers concluded that for patients with troponin levels below the 5ng/L cutoff, there was a 99.6 per cent certainty that they will not suffer from a heart attack within the next 30 days.

“Until now there were no quick ways to rule out a heart attack within the emergency department. We have identified a cardiac troponin concentration (less than 5 nanograms per deciliter; <5ng/L) below which patients are at very low risk of heart attack either during the admission or in the ensuing 30 days. These patients are therefore potentially suitable for immediate and safe discharge from the emergency department," lead author Dr Anoop Shah noted.


Fidgeting is good

Do you find yourself fidgeting at work to the annoyance of your co-workers? Don’t worry—you may outlive them!

A British study published in the American Journal of Preventive Medicine suggests that fidgeting may counteract some of the negative health effects associated with sitting for long.

Prolonged sitting can contribute to a number of health issues including obesity, heart disease and early death irrespective of physical activity level. Even adults who exercise regularly and sleep for eight hours at night spend up to 15 hours a day sitting down.

The health impact of fidgeting was studied on 12,778 women aged 37 to 78 years who answered questions about eating habits, smoking, alcohol intake, exercise, average daily sitting time and fidgeting. The women were followed for an average of 12 years.

Sitting for seven or more hours per day (versus less than five hours per day) increased the risk of death from any cause by 30 per cent—but only in women who rarely fidgeted.

Women in the middle- and high-fidgeting groups did not have a greater risk of dying even if they sat for longer periods of time.

"While further research is needed, the findings raise questions about whether the negative associations with fidgeting, such as rudeness or lack of concentration, should persist if such simple movements are beneficial for our health," the study co-author commented.

Did You Know
Want to put your children to sleep? Try reading to them The Rabbit Who Wants to Fall Sleep, a children’s storybook written by Carl-Johan Forssen Ehrlin that claims on its cover is “a new way of getting children to sleep”.


It's safe

Is it safe to have sex after a heart attack? Many heart attack survivors are reluctant to resume sexual activity after a cardiac event thinking it might trigger another episode.

German researchers report in the Journal of the American College of Cardiology that most patients can safely resume sexual activity after a heart attack. In fact, sexual activity is comparable to moderate physical activity such as climbing two staircases or taking a brisk walk.

The researchers analysed the sexual activity of 536 heart attack patients, aged 30 to 70 years, a year before a heart attack: 14.9 per cent of patients reported no sexual activity in the 12 months before their heart attack, 4.7 per cent had sex less than once a month, 25.4 per cent less than once a week and 55 per cent one or more times a week.

Only 0.7 per cent (three patients) reported having sex within an hour of a heart attack, while nearly 80 per cent said their last sexual activity was more than 24 hours before the heart attack.

The patients were then followed for 10 years during which time 100 more adverse cardiovascular events occurred. But sexual activity did not trigger any of those events.

"Based on our data, it seems very unlikely that sexual activity is a relevant trigger of heart attack. It is important to reassure patients that they need not be worried and should resume their usual sexual activity," the study author noted.

But the researchers added that the various medications that heart disease patients take can cause erectile dysfunction. Doctors should warn patients about the risk of combining certain heart medications with erectile dysfunction medications which can lead to serious drop in blood pressure.


Do calcium supplements help?

Calcium supplements are often recommended for older adults to preserve bone health. But does it really work? According to two new studies from New Zealand published in The BMJ, increasing calcium intake may not improve bone density and reduce the risk of fractures.

The studies sought to find the effects of increased dietary or supplemental calcium intake on bone density and risk of fracture in adults over age 50.

The first study assessed calcium intake and bone density by analysing 59 previous randomised controlled trials. Increasing calcium intake either through diet or by taking supplements increased bone mineral density by 1-2 per cent which is not clinically significant to reduce a person's risk of fracture.

The second study looked at calcium intake and the risk of fractures and concluded that "evidence that calcium supplements prevent fractures is weak and inconsistent".

For most people the benefits may not outweigh the risk of adverse events such as constipation, kidney stones and even cardiovascular events.

“Collectively these results suggest that clinicians … should not recommend increasing calcium intake for fracture prevention either with calcium supplements or through dietary sources,” the authors conclude.

Did You Know
Firstborn children are 10 per cent more likely to develop nearsightedness and 20 per cent more likely to have severe nearsightedness than their siblings. The probable reason: parents invest more in the education of the firstborn. The result: they spend more time reading and doing indoor activities that promote nearsightedness.
JAMA Ophthalmology


BP med at bedtime

Taking your hypertension medications at bedtime—instead of in the morning—is more effective in maintaining your blood pressure, with the added advantage of reducing your risk of type 2 diabetes by half.

This interesting finding is reported in two separate papers in the journal Diabetologia.

A dip in sleep-time blood pressure is important. But people with hypertension may not have that dip as healthy people normally do.

The first study sought to see if sleep-time blood pressure levels were a significant marker for the development of diabetes in 2,656 people with varied blood pressure levels who did not have diabetes at the start of the study; 190 participants developed type 2 diabetes during an average of 5.9 years of follow-up.

The study strongly suggested that those whose blood pressure did not lower during sleep were more likely to develop diabetes.

The purpose of the second study was to find out whether timing of blood pressure medication mattered in the development of diabetes.

For the study, 2,012 hypertensive patients without diabetes were randomly assigned to either take all of their hypertension medication at bedtime or upon waking up.

During an average 6 years of follow-up, 171 participants developed type 2 diabetes.

Those who took their medication before bedtime had significantly lower average sleep-time blood pressure and greater average dip in sleep-time blood pressure than those who took their medication in the morning.

Even more significantly, they had a 57 per cent lower risk of developing type 2 diabetes.

The greatest reductions in risk were seen among those taking medications that target a hormone called angiotensin II, which is responsible for increased blood pressure, increased glucose release from the liver and decreased insulin sensitivity.

"In hypertensive patients without diabetes, ingestion of the entire daily dose of one or more blood pressure-lowering medications at bedtime compared with ingestion of all such medications upon awakening results in significantly improved sleeping blood pressure control and prevention of new-onset diabetes," the researchers concluded.


Asthma & growth

Infants who are treated with asthma medications called inhaled corticosteroids (ICS) during the first two years of life are likely to have stunted growth, according to a Finnish study presented at the 54th Annual European Society for Pediatric Endocrinology Meeting.

Inhaled corticosteroids are commonly used in infants with recurrent wheezing.

For the study, researchers analysed information on asthma medicine intake and its effect on the height and weight and of 12,482 Finnish children aged 0-24 months.

Children who used inhaled corticosteroids during the first two years of life were too short for their age, especially children who were given the asthma medicine budesonide for more than 6 months.

“Our research shows a link between long-term treatment of ICS during infancy and stunted growth at or after the age of 2 in otherwise healthy children" and highlights the importance of appropriate use of these medicines in infants, the lead researcher concluded.

The researchers are going to study the impact of these medicines on growth in older children and over longer periods.


Dying peacefully at home

Terminally ill cancer patients who choose to die at home experience more peace with no greater pain compared to those who die in a hospital where pain medications are readily available. It also helped their relatives better cope with the loss.

For the British study in the journal BMC Medicine, 352 bereaved relatives of cancer patients answered questions about the patients’ pain and peace in the last week of life and the relative’s grief at the loss; 177 patients died in a hospital and 175 died at home.

While about 25 per cent of patients who died in a hospital experienced little to no peace in the last week of their lives, only 12 per cent of patients dying at home were unable to find peace as they faced death.

Patients who died at home did not suffer more pain compared to those who died receiving hospital care.

"Many people with cancer justifiably fear pain. So, it is encouraging that we observed patients dying at home did not experience greater pain than those in hospitals, where access to pain-relieving drugs may be more plentiful," said lead author.

Dying at home was easier on the family, too. Relatives reported less intense grief even months after the death of a loved one.

“We know that many patients fear being at home believing they place an awful burden on their family. However, we found that grief was actually less intense for relatives of people who died at home.”

However, dying at home requires that both the patient and family agree with the decision. The patients should also have access to palliative and nursing care at home.

Did You Know
The UK is the best place to die in the world and ranks highest in the Quality of Death Index (based on palliative and hospice care). India ranks 67th of 80 countries, but “Kerala’s palliative care system stands out as a model for the region. With only 3 per cent of India's population, the tiny state provides two-thirds of India's palliative care services".
Economist Intelligence Unit


Spray away from the kids

Children who are exposed to household pesticides have an increased risk of developing certain childhood cancers.

For the Harvard study published in the journal Pediatrics, researchers analyzed 16 previous studies that looked at the link between residential pesticides and the risk of childhood cancers.

Compared to children without exposure, those exposed to indoor insecticides have a 47 per cent greater risk of developing childhood leukemia and are 43 per cent more likely to be diagnosed with childhood lymphoma. Herbicide exposure also increased the risk of leukaemia.

The study also found a modest association between childhood home pesticide or herbicide exposure and childhood brain tumours.

Pesticides are meant to kill organisms. So it is not advisable to use these chemicals in places where kids spend a lot of time, the study author said.

“Preventive measures should be considered to reduce children’s exposure to pesticides at home,” the study concluded.

Promising results for HIV prevention pill

Two new studies have shown promising results for the daily HIV prevention pill Truvada (emtricitabine-tenofovir) as a pre-exposure prophylaxis (PrEP).

The pill has shown to reduce the risk of HIV infection by up to 92 per cent in clinical trials. This is the first time it has been studied in real world setting and was effective in preventing HIV infections in high risk patients.

The first study published in Clinical Infectious Diseases involved 657 mostly gay and bisexual men aged 20 to 68 who were at high risk for HIV infection. All participants remained HIV free while on the drug between 2012 and 2015.

A second study published in The Lancet involved 544 gay men who had unprotected sex. Half of them were started on PrEP rightaway while the other half had to wait a year for the pill.

There were three infections among the men who received the treatment rightaway compared to 20 in the delayed-treatment group, showing an 86 per cent reduction in the risk of infection. Participants in the delayed group were offered the treatment ahead of schedule because the positive effects of the daily pill were so pronounced.

"These results are extremely exciting and show PrEP is highly effective at preventing HIV infection in the real world," said the lead investigator of The Lancet study.


Eat less in smaller plates

Want to eat less and consume fewer calories? Eat from smaller plates and packages. A review of 61 previous studies involving 6,711 participants suggests that people consume more food and drink when it is offered in larger plates or comes in larger-sized portions or packages.

By consistently using smaller tableware and package, adults can reduce the average daily energy consumed from food by 12 per cent to 29 per cent.

The size of this effect did not vary by gender, by people’s body mass index or feelings of hunger. Both normal-weight and overweight people ate less when offered smaller versions.

“It provides the most conclusive evidence to date that people consistently consume more food and drink when offered larger-sized portions, packages, or tableware than when offered smaller-sized versions,” said the lead study author.

Overeating can increase the risk of heart disease, diabetes, and certain cancers which can lead to premature death.

“This suggests that policies and practices that successfully reduce the size, availability and appeal of larger-sized portions, packages, individual units and tableware can contribute to meaningful reductions in the quantities of food (including non-alcoholic beverages) people select and consume in the immediate and short term.”

The Cambridge study was published in the Cochrane Database of Systematic Reviews.

Negative parenting

Children’s self-esteem can be affected by maternal and paternal negativity. But do gender-based power structures play a role?

A British study published in the Journal of Cross-Cultural Psychology wanted to assess the impact of household power structures that exist within different cultures on a child’s wellbeing.

The study focused on 125 English and Indian families living in West London and found that a child’s self-esteem is dependent on the behaviour of the parent who is considered to be more powerful within the family.

In Indian culture, fathers are considered to be the head of the family and are usually responsible for discipline. When Indian fathers display more negative parenting traits such as detachment, intrusiveness, lax enforcement of discipline, and controlling behaviour, their children tend to have lower self-esteem.

However, in western cultures mothers have a more crucial role and children reported lower self-esteem when mothers displayed such negative traits.

“Mothers and fathers play different roles in different cultures—these findings highlight the importance of these distinct gender-based power structures on a child’s self-worth,” the study co-author noted.


Cancer care in pregnancy

Pregnant women who get a diagnosis of cancer can start treatment rightaway and do not have to terminate their pregnancy over fears of the negative effects of the cancer drugs on the unborn child.

For the study published in the New England Journal of Medicine, the researchers compared 129 European children whose mothers were diagnosed with cancer during pregnancy with a similar number of children born to mothers not affected by cancer.

The most common cancers among the mothers were breast and blood cancers, such as leukaemia and lymphoma. Eighty-nine children were exposed to chemotherapy before birth, four to radiotherapy, seven to both chemo- and radiotherapy, one each to cancer drugs trastuzumab and interferon beta and 13 to surgery alone. Fourteen mothers with cancer did not receive treatment during their pregnancy.

The children's physical and mental health were examined when they were 18 months and three years old. Forty-seven children also had electrocardiograms (ECGs) and echocardiography to assess their heart function.

There were no significant differences in the mental and physical development and heart function of children exposed to chemotherapy, radiotherapy, surgery alone or no treatment The number of chemotherapy cycles, which ranged from one to ten, also did not seem to have any impact on the children.

The authors, however, caution, “Our data include many types of chemotherapy, but we cannot guarantee that all types of chemotherapy are safe."

"Our results show that fear of cancer treatment is no reason to terminate a pregnancy, that maternal treatment should not be delayed and that chemotherapy can be given," said the lead researcher.

The study also showed that children of mothers with cancer are more likely to be born prematurely, regardless of whether or not the mothers received cancer treatment during pregnancy.

“In most cases, they were born prematurely due to a medical decision to induce preterm so as to continue cancer treatment after the delivery. In some cases preterm delivery was spontaneous and it is possible that cancer treatment plays a role in this.”

Since children suffer more from prematurity than from chemotherapy, “avoiding prematurity is more important than avoiding chemotherapy," the lead researcher added.


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