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Health

Complications during pregnancy linked to a higher risk of heart disease, study finds

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CNN
 — 

Five major pregnancy complications are strong lifelong risk factors for ischemic heart disease, a new study finds, with the greatest risk coming in the decade after delivery.

Ischemic heart disease refers to heart problems, including heart attack, caused by narrowed or dysfunctional blood vessels that reduce blood and oxygen flow to the heart.

Gestational diabetes and preeclampsia increased the risk of ischemic heart disease in the study by 54% and 30%, respectively, while other high blood pressure disorders during pregnancy doubled the risk. Delivering a baby early – before 37 weeks – or delivering a baby with a low birth weight were associated with a 72% and 10% increased risk, respectively.

The study, published in Wednesday in the BMJ, followed a cohort of more than 2 million women in Sweden with no history of heart disease who gave birth to single live infants between 1973 and 2015.

Roughly 30% of the women had at least one adverse pregnancy outcome. Those who had multiple adverse outcomes – whether in the same or different pregnancies – showed further increased risk of ischemic heart disease.

“These pregnancy outcomes are early signals for future risk of heart disease and can help identify high-risk women earlier and enable earlier interventions to improve their long-term outcomes and help prevent the development of heart disease in these women,” said Dr. Casey Crump, an author of the study and professor of family medicine at the Icahn School of Medicine at Mount Sinai.

Heart disease is the leading cause of death among women in the United States and accounts for 1 in 5 female deaths, according to the US Centers for Disease Control and Prevention. This research adds to mounting evidence that pregnancy provides important information about a woman’s cardiovascular health.

“What happens to a woman during pregnancy is almost like a stress test or a marker for her future cardiovascular risk after pregnancy. And unfortunately, a lot of women don’t get told this by anybody,” said CNN Medical Correspondent Dr. Tara Narula, an associate professor of cardiology and the associate director of the Women’s Heart Program at Lenox Hill Hospital. She was not involved in the new study.

Although it’s not completely clear why, experts say the normal changes that occur during pregnancy may unmask underlying health issues in some women with certain risk factors.

Experiencing an adverse pregnancy outcome – even temporarily – could result in changes to blood vessels and the heart that may persist or progress after delivery, increasing a woman’s risk for cardiovascular disease.

This heightened risk is a particular concern for women in the US, experts say, where the maternal mortality rate is several times higher than in other high-income countries.

“There’s been a change in the birthing population. US women are getting pregnant at a later age, and they have already accrued maybe one or two cardiovascular risk factors. Perhaps there are other stressors in life – depression, stress, isolation, obesity – lots of different things that are impacting women in the US,” said Dr. Garima Sharma, associate professor of cardiology and director of the Cardio-Obstetrics Program at Johns Hopkins University School of Medicine, who also was not involved in the new study.

Pregnancy complications are carefully monitored during pregnancy, but there is little evaluation of and education about the effects on cardiovascular health after delivery for women, experts say.

“And so they have their delivery, they’ve had maybe preeclampsia or gestational diabetes, and nobody really follows up with them. They are not told that, in fact, they are at increased risk,” Narula said.

Gestational diabetes is a marker not only for increased risk of diabetes but also for general cardiovascular disease. Preeclampsia and eclampsia are markers for hypertension risk as well as general cardiovascular risks.

Narula, a cardiologist who specializes in caring for women, regularly considers adverse pregnancy outcomes when evaluating patients and emphasizes the continued need for this.

“The classic risk calculator that we use doesn’t have anything in there for pregnancy complications, but you know, it should for women, and hopefully someday, they will start to take that into account,” she said.

The American Heart Association recommends that all health care professionals take a detailed history of pregnancy complications when assessing a woman’s heart disease risk, but this is not consistently done in clinical practice, especially in primary care, where most women are seen, Crump says.

“Raising awareness of these findings among physicians as well as women hopefully will enable more of these women to be screened early and hopefully improve their long-term outcomes,” he said.

Roughly 1 in 3 women will have an adverse pregnancy outcome. Experts say that improving your health before getting pregnant can help avoid these issues.

“Reducing your risk should start preconception, and so getting your body and yourself into the healthiest state possible before you ever even get pregnant is really the first step,” Narula said.

This includes achieving and maintaining a healthy body weight with a good diet and regular exercise, controlling high blood pressure and diabetes, quitting smoking and managing stress.

Taking action after pregnancy is equally important, as research has estimated that only 30% to 80% of women have a postpartum checkup 6 to 8 weeks after delivery.

“Making sure that these women actually are appropriately followed after their delivery and that there is a warm handoff between [obstetrics] and [maternal-fetal medicine] to their primary care doctors or preventive cardiologists who can then talk about optimizing cardiovascular risks and reduction of these risk factors post-pregnancy in the postpartum time frame is crucial,” Sharma said.

Experts hope that increased patient and provider awareness of the connection between pregnancy and heart health will keep birth from being a cause of death.

“Cardiovascular disease is preventable. It’s a leading cause of maternal mortality, but it doesn’t have to be. If we do a better job at screening patients before they get pregnant, if we do a better job of treating them during pregnancy and postpartum, we can improve women’s outcomes,” Narula said. “It’s a tragedy to bring a new life into the world, and then the mother suffers some horrible complication and/or death that could have been prevented.”

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Health

Ultraprocessed foods linked to ovarian and other cancer deaths, study finds

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CNN
 — 

Eating more ultraprocessed foods raises the risk of developing and dying from cancer, especially ovarian cancer, according to a new study of over 197,000 people in the United Kingdom, over half of whom were women.

Overly processed foods include prepackaged soups, sauces, frozen pizza and ready-to-eat meals, as well as hot dogs, sausages, french fries, sodas, store-bought cookies, cakes, candies, doughnuts, ice cream and many more.

“Ultra-processed foods are produced with industrially derived ingredients and often use food additives to adjust colour, flavour, consistency, texture, or extend shelf life,” said first author Dr. Kiara Chang, a National Institute for Health and Care Research fellow at Imperial College London’s School of Public Health, in a statement.

“Our bodies may not react the same way to these ultra-processed ingredients and additives as they do to fresh and nutritious minimally processed foods,” Chang said.

However, people who eat more ultra-processed foods also tend to “drink more fizzy drinks and less tea and coffee, as well as less vegetables and other foods associated with a healthy dietary pattern,” said Duane Mellor, a registered dietitian and senior teaching fellow at Aston Medical School in Birmingham, UK, in an email.

“This could mean that it may not be an effect specifically of the ultra-processed foods themselves, but instead reflect the impact of a lower intake of healthier food,” said Mellor, who was not involved in the study.

The study, published Tuesday in the journal eClinicalMedicine, looked at the association between eating ultraprocessed foods and 34 different types of cancer over a 10-year period.

Researchers examined information on the eating habits of 197,426 people who were part of the UK Biobank, a large biomedical database and research resource that followed residents from 2006 to 2010.

The amount of ultraprocessed foods consumed by people in the study ranged from a low of 9.1% to a high of 41.4% of their diet, the study found.

Eating patterns were then compared with medical records that listed both diagnoses and deaths from cancer.

Each 10% increase in ultraprocessed food consumption was associated with a 2% increase in developing any cancer, and a 19% increased risk for being diagnosed with ovarian cancer, according to a statement issued by Imperial College London.

Deaths from cancers also increased, the study found. For each additional 10% increase in ultraprocessed food consumption, the risk of dying from any cancer increased by 6%, while the risk of dying from ovarian cancer rose by 30%, according to the statement.

“These associations persisted after adjustment for a range of socio-demographic, smoking status, physical activity, and key dietary factors,” the authors wrote.

When it comes to death from cancer among women, ovarian cancer is ranked fifth, “accounting for more deaths than any other cancer of the female reproductive system,” noted the American Cancer Society.

“The findings add to previous studies showing an association between a greater proportion of ultra-processed foods (UPFs) in the diet and a higher risk of obesity, heart attacks, stroke, and type 2 diabetes,” said Simon Steenson, a nutrition scientist at the British Nutrition Foundation, a charity partially supported by food producers and manufacturers. Steenson was not involved in the new study.

“However, an important limitation of these previous studies and the new analysis published today is that the findings are observational and so do not provide evidence of a clear causal link between UPFs and cancer, or the risk of other diseases,” Steenson said in an email.

People who ate the most ultraprocessed foods “were younger and less likely to have a family history of cancer,” Chang and her colleagues wrote.

High consumers of ultraprocessed foods were less likely to do physical activity and more likely to be classified as obese. These people were also likely to have lower household incomes and education and live in the most underprivileged communities, the study found.

“This study adds to the growing evidence that ultra-processed foods are likely to negatively impact our health including our risk for cancer,” said Dr. Eszter Vamos, the study’s lead author and a clinical senior lecturer at Imperial College London’s School of Public Health in a statement.

This latest research is not the first to show an association between a high intake of ultraprocessed foods and cancer.

A 2022 study examined the diets of over 200,000 men and women in the United States for up to 28 years and found a link between ultraprocessed foods and colorectal cancer — the third most diagnosed cancer in the United States — in men, but not women.

And there are “literally hundreds of studies (that) link ultraprocessed foods to obesity, cancer, cardiovascular disease, and overall mortality,” Marion Nestle, the Paulette Goddard professor emerita of nutrition, food studies and public health at New York University told CNN previously.

While the new UK-based study cannot prove causation, only an association, “other available evidence shows that reducing ultra-processed foods in our diet could provide important health benefits,” Vamos said.

“Further research is needed to confirm these findings and understand the best public health strategies to reduce the widespread presence and harms of ultra-processed foods in our diet,” she added.

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Health

Adult drug use rose during pandemic, but dropped dramatically in youth, study says

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CNN
 — 

Use of marijuana and other substances dropped in teenagers during the first year of the pandemic, according to a new study.

But adults’ use of cannabis, illegal drugs and alcohol, including binge drinking, either stayed the same or increased compared to the two years before Covid-19.

“Substance use decreased between 2019 and 2020 among those aged 13 to 20 years,” wrote first author Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse.

However, “consistent declines were not seen in older persons other than tobacco use reductions, and cannabis use increased among adults ages 25 years and older,” he and his coauthors wrote.

The study analyzed data from the Population Assessment of Tobacco and Health Study, which follows tobacco and other substance use over time among 49,000 US youths and adults.

“A particular strength of this study was the longitudinal design,” said Joseph Palamar, an associate professor of population health at NYU Grossman School of Medicine, who was not involved in the study.

“This design allows us to look at changes among the same people over time as opposed to other national studies which compare different groups of people across time,” he said.

Substance abuse dropped in teenagers between ages 13 and 17, according to the study published Tuesday in the journal JAMA Network Open.

Cannabis use among teenagers ages 13 and 15 dropped by 3.4 percentage points in 2020 compared to 2018 and 2019, while tobacco use declined by about 4 points, the study found. The use of other illegal or misused prescription drugs also fell 2.5 percentage points in this age group.

Use of marijuana in teens ages 16 and 17 dropped 7.3 percentage points in 2020 compared to 2018 and 2019. Tobacco use fell by over 10 points and misuse of drugs sank by nearly 3 percentage points. Binge drinking dipped by 1.6 percentage points across the age group.

“I think availability plays a big part,” Palamar said. “If high schoolers are separated from their friends for a long time and stuck inside, they’ll likely have decreased access to drugs.

“Even if a teen successfully obtained weed, this doesn’t mean he or she had somewhere away from parents to smoke it if the whole family was on lockdown,” he added.

The use of alcohol increased by over five percentage points (from 60.2% to 65.2%) among adults ages 21 to 24 years old in 2020 compared to the previous two years. Binge drinking, however, fell by 2.2 points.

Tobacco use fell by about 8 percentage points, but use of marijuana and other illegal or prescription drugs did not change significantly in this age group, according to the study.

Use of marijuana increased slightly in adults 25 and up, by 1.2 percentage points. Declines in other substance abuse in this age group were not significant, the study authors said.

Tobacco use fell for all adults, the study found. The number of young adults ages 18 to 20 smoking tobacco dropped by just over 15 percentage points in 2020 compared to 2018 and 2019. Smoking also declined by about 8 points in adults ages 21 and up over the same period.

However, a drop in drug use during the early days of Covid did not mean the reduction continued as the pandemic wore on, said Palamar, who has been studying drug availability during that period.

“Decreases in use during the early months of Covid are meaningful, but we need to keep in mind that use of some drugs rebounded,” Palamar said. “For example, we found that seizures of marijuana and methamphetamine decreased after the start of Covid, and then rebounded to a much higher rate later in the year.”

A separate survey of people ages 19 to 30 found they were using marijuana and hallucinogens at high rates in 2021. The Monitoring the Future Study, published in 2022, found 11% of people in this age group used marijuana on a daily basis in 2021, while 43% said they had used it in the past year.

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Health

Covid-19 is a leading cause of death for children in the US, despite relatively low mortality rate

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CNN
 — 

Covid-19 has become the eighth most common cause of death among children in the United States, according to a study published Monday.

Children are significantly less likely to die from Covid-19 than any other age group – less than 1% of all deaths since the start of the pandemic have been among those younger than 18, according to federal data. Covid-19 has been the third leading cause of death in the broader population.

But it’s rare for children to die for any reason, the researchers wrote, so the burden of Covid-19 is best understood in the context of other pediatric deaths.

“Pediatric deaths are rare by any measure. It’s something that that we don’t expect to happen and it’s a tragedy in a unique way. It’s a really profound event,” said Dr. Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases.

“Everyone knows that Covid is the most severe in the elderly and immunocompromised and that it’s less severe in children, but that does not mean it’s a benign disease in children. Just because the numbers are so much lower in children doesn’t mean that they’re not impactful.”

In 2019, the last year before the pandemic, the leading causes of death among children and young adults ages 0 to 19 included perinatal conditions, unintentional injuries, congenital malformations or deformations, assault, suicide, malignant neoplasms, diseases of the heart and influenza and pneumonia.

The researchers’ analysis of data from the US Centers for Disease Control and Prevention found that there were 821 Covid-19 deaths in this age group during a 12-month period from August 2021 to July 2022. That death rate – about 1 for every 100,000 children ages 0 to 19 – ranks eighth compared with the 2019 data. It ranks fifth among adolescents ages 15 to 19.

Covid-19 deaths displace influenza and pneumonia, becoming the top cause of death caused by any infectious or respiratory disease. It caused “substantially” more deaths than any vaccine-preventable disease historically, the researchers wrote.

According to CDC data, children are less vaccinated against Covid-19 than any other age group in the US. Less than 10% of eligible children have gotten their updated booster shot, and more than 90% of children under 5 are completely unvaccinated.

“If we looked at all those other leading causes of death – whether you’re talking about motor vehicle accidents or childhood cancer – and we said, ‘Gosh, if we had some simple, safe thing we could do to get rid of one of those, wouldn’t we just jump at it?” And we have that with Covid with vaccines,” said O’Leary, who is also a professor of pediatric infectious disease at the University of Colorado School of Medicine and Children’s Hospital Colorado.

A CDC survey of blood samples suggest that more than 90% of children have already had Covid-19 at least once.

There is uncertainty about exactly how much risk the virus will continue to pose, O’Leary said, but the potential benefits of vaccination clearly outweigh any potential risks.

“Vaccination clearly is our best option right now,” and the benefits clearly outweigh the risks, he said. “Better safe than sorry.”

The findings of the new study, published in JAMA Network Open, may underestimate the mortality burden of Covid-19 because the analysis focuses on deaths where Covid-19 was an underlying cause of death but not those where it may have been a contributing factor, the researchers wrote. Also, other analyses of excess deaths suggest that Covid-19 deaths have been underreported.

As Covid-19 continues to spread in the US, the researchers say that intervention methods such as vaccination and ventilation will “continue to play an important role in limiting transmission of the virus and mitigating severe disease.”

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World

Peshawar, Pakistan mosque: Suspected suicide attack kills more than 30 people and injures 125

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CNN
 — 

A deadly blast inside a mosque in Pakistan’s northwestern city of Peshawar Monday was likely a suicide attack, according to authorities.

The powerful explosion left at least 31 people dead and 125 injured, according to Peshawar deputy commissioner Shafiullah Khan.

Rescue operations are now underway inside the mosque, which is situated inside a police compound in the city and is mostly attended by law enforcement officials.

No claims of responsibility have been made in relation to the attack so far, which took place in the middle of afternoon prayers.

In a statement to CNN, Peshawar Police Chief Mohammad Aijaz Khan said the blast inside the Police Lines Mosque was “probably a suicide attack,” echoing Pakistan Prime Minister Shehbaz Sharif.

“The brutal killing of Muslims prostrating before Allah is against the teachings of the Quran,” Sharif said in a statement, adding that “targeting the House of Allah is proof that the attackers have nothing to do with Islam.”

“Terrorists want to create fear by targeting those who perform the duty of defending Pakistan,” the prime minister continued.

“Those who fight against Pakistan will be erased from the page.”

Sharif went on to say that “the entire nation and institutions are united to end terrorism” and that there’s a “comprehensive strategy” in the works in order to restore law and order in the northwest Khyber Pakhtunkhwa province, where Peshawar is located.

Pakistan’s former leader Imran Khan, whose party the Pakistan Tehreek e Insaaf holds the provincial government of Khyber Pakhtunkwa also condemned the blast saying in a tweet that “it is imperative we improve our intelligence gathering & properly equip our police forces to combat the growing threat of terrorism.”

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Entertainment

MrBeast helps 1,000 blind people see again by sponsoring cataract surgeries

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CNN
 — 

YouTube superstar MrBeast is making the world clearer – for at least 1,000 people.

The content creator’s latest stunt is paying for cataract removal for 1,000 people who were blind or near-blind but could not afford the surgery.

“We’re curing a thousand people’s blindness,” says MrBeast – real name Jimmy Donaldson – in the Saturday video, which reached over 32 million views as of Sunday afternoon.

The video features touching before-and-after footage of patients seeing with clear vision after finishing the surgery. The YouTuber also gave cash donations and other gifts to some of the participants.

Jeff Levenson, an ophthalmologist and surgeon, worked with Donaldson to perform the first round of surgeries in Jacksonville, Florida. Levenson has coordinated the “Gift of Sight” program for over 20 years, which provides free cataract surgery for uninsured patients who are legally blind due to cataracts.

“Half of all blindness in the world is people who need a 10-minute surgery,” Levenson says in the video, referring to the cataract removal surgery.

Levenson explained to CNN he became inspired to help people access cataract surgery after undergoing his own cataract correction surgery.

“In the days and weeks after my own cataract surgery, I was stunned by how bright and beautiful and vivid the world was,” he said. “But I was shocked by the idea that there are hundreds of millions, probably 200 million people around the world, who are blind or nearly blind from cataracts and who don’t have access to the surgery.”

Levenson got a call from a member of Donaldson’s team in September. “I had never heard of MrBeast,” he said. “So I almost hung up. But I gratefully did not hang up.”

They started by calling homeless shelters and free clinics to create a list of patients in the Jacksonville area who needed cataract surgery but could not afford it. Eventually, they had a group of 40 patients – and Levenson performed all of their surgeries in a single day, starting at 7 a.m. and ending at 6 p.m.

Levenson said that patients were in “disbelief that somebody would actually seek them out to to rescue them from blindness, and then have the kindness and generosity of spirit to offer the surgery.”

The ophthalmologist also connected Donaldson’s team with SEE International, for which he serves as the chief medical officer. The nonprofit provides free eyecare around the world to patients in need. The organization helped Donaldson reach even more patients, for a total of 1,000 surgeries completed around three weeks. The video shows patients receiving the surgery in Jamaica, Honduras, Namibia, Mexico, Indonesia, Brazil, Vietnam and Kenya.

Levenson said he hopes the video and Donaldson’s generosity inspire “a concerted effort to end needless blindness.”

“If MrBeast can light a fire, and if we can get governmental and private support behind it, we can end half of all the blindness in the world,” he said. “Without all that much cost, and with incredible gains in human productivity and human potential.”

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US

6 dead, 3 injured in crash between bus and box truck in upstate New York

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CNN
 — 

Six people died and three others were injured in a crash involving an express bus and a freight truck in upstate New York Saturday morning, according to authorities.

New York State Police responded to a collision between the bus and the Freightliner box truck around 6 a.m. ET on State Highway 37 in Louisville, a town near the US-Canada border, according to a press release from the agency.

The crash left one person in critical condition and seriously injured two people who were on the express bus, state police said. Victims were transported to several hospitals, according to the release.

There were 16 people on board the vehicles, 15 in the express bus and one in the truck, according to Matthew Denner, director of Emergency Services for St. Lawrence County.

“The facts about the cause of this accident are unknown at this time,” spokesperson Randolph P. Ryerson for Penske, the rental company for the truck involved, told CNN in a statement.

“We do not yet have specific information about the rental vehicle involved or information about who was driving the rental vehicle at the time of the incident,” Ryerson added.

The National Transportation Safety Board announced it is launching a six member team to conduct a safety investigation into the fatal collision.

Mayor Mike Zagrobelny of Waddington, a town near the scene of the accident, thanked first responders from around the county who assisted in a post on Facebook Saturday.



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Health

Weight loss surgery extends lives, study finds

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CNN
 — 

Weight loss surgery reduces the risk of premature death, especially from such obesity-related conditions as cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people who had bariatric surgery in Utah.

Compared with those of similar weight, people who underwent one of four types of weight loss surgery were 16% less likely to die from any cause, the study found. The drop in deaths from diseases triggered by obesity, such as heart disease, cancer and diabetes, was even more dramatic.

“Deaths from cardiovascular disease decreased by 29%, while deaths from various cancers decreased by 43%, which is pretty impressive,” said lead author Ted Adams, an adjunct associate professor in nutrition and integrative physiology at the University of Utah’s School of Medicine.

“There was also a huge percentage drop — a 72% decline — in deaths related to diabetes in people who had surgery compared to those who did not,” he said. One significant downside: The study also found younger people who had the surgery were at higher risk for suicide.

The study, published Wednesday in the journal Obesity, reinforces similar findings from earlier research, including a 10-year study in Sweden that found significant reductions in premature deaths, said Dr. Eduardo Grunvald, a professor of medicine and medical director of the weight management program at the University of California San Diego Health.

The Swedish study also found a significant number of people were in remission from diabetes at both two years and 10 years after surgery.

“This new research from Utah is more evidence that people who undergo these procedures have positive, beneficial long-term outcomes,” said Grunvald, who coauthored the American Gastroenterological Association’s new guidelines on obesity treatment.

The association strongly recommends patients with obesity use recently approved weight loss medications or surgery paired with lifestyle changes.

“And the key for patients is to know that changing your diet becomes more natural, more easy to do after you have bariatric surgery or take the new weight loss medications,” said Grunvald, who was not involved in the Utah study.

“While we don’t yet fully understand why, these interventions actually change the chemistry in your brain, making it much easier to change your diet afterwards.”

Despite the benefits though, only 2% of patients who are eligible for bariatric surgery ever get it, often due to the stigma about obesity, said Dr. Caroline Apovian, a professor of medicine at Harvard Medical School and codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. Apovian was the lead author for the Endocrine Society’s clinical practice guidelines for the pharmacological management of obesity.

Insurance carriers typically cover the cost of surgery for people over 18 with a body mass index of 40 or higher, or a BMI of 35 if the patient also has a related condition such as diabetes or high blood pressure, she said.

“I see patients with a BMI of 50, and invariably I will say, ‘You’re a candidate for everything — medication, diet, exercise and surgery.’ And many tell me, ‘Don’t talk to me about surgery. I don’t want it.’ They don’t want a surgical solution to what society has told them is a failure of willpower,” she said.

“We don’t torture people who have heart disease: ‘Oh, it’s because you ate all that fast food.’ We don’t torture people with diabetes: ‘Oh, it’s because you ate all that cake.’ We tell them they have a disease, and we treat it. Obesity is a disease, too, yet we torture people with obesity by telling them it’s their fault.”

Most of the people who choose bariatric surgery — around 80% — are women, Adams said. One of the strengths of the new study, he said, was the inclusion of men who had undergone the procedure.

“For all-causes of death, the mortality was reduced by 14% for females and by 21% for males,” Adams said. In addition, deaths from related causes, such as heart attack, cancer and diabetes, was 24% lower for females and 22% lower for males who underwent surgery compared with those who did not, he said.

Four types of surgery performed between 1982 and 2018 were examined in the study: gastric bypass, gastric banding, gastric sleeve and duodenal switch.

Gastric bypass, developed in the late 1960s, creates a small pouch near the top of the stomach. A part of the small intestine is brought up and attached to that point, bypassing most of the stomach and the duodenum, the first part of the small intestine.

In gastric banding, an elastic band that can be tightened or loosened is placed around the top portion of the stomach, thus restricting the volume of food entering the stomach cavity. Because gastric banding is not as successful in creating long-term weight loss, the procedure “is not as popular today,” Adams said.

“The gastric sleeve is a procedure where essentially about two-thirds of the stomach is removed laparoscopically,” he said. “It takes less time to perform, and food still passes through the much-smaller stomach. It’s become a very popular option.”

The duodenal switch is typically reserved for patients who have a high BMI, Adams added. It’s a complicated procedure that combines a sleeve gastrectomy with an intestinal bypass, and is effective for type 2 diabetes, according to the Cleveland Clinic.

One alarming finding of the new study was a 2.4% increase in deaths by suicide, primarily among people who had bariatric surgery between the ages of 18 and 34.

“That’s because they are told that life is going to be great after surgery or medication,” said Joann Hendelman, clinical director of the National Alliance for Eating Disorders, a nonprofit advocacy group.

“All you have to do is lose weight, and people are going to want to hang out with you, people will want to be your friend, and your anxiety and depression are going to be gone,” she said. “But that’s not reality.”

In addition, there are postoperative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, a potential failure to lose weight or even weight gain, said Susan Vibbert, an advocate at Project HEAL, which provides help for people struggling with eating disorders.

“How are we defining health in these scenarios? And is there another intervention — a weight neutral intervention?” Vibbert asked.

Past research has also shown an association between suicide risk and bariatric surgery, Grunvald said, but studies on the topic are not always able to determine a patient’s mental history.

“Did the person opt for surgery because they had some unrealistic expectations or underlying psychological disorders that were not resolved after the surgery? Or is this a direct effect somehow of bariatric surgery? We can’t answer that for sure,” he said.

Intensive presurgery counseling is typically required for all who undergo the procedure, but it may not be enough, Apovian said. She lost her first bariatric surgery patient to suicide.

“She was older, in her 40s. She had surgery and lost 150 pounds. And then she put herself in front of a bus and died because she had underlying bipolar disorder she had been self-medicating with food,” Apovian said. “We as a society use a lot of food to hide trauma. What we need in this country is more psychological counseling for everybody, not just for people who undergo bariatric surgery.”

Managing weight is a unique process for each person, a mixture of genetics, culture, environment, social stigma and personal health, experts say. There is no one solution for all.

“First, we as a society must consider obesity as a disease, as a biological problem, not as a moral failing,” Grunvald said. “That’s my first piece of advice.

“And if you believe your life is going to benefit from treatment, then consider evidence-based treatment, which studies show are surgery or medications, if you haven’t been able to successfully do it with lifestyle changes alone.”

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Business

FDA vaccine advisers vote to harmonize Covid-19 vaccines in the United States

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CNN
 — 

A panel of independent experts that advises the US Food and Drug Administration on its vaccine decisions voted unanimously Thursday to update all Covid-19 vaccines so they contain the same ingredients as the two-strain shots that are now used as booster doses.

The vote means young children and others who haven’t been vaccinated may soon be eligible to receive two-strain vaccines that more closely match the circulating viruses as their primary series.

The FDA must sign off on the committee’s recommendation, which it is likely to do, before it goes into effect.

Currently, the US offers two types of Covid-19 vaccines. The first shots people get – also called the primary series – contain a single set of instructions that teach the immune system to fight off the original version of the virus, which emerged in 2019.

This index strain is no longer circulating. It was overrun months ago by an ever-evolving parade of new variants.

Last year, in consultation with its advisers, the FDA decided that it was time to update the vaccines. These two-strain, or bivalent, shots contain two sets of instructions; one set reminds the immune system about the original version of the coronavirus, and the second set teaches the immune system to recognize and fight off Omicron’s BA.4 and BA.5 subvariants, which emerged in the US last year.

People who have had their primary series – nearly 70% of all Americans – were advised to get the new two-strain booster late last year in an effort to upgrade their protection against the latest variants.

The advisory committee heard testimony and data suggesting that the complexity of having two types of Covid-19 vaccines and schedules for different age groups may be one of the reasons for low vaccine uptake in the US.

Currently, only about two-thirds of Americans have had the full primary series of shots. Only 15% of the population has gotten an updated bivalent booster.

Data presented to the committee shows that Covid-19 hospitalizations have been rising for children under the age of 2 over the past year, as Omicron and its many subvariants have circulated. Only 5% of this age group, which is eligible for Covid-19 vaccination at 6 months of age, has been fully vaccinated. Ninety percent of children under the age of 4 are still unvaccinated.

“The most concerning data point that I saw this whole day was that extremely low vaccination coverage in 6 months to 2 years of age and also 2 years to 4 years of age,” said Dr. Amanda Cohn, director of the US Centers for Disease Control and Prevention’s Division of Birth Defects and Infant Disorders. “We have to do much, much better.”

Cohn says that having a single vaccine against Covid-19 in the US for both primary and booster doses would go a long way toward making the process less complicated and would help get more children vaccinated.

Others feel that convenience is important but also stressed that data supported the switch.

“This isn’t only a convenience thing, to increase the number of people who are vaccinated, which I agree with my colleagues is extremely important for all the evidence that was related, but I also think moving towards the strains that are circulating is very important, so I would also say the science supports this move,” said Dr. Hayley Gans, a pediatric infectious disease specialist at Stanford University.

Many others on the committee were similarly satisfied after seeing new data on the vaccine effectiveness of the bivalent boosters, which are cutting the risk of getting sick, being hospitalized or dying from a Covid-19 infection.

“I’m totally convinced that the bivalent vaccine is beneficial as a primary series and as a booster series. Furthermore, the updated vaccine safety data are really encouraging so far,” said Dr. David Kim, director of the the US Department of Health and Human Services’ National Vaccine Program, in public discussion after the vote.

Thursday’s vote is part of a larger plan by the FDA to simplify and improve the way Covid-19 vaccines are given in the US.

The agency has proposed a plan to convene its vaccine advisers – called the Vaccines and Related Biological Products Advisory Committee, or VRBPAC – each year in May or June to assess whether the instructions in the Covid-19 vaccines should be changed to more closely match circulating strains of the virus.

The time frame was chosen to give manufacturers about three months to redesign their shots and get new doses to pharmacies in time for fall.

“The object, of course – before anyone says anything – is not to chase variants. None of us think that’s realistic,” said Jerry Weir, director of the Division of Viral Products in the FDA’s Office of Vaccines Research and Review.

“But I think our experience so far, with the bivalent vaccines that we have, does indicate that we can continue to make improvements to the vaccine, and that would be the goal of these meetings,” Weir said.

In discussions after the vote, committee members were supportive of this plan but pointed out many of the things we still don’t understand about Covid-19 and vaccination that are likely to complicate the task of updating the vaccines.

For example, we now seem to have Covid-19 surges in the summer as well as the winter, noted Dr. Michael Nelson, an allergist and immunologist at the University of Virginia. Are the surges related? And if so, is fall the best time to being a vaccination campaign?

The CDC’s Dr. Jefferson Jones said that with only three years of experience with the virus, it’s really too early to understand its seasonality.

Other important questions related to the durability of the mRNA vaccines and whether other platforms might offer longer protection.

“We can’t keep doing what we’re doing,” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation. “It’s been articulated in every one of these meetings despite how good these vaccines are. We need better vaccines.”

The committee also encouraged both government and industry scientists to provide a fuller picture of how vaccination and infection affect immunity.

One of the main ways researchers measure the effectiveness of the vaccines is by looking at how much they increase front-line defenders called neutralizing antibodies.

Neutralizing antibodies are like firefighters that rush to the scene of an infection to contain it and put it out. They’re great in a crisis, but they tend to diminish in numbers over time if they’re not needed. Other components of the immune system like B-cells and T-cells hang on to the memory of a virus and stand ready to respond if the body encounters it again.

Scientists don’t understand much about how well Covid-19 vaccination boosts these responses and how long that protection lasts.

Another puzzle will be how to pick the strains that are in the vaccines.

The process of selecting strains for influenza vaccines is a global effort that relies on surveillance data from other countries. This works because influenza strains tend to become dominant and sweep around the world. But Covid-19 strains haven’t worked in quite the same way. Some that have driven large waves in other countries have barely made it into the US variant mix.

“Going forward, it is still challenging. Variants don’t sweep across the world quite as uniform, like they seem to with influenza,” the FDA’s Weir said. “But our primary responsibility is what’s best for the US market, and that’s where our focus will be.”

Eventually, the FDA hopes that Americans would be able to get an updated Covid-19 shot once a year, the same way they do for the flu. People who are unlikely to have an adequate response to a single dose of the vaccine – such as the elderly or those with a weakened immune system – may need more doses, as would people who are getting Covid-19 vaccines for the first time.

At Thursday’s meeting, the advisory committee also heard more about a safety signal flagged by a government surveillance system called the Vaccine Safety Datalink.

The CDC and the FDA reported January 13 that this system, which relies on health records from a network of large hospital systems in the US, had detected a potential safety issue with Pfizer’s bivalent boosters.

In this database, people 65 and older who got a Pfizer bivalent booster were slightly more likely to have a stroke caused by a blood clot within three weeks of their vaccination than people who had gotten a bivalent booster but were 22 to 42 days after their shot.

After a thorough review of other vaccine safety data in the US and in other countries that use Pfizer bivalent boosters, the agencies concluded that the stroke risk was probably a statistical fluke and said no changes to vaccination schedules were recommended.

At Thursday’s meeting, Dr. Nicola Klein, a senior research scientist with Kaiser Permanente of Northern California, explained how they found the signal.

The researchers compared people who’d gotten a vaccine within the past three weeks against people who were 22 to 42 days away from their shots because this helps eliminate bias in the data.

When they looked to see how many people had strokes around the time of their vaccination, they found an imbalance in the data.

Of 550,000 people over 65 who’d received a Pfizer bivalent booster, 130 had a stroke caused by a blood clot within three weeks of vaccination, compared with 92 people in the group farther out from their shots.

The researchers spotted the signal the week of November 27, and it continued for about seven weeks. The signal has diminished over time, falling from an almost two-fold risk in November to a 47% risk in early January, Klein said. In the past few days, it hasn’t been showing up at all.

Klein said they didn’t see the signal in any of the other age groups or with the group that got Moderna boosters. They also didn’t see a difference when they compared Pfizer-boosted seniors with those who were eligible for a bivalent booster but hadn’t gotten one.

Further analyses have suggested that the signal might be happening not because people who are within three weeks of a Pfizer booster are having more strokes, but because people who are within 22 to 42 days of their Pfizer boosters are actually having fewer strokes.

Overall, Klein said, they were seeing fewer strokes than expected in this population over that period of time, suggesting a statistical fluke.

Another interesting thing that popped out of this data, however, was a possible association between strokes and high-dose flu vaccination. Seniors who got both shots on the same day and were within three weeks of those shots had twice the rate of stroke compared with those who were 22 to 42 days away from their shots.

What’s more, Klein said, the researchers didn’t see the same association between stroke and time since vaccination in people who didn’t get their flu vaccine on the same day.

The total number of strokes in the population of people who got flu shots and Covid-19 boosters on the same day is small, however, which makes the association a shaky one.

“I don’t think that the evidence are sufficient to conclude that there’s an association there,” said Dr. Tom Shimabukuro, director of the CDC’s Immunization Safety Office.

Nonetheless, Richard Forshee, deputy director of the FDA’s Office of Biostatistics and Pharmacovigilance, said the FDA is planning to look at these safety questions further using data collected by Medicare.

The FDA confirmed that the agency is taking a closer look.

“The purpose of the study is 1) to evaluate the preliminary ischemic stroke signal reported by CDC using an independent data set and more robust epidemiological methods; and 2) to evaluate whether there is an elevated risk of ischemic stroke with the COVID-19 bivalent vaccine if it is given on the same day as a high-dose or adjuvanted seasonal influenza vaccine,” a spokesperson said in a statement.

The FDA did not give a time frame for when these studies might have results.

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Entertainment

Sheryl Lee Ralph, Chris Stapleton and Babyface to perform in 2023 Super Bowl pre-show

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CNN
 — 

The full entertainment lineup for the 2023 Super Bowl has arrived.

In addition to Rihanna’s highly anticipated halftime show performance, a number of additional Hollywood heavyweights are joining the major sporting event as pre-show performers.

The NFL announced on Tuesday that Emmy-winning actor Sheryl Lee Ralph will perform “Lift Every Voice and Sing” in the pre-show. The “Abbott Elementary” star notably sang on stage while accepting her Emmy award in 2022.

Joining Ralph in the pre-show festivities is Grammy-winning country music artist Chris Stapleton, who has been tapped to sing the National Anthem. R&B crooner Kenneth “Babyface” Edmonds will also perform, with a rendition of “America the Beautiful.”

Each performer will have talent accompanying them to provide American Sign Language (ASL) on behalf of the National Association of the Deaf (NAD), according to a release from the NFL.

Oscar winner Troy Kotsur will sign the national anthem alongside Stapleton. Kotsur won a supporting actor Academy Award in 2022 for his work in “CODA,” becoming the second Deaf person ever to win an acting Oscar after Marlee Matlin.

In case you need any more Super Bowl LVII hype before the February 12 game, here’s our gentle reminder that Rihanna released a teaser on her Instagram to tide you over until then.



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