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Cocoa Might Give Your Brain a Boost: Study


MONDAY, Nov. 30, 2020 (HealthDay News) -- Could the main ingredient found in chocolate super-charge your brain, help young, healthy adults think better, faster and more efficiently? Just maybe, according to a small new study out of Britain.

The finding is based on work with 18 healthy men, aged 18 to 45. All underwent brain scans and mental acuity tests after consuming a cocoa drink packed with high levels of flavanols. They are naturally found in significant amounts in cocoa, grapes, apples, teas and berries, among other items.

"We have known for many years that flavanols from cocoa, in particular, can improve vascular function in humans," said study author Catarina Rendeiro. She's a lecturer in nutritional sciences with the school of sport, exercise and rehabilitation sciences at the University of Birmingham, in the United Kingdom. "These benefits are apparent even after only one single dose of cocoa. However, the extent to which some of these benefits could translate into the brain vasculature were less clear. That's where this study comes in."

The goal: "To investigate whether one single dose of cocoa flavanols could improve brain oxygenation levels," Rendeiro explained.

None of the participants had any known heart, brain or respiratory issues. And each was tested twice, once after blindly drinking a high-flavanol cocoa mix and once after ingesting a low-flavanol version.

Two hours after each drink, participants were subjected to a standard "vascular challenge," meaning they breathed in 5% carbon dioxide, roughly 100 times the normal concentration. Doing so can trigger dizziness, disorientation, exhaustion and an inability to focus. The typical response is for the body to jack up blood flow to the brain, to supply it with more oxygen and force out the excess carbon dioxide.

Brain-scanning technology was first deployed to assess the degree of this response after each drink, with a specific focus on activity in the frontal cortex, which is key to planning, regulating behavior and decision-making.

The researchers found that after drinking the flavanol-rich concoction, 14 of 18 men saw their oxygenation response rise more than three times higher than it had following a low-flavanol drink. The flavanol-heavy drink also triggered a one-minute faster response.

In addition, after drinking flavanol-enriched cocoa, the men were able to respond about 11% more quickly when asked to problem-solve, but only when the tests were at their most challenging. No difference in response was seen when posed with simple tasks.

"This suggests that the beneficial effects of flavanols may only emerge when the cognitive challenge is sufficiently high," Rendeiro said.

Rendeiro also observed that those men who didn't show any improvement in brain performance were also the ones who had the best blood oxygenation responses to begin with. "So it seems that these individuals won't benefit further from intake of flavanols because they are performing already at their maximum," she said.

"It is currently unclear why these subjects had higher responses, but it might be related to higher levels of fitness," Rendeiro said. "But we did not measure this in the study." Still, the findings suggest that "even in a healthy brain there is clearly still room for improvement, and diets rich in flavanols might do just that," she suggested.

But does that mean chocolate lovers should start reaching for a Snickers? Maybe not.

"Unfortunately, it is difficult to know what the content of flavanols is in chocolate products as these are not disclaimed in labels," Rendeiro explained. "Generally, scientific articles that have measured content of flavanols in commercially available chocolates do not seem to find any relationships between content of cocoa solids and levels of flavanols. This is mainly because the processing of cocoa to make chocolate can substantially damage flavanols. So having more cocoa solids does not equate necessarily to more flavanol content."

Still, "consuming a variety of foods rich in flavanols -- such as grapes, green tea, apples and berries -- can provide levels of flavanols that are beneficial for brain and vascular function," she said.

Meanwhile, Judy Pa, an associate professor of neurology at the University of Southern California, Los Angeles, said the findings "aligned with what we would expect."

Pa said, "More research is needed. However, I think most of us would agree that a balanced diet with a healthy dose of fruits and vegetables is beneficial for numerous reasons, and perhaps those foods high in flavanols may provide some additional benefit."

As to flavanol's potential as a way to address dementia risk, a similar take was offered by Claire Sexton, director of scientific programs and outreach for the Alzheimer's Association.

"It would be wonderful if a particular food or supplement could delay or prevent Alzheimer's disease," said Sexton, "but we do not have scientific evidence that these claims are true. We need randomized, controlled clinical trials to evaluate whether any of these foods or supplements has a scientifically proven beneficial effect."

At this point, she said, "people should not put too much stock in specific nutrients -- including subsets of flavanols -- for reducing dementia risk until more research is done. Rather, they should focus on eating an overall healthy diet."

Rendeiro and her colleagues published their findings recently in the journal Scientific Reports.

More information

The University of California, Davis, has more on flavanols.


SOURCES: Catarina Rendeiro, MSc, PhD, lecturer in nutritional sciences, school of sport, exercise & rehabilitation sciences, University of Birmingham, U.K.; Judy Pa, PhD, associate professor, neurology, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles; Claire Sexton, PhD. director, scientific programs and outreach, Alzheimer's Association; Scientific Reports, Nov. 24, 2020

Ventilators May Leave COVID Survivors With Windpipe Injuries


MONDAY, Nov. 30, 2020 (HealthDay News) -- COVID-19 patients who end up on a ventilator may be at risk of rare but serious injuries to the throat, a new study suggests.

The study, at one hospital in Italy, found a high rate of the injuries among COVID-19 patients treated early on in the pandemic. Of 30 who spent at least two weeks on a ventilator, nearly half sustained injuries to the trachea (windpipe) that are normally rare.

Experts said it's not clear how common the injuries might have been at other hospitals earlier in the pandemic. And the risks may be different now, as doctors have learned more about treating COVID-19.

"The management of COVID-19 patients in the second wave is quite different from the first wave," said Dr. Giacomo Fiacchini, the lead author on the study.

At his hospital -- Azienda Ospedaliero-Universitaria Pisana, in Pisa -- fewer patients end up on ventilators now.

"There is no longer the rush to mechanically ventilate these patients," Fiacchini said. "So the number of intubated patients who need many days of invasive mechanical ventilation has been reduced."

Mechanical ventilators supply potentially life-saving air to patients who cannot breathe on their own, via a tube threaded down the trachea.

But that tube can sometimes place too much pressure on the tracheal tissue, leading to large lesions or even fistulas -- abnormal tissue connections between the trachea and the esophagus (the tube that takes water and food from the mouth to the stomach).

Normally, that's a rare risk.

The pandemic, however, has not been a normal time. Of the 30 COVID-19 patients Fiacchini's team studied, 47% suffered a tracheal injury.

All were on ventilators for two weeks or more. But that alone did not explain the high injury rate: The researchers compared their COVID-19 patients with a control group of 45 patients who'd been on ventilators for a similarly long time the year before -- when no one had COVID-19.

And only 2% of those patients suffered a tracheal injury, the findings showed.

U.S. critical-care specialists said they were not aware of any hospitals in the United States reporting similar patterns.

"This is a pretty small study," said Dr. Gabriel Lockhart, who directs the intensive care unit at Saint Joseph Hospital/National Jewish Health in Denver.

"This gives us a signal," Lockhart said. "There could be some fire behind the smoke, but it's hard to know if this is seen more broadly."

Dr. Greg Martin, president-elect of the Society of Critical Care Medicine, agreed.

He noted that the patients, all hospitalized between March and May 2020, fell ill earlier in the pandemic, in a country that was one of the earliest hit.

There has been a "learning curve" in managing COVID-19 patients, Martin said. And during the initial surge, staff and resources at some hospitals were stretched thin. It's not clear how much of a factor that was in the United States, he added.

The Italian doctors speculate on some potential reasons for the tracheal injuries. For one, all of their COVID-19 patients were given anti-inflammatory corticosteroid drugs, at high doses.

Lockhart agreed that could have been a factor. The drugs suppress the immune system, which might impede healing of any tissue breakdown caused by the ventilator tube.

It's also possible that placing ventilator patients in the prone position (on the stomach) contributed, according to Fiacchini.

During the pandemic, doctors have found that hospitalized COVID-19 patients can get more oxygen if they spend time in the prone position.

But maneuvering ventilator patients into position might contribute to tracheal injuries, the Italian team speculated.

No one suggested the prone position be abandoned, since it appears generally beneficial.

Instead, Martin said, the risk of tracheal injuries can be mitigated by, for example, closely monitoring the pressure in the ventilator tube and adjusting it so it's not continuously resting in the same place.

The findings highlight a broader point, Martin and Lockhart said: Patients who survive a serious COVID-19 infection can face complications and a long recovery.

The experience of a long intensive care unit (ICU) stay, alone, can cause so-called "post-ICU syndrome," Martin noted. Those problems range from lost muscle mass and strength, to issues with memory and thinking, to post-traumatic stress.

"Even for those who recover [from COVID-19]," Lockhart said, "it's often not a smooth road. Your life may not be the same afterward."

The findings were published online Nov. 19 in JAMA Otolaryngology Head & Neck Surgery.


More information

The U.S. Centers for Disease Control and Prevention has more on COVID-19's long-term effects.

SOURCES: Giacomo Fiacchini, MD, otolaryngology, audiology and phoniatric operative unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Gabriel C. Lockhart, MD, director, intensive care unit, Saint Joseph Hospital, assistant professor, medicine, National Jewish Health, Denver; Greg S. Martin, MD, MSc, president-elect, Society of Critical Care Medicine, Mount Prospect, Ill., and professor, medicine, Emory University School of Medicine, Atlanta; JAMA Otolaryngology Head & Neck Surgery, Nov. 19, 2020, online

'Repeat After Me' for Better Diabetes Care

MONDAY, Nov. 30, 2020 (HealthDay News) -- Repeat this: The key to helping people with diabetes stay healthier and out of the hospital could be as simple as better communication.

And an underutilized technique called "teach-back" may make a big difference for type 1 and type 2 diabetes patients, a new study finds.

It's a simple concept: After a health care provider explains various details on treatment plans, medications and how to manage the disease at home, they then ask the patient to repeat back the information.

In the study, the technique "was associated with their better [patient] knowledge and also their better self-advocacy and their self-management," said Young-Rock Hong, the study's lead investigator. Hong is an assistant professor at the University of Florida College of Public Health and Health Professions.

Doctors already learn the technique in medical school, noted Dr. Scott Isaacs, spokesman for the American Association of Clinical Endocrinology and medical director for Atlanta Endocrine Associates.

"It turns out that when you tell a patient something, they only hear about 10% of what you're telling them. And so, by using this technique it allows you to assess their understanding and their recall," said Isaacs, who wasn't part of the study.

The reason for the lack of initial understanding could include that it's new information to the patient and can be overwhelming to take in, Isaacs said.

The study analyzed data on more than 2,900 adults with diabetes. At the one-year follow-up, patients whose care providers used teach-back with them were 20% less likely to have diabetes-related health complications, including heart disease and kidney or eye problems. They were also less likely to be hospitalized with diabetes-related complications. Data came from the 2011-2016 Medical Expenditure Panel Survey administered by the U.S. Agency for Healthcare Research and Quality.

Besides improving diabetes care, this technique could save billions of dollars annually in U.S. health care expenditures, researchers said, with savings of $1,400 to $1,700 for each diabetes patient.

But only one-quarter of patients had consistent teach-back experiences with their doctors, the study found.

So why don't more doctors use this approach?

Researchers suggested doctors may not feel they have enough time for teach-back during the visits, or they may be skeptical about its effectiveness. They may also feel they're talking down to or quizzing their patients.

Hong previously studied teach-back with patients who had high blood pressure, type 2 diabetes and heart disease, finding patients engaged in teach-back were significantly less likely to require hospitalizations related to those conditions.

"Based on our previous findings, those who have the teach-back method of communication, they have better patient satisfaction, which means they may have better interactions, better relationships with their providers," Hong said.

"They may have some better adherence to their medications and also other self-management skills related to their conditions," he added.

Diabetes affects more than 34 million Americans. Another 88 million have prediabetes. The disease requires active self-management and continuous care by health care providers in order to prevent health complications, the research team noted.

Isaacs said the goal of treating diabetes is to prevent or delay the complications of diabetes and improve quality of life. "This is really important for patients to have that knowledge of the disease and also to be able to comply with treatments," he explained.

"If they don't understand why they're being treated or how to follow whatever the treatments are, it's fighting a losing battle, but little things sometimes make a big difference," Isaacs added.

The study appears in the November/December issue of the Journal of the American Board of Family Medicine.

More information

The U.S. Agency for Healthcare Research and Quality offers more information on teach-back communication.

SOURCES: Young-Rock Hong, PhD, MPH, assistant professor, Health Services Research, Management and Policy department, College of Public Health and Health Professions, University of Florida, Gainesville; Scott D. Isaacs, MD, spokesman, American Association of Clinical Endocrinology, and medical director, Atlanta Endocrine Associates, and adjunct assistant professor, Emory University School of Medicine, Atlanta; Journal of the American Board of Family Medicine, November/December 2020

AHA News: Eating Foods That Promote Inflammation May Worsen Heart Failure

MONDAY, Nov. 30, 2020 (American Heart Association News) -- People with heart failure who eat a diet high in foods that cause inflammation are twice as likely to end up in the hospital or die as those who eat foods known to reduce inflammation, new research shows.

"If people with heart failure can reduce the amount of pro-inflammatory foods that they eat, it might help with their survival," said lead researcher JungHee Kang, a nursing research assistant and PhD student at the University of Kentucky in Lexington.

Diet has been shown to play a role in regulating inflammation, which is associated with many chronic illnesses, including heart disease. Diets high in foods such as red meat, refined grains and high-fat dairy products have been shown to increase inflammation, while foods such as olive oil, whole grains, and fruits and vegetables have been shown to lower it.

Kang looked at data from a previous study in which her team asked 213 heart failure patients to keep diaries of what they ate for four days. They then categorized the diets using an index that scores foods based on whether they increase or decrease inflammation. After following participants for a year, they found those whose diets had higher inflammatory scores were more than twice as likely to die or be hospitalized compared to those whose diets had lower inflammatory scores.

The results were presented at the American Heart Association's virtual Scientific Sessions earlier this month. The research is considered preliminary until published in a peer-reviewed journal.

"It's well known that diet plays a critically important role in the development of heart disease and stroke," said Dr. Amit Khera, professor of medicine and director of the preventive cardiology program at the University of Texas Southwestern Medical Center in Dallas. "This is a reminder that diet is important. The only surprise to me was the magnitude of the effect."

Khera said the study also was important because it looked specifically at heart failure outcomes, whereas previous diet studies focused more on heart attacks and strokes. According to AHA statistics, an estimated 6.2 million U.S. adults have heart failure, which occurs when the heart doesn't pump enough blood and oxygen to support the other organs in the body.

Many diets that are considered heart-healthy "have more in common than they do differences," said Khera, an author of AHA and American College of Cardiology guidelines for preventing cardiovascular disease.

For example, the Mediterranean diet, which describes an eating pattern common in countries bordering the Mediterranean Sea, includes olive oil as a primary fat source, a lot of fruits, vegetables, grains, beans, nuts and seeds and low amounts of dairy products, eggs, fish and poultry. The DASH (Dietary Approaches to Stop Hypertension) diet, meanwhile, was designed to help lower blood pressure. It also includes a lot of vegetables, fruits and whole grains and limits foods high in saturated fats. But the DASH diet allows more protein from low-fat dairy, meat and poultry.

The guidelines recommend plant-based and Mediterranean eating patterns, while limiting processed meats, refined carbohydrates, cholesterol, sodium and sweetened drinks.

"There's a lot of overlap," Khera said. "It's like a Venn diagram. The sweet spot is in the middle."

What's needed now, Kang said, is research to confirm whether anti-inflammatory diets can be used to reduce heart failure mortality.

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email editor@heart.org.

By Laura Williamson


Women Have Poorer Survival Than Men in Years After First Heart Attack

MONDAY, Nov. 30, 2020 (HealthDay News) -- Here's a good reason for women to take a heart attack more seriously than they might: A new study shows that women are more likely to develop heart failure or die within five years of their first severe heart attack than men are.

Though the gender gap was narrower for a less severe type of heart attack, that wasn't true with a more severe type, according to Canadian researchers who discovered women have a 20% greater risk of developing heart failure or dying within five years.

Why?

The study found a few clues: Women were generally older at the time of their heart attacks and had more risk factors that could have increased their heart failure risk, but they also were seen less frequently by a cardiovascular specialist, were not as likely to have been prescribed heart medications, and had slightly lower rates of certain surgical procedures.

Women tend to be about 10 years older than men when they first have heart attacks and there may be some barriers that can be resolved by improving elder care, said study co-author Dr. Justin Ezekowitz. He's a cardiologist and co-director of the Canadian VIGOUR Centre at the University of Alberta, in Edmonton.

"I think still there is a gap that needs to be better understood. I think we do need to understand whether or not there are also different risks that women may have," Ezekowitz said. "And we tried to identify a few of those, but we didn't come up with one single factor. I think it's a constellation of factors that makes it more difficult to understand."

For the study, the researchers analyzed data on more than 45,000 patients who were hospitalized for their first heart attack between 2002 and 2016 in Alberta, Canada. Nearly 31% of those patients were women.

The investigators focused on two types of heart attacks: the severe, life-threatening ST-elevation myocardial infarction (STEMI); and the less severe NSTEMI, which is more common. The study followed the patients for an average of six years.

Women were more likely to develop heart failure in the hospital or after discharge for both types of heart attack when no adjustments were made for variables, but the gap was considerably narrower for the NSTEMI patients after those adjustments, according to the study authors.

Women were an average age of 72, compared to 61 for men at the time of their first heart attacks. They also tended to have more complicated medical histories at the time of their heart attacks, including high blood pressure, diabetes, atrial fibrillation and chronic obstructive pulmonary disease (COPD). These are risk factors that contribute to heart failure.

Nearly 73% of women were seen by a cardiovascular specialist, compared to 84% of men. Women were also less likely to receive heart medicines like beta blockers or cholesterol-lowering statins, and slightly less likely to receive certain procedures to restore blood flow, such as surgical angioplasty.

The study was published online Nov. 30 in the journal Circulation.

Among the potential solutions to close the gap could be more accommodations for patients' preferences when delivering care, Ezekowitz said.

"For the longest time we've offered cardiac rehabilitation in fixed buildings. It may be more difficult for somebody who's older to attend cardiac rehabilitation than somebody who's younger because of mobility or they can't get transportation," Ezekowitz explained. "We can start to offer that in a much more bespoke model as in 'this person has these types of issues, therefore we need to offer this different type of model for them.' I think that will help more people access care and get high-quality care."

If a woman is older at the time of her heart attack, there may be some intrinsic biases by providers that certain therapies don't work as well in older people, and so some of that care may be held back, he added.

"We've got to recognize some of the gaps can be filled in by providing elder-friendly care, care that's appropriate for different ages but also making people more aware that many of our therapies work equally well in young and old people," Ezekowitz said. "We need to be very careful not to limit their therapy based on age alone."

Critically important is increasing efforts to prevent these types of heart attacks in the first place, said Dr. Gregg Fonarow, a cardiologist at the University of California, Los Angeles. This includes reducing cholesterol, controlling blood pressure, increasing exercise, stopping smoking and eating a healthy diet.

Even after a heart attack occurs, there are therapies that can lower the risk of developing heart failure or mortality after that heart attack that are cardioprotective, Fonarow added. These include ACE inhibitor and beta blocker drugs, as well as high-intensity statins.

"These therapies tend to be underutilized in women relative to men," Fonarow said. "So, there's more work that needs to be done to provide higher quality and equitable care to women in a way that will decrease their risk of complications and recurrent events, heart failure and premature cardiovascular death after an acute coronary event."

More information

The U.S. Centers for Disease Control and Prevention offers more information on heart failure.



SOURCES: Justin Ezekowitz, MD, cardiologist, Mazankowski Alberta Heart Institute, co-director, Canadian VIGOUR Centre, professor, department of medicine, division of cardiology, University of Alberta, Edmonton, Alberta, Canada; Gregg Fonarow, MD, chief, division of cardiology, University of California, Los Angeles; Circulation, Nov. 30, 2020, online

Some Talc Products Contain Asbestos: Study

MONDAY, Nov. 30, 2020 (HealthDay News) – Nearly 15% of talc-based cosmetic products analyzed in a recent study contained asbestos.

Environmental Working Group (EWG) -- an American advocacy nonprofit that commissioned the tests and did the analysis -- said methods used by the cosmetics industry to screen talc supplies are inadequate. The voluntary testing method developed by industry is not sensitive enough to screen for asbestos when compared to electron microscopy, the group said.

"Many well-known brands use talc in body and facial powders that can be inhaled," said Nneka Leiba, an EWG vice president.

She noted that EWG's online database has identified more than 2,000 personal care products that contain talc, including more than 1,000 loose or pressed powders that could pose an inhalation risk.

"It's troubling to think how many Americans have been using talc-based cosmetics products potentially contaminated with asbestos," Leiba said in an EWG news release.

The analysis was published Nov. 25 in the journal Environmental Health Insights.

The Scientific Analytical Institute conducted the tests, using electron microscopy to analyze samples. The U.S. Food and Drug Administration does not require testing talc supplies.

"It is critical that the FDA develop a rigorous screening method for talc used in personal care products," said Sean Fitzgerald, head of the Greensboro, N.C.-based institute. "The lab repeatedly finds asbestos in products made with talc, including cosmetics marketed to children. It's outrageous that a precise method for testing personal care products for the presence of asbestos exists, but the cosmetics industry isn't required to use it."

Fitzgerald's lab tested 21 samples of powder cosmetics, including eye shadow, foundation, blush, face and body powders.

Talc is often used in cosmetics as a filler or to improve texture or absorb moisture. Talc and asbestos can be formed in the same rocks that are mined for both cosmetics use and industrial use. The federal government does not require that cosmetics be tested for asbestos, instead encouraging companies to select talc mines carefully to avoid asbestos contamination, according to the study.

In May, Johnson & Johnson announced it would end the sale of its talc-based baby powder in the United States and Canada. Thousands of people have filed lawsuits against the company, claiming the product caused cancer, the study said.

"Inhaling even the tiniest amount of asbestos in talc can cause mesothelioma and other deadly diseases, many years after exposure," Tasha Stoiber, a senior scientist at EWG, said in the release. "How much talc is inhaled -- and how much is contaminated with asbestos -- is hard to know, but it only takes one asbestos fiber, lodged in the lungs, to cause mesothelioma decades later."

EWG reports that exposure to asbestos is linked to asbestosis, mesothelioma, and lung and ovarian cancer.

Based on federal data, the EWG Action Fund estimates that up to 15,000 Americans die each year from asbestos-triggered disease.

In March 2019, Congresswoman Debbie Dingell (D-Mich.), introduced legislation that would require warning labels on cosmetics that could contain asbestos and are marketed to children.

EWG called for Congress to pass legislation mandating rigorous testing of talc-based personal care products.

More information

The U.S. Environmental Protection Agency has more information on asbestos.

SOURCE: Environmental Working Group, news release, Nov. 25, 2020

Fauci Warns of Another Surge of COVID Cases After Thanksgiving Travel

MONDAY, Nov. 30, 2020 (HealthDay News) -- After millions of Americans chose to travel for Thanksgiving, Dr. Anthony Fauci warned on Sunday that a "surge superimposed upon" a surge of coronavirus cases will likely follow.

As the number of coronavirus-related deaths per day rose to its highest point since April, Fauci and other public health officials stressed the importance of wearing masks and practicing social distancing, the Washington Post reported.

"It's going to get worse over the next several weeks, but the actions that we take in the next several days will determine how bad it is or whether or not we continue to flatten our curve," U.S. Surgeon General Jerome Adams told Fox News.

White House coronavirus task force coordinator Deborah Birx told CBS News that the number of coronavirus cases is "three, four and 10 times" as high as it was during the pandemic's second surge after Memorial Day weekend.

"It looked like things were starting to improve in our northern plain states, and now with Thanksgiving, we're worried that all of that will be reversed," Birx said.

The number of coronavirus-related deaths are nearing record levels in the United States and roughly 95,000 people are currently hospitalized with the disease, Adm. Brett Giroir, assistant secretary of health and human services, told CNN. Roughly 20 percent of all hospitalized people have COVID-19, he added.

As for the future, "we really have to see what this weekend looks like. I can't really project that," Giroir told CNN.

In a bit of good news, the first wave of vaccinations are expected to begin for targeted groups in a matter of weeks, the Post reported.

The U.S. Centers for Disease Control and Prevention advisory committee on immunization practices will meet Tuesday to vote on coronavirus vaccine priority rankings. Health-care workers are likely to be the first to receive the vaccine once it has been approved, the Post reported. Priority is also likely to be given to nursing home residents and staff, followed by other vulnerable populations. Giroir predicted that the United States should have enough vaccine to immunize 20 million Americans by the end of the year.

"We have to immunize for impact," he said. "The rest of America will get it in the second quarter, third quarter of 2021, but we can maximize our impact right now."

Moderna to request emergency approval for its vaccine

Meanwhile, Moderna said it would apply on Monday for emergency use authorization of its coronavirus vaccine and the first shots could be given as early as Dec. 21, The New York Times reported.

Moderna's application is based on data showing that its vaccine is 94.1 percent effective, and that its study of 30,000 people has met the scientific criteria needed to determine whether the vaccine works. The finding from the complete set of data is in line with earlier data that found the vaccine to be 94.5 percent effective, the Times said.

Not only that, the vaccine was 100 percent effective at preventing severe disease from the coronavirus, Moderna officials said. The product was developed in collaboration with government researchers from the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases.

The company is "on track" to produce 20 million doses by the end of December, and 500 million to a billion in 2021, the newspaper reported. Each person requires two doses, administered a month apart, so 20 million doses will be enough for 10 million people.

Earlier this month, Pfizer asked the U.S. Food and Drug Administration for the same emergency use approval. Pfizer has said it can produce up to 50 million doses this year, with about half going to the United States, the Times reported. Its vaccine also requires two doses per person.

A global scourge

By Monday, the U.S. coronavirus case count passed 13.4 million while the death toll neared 267,000, according to a Times tally. According to the same tally, the top five states in coronavirus cases as of Monday were: Texas and California with just over 1.2 million cases each; Florida with over 992,600; Illinois with more than 721,000; and New York with almost 646,000.

Curbing the spread of the coronavirus in the rest of the world remains challenging.

Many European countries are tightening restrictions, the Associated Press reported. France has entered a nationwide lockdown, and Germany and Austria have started partial lockdowns as government officials across the continent scramble to slow a sharp rise in infections that threatens to overwhelm their health care systems.

England has followed suit, while Italy, Greece and Kosovo also announced new measures, the AP reported.

Things are no better in India, where the coronavirus case count has passed 9.4 million on Monday, a Johns Hopkins University tally showed. More than 137,000 coronavirus patients have died in India, according to the Hopkins tally, but when measured as a proportion of the population, the country has had far fewer deaths than many others. Doctors say this reflects India's younger and leaner population. Still, the country's public health system is severely strained, and some sick patients cannot find hospital beds, the Times said. Only the United States has more coronavirus cases.

Meanwhile, Brazil passed 6.3 million cases and had nearly 173,000 deaths as of Monday, the Hopkins tally showed.

Worldwide, the number of reported infections neared 63 million on Monday, with more than 1.4 million deaths recorded, according to the Hopkins tally.

More information

The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.

SOURCES: The New York Times; Washington Post; Associated Press

Health Highlights, Nov. 30, 2020


Below are newsworthy items compiled by HealthDay staff:


Biden Fractures Foot Playing With His Dog


President-elect Joe Biden Jr. suffered a hairline fracture in his foot that will have him wearing a walking boot for several weeks, The New York Times reported Sunday.

The injury occurred when he slipped while playing with one of his dogs, Major, a German shepherd. An X-ray showed no fracture, but a "follow-up CT scan confirmed hairline [small] fractures of President-elect Biden's lateral and intermediate cuneiform bones, which are in the midfoot," Dr. Kevin O'Connor, the director of executive medicine at GW Medical Faculty Associates, said in a statement.

Biden went to an orthopedist in Newark, Del., on Sunday and then to an imaging center.

President Trump, who has refused to concede to Biden, retweeted an NBC News video of Biden leaving the doctor's office, and added, "Get well soon!," the Times reported.

COVID in Kids: The Most Telling Symptoms

MONDAY, Nov. 30, 2020 (HealthDay News) -- Among thousands of kids tested for COVID-19, an upset stomach, loss of taste/smell, fever and headache were symptoms most predictive of positive test results, a Canadian study found.

But one-third of children and teens with the coronavirus showed no symptoms, the researchers noted.

"Because more than one-third of pediatric patients who test positive for SARS-CoV-2 infection exhibit no symptoms, identifying children who are likely to be infected is challenging. Indeed, the proportion of asymptomatic SARS-CoV-2 infections in children is likely much higher than we have reported, given the likelihood that many would not present for testing," Dr. Finlay McAlister, of the University of Alberta, Edmonton, and co-authors said.

Cough and a runny nose were also frequent among kids who tested positive, but the investigators said those same complaints were common among kids who tested negative and couldn't be considered tell-tale signs of COVID-19 infection.

"Many other influenza-like symptoms (such as cough, [runny nose] and sore throat) were as common, or more common, in children testing negative for SARS-CoV-2," and thus had limited predictive value for detecting COVID-19 in children," the authors wrote in the Nov. 24 issue of the CMAJ (Canadian Medical Association Journal).

The findings suggest that "administrators of screening questionnaires for schools or daycares may wish to consider reassessing the symptoms they screen for to include only those that are most strongly associated with positive results for swabs for SARS-CoV-2 infection," the researchers reported.

For the study, they assessed symptoms among more than 2,400 children in the province of Alberta, Canada, who were tested for the coronavirus between April 13 and Sept. 30, 2020.

Loss of smell/taste was seven times higher in kids with COVID-19; upset stomach was five times more likely, and headache was twice as likely, the investigators found. Fever was 68% more likely in kids with a positive test result.

In kids with loss of smell/taste combined with headache and upset stomach, the odds of a positive test were 65 times higher compared to children and teens without that cluster of symptoms, according to the study.

Children 4 years and younger were more likely to test negative, and teens aged 13 to 17 were more likely to test positive, the team said in a journal news release.

"Given the high proportion of children with SARS-CoV-2 who remain asymptomatic, it is unlikely that any symptom screening strategy will prevent every child with SARS-CoV-2 infection from entering school," Dr. Nisha Thampi, an infectious diseases pediatrician at Children's Hospital of Eastern Ontario, and colleagues wrote in an accompanying editorial.

"Therefore, school-based health and safety measures beyond screening -- including physical distancing, hand hygiene, masking, improved ventilation and outdoor learning opportunities -- play an essential role in preventing the spread of infection in this setting," Thampi and colleagues added.

More information

For more on children and COVID-19, visit the U.S. Centers for Disease Control and Prevention.

SOURCE: CMAJ (Canadian Medical Association Journal), news release, Nov. 24, 2020

One Type of Injury Should Raise Red Flag for Domestic Violence

MONDAY, Nov. 30, 2020 (HealthDay News) – As many as one-third of adult women who have a particular fracture to their forearms may be victims of intimate partner violence, according to a new study.

The findings underscore the need to screen women who receive fractures to their ulna for possible intimate partner violence, researchers said. That includes those who say they were injured in a fall.

The ulna is the bone on the pinkie side of the forearm. Fractures to it often occur as people hold up their hands to protect their faces from being struck with an object.

"I never correlated it with intimate partner violence until recently. I shared my thoughts with our orthopedic surgeons and, with their interest and support, decided to pursue the study," said senior author Dr. Bharti Khurana, director of emergency musculoskeletal radiology at Brigham and Women's Hospital in Boston.

The researchers searched electronic records for these fractures in 18- to 50-year-old women at six hospitals. They found 62 patients (average age: 31) who had these fractures. Twelve had confirmed cases of intimate partner violence. Eight were suspected of intimate partner violence.

The findings are to be presented at a virtual meeting of the Radiological Society of North America, which continues through Dec. 5.

"The radiological characteristics we were looking at were the location of the fracture, the pattern of the fracture in terms of how it broke, and the displacement of the fracture," said study lead author Dr. David Sing, an orthopedic surgery resident at Boston Medical Center.

"Out of all those things, what we usually saw was a minimally displaced fracture, meaning the bone is broken all the way through but has not shifted significantly," he said in a meeting news release.

Confirmed cases were also linked with homelessness and previous emergency room visits with musculoskeletal injuries.

All the study patients who were not confirmed or suspected to be victims of intimate partner violence had fractures that came from motor vehicle accidents or other mishaps such as crashing into a tree while skiing. Four of the eight patients suspected of being victims of violence said they had fallen. Khurana noted that falls are more likely to result in a fracture to the radius, the other forearm bone.

The study found that formal violence screening was only completed in about 40% of the confirmed or suspected cases.

Researchers suggested that radiologists who see the fractures in their patients can let the emergency department physician or orthopedic surgeon know that the fracture is often seen in intimate partner violence. The ordering physician can then look at the patient's clinical history to see if there is anything suspicious.

In the study, historical imaging analysis alone was able to raise suspicion in 75% of clinically confirmed cases of intimate partner violence.

"Careful analysis of previous imaging exams may also help radiologists confirm their suspicion of intimate partner violence," said study co-author Dr. Rahul Gujrathi, a radiology fellow at Brigham and Women's Hospital, who noted that during COVID-19 lockdowns the rate of intimate partner violence has gone up with people trapped at home with their abusers.

Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

More information

The National Domestic Violence Hotline can be reached at 800-799-SAFE (7233) and more information is available at its website.

SOURCE: Radiological Society of North America, news release, Nov. 30, 2020

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