Medical Bulletin 13/ November/ 2024
Here are the top medical news for the day:
Can Heart Medicine Lead to Depression?
All patients who have had a heart attack are typically treated using beta blockers. According to a Swedish study conducted earlier this year, this drug is unlikely to be needed for those heart patients who have a normal pumping ability. Now a sub-study at Uppsala University shows that there is also a risk that these patients will become depressed by the treatment.
“We found that beta blockers led to slightly higher levels of depression symptoms in patients who had had a heart attack but were not suffering from heart failure. At the same time, beta blockers have no life-sustaining function for this group of patients,” says Philip Leissner, a doctoral student in cardiac psychology and the study’s first author.
The researchers wanted to look at the side effects of beta blockers, that is, whether they affect anxiety and depression levels. Earlier this year, a major national study was conducted in Sweden, which found that those who received beta-blocking drugs were not protected from relapse or death compared to those who did not receive the drug. Leissner and his colleagues based their research on these findings and conducted a sub-study. It ran from 2018 to 2023 and involved 806 patients who had had a heart attack but no problems with heart failure. Half were given beta blockers and the other half were not. About 100 of the patients receiving beta blockers had been taking them since before the study, and the researchers observed more severe symptoms of depression in them.
“Most doctors used to give beta blockers even to patients without heart failure, but as the evidence in favour of doing so is no longer so strong, this should be reconsidered. We could see that some of these patients appear to be more at risk of depression. If the drug doesn’t make a difference to their heart, then they are taking it unnecessarily and at risk of becoming depressed,” adds Leissner.
References: Philip Leissner, Katarina Mars, Sophia Humphries, Patric Karlström, Troels Yndigegn, Tomas Jernberg, Robin Hofmann, Claes Held, Erik M G Olsson, Short- and long-term effects of beta-blockers on symptoms of anxiety and depression in patients with myocardial infarction and preserved left ventricular function: a pre-specified quality of life sub-study from the REDUCE-AMI trial, European Heart Journal. Acute Cardiovascular Care, 2024;, zuae112, https://doi.org/10.1093/ehjacc/zuae112
Switch from Smoking to Vaping to Improve Respiratory Health: Study Finds
A new paper in Nicotine and Tobacco Research, published by Oxford University Press, finds that people who switch from smoking cigarettes to vaping see improved respiratory health, but people who begin consuming electronic cigarettes while continuing to smoke regular cigarettes do not report improved respiratory symptoms.
Vaping reduces exposure to toxic chemicals but it has been unclear whether switching from cigarettes to e-cigarettes results in a reduction of the respiratory problems—like wheezing and coughing—common in regular cigarette smokers. Researchers here used data from the Population Assessment of Tobacco and Health (PATH) study, a national longitudinal measure of tobacco use in the United States performed by the National Institutes of Health. The investigators here observed adult participants between 2013 and 2019 who reported smoking cigarettes exclusively at the beginning of the investigation and reported a baseline cough or wheeze.
The researchers divided the subjects into four groups: those who transitioned from exclusive cigarette smoking to quitting nicotine altogether, those who switched from cigarette smoking to vaping exclusively, those who continued to smoke cigarettes only, and those who kept smoking and also began vaping.
Completely switching from cigarettes to e-cigarettes led to a moderate increase in the resolution of wheeze symptoms compared with persistent smoking. However, there were lower rates of respiratory symptom resolution among those transitioning to vaping while maintaining or increasing their smoking. Among 5,210 subjects with a baseline cough, 3,362 (65%) saw their coughs go away. Of the 5,367 people who reported a baseline wheeze, the researchers observed that 2,862 (53%) saw improvements. Switching from cigarettes to e-cigarettes exclusively resulted in significantly reduced wheezing but not cough resolution. Transitioning to both smoking and vaping was not associated with respiratory improvement overall or even among participants who reduced their cigarette smoking intensity.
The researchers note that the rates of symptom resolution were 14% lower for cough and 15% lower for wheeze among those who switched to dual use and maintained or increased their smoking intensity; those who started using electronic cigarettes while continuing to smoke the same number of regular cigarettes saw their wheeze and coughing get worse. Switching from smoking cigarettes to quitting nicotine altogether was, perhaps unsurprisingly, associated with the best improvements in both coughs and wheezing.
Reference: Jonathan B Berlowitz, Wubin Xie, Alyssa F Harlow, Hasmeena Kathuria, Emelia J Benjamin, Andrew C Stokes, Association of Cigarette–E-Cigarette Transitions With Respiratory Symptom Resolution, Nicotine & Tobacco Research, 2024;, ntae224, https://doi.org/10.1093/ntr/ntae224
Researchers Highlight the Best Time for RSV Vaccine During Pregnancy
Current guidelines recommend that pregnant people receive a vaccine against respiratory syncytial virus (RSV)—which typically causes mild, cold-like symptoms in most adults but can be deadly for infants—during weeks 32–36 of pregnancy. New research led by investigators at Mass General Brigham suggests that vaccination earlier in that timeframe, closer to 32 weeks, could provide the best protection for newborns against RSV. The findings are published in the American Journal of Obstetrics & Gynecology.
To assess whether maternal vaccine timing is an important consideration for RSV vaccination, the investigators measured RSV antibodies in the umbilical cord at the time of delivery among 124 women who received the RSV vaccine during weeks 32–36 of pregnancy and in the blood of 29 2-month-old infants of these mothers. All study participants were receiving care at Massachusetts General Hospital or Mount Sinai Health System in New York City. Levels of RSV antibodies can predict protection against RSV infection in infants too young to yet receive their own vaccines.
The investigators found that maternal RSV vaccination at least 5 weeks prior to delivery led to the most efficient transfer of maternal antibodies across the placenta to the newborn, compared with maternal vaccination at 2-3 or 3-4 weeks prior to delivery. In an additional analysis, RSV antibody levels in maternal and cord blood after RSV vaccination were compared with RSV antibody levels in 20 unvaccinated mothers. Maternal RSV vaccination resulted in significantly higher and longer-lasting maternal and cord RSV antibody levels.
This study was designed to measure antibody transfer, but larger studies of infants 2 to 6 months of age will be needed to determine the extent to which this leads to enhanced protection.
Reference: JASSET, O. J., ZAPANA, P. A. L., BAHADIR, Z., SHOOK, L., DENNIS, M., GILBERT, E., ... & EDLOW, A. G. (2024). Enhanced placental antibody transfer efficiency with longer interval between maternal RSV vaccination and birth. American Journal of Obstetrics and Gynecology.
Consistent Bedtime Sleep May Lead to Better Child Emotion
A study published in the Journal of Developmental and Behavioral Pediatrics, showed that children who followed a consistent bedtime routine and fell asleep at the same time each night displayed better control of their emotions and behavior when they were under stress or working with others. Researchers analyzed sleep and behavior data from 143 six-year-old children in the Penn State study.
When children in the longitudinal INSIGHT study were newborns, their mothers received training in responsive parenting, which involves responding to a child’s emotional and physical needs in a warm, timely and consistent manner. The new analysis from the study demonstrates continued benefits of regular sleep timing.
“Children who had consistent bedtimes were generally able to regulate their behavior and emotions,” Dadzie, doctoral student in biobehavioral health, said. “On the other hand, children whose bedtimes and sleep times were all over the place showed more impulsivity and less control.”
Children in the study wore a monitor on their wrist for seven days to measure their nighttime sleep and activity. The devices monitored multiple aspects of sleep — time the child fell asleep, time the child woke in the morning, the midpoint of sleep timing, how efficiently the child remained asleep and the total amount of sleep the child got each night.
These data were compared to the child’s performance on a task designed to see how they responded to frustration. Each child selected a toy that they wanted to play with from a large selection. The chosen toy was placed in a clear box and locked. The child was given a set of keys, none of which unlocked the box. The researchers then observed the child for self-regulated behavior — including self-talk and trying each key — and a lack of self-regulation — including throwing the keys without trying them all. After four minutes, the researchers returned with a working key and allowed the child to play with the toy.
The researchers also watched the children decorate a picture frame with their parents. Children’s behavior was identified as prosocial if they engaged in cooperative activities like sharing and cooperation or antisocial if they destroyed craft supplies or talked back to their parents. Results showed that the more a child’s bedtime varied each night, the worse they regulated their behavior and emotions.
Reference: Dadzie, Adwoa BS*; Master, Lindsay MAS*; Hohman, Emily E. PhD†; Acton, Erika Hernandez PhD‡; Tauriello, Sara MS§; Paul, Ian M. MD, MSc║; Savage, Jennifer S. PhD†,¶; Anzman-Frasca, Stephanie PhD§,**; Buxton, Orfeu M. PhD*. Associations Between Sleep Health and Child Behavior at Age 6 Years in the INSIGHT Study. Journal of Developmental & Behavioral Pediatrics ():10.1097/DBP.0000000000001326, November 8, 2024. | DOI: 10.1097/DBP.0000000000001326
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