Medical Bulletin 18/ November/ 2024
Here are the top medical news for the day:
Exposure to Antiseizure Medication Inutero May Lead to Neurodevelopmental Risks in Children
Children born to mothers who take antiseizure medications to manage seizures and psychiatric conditions during pregnancy may face increased risks of neurodevelopmental conditions, according to new data from researchers at Drexel’s Dornsife School of Public Health. The findings were published in the journal Nature Communications.
The current work -- using data from more than three million children from the United Kingdom and Sweden, including 17,495 who were exposed to antiseizure medications during pregnancy -- found that children exposed to the antiseizure drug lamotrigine in utero were at no additional risk for autism or intellectual disability compared with those exposed to other antiseizure medications. However, children exposed to valproate, topiramate, and carbamazepine were linked to specific neurodevelopmental issues. However, the absolute risk of neurodevelopmental outcomes in offspring is low, the researchers caution, regardless of antiseizure drug regimen. Compared to children unexposed to antiseizure medications, those exposed to the drug topiramate during pregnancy were 2.5 times more likely to be diagnosed with intellectual disability, which raises their risk to 2.1% by age 12. In comparison with other drugs available, the authors found very little data suggesting that the drug lamotrigine in pregnancy increases the risk of neurodevelopmental issues in offspring.
According to the researchers, the data does not argue against use of antiseizure medications in patients who benefit, but rather encourages these patients to have a conversation with their doctor to determine if their course of treatment is most appropriate for them.
The study utilized data on drug prescriptions in the United Kingdom, and dispensation and self-reported data on drug use in Sweden, as well as electronic health records data for diagnoses. The authors conducted a sibling analysis to help minimize the influence of other factors, such as severity of diagnosis and underlying genetics, that may influence the results.
Reference: Madley-Dowd, P., Ahlqvist, V.H., Forbes, H. et al. Antiseizure medication use during pregnancy and children’s neurodevelopmental outcomes. Nat Commun 15, 9640 (2024). https://doi.org/10.1038/s41467-024-53813-1
Study in Nature to Reduce Emotional Distress
A new study found that spending two hours a week of class time in a natural environment can reduce emotional distress among 10- to 12-year-olds who had the most significant mental health problems before the program began.
The research comes on the heels of the publication of a UNICEF report pointing to the importance of green space for children’s development.
The study published this week in JAMA Network Open, looked at the effects of spending time in nature on the behaviour and mental health symptoms of over 500 schoolchildren across Quebec in the spring of 2023.
The researchers found that at the end of a three-month period, teachers noted that the biggest changes in behaviour occurred in children with the most significant problems at the outset, including anxiety and depression, aggressivity and impulsivity, or social problems relating to interaction with their peers. Interviews with the teachers following the intervention also suggested that children were more calm, relaxed and attentive in class after time spent in nature. The research builds on earlier observational studies but is the first to use a randomized controlled trial to provide concrete information about the benefits to children of spending time in nature.
Including the members of the control group, approximately 1,000 children took part in the study. All were between the ages of 10 and 12 years and in grades five or six. They came from 33 different elementary schools in neighbourhoods representing a range of socioeconomic statuses and scattered around Quebec. All schools were within one kilometre of a park or green space. Half of the children stayed in school, while a similar number of children took part in the nature-based intervention.
To be able to measure changes in behaviour over the three-month period, students and teachers in the control group and the nature-intervention group were asked to fill out short questionnaires. These were designed to measure children’s emotional and behavioural difficulties, as well as their strengths.
During the two hours they spent in the park each week, teachers were asked to offer their regular classes in subjects such as math, languages or science. In addition, they were asked to incorporate a short 10-15-minute activity designed to promote mental health, with examples drawn from a teachers’ kit designed by the research team. The activities included things like drawing a tree or a mandala, writing haikus, mindful walking, talking about cycles of life and death in nature, and so on.
Reference: Loose T, Fuoco J, Malboeuf-Hurtubise C, et al. A Nature-Based Intervention and Mental Health of Schoolchildren: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2024;7(11):e2444824. doi:10.1001/jamanetworkopen.2024.44824
Sitting more Than 10 Hours May Put Heart Health at Risk
More time spent sitting, reclining or lying down during the day may increase the risk of cardiovascular disease (CVD) and death, according to a study in JACC, the flagship journal of the American College of Cardiology, and presented at the American Heart Association’s Scientific Sessions 2024. More than roughly 10-and-a-half hours of sedentary behavior per day was significantly linked with future heart failure (HF) and cardiovascular (CV) death, even among people meeting recommended levels of exercise.
“Our findings support cutting back on sedentary time to reduce cardiovascular risk, with 10.6 hours a day marking a potentially key threshold tied to higher heart failure and cardiovascular mortality,” said Shaan Khurshid, MD, MPH, a cardiologist at the Massachusetts General Hospital and co-senior author of the study. “Too much sitting or lying down can be harmful for heart health, even for those who are active.”
This study examined the amount of sedentary time at which Cardiovascular disease risk is greatest and explored how sedentary behavior and physical activity together impact the chances of atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI) and cardiovascular mortality.
Among the 89,530 study participants of the UK biobank, the average age was 62 years and 56.4% were women. Participants submitted data from a wrist-worn triaxial accelerometer that captured movement over seven days. The average sedentary time per day was 9.4 hours.
After an average follow-up of eight years, 3,638 individuals (4.9%) developed incident atrial fibrillation, 1,854 (2.1%) developed incident heat failure, 1,610 (1.84%) developed indecent myocardial infarction and 846 (0.94%) died of cardiovascular causes, respectively.
The effects of sedentary time varied by outcome. For atrial fibrillation and myocardial infarction, the risk increased steadily over time without major shifts. For heart failure and cardiovascular mortality, increase in risk was minimal until sedentary time exceeded about 10.6 hours a day, at which point risk rose significantly, showing a “threshold” effect for the behavior.
For study participants who met the recommended 150 minutes of moderate-to-vigorous physical activity or more, the effects of sedentary behavior on atrial fibrillation and myocardial infarction risks were substantially reduced, but effects on higher risk of heart failure and cardiovascular mortality remained prominent.
Reference: Ajufo, E., Kany, S., Ramo, J., Churchill, T., Guseh, J., Aragam, K., ... & Khurshid, S. (2024). Accelerometer-Measured Sedentary Behavior and Future Cardiovascular Disease. Circulation, 150(Suppl_1), A4124709-A4124709.
Can Heart Shape Predict Risk for Cardiovascular Diseases?
A new multi-national study has revealed that the shape of the heart is influenced in part by genetics and may help predict the risk of cardiovascular diseases.
Researchers are first to examine the genetic basis of the heart's left and right ventricles using advanced 3D imaging and machine learning.
By studying both ventricles together, the team was able to capture the more intricate, multi-dimensional aspects of the heart shape.
This new approach of exploring shape has led to the discovery of new heart-associated genes and provided a better understanding of the biological pathways linking heart shape to cardiovascular disease.
Genetic information related to heart shape can provide a risk score for heart disease, offering potentially early and more tailored assessment in clinical settings.
The team used cardiovascular MRI images from over 40,000 individuals from the UK Biobank, a large-scale biomedical database and research resource containing genetic and health information from half a million UK participants, to create 3D models of the ventricles.
Through statistical analysis, they identified 11 shape dimensions that describe the primary variations in heart shape.
Subsequent genetic analysis found 45 specific areas in the human genome linked to different heart shapes.
Fourteen of these areas had not been previously known to influence heart traits.
This study sets an important foundation for the exploration of genetics in both ventricles," said Dr Richard Burns, Statistical Geneticist at Queen Mary.
"The study confirms that combined cardiac shape is influenced by genetics, and demonstrates the usefulness of cardiac shape analysis in both ventricles for predicting individual risk of cardiometabolic diseases alongside established clinical measures."
Reference: https://www.qmul.ac.uk/whri/news-and-events/2024/items/new-research-shows-relationship-between-heart-shape-and-risk-of-cardiovascular-disease.html
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