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• The CDC issued an advisory warning doctors and public health authorities to be vigilant as cases of dengue fever rise globally.
• Dengue is transmitted by the Aedes mosquito, and there is no cure. Severe cases, which are rare, can be life threatening.
• As global temperatures rise, experts and the CDC expect the mosquitoes’ territory to expand and dengue cases to increase.

As cases of dengue fever rise worldwide, the Centers for Disease Control and Prevention (CDC) issued an advisory for physicians, public health authorities, and the public in the United States to be alert to the trend.  

So far in 2024, cases of dengue fever in countries in the Americas have reached record-breaking levels, with more than 9.7 million reported cases — twice the number for the entire year in 2023 (4.6 million). Puerto Rico declared a public health emergency in March after the World Health Organization declared one in December 2023.

In the mainland U.S., 745 cases have been identified in travelers in the first six months of the year, which is higher than normal. There are no vaccines for anyone who has not previously had a dengue infection, and there is one vaccine for children between the ages of 9 and 16 who have been infected, but the manufacturer has discontinued production due to a lack of demand. In Puerto Rico, for example, available doses are expected to expire in 2026.

There are four strains of dengue, all carried by the Aedes mosquito, which generally lives in tropical and subtropical regions. The hotter and wetter months of the year are typically when cases of dengue peak, but as global temperatures rise, the CDC says, cases will most likely increase each year.

What does dengue fever look like?

Symptoms depend on the severity of the disease. Around 75% of people with dengue fever will not experience symptoms.

Mild symptoms may include a sudden fever of around 104°F (40°C) and one or more of the following:

• aching muscles and joints
• rash
• pain behind the eyes
• nausea and vomiting
• facial flushing
• sore throat
• headache
• red eyes

Symptoms usually last between 2–7 days, and most people feel better after one week. The fever typically persists for at least 24 hours and may spike again.

Between 0.5% and 5% of cases become severe and can be life threatening.

In this instance, the fever typically falls to 99.5 to 100.4°F (37.5 to 38°C). Anywhere between a day and a week later, additional symptoms include:

• abdominal pain or tenderness
• vomiting at least three times in 24 hours
• bleeding from the nose or gums
• vomiting blood
• blood in the stool
• fatigue
• feeling restless or irritable
• changes in temperature from very hot to very cold
• cold, clammy skin
• a weak and rapid pulse
• a reduced difference between systolic and diastolic blood pressure

Who is at risk for dengue fever?

There are currently four known strains of the Dengue virus, and there is no cure, so essentially, anyone bitten by a mosquito carrying the virus could catch it.

Dr. David Cutler, MD, board certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, told Healthline that those at highest risk of severe dengue, which can result in death, are infants under 1, pregnant people, adults over 65, or those with underlying medical conditions like hypertension, diabetes, asthma, chronic kidney disease, chronic liver disease, peptic ulcer disease or other gastritis, obesity, or anyone receiving anticoagulation medications.

“Treating dengue requires supportive care as there is no cure for this disease. Monitoring fever, hydration status and blood tests are important for detecting any signs of the disease becoming critical. Controlling fever, preventing dehydration and restricting disease spread through mosquito control are the most important measures to managing dengue,” said Dr. Cutler.

“Preventing [the] spread of disease, especially in young children, requires that everyone sleep under a mosquito net. Insect repellents are also an important preventive measure. Emptying and cleaning standing water containers deprives mosquitoes of places to breed. Screens on windows and doors will help prevent mosquitoes from entering the home,” Dr. Cutler explained.

Dr. Jessica Tuan, MD, an infectious diseases specialist at Yale Medicine, told Healthline that traveling to areas where dengue is most prominent also puts people at risk for exposure.

“Those who have traveled to dengue-endemic areas are at highest risk for acquiring dengue. Dengue is endemic in tropical areas including Africa, the Americas, Southeast Asia, Eastern Mediterranean region, and the Western Pacific. Areas with frequent or continuous dengue transmission include Puerto Rico, U.S. Virgin Islands, American Samoa, Republic of Marshall Islands, Federated States of Micronesia, Republic of Palau,” Dr. Tuan said.

“Take measures to prevent mosquito bites, including using mosquito repellent, for those traveling to or living in dengue-endemic areas. The Advisory Committee on Immunization Practices recommends the dengue vaccine, Dengvaxia, for children 9–16 years old with prior laboratory-confirmed dengue virus infection and living in areas with frequent or continuous dengue transmission,” she added.

Can dengue mutate like the coronavirus?

Dr. James Shepherd, MD, an infectious diseases specialist at Yale Medicine, told Healthline that the dengue virus cannot mutate the way the COVID-19 virus has simply because there’s no cure for it.

“As there is no treatment there is no selection for treatment resistance. Is that a possibility in the near future? Not without development of new treatments to select resistance. There may be selection by human and mosquito host factors and evolution of viral pathogens is a natural process but there are no significant changes in the virus correlating with human disease that I am aware of,” Dr. Shepherd said.

Dr. Shepherd added that as the CDC expects more cases of dengue due to rising global temperatures, finding some sort of antiviral medication might be possible.

“As Aedes mosquitoes spread northwards with rising global temperatures dengue outbreaks are becoming more common in more temperate, richer countries and this presents a greater incentive for drug companies to spend on new antiviral drug development,” Dr. Shepherd said.

• A new study has found that Wegovy helped women lose more weight than men.
• Metabolism, fat patterns, social pressures, or genetics might explain the difference.
• However, both experienced the same improvement in heart failure symptoms.
• It is thought that obesity might cause the type of heart failure studied.
• Experts say Wegovy could potentially reduce women’s risk of death from heart disease.

A new study published in the Journal of the American College of Cardiology found the GLP-1 drug Wegovy (semaglutide) helped females living with heart failure with preserved ejection fraction (HFpEF) lose more weight than their male counterparts.

Heart failure is a medical condition in which the heart can no longer pump blood as efficiently as it should. Those with HFpEF have hearts that pump normally but are stiff, so they can’t function the way they should.

There is growing evidence that HFpEF is caused by obesity. However, females have a greater risk of developing this condition.

The study also reported that while females lost more weight, both males and females experienced about the same improvement in their heart failure symptoms.

Wegovy causes greater weight loss but not more benefit

The study, which included two trials, involved 1,145 people with HFpEF. Some had diabetes, while others did not.

About half the study participants were females. Upon analysis of the data, it was found that they had a higher body mass index (BMI) as well as worse heart failure symptoms.

They were also less likely to have abnormal heart rhythm or coronary artery disease in comparison to the males.

People in the study were given either 2.4 milligrams of Wegovy or a placebo once per week. This treatment extended over a period of one year (52 weeks).

The researchers reported that the females lost a larger percentage of their body weight over the course of the study (9.6% versus 7.2%),

However, the benefits to their heart failure symptoms appeared to be virtually the same. Both males and females improved by about 7.5 points on a 100-point scale.

According to reporting by Reuters, the scientists found this outcome to be “surprising” since they expected to see greater improvements in symptoms with more weight loss.

Why Wegovy might help females lose more weight

Dr. John Lowe, a Physician at Restore Care, commented on the study, saying that this difference between the sexes could be explained by metabolism as well as hormonal profiles.

“As a general rule, females have more fat in their bodies, and it is distributed in a different way, which may respond to the mechanisms of action of this medication better,” he said.

Lowe went on to point out that research has shown that females often react differently in weight loss trials due to “diverse prompting factors and social pressures.”

“[T]hese factors could increase the chances of adherence to treatment protocols and lifestyle changes, thus enhancing this drug’s effectiveness,” he suggested.

Lowe added that pharmacogenomics studies show that genetic variations can also affect how individuals react to a medication. This might account for the differences, he said.

How Wegovy might reduce the risk of heart disease in females

Dr. Michael O. McKinney, a physician and nutritionist with Healthy Outlook, commented on the study, saying that obesity is a major risk factor for developing cardiovascular disease.

Additionally, heart disease is the leading cause of death for males and females.

“Wegovy could play a central role in mitigating this risk through weight reduction for women suffering from obesity,” he said. “Losing weight helps to mitigate several cardiovascular risk factors such as decreased blood pressure levels, cholesterol and inflammation.”

McKinney went on to discuss the fact that weight loss in females living with obesity and heart disease can improve the management of their condition as well as reverse some of the consequences of carrying excess pounds.

“[I]f it works better in women than men, then Wegovy could be an amazing strategy for such patients toward effective control of their body weight, thereby reducing the chances of them having heart problems in the future,” he said.

McKinnney further described the findings of the study as “promising,” especially for females in at-risk groups.

“This means that targeting efficient strategies toward achieving what would optimize female physiological functions will highly contribute to a better health system by reducing mortality rates due to heart disease among women,” he concluded.

Takeaway

A new study has found that females with obesity and heart failure with preserved ejection fraction lost more weight than males when using the GLP-1 drug Wegovy.

Both males and females experienced improvements in their heart failure symptoms. However, neither group did better than the other.

Experts say the differences in weight loss between males and females could be due to variations in metabolism, fat distribution, social pressures, or genetics.

However, given the fact that females living with obesity are more prone to this type of heart disease and heart disease is the number one killer for all people, Wegovy has the potential to help reduce the risk of heart disease-related death.

• Many Americans 60 years and older still take aspirin for the primary prevention of cardiovascular disease, even though guidelines have changed.
• Aspirin can put individuals at an increased risk of bleeding and anemia and is not right for everyone.
• In the last five years, guidelines for aspirin and primary CVD prevention have shifted, but many Americans still appear unaware of them.

Older adults are still likely to take a daily, low dose aspirin for the primary prevention of cardiovascular disease, even though doing so carries significant risks.

Using aspirin to ward off heart attack and stroke used to be a no-brainer. Doctors previously recommended it for both primary and secondary prevention of cardiovascular disease.

However, following the results of three major aspirin trials in 2018, guidance around aspirin has shifted. It is generally no longer recommended for individuals who have not had a heart attack or stroke. However, it is still recommended for patients who have already experienced a cardiovascular event and are trying to prevent another from occurring.

Aspirin no longer carries a blanket recommendation because of the potential risks it carries, particularly bleeding risk and anemia. 

Both the American Heart Association and the United States Preventive Services Taskforce have changed their guidelines in recent years to indicate that aspirin isn’t right for all patients and does carry risks. Despite these changes, new data reveals that many Americans who should not be taking daily aspirin still are, particularly those at the highest risk for harm.

In a research letter published in the Annals of Internal Medicine, researchers found that 18.5 million Americans aged 60 or older, about one in three, were still using aspirin for primary prevention of CVD. Many of them, about 3.3 million, were doing so without medical advice.

“This practice was supported by evidence prior to 2018. It naturally takes some time for new data to percolate and reach physicians and patients and for these to translate into changes in management. Potentially, there may also be a component of lack of awareness and hesitancy to change medical management,” Mohak Gupta, MD, a Cardiology Fellow at Houston Methodist Hospital and First Author of the letter, told Healthline.

Older Americans continue to take aspirin

Gupta’s research utilized self-reported health data between 2012 and 2021. The sample of 186,425 American adults is a snapshot of the US population, representative of roughly 150 million people. More than half the participants were women, and about one-third were non-white.

Compared to ten years ago, fewer adults are using aspirin for the primary prevention of CVD, but the number is still high. The number of adults without CVD who reported using aspirin was 14.4%, down from 20.6% in 2021.

However, when stratified by age, a different picture emerges: for adults 70 and older, 38% are still using aspirin. That’s important because bleeding risks become more prominent with age.

“The older adults are the most vulnerable since they are at higher risk of bleeding. They take more medications, and that can have more drug interactions with aspirin potentially causing more risk of bleeding,” Parul M. Goyal, MD, an Associate Professor of Medicine and Director of Medicine for Seniors at Vanderbilt University Medical Center who wasn’t affiliated with the study, told Healthline.

The study authors write that their findings have real-world implications: despite changing regulations, there is a disparity or knowledge gap about these changes among patients, particularly older ones. Patients and healthcare providers must have serious conversations about the risks and benefits of daily aspirin use.

“Doctors should engage in risk-benefit discussions with patients using aspirin for primary prevention, especially for adults 60 years of age and older, and discontinue aspirin where appropriate– such as in older patients, those at high bleeding risk,” said Gupta.

Why recommendations for daily aspirin use have changed

A trio of studies in 2018 represented a seismic shift in the perception of aspirin for primary CVD prevention. Those studies, the ASCEND trial, the ASPREE trial, and the ARRIVE trial, looked at the risks and benefits of aspirin in different patient populations, including those with diabetes and the elderly. The trials highlighted the potential danger of bleeding events, especially in otherwise healthy individuals, and helped to reshape aspirin recommendations.

In 2019, the American Heart Association issued updated recommendations for aspirin, indicating that while aspirin is still “well established” for secondary prevention of CVD, using it for primary prevention is “controversial.”

Three years later, in 2022, the United States Preventive Services Taskforce updated its own recommendations from 2016. 

“The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older,” said the statement.

“When we’re talking about primary prevention patients, there’s a little bit more risk-benefit consideration. Are we more likely to prevent that first heart attack or stroke, or are we more likely to actually cause a major bleeding episode using aspirin?” Donald Lloyd-Jones, MD, past President of the American Heart Association and Professor of Preventive Medicine at Northwestern University’s Feinberg School of Medicine, told Healthline.

“In secondary prevention, it’s crystal clear: you should be on aspirin, period,” he added.

Aspirin and bleeding risk: what to know

Aspirin is a blood-thinner, meaning that it has anticoagulant or antiplatelet properties, which make it difficult for blood to clot. These properties are useful for preventing heart attack and stroke but can cause other health issues, namely increased bleeding risk.

“The kind of bleeding that led to the change in guidelines was all kinds of bleeding. So it is falling and hitting your head, but it’s a lot of spontaneous bleeding in the stomach,” Eleanor Levin, MD, a Clinical Professor of Cardiovascular Medicine at Stanford Medicine, told Healthline.

For older adults, falling can be a serious health concern. When combined with an increased bleeding risk due to aspirin, you have a potentially fatal mixture.

“You have to consider again, in older people at risk of falls and head trauma, and increased intracranial bleeding, that if they haven’t had a stroke before, that you’re putting them at risk for bleeding,” said Levin.

A 2023 study based on the ASPREE trial also found that a daily low dose aspirin put patients ages 65 years and older at a 20% higher risk of anemia.

Anemia is a condition in which your body doesn’t produce enough healthy red blood cells to transport the necessary amount of oxygen, leading to shortness of breath, dizziness, and headaches.

Experts contacted by Healthline said that patients and doctors should have an informed conversation about the risks and benefits of taking aspirin for the primary prevention of CVD. 

Lloyd-Jones also cautioned that if you have been taking aspirin, even if you’re doing so without medical advice, you should consult a doctor before stopping. Doing so can lead to an increased risk of cardiovascular events.

“This paper should not make anyone stop any medication. It should make people talk to their doctor about why they are taking aspirin,” he said.

The bottom line

Many older Americans continue to take a daily low-dose aspirin for the primary prevention of cardiovascular disease, even though it may put them at increased risk of bleeding.

In the past five years, recommendations have changed around taking aspirin to prevent CVD in individuals who have never had a heart attack or stroke previously.

Experts say that patients should have a detailed conversation about the risks and benefits of taking aspirin as primary prevention for CVD to identify if they would be a good candidate.

• Stressing out about finding ways to relax can increase anxiety, leading to feeling “stresslaxed.”
• Health experts say there are several ways you can avoid or overcome feeling “stresslaxed.”
• Chronic stress can increase a number of health risks, including high blood pressure, heart attack, and stroke.

Recognizing you are stressed and need to relax is a good step toward helping yourself.

However, when finding ways to de-stress adds more stress to your life, you may end up feeling “stresslaxed,” a counterproductive effect that can lead to a vicious cycle of increased anxiety and worry.

“This term refers to the phenomena or experience of people who are in an anxious or stressed state trying to calm down and feel more relaxed by forcing themselves to take a break or unwind,” Dr. Michael Schirripa, psychiatrist, podcast host, and author of the upcoming novel Mindhunt, told Healthline.

When people force themselves to relax, they can become more anxious, and they may worry more about how well or efficiently they are actually able to relax.

The clinical term for “stresslaxed” is relaxation-induced anxiety, said Deborah Serani, Psy.D., professor at Adelphi University and author of the award-winning book, “Living with Depression.”

“Research suggests that if you already struggle with generalized anxiety or overthinking, you may be more prone to stresslaxing. Other evidence says individuals with stresslaxing struggles may also experience panic attacks in addition to their stress and anxiety. And then there are others who may become depressed because they can’t relax freely,” she told Healthline.

Does the brain resist forced relaxation?

In many ways, the brain resists forced relaxation, particularly the part of the brain called the amygdala, which is always searching for danger.

“We need to remember that our brains are always ‘on’ and are actually designed to be worried. After all, that anxiety can keep us alive as we are always aware of potential dangers that may threaten us,” Schirripa said.

People who live with anxiety, worry, and ruminations have difficulties with cognitive control, meaning they find it hard to put certain thoughts “on hold,” said Serani.

“Along a different line, there are some people who may need to stay busy because subconsciously, being calm, having space, and experiencing ease may give rise to negative thoughts or memories of traumatic experiences,” she added.

Why is it hard for some people to relax?

Schirripa said people find it difficult to relax due to external pressures and internal dynamics.

External pressures, such as work, study, family, and other commitments, can make people feel like they are constantly “switched on” to the outside world and are at the beck and call of others.

“They can then feel obligated to meet the demands of these outside influences, and as such, this can lead to a perception that they are not allowed to actually have any downtime or a space to relax that is just for themselves,” Schirripa said.

Serani noted that work time and leisure time no longer have definitive boundaries.

“Long ago, the workday ended at 5 pm and the weekends were for rest and relaxation, and on Sundays, stores were closed, which helped to make home time and relaxation easier to do. These predictable guidelines just don’t exist anymore,” she said.

Furthermore, technology, access, and other modern conveniences have blurred the lines of work and play, leading to what sociologist Dalton Conley of Princeton University coined “Weisure” (the merging of work and leisure activities).

“So, it becomes very hard to carve out relaxation time,” Serani said.

Internal dynamics that affect the ability to relax include feeling the drive to keep active and not giving oneself permission to slow down and relax.

“Sometimes people worry that if they are relaxed, that they will be bored or, alternatively, by slowing down and relaxing, there can be a fear that they will need to focus too much on the thoughts or feelings going on inside them,” said Schirripa.

Are there long-term consequences of not being able to properly relax?

Chronic stress has been connected to high blood pressure, which can lead to heart attacks and strokes, fatigue, ulcers, headaches, backaches, difficulty concentrating, and irritability.

“Depression and anxiety can surge, as can social, relational, and interpersonal difficulties when you don’t stop and smell the roses,” said Serani.

Not being able to properly switch off and relax can “reset” the nervous system to function at an overly stimulated level, added Natalie Christine Dattilo, PhD, clinical psychologist, founder of Priority Wellness, and instructor at Harvard Medical School.

“Over time, this can make it more difficult to elicit a relaxation response,” she told Healthline. “I meet with people who tell me they feel agitated, on edge, and anxious ‘from the neck down,’ but don’t describe feeling mentally anxious at all…which for me is an indication that we need to actively reset their default activation state through intentional relaxation practice.”

Strategies to help you relax

When trying to relax, Dattilo said first realize that relaxation is not as passive an activity as people have been led to believe, and it doesn’t come naturally to some people.

“I think one of the main reasons some people find it hard to relax is because it’s actually a skill we need to practice on a regular basis in order to fully experience its beneficial effects,” said Dattilo.

Often, people confuse relaxation with “zoning out.”

“This can certainly give our brain a break, but the real goal of relaxation is to ‘downshift’ our nervous system,” Dattilo said.

Downshifting happens through an active process designed to elicit the “relaxation response,” the physiological opposite of the fight-or-flight response.

“It counteracts the negative effects of stress and returns our nervous system to a homeostatic balance,” she said. 

Triggering the relaxation response can be done through visualization, muscle relaxation, massage, breathing techniques, meditation, prayer, and yoga.

Try the following tips to set relaxation in motion.

• Set boundaries between work and home life. “Also, consider powering down from technology early each night. Make self-care a priority and learn how to manage this every day,” said Serani.
• Practice the Benson Relaxation Method, which involves sitting in a comfortable position, closing your eyes, intentionally relaxing all the muscles, beginning at your feet and working up to your head, breathing slowly, for 20 minutes. “This will likely feel a little challenging or forced at first, so maybe start with 5 minutes and gradually work your way up,” said Dattilo.
• Focus on a “done” list to recall what you’ve already accomplished. “Thinking about the to-do list perches you in the future, keeping you from being in the moment,” said Serani. “Highlighting your done list will aid in celebrating your finished chores and encourage relaxation. A done list helps you linger in the past.”
• Engage in 5-minute meditation. “Studies show that even 5 minutes of deep breathing, silence, and restfulness can enhance mental and physical functioning,” Serani said. If you can go for more time meditating, consider a guided meditation with an app, or simply rest, nap, or enjoy some solitude, she said.
• Feed your senses and ground yourself by using the “5,4,3,2,1 Technique” to reduce anxiety so you can relax more readily. “Ask yourself to find 5 things you can see, 3 things you can hear, 4 things you can touch, 2 things you can smell, and 1 thing you can taste,” said Serani.

Dr Shreya Singhal is a junior doctor working in West London, as well as being a keen backpacker. She has worked in Infectious Diseases and General Practice and shares her top tips for people looking to travel this summer. With lots …

• This month, the Supreme Court preserved access to the abortion pill nationwide and to emergency abortions in Idaho.
• Meanwhile, in Texas, where abortion bans are among the strictest in the U.S., a new study found an uptick in infant mortalities following a 2021 ban on abortion.
• Senate Bill 8 (SB 8) bans abortion if a fetal heartbeat can be detected with no emergency exemptions.
• Access to quality prenatal care can be lifesaving no matter where you live, but it is particularly crucial in states like Texas.

Earlier this month, the U.S. Supreme Court unanimously voted to preserve access to the abortion pill mifepristone.

On June 27, Supreme Court justices temporarily ruled in favor of pregnant people seeking emergency abortions in Idaho, which could be lifesaving.

Meanwhile, in states like Texas, where abortion bans and restrictions are among the strictest in the nation, infant mortality rates have jumped following the state’s 2021 ban on abortion.

A new report shows that Senate Bill 8 (SB 8), the Texas law that banned abortions after a fetal heartbeat can be detected, may have caused the uptick in fetal deaths. 

The law, which went into effect September 21, 2021, provided no exemptions for congenital anomalies and banned abortions as early as five or six weeks, which is before most people know they are pregnant. 

The study, published in JAMA Pediatrics on June 24, suggests that pregnant people were forced to keep their pregnancies even when the fetuses had potentially lethal fetal congenital anomalies. The researchers estimated that SB 8 led to 216 extra infant deaths that would not have occurred if the ban hadn’t gone into effect.

Prior research has found that states with abortion restrictions record more infant deaths than states that permit the procedure.

The Supreme Court’s decision to preserve emergency abortions could help reduce the number of infant deaths in Idaho, but in Texas, these preventable mortalities rest in the hands of SB 8.

“Pregnant people deserve comprehensive access to abortion care no matter the circumstances. The only way to ensure people can access the care they need, in emergency situations or any other circumstances, is to repeal all abortion bans and restrictions,” said Destiny Lopez, acting co-CEO of the Guttmacher Institute, in a statement shared with Healthline in response to the Supreme Court’s June 27 ruling.

Texas abortion ban led to an increase in infant deaths

The new JAMA report is thought to be the first to look specifically at how SB 8 contributed to infant deaths. 

Jessie Hill, a law professor at Case Western Reserve University who specializes in reproductive rights, told Healthline she’s not surprised the increase in infant deaths was a consequence of SB 8.

“I think it was an entirely foreseeable result of Texas’s near-total abortion ban,” she said.

Researchers from the Johns Hopkins Bloomberg School of Public Health first calculated the number of infant deaths in the U.S. and Texas between 2018 and 2022. There were 102,391 infant deaths in the country, 10,351 of which occurred in Texas.

They then analyzed monthly death certificate data between 2021 and 2022 and found that the number of infant deaths, or deaths in babies under 12 months old, increased by 12.9 percent in Texas — from 1,985 to 2,240. 

The increase recorded in the rest of the U.S., for comparison, was just 1.8 percent. 

To better understand the impact of SB 8, the research team then zeroed in on the number of infant deaths recorded between March and December 2022, which is the time period in which the first pregnancies happened with SB.8 in effect.

Based on the researchers’ estimates, the law led to 216 excess infant deaths, which is a 12.7% increase in infant deaths.

Why abortion bans may cause more infant deaths

According to the researchers, abortion bans like SB 8 prevent people from ending pregnancies, including ones with severe fetal abnormalities that are diagnosed later in pregnancy.

Congenital malfunctions are the leading cause of infant mortality in the U.S. — they account for 1 in 5 infant deaths, past data from the Centers for Disease Control and Prevention (CDC) shows.

An increase in infants born with congenital malfunctions, some of which are deadly, would then lead to an increase in infant deaths. 

“Despite amazing advances in neonatal intensive care, pediatric surgery, and other advanced treatments, when it comes to congenital anomalies, some conditions are so severe that they cannot be fixed,” Arianna Cassidy, MD, a maternal fetal medicine physician in the UCSF Department of Obstetrics, Gynecology & Reproductive Sciences, told Healthline.

For example, babies with congenital anomalies that are born prematurely may not be big enough to receive the treatments they need to survive, Cassidy said.

And for infants with congenital anomalies that are candidates for surgery, the surgeries themselves come with risks. 

“Each surgery has risks, such as developing an infection or having another complication, which could be fatal,” says Cassidy, noting that there are many ways complications from surgery for anomalies could lead to an increase in infant deaths.

It’s also believed that abortion restrictions might lead to pregnant people being exposed to potential risks, including financial and emotional stress, that might lead to complications.

More studies are needed to better understand why the infant deaths occurred, the researchers stated.

Access to quality prenatal care could be lifesaving

The findings of the JAMA study highlight the severe health consequences — to both the infant and their families — that occur when abortions are prohibited. 

Past evidence revealed that infant mortality disproportionately affects Black women and that having an infant die leads to significant trauma and, potentially, criminalization.  

Hill believes it’s irrational to make pregnant people carry nonviable pregnancies to term and give birth only to watch the babies die shortly thereafter.

“This report further demonstrates the profound cruelty of abortion bans like Texas’s,” Hill said. 

To Cassidy, the findings are chilling, especially when you consider the ripple effect this kind of law can have.

“It’s the suffering and death of infants, but also suffering of women and families, the sadness and loss in entire communities, the moral injury of physicians and other healthcare providers, and the cost of prolonged hospital stays,” she said.

Hill hopes the findings will make people question whether states that ban abortions are genuinely motivated by an interest to preserving life. 

“If the state truly wants to protect infants, it has many means to do so, such as increasing access to prenatal care and health care generally,” Hill said. 

Takeaway

This month, the Supreme Court ruled in favor to preserve access to the abortion pill mifepristone nationwide, as well as access to abortion in emergency situations in Idaho.

In Texas, however, the strictest abortion bans in the nation remain upheld. A new report found that SB 8, the Texas law that banned abortions after a fetal heartbeat can be detected, may have caused an uptick in infant deaths.

The ban likely prevented people from ending pregnancies, including ones with severe, life-threatening fetal abnormalities that typically get diagnosed later in pregnancy.

• Evidence from a large U.S. study indicates that multivitamin supplements do not improve mortality risk.
• Individuals taking a multivitamin supplement actually had a slightly higher mortality risk than those who did not.
• Multivitamins are taken by roughly one in three US adults, but their health benefits are not well established.

Daily multivitamins are some of the most popular supplements in the United States, but they may not actually make you healthier.

An estimated one-third of US adults take a multivitamin. Consumer spending on them amounts to about 8 billion dollars annually, roughly one-seventh of all dollars that go towards supplements. Of course, the appeal of getting all your necessary vitamins and minerals in one pill per day is alluring. Adults report taking multivitamins to maintain health and fitness and to prevent chronic disease. 

However, evidence, or, more accurately, a lack of evidence, has been mounting for some time that daily multivitamins may not provide consumers with any real protective benefit when it comes to chronic conditions like heart disease and cancer.

In fact, for healthy individuals, a multivitamin may provide no benefit at all. 

In a large study involving nearly 400,000 US adults without a history of chronic diseases over a follow-up period of more than 20 years, those taking a daily multivitamin showed no improvement in mortality risk compared to those who did not.

In fact, those who were taking the supplement demonstrated a slightly increased (4%) mortality risk. The average age of participants was 61.5.

The findings, from researchers at the National Cancer Institute, were published in JAMA Network Open.

Erikka Loftfield, PhD, a researcher in the Division of Cancer Epidemiology & Genetics at the National Cancer Institute, and first author of the study, told Healthline, “To date, there has been insufficient evidence to determine the benefits and harms of MV use…Leveraging data from three large and geographically diverse US cohorts with repeat assessments of MV use and extended follow-up for mortality outcomes, we aimed to evaluate the association of MV use with leading causes of chronic disease-related death.”

No mortality benefit from multivitamin

Loftfield and her team utilized three separate cohorts for their study, totaling 390,124 generally healthy US adults, with follow-up data of about 20 years.

The study’s size and length are two of its greatest strengths. However, it is observational in nature, meaning that, unlike a controlled trial, it does not demonstrate causality between two events — in this case, taking a multivitamin and death. Instead, it helps to form a picture of any associations between these events at a large scale in the real world.

Part of the difficulty of conducting a study of this nature is the sheer volume of data to sort through and the potential for confounding. For example, the study discusses two distinct problems they had to control for in their data: the “sick user effect” and the “healthy user effect.”

There is a concern that health outcomes related to multivitamin use are misleading because of the demographics using them. The “sick user effect” refers to the possibility that individuals who are sick may more frequently use multivitamins due to their health condition.

On the other hand, the “healthy user effect” is the opposite: individuals who already live a healthy lifestyle may be more inclined to use a multivitamin as part of their routine than those who are less health conscious. Without proper controls in place, these effects could lead a researcher to two opposing conclusions about the effects of multivitamins on mortality risk.

Loftfield told Healthline that they were able to control for these distinct effects, by adjusting for lifestyle factors like smoking, diet, and physical activity. They also excluded individuals with major chronic diseases, including cancer, at baseline to account for the “sick user effect.”

Ultimately, after controlling for all these factors, they found that those taking a multivitamin did not have a lower risk of all-cause mortality than those who did not. Nor did they observe any benefits related to specific health outcomes, including cancer, heart disease, and stroke.

The findings are in line with prior research, including recommendations made by the US Preventive Services Task Force in 2022 and 2014, which said there was little to no benefit in taking them.

Dr. Parul M. Goyal, MD, an Associate Professor of Medicine and Director of Medicine for Seniors at Vanderbilt University Medical Center who wasn’t affiliated with the study, told Healthline the results were not surprising.

“The patients that they enrolled are all patients without any chronic medical conditions. Essentially, they’re all healthy patients. Typically, if you are a healthy individual, and you are exercising, you’re eating a regular diet, you’re consuming your fruits and vegetables, you are getting your regular intake of vitamins and supplements,” she said.

Goyal notes that there are some individuals who would likely benefit from a multivitamin supplement, including those with anemia, diabetes, and postmenopausal women. She encourages patients to speak with their healthcare professional before taking a multivitamin.

Do dietitians recommend taking a multivitamin supplement?

Healthline spoke to two registered dietitians to hear their recommendations about eating a healthy diet and taking multivitamin supplements.

“My recommendations for patients are always personalized. In my practice at the Cleveland Clinic, a recommendation to take or skip a multivitamin is based on many factors, including the patient’s current health, dietary pattern, other supplements being taken, and personal health goals. An MVI is not insurance [from] an unhealthy dietary pattern,” said Kristin Kirkpatrick, MS RD, a registered dietitian at the Cleveland Clinic and co-author of Regenerative Health.

Alyssa Kwan, MS, RD, a Clinical Dietitian in Cardiology at Stanford Medicine, told Healthline, “I do not generally recommend a multivitamin for those following a healthy diet and eating well-balanced meals…I will only recommend one if patients are not nutritionally meeting their nutrient needs or have a poor diet at baseline. Maybe their appetite is really poor or they are just not able to meet everything via diet alone, then I would recommend supplementing with a multivitamin.”

Like Kirkpatrick, Kwan also cautions that a multivitamin should not be taken to cover unhealthy “choices of foods that are not nutritionally dense.”

The bottom line

In a large observational study involving nearly 400,000 US adults over 20 years, taking a daily multivitamin did not lower mortality risk overall, nor for specific chronic conditions like cardiovascular disease and cancer.

Multivitamins are among the most popular supplements on the market, taken by roughly one in three US adults. Despite their popularity, their health benefits are not well established.

Experts interviewed by Healthline say that if you eat a healthy diet, taking a multivitamin is not recommended. Always speak with your healthcare provider before starting or stopping taking a nutritional supplement.

• People who were treated with the GLP-1 drug liraglutide and did an exercise program lost weight and body fat but were able to preserve their bone health.
• Both liraglutide and exercise helped people maintain weight loss, but exercise minimized the loss of bone density.
• Other research shows that certain types of exercise can strengthen bones, even in people not trying to lose weight.

Losing weight can help people who are living with obesity or overweight and reduce their risk of type 2 diabetes, sleep apnea, heart disease, and other health issues. But weight loss can also lead to bone loss.

This is a concern as more people are taking GLP-1 receptor agonists such as Ozempic, Wegovy, and Zepbound to help them lose weight.

“Bone mineral density should be a serious consideration, given that we reach our peak bone mass by age 30 and then start to lose bone mass as we move beyond our 30s,” said Jennifer Sacheck-Ward, PhD, a professor of prevention and wellness at George Washington University’s Milken Institute School of Public Health.

“If taking GLP-1 receptor agonists accelerates this loss, then we will have more individuals who are at increased risk of serious fractures, and at younger ages,” she told Healthline.

New research, though, suggests that exercise can help preserve bone health in people being treated with a GLP-1 drug.

In the study, researchers found that people who were treated for a year with liraglutide (sold under the brand names Saxenda and Victoza) and did a program of moderate- to-vigorous-intensity exercise had similar changes in bone mineral density as those who didn’t undergo any treatment.

This was despite people in the combination liraglutide and exercise group losing more weight than people treated with liraglutide alone or exercise alone.

The study was published June 25 in JAMA Network Open.

GLP-1 drugs and bone density

The study was carried out from 2016 through 2019 in Denmark. It included 195 people ages 18 to 65 who were living with obesity but not diabetes. The average age of participants was 43, and nearly two-thirds were female.

Participants first followed a low calorie diet for 8 weeks, which provided 800 calories per day.

In general, adults not trying to lose weight need around 1,600 to 3,000 calories per day, although this varies depending on factors such as age, sex, size and activity level.

Next, researchers randomly assigned people to one of four groups for 52 weeks: a moderate- to vigorous-intensity exercise program, daily injections of liraglutide, a combination of exercise and liraglutide, or the non-treatment (placebo) group.

Participants underwent DEXA scans to measure bone mineral density in their hip, lower spine and forearm. These scans were done before people started the low-calorie diet and again at the end of the 52-week treatment period.

On average, participants lost 29 pounds while on the 8-week low calorie diet. During the 52-week treatment period, people in the placebo group regained weight and lost 15 pounds overall.

Those in the exercise and liraglutide groups maintained their weight loss (25 to 30 pounds overall), and people in the combination group lost additional weight (37 pounds overall).

The combination group also had larger amounts of fat loss compared to the other groups.

In addition, the groups saw different changes in bone mineral density. In the combination exercise and liraglutide group, bone mineral density in the hip and lower spine was similar to the placebo group — meaning this group maintained bone health.

The liraglutide group saw a greater decrease in bone mineral density in the hip and lower spine compared to the exercise group. This suggests that exercise can help prevent bone loss.

Also, both the exercise and combination groups saw an increase in bone mineral density in the forearm.

One limitation of the study is that researchers excluded people over age 65 and those with other chronic health conditions. Thus, the researchers write that the results may not apply to people with diabetes or older adults.

Exercise is recommended for better bone health

Spencer Nadolsky, DO, an obesity and lipid specialist and medical director of WeightWatchers, said loss of bone mineral density is always a concern when intentionally losing weight.

But “I wouldn’t be concerned about GLP-1 medicines causing more than expected losses in bone densities with the amount of weight lost,” he told Healthline. 

“Having said that, I always recommend resistance training for those who are trying to intentionally lose weight in order to minimize bone loss,” he said. 

This is particularly true for people using a GLP-1 drug because they are so effective at helping people lose weight, he said. He also pointed out that newer GLP-1 drugs, such as semaglutide and tirzepatide, are even more effective at promoting weight loss.

The new study’s results fit with other research showing that exercise can help preserve bone health in people who lose weight by cutting calories. In particular, heavy resistance or high impact exercise may have the largest effect on bone health.

Sacheck-Ward said the new study shows that there is a healthy way to lose weight with the use of GLP-1 drugs while preserving bone health.

However, she still has some concerns, “given the reality that the majority of Americans do not engage in the amount of physical activity recommended by the Physical Activity Guidelines for Americans,” she said.

She also pointed out that people in the exercise group lost a similar amount of weight as those in the liraglutide group — but the exercise group maintained their bone mineral density. 

“This should be a serious consideration, especially given the natural loss of bone mass as we progress past our 30s and 40s and with bone fractures posing a significant risk for mortality in older age,” she said.

“Why not choose exercise then, without the side effects [of a GLP-1 drug], and with the bigger bang for our buck on many aspects of our health?” she said.

Takeaway

In a new study, participants followed an 8-week low-calorie diet to lose weight. This was followed by 52 weeks of one of four interventions: treatment with the GLP-1 drug liraglutide, an exercise program, a combination of liraglutide and exercise, or a placebo group.

The combination group lost the most weight and body fat over the course of the study but had similar changes in bone mineral density to those who didn’t undergo treatment.

Both exercise and liraglutide alone led to similar amounts of weight loss, but the liraglutide group had larger amounts of bone loss. Other research shows that certain types of exercise can strengthen the bones.

• The FDA has granted accelerated approval to a novel drug for the treatment of a rare autoimmune disease that damages the liver.
• Primary biliary cholangitis (PBC) occurs when the immune system attacks the bile ducts, leading to liver damage and other serious health outcomes.
• Treatment options for PBC are limited and frequently not well-tolerated by patients.

The U.S. Food and Drug Administration(FDA) has just approved a first-in-class drug for the treatment of a rare autoimmune liver disease.

On June 10th, the FDA granted accelerated approval to the drug Iqirvo (elafibranor) to treat primary biliary cholangitis (PBC).

PBC is a rare autoimmune liver condition in which the small bile ducts in the liver are inflamed and damaged, causing bile and toxins to build up.

As the bile collects in the liver, it damages the surrounding tissue, which can lead to severe health problems like cirrhosis of the liver and destruction of the bile ducts.

Prior treatment options for PBC were limited and frequently not well-tolerated by patients. The definitive treatment for PBC requires a liver transplant. Experts say the approval of Iqirvo will meet a currently unmet need and help to expand options for patients.

“This is an exciting time for new therapies for the treatment of PBC. I am optimistic that the approval of elafibranor will allow more patients with PBC to have an improved prognosis as there will be additional options to provide for second line therapy to help achieve biochemical remission,” Aparna Goel, MD, a Clinical Associate Professor of Medicine, specializing in gastroenterology and hepatology at Stanford Medicine, told Healthline.

How does Iqirvo work?

Iqirvo helps to treat PBC through several pathways, including promoting bile acid transportation, modulating bile production, and decreasing inflammation.

“Iqirvo is the first treatment advance for PBC in 8 years and is the very first in a new class of medicines called PPARs. PPARs are designed with the aim of targeting the underlying PBC disease,” a representative for Ipsen Biopharmaceuticals, the developer of Iqirvo, told Healthline.

The FDA granted the drug accelerated approval following a promising phase 3 trial, the results of which were published in the New England Journal of Medicine in November, 2023.

That trial involved 161 patients who had inadequate response to or unacceptable side effects with ursodeoxycholic acid, the current primary treatment for PBC. 

“First line treatment for PBC is ursodeoxycholic acid. This has been the standard of care for many years. However, at least 60% of patients are either intolerant to or have an incomplete response to ursodeoxycholic acid,” said Goel.

About 67% of the patients in the trial received Iqirvo, while the rest received a placebo. After 52 weeks, half the individuals taking Iqirvo achieved a “statistically significant treatment benefit,” compared to only 4% of those taking the placebo.

Patients taking Iqirvo did experience some side effects during the trial. The most common side effects included abdominal pain, diarrhea, nausea, and vomiting.

Rhabdomyolysis, a serious and potentially fatal muscle-wasting disease, occurred in one individual taking Iqirvo.

“It will be important to monitor for any signs of muscle injury (rhabdomyolysis ) and kidney function as patients are started on this medication. As with any new medication, the long-term safety and efficacy will need to be carefully monitored,” said Goel.

What to know about the autoimmune disease primary biliary cholangitis

PBC is a rare autoimmune disease. According to the latest statistics from the National Institutes of Health (2014), PBC affects about 58 in every 100,000 women and 15 in every 100,000 men in the United States. However, like other rare diseases, the exact number of people who have PBC isn’t entirely clear. Like other autoimmune conditions, PBC is also far more common in women than in men.

Overall, women account for about 80% of all cases of autoimmune disease.

In individuals with PBC, the immune system mistakenly attacks the bile ducts of the liver, causing inflammation and damage. Bile is an acidic fluid formed in the liver that is used in digestion. It is transported by the bile ducts to other organs like the small intestines where it can be used to break down food material. 

Damaged bile ducts can not effectively transport bile, a condition known as cholestasis. As bile builds up in the liver, it can cause scarring (fibrosis), which can lead to irreversible, advanced cirrhosis. A patient may eventually require a liver transplant due to chronic liver damage.

PBC can be hard to diagnose as it begins with mild symptoms, including tiredness and itchy skin. As it progresses, other more severe symptoms like abdominal pain and joint pain may develop. In its final stages, highly visible symptoms may occur like darkening of skin color, the presence of fatty deposits under the skin, and jaundice. 

The cause of PBC is still not well understood, but is believed to be the result of a combination of genetic and environmental factors that lead to the development of an autoimmune condition.

“Several environmental triggers have been associated with ‘activating’ the disease including toxins, viruses and several bacteria. As knowledge of the disease increases, appropriate recognition and testing of the disease is also increasing which is likely to change the prevalence estimates,” said Goel.

The bottom line

This month, the FDA granted accelerated approval to Iqirvo (elafibranor) for the treatment of primary biliary cholangitis (PBC).

PBC is a rare autoimmune disease in which the bile ducts are damaged, leading to inflammation and scarring of the liver.

Current treatment options for PBC are limited and often not well-tolerated. Experts say the new medication is promising, but will need to be monitored for continued safety.

• Certain types of medications can make people more prone to heat-related illness.
• These include diuretics, beta-blockers, anticholinergics, and antipsychotics.
• They can cause dehydration, a lack of sweating, and problems regulating temperature.
• It’s important to keep cool and drink plenty of water during hot weather.
• If you experience symptoms of heat-related illness, seek medical assistance right away.

While the hotter summer months can represent fun in the sun for many of us, a heatwave can turn deadly for others, especially if they are using certain types of medications.

Medications that are commonly used to treat high blood pressure, heart conditions, allergies, and mental health disorders, among others, may put you at risk for being sensitive to high temperatures.

If you aren’t careful, you could develop heat exhaustion or heat stroke. Heat stroke, which is the more serious of the two, can lead to permanent disability or even be fatal. Both require immediate first aid.

Medications that can make you more sensitive to heat

Sazan Sylejmani, PharmD, an experienced Pharmacy Manager and owner of Westmont Pharmacy, told Healthline there are four important types of medications that can increase your sensitivity to heat.

The first of these is diuretics, which are medications that increase how much you urinate. You might also have heard them referred to as “water pills” since they help eliminate fluid retention in your body.

Diuretics are often used to treat high blood pressure and other cardiovascular conditions since they can reduce the amount of fluid in your blood vessels, leading to less pressure against their walls.

According to Sylejmani, some common examples of diuretics are furosemide and hydrochlorothiazide.

Another type of medication that can make you more sensitive to heat is beta-blockers.

Since they help the heart beat more slowly and with less force, these medications are most often used to treat irregular heartbeat and high blood pressure, but they have a range of other applications, including the treatment of anxiety disorders.

Some common examples, per Sylejmani, include metoprolol and propranolol.

A third type of medication he mentioned was anticholinergics.

These drugs work by blocking the action of acetylcholine, making them useful in treating conditions like overactive bladder, incontinence, and chronic obstructive pulmonary disease.

Oxybutynin and benztropine are examples of anticholinergics.

Finally, Sylejmani spoke about antipsychotics.

Antipsychotic medications are used to treat schizophrenia and other mental health conditions since they are capable of targeting certain neurotransmitters in the brain.

He listed risperidone and olanzapine as two medications belonging to this class.

How these medications can put you at increased risk

Dr. Paunel Vukasinov, who is with Medical Offices of Manhattan and is a contributor to LabFinder, explained that the ways these medications put you at risk during hot weather really comes down to three things.

“These medications can impact the body’s ability to regulate temperature, impact the body’s ability to sweat, or lead to worsening dehydration,” he said.

When it comes to diuretics, which cause you to shed excess fluid, if you are also sweating a lot, he said this “can worsen [dehydration] by further removing sodium and water from the body which can lead to complications including low blood pressure and even passing out.”

Sylejmani added that the problem with beta-blockers is they reduce the heart’s ability to pump blood. This can impair your body’s natural ability to dissipate heat and cool itself.

Regarding anticholinergics, Vukasinov said they affect your ability to sweat.

“[T]he core body temperature can rise, which can be further exacerbated by hot weather conditions,” he stated.

Sylejmani further explained that antipsychotics can interfere with our body’s ability to regulate its own temperature, putting people at risk.

How to minimize your risk during a heatwave

“By understanding the interplay between medications and hot weather, patients can better manage their health and minimize risks associated with extreme heat,” said Sylejmani.

He suggests taking the following steps in order to play it safe when temperatures soar:

• Stay hydrated. Drink plenty of fluids, especially water. If you’re taking medication, talk with a healthcare professional for an individualized fluid intake recommendation. “Avoid alcohol and caffeine as they can further dehydrate you,” said Sylejmani.
• Wear lightweight, loose-fitting clothing. This will allow air to reach your body and evaporate your sweat, allowing you to cool off.
• Stay in cool, shaded, or air-conditioned areas as much as possible. If you don’t have an air conditioner at home, the U.S. Centers for Disease Control and Prevention suggests checking with your local health department to see if there are shelters in your area. Malls or public libraries can also be safe spaces to seek refuge from the heat.
• Monitor yourself for signs of heat-related illness. These include excessive sweating, confusion, dizziness, or headaches. “[S]eek medical attention if symptoms appear,” Sylejmani advised.
• Consult with your doctor about adjusting your medication. “They might adjust dosages or advise timing the medication differently to reduce risks,” he said.

Takeaway

When temperatures rise during the summer, it can put people who use certain medications at risk.

Medications like diuretics, beta-blockers, anticholinergics, and antipsychotics, in particular, may be problematic.

These types of medications can cause dehydration, lack of sweating, or problems with regulating body temperature, which puts people at risk for heat exhaustion and heat stroke.

Experts say it’s important to keep your environment cool, drink lots of fluids, and seek medical assistance if you experience any of the warning signs of heat-related illness, including excessive sweating, confusion, dizziness, or headaches.

You may also need to speak with your physician about making adjustments to your medication during the hotter months of the year.