A baby girl in Texas — born prematurely to a mother with COVID-19 — is the strongest evidence to date that intrauterine (in the womb) transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can occur, reports The Pediatric Infectious Disease Journal, the official journal of The European Society for Paediatric Infectious Diseases. The journal is published in the Lippincott portfolio by Wolters Kluwer.

As we age, the immune system gradually becomes impaired. One aspect of this impairment is chronic inflammation in the elderly, which means that the immune system is constantly active and sends out inflammatory substances. Such chronic inflammation is associated with multiple age-related diseases including arthritis and Alzheimer’s disease, and impaired immune responses to infection. One of the questions in ageing research is whether chronic inflammation is a cause of ageing, or a consequence of the ageing process itself? Scientists in the laboratory of Director Adam Antebi at the Max Planck Institute for Biology of Ageing in Cologne, Germany have found evidence suggesting that increased inflammation causes the ageing process to speed up, and that there is a fine balance between maintaining immune system function and longevity.

• Rapid eye movement (REM) sleep is necessary for the body to repair itself
• People with lower levels of REM sleep were found to have higher mortality
• We should get the right amount of sleep – seven hours recommended for adults

Deep sleep is essential for good health, and too little of it may shorten your life, a new study suggests.

REM (rapid eye movement) sleep is when dreams occur and the body repairs itself from the ravages of the day. For every 5% reduction in REM sleep, mortality rates increase 13% to 17% among older and middle-aged adults, researchers report.

“Numerous studies have linked insufficient sleep with significant health consequences. Yet, many people ignore the signs of sleep problems or don’t allow enough time to get adequate sleep,” said lead researcher Eileen Leary. She is a senior manager of clinical research at Stanford University in Palo Alto, California.

“In our busy, fast-paced lives, sleep can feel like a time-consuming nuisance. This study found in two independent cohorts that lower levels of REM sleep were associated with higher rates of mortality,” she said.

Ways to optimise REM

How REM sleep is associated with risk of death isn’t known, Leary said. Also, this study couldn’t prove that poor REM causes death, only that it’s associated with an increased risk of dying early.

“The function of REM is still not well understood, but knowing that less REM is linked to higher mortality rates adds a piece to the puzzle,” she said.

It’s still too early to make recommendations about improving REM sleep based on this study, Leary said.

“As we learn more about the relationship, we can begin looking at ways to optimise REM. But that is outside the scope of this project,” she said.

For the study, Leary and her colleagues included more than 2 600 men, average age 76, who were followed for a median of 12 years. They also collected data on nearly 1 400 men and women, average age 52, who were part of another study and were followed for a median of 21 years.

Reliable predictor of mortality

Poor REM sleep was tied to early death from any cause as well as death from cardiovascular and other diseases, the researchers found.

REM sleep’s links to mortality were similar in both groups.

“REM sleep appears to be a reliable predictor of mortality and may have other predictive health values,” Leary said. “Strategies to preserve REM may influence clinical therapies and reduce mortality risk, particularly for adults with less than 15% of REM sleep.”

Previous studies have focused on total sleep time and have shown that both not enough total sleep and too much total sleep can be associated with increased risk of dying early, said Dr Michael Jaffee, an associate professor of neurology at the University of Florida in Gainesville.

“When we sleep, we go through different stages to include REM sleep. REM describes our eye movements during this stage and is also the state associated with when we have dreams,” he said.

This study shows that it is not just total sleep time that may be important, but assuring the right balance of the different stages of sleep, said Jaffee, who co-authored an editorial that accompanied the study.

Proper sleep time

Neurologists need to look for conditions affecting patients, such as obstructive sleep apnoea, that can reduce REM, and doctors should also be aware that certain medications they prescribe can reduce REM, he said.

The study also opens up additional avenues for research to determine if scientists should focus on treatments that affect not just total sleep but target sleep stage balance, Jaffee said.

“This study shows yet another reason for the importance of proper sleep time – recommendations for adults is seven hours – and a good balance of sleep stages by assuring that any possible conditions, such as obstructive sleep apnoea, that can cause a reduction in REM to be evaluated and managed,” he said.

“Anyone with difficulty with sleeping or with loud snoring can benefit from discussing this with their physician,” Jaffee added.

The report was published online on 6 July in JAMA Neurology.

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• Every day waste-pickers are searching for recyclables on rubbish dumps across South Africa
• They are too poor to buy personal protective equipment to protect them against SARS-CoV-2
• However, the risk of infection from most kinds of rubbish is small  

At Arlington and Uitenhage waste disposal sites in Port Elizabeth, hundreds of people daily search for recyclable materials to sell and food to eat. 

Martin Witbooi from Walmer is one of them.

He tells Spotlight personal protective equipment (PPE) is “a luxury”. “We normally wash and wear gloves and masks that we get from industrial waste. Otherwise, without those trucks from industrial areas, we have to make our makeshift masks with clothing. As a result, some of us see no point in wearing gloves or masks every time we carry out our duties.”

The 31-year-old father of two tells Spotlight that many people (working at the Arlington landfill site) “are afraid of Covid-19, but it is virtually impossible for us not to get this virus because we are exposed to it”. “Even right now we don’t know who has this virus as people here are always coughing and complain of fever and chest pains. If we are not yet infected, we literally survived by the grace of Jesus Christ.”

Small risk from waste

Covid-19 rates in the area are soaring. At 30 603 (as of 2 July), The Eastern Cape has the third most confirmed cases of South Africa’s nine provinces – and most of those cases are clustered around Nelson Mandela Bay.

What is the risk from waste? “Now that 95% of people who tested positive for Covid-19 are being kept at home, the waste they are generating includes personal protective equipment,” says Professor Angela Mathee, Director of the Environmental Health Research Unit at the South African Medical Research Council (SAMRC).

Mathee says the discarded used PPE could end up at landfill sites which can pose some risk for people rummaging through waste.

But the risk from most types of waste is small.

Head of the Division of Medical Virology at Stellenbosch University, Professor Wolfgang Preiser, says that studies show that in controlled settings (like a laboratory) the virus remains infectious for between hours to several days depending on factors like the type of surface, temperature, and moisture. 

‘Dirt’ may shield virus

“But there are also studies that have looked for virus ‘survival’ (which means testing whether the virus on the surface will actually infect cell cultures in the laboratory), and found that under special circumstances, it can ‘survive’ for several days.” Preiser says the current “recommendation [is] for waste from households where someone is in quarantine or in isolation [to] be double-bagged before being put out with the domestic waste”. “If no one opens that double bag again, no problem,” he says. 

“I would not worry too much about recyclables such as glass bottles and paper being picked up. Even if someone, for example, coughed into their hand and did not wash it before disposing of the bottle, it is unlikely that small amounts of infectious secretions would allow the virus to remain infectious. Used tissues and masks are a different problem,” he says. “If there is quite a large amount of secretions with a lot of virus, the ‘dirt’ may shield the virus from outside influences and allow it to remain infectious for longer.”

But Preiser notes none of this “should be much to worry about if those who handle this had gloves (not single-use medical ones, but proper working gloves that can be washed or cleaned after use) and could wash their hands regularly or use alcohol-based hand rub – especially before drinking, eating or smoking after having handled rubbish.”

He also notes that “those going through household waste in search of recyclables, are at risk in places where there is rampant community transmission”. “Formal waste services should have issued their staff with protective equipment and instructions. As they do not really handle the waste itself, but the bins and bags, their risk is then small. Nevertheless, there are frequent cases of Covid-19 among municipal solid waste staff,” Preiser says although noting this may be due to staff contracting Covid-19 in the community and then transmitting to their colleagues.

Unsafe even before Covid-19

For Zukisa Pikini of Uitenhage, the landfill site is the only way of surviving. “Without this dump I won’t be able to feed my family. It’s better to come here and search for food instead of sleeping with an empty stomach. For the past three months I have been working at the dump just to feed my 12-year-old boy, and life is hard here. It is survival of the fittest. All of us eat rubbish and we constantly fight over it. Nothing is guaranteed,” she says.

“I feel scared to work in this environment because I’m taking TB and HIV treatment and I also have one lung,” says Pikini. She tells Spotlight she registered for food parcels, but have not received any. Pikini says she knows that she is putting herself at risk for contracting diseases. “I have no choice but to work for my kids.”

“We (the SAMRC) have done a study recently (last year) on the health of people who are living on landfill sites,” says Mathee. “It shows 90% of them are wearing some kind of PPE, but mostly garden gloves, but because you are wearing gloves, it doesn’t mean you are completely safe. The study found informal waste-workers at landfill sites are vulnerable, as 37% of them had some kind of common mental disorder like anxiety, depression or stress.”

The study looked at the prevalence of respiratory health symptoms among waste-recyclers at two sites in Gauteng. “A persistent cough was the most common symptom reported (46.8%), followed by breathlessness (19.6%) and rapid breathing (15.8%),” the study found. 

“Many of them reported that they had injuries from rat bites, dog bites and some of the landfills have steep slopes, so they often fall,” says Mathee. “They also have very low access to health care. When  they fall ill, they often do not go to clinics or hospitals for medical assistance. They just work through their illnesses,” she says. 

“I know their challenge that they are poor and if PPEs are not supplied by somebody, they won’t be able to afford it themselves.” Mathee, however, still encourages waste-pickers to wear PPEs.

No PPE plans for waste-pickers

The SAMRC study noted that occupational health and safety awareness is important to minimise hazards faced by informal workers. “In addition, providing waste-recyclers with the correct protective clothing, such as respiratory masks, and training on basic hygiene practices, could reduce the risks associated with waste sorting,” the study notes.

In a research briefing note, Dr Melanie Samson, Senior Lecturer in Human Geography at Wits University noted that in 2014 waste-pickers saved the country’s municipalities up to R750 million in landfill airspace (airspace is the projected bank cubic yards [BCY] of the landfill to be filled with waste as determined by survey and/or other engineering techniques).

Despite this, it appears that the Nelson Mandela Bay Metro has no immediate plan to provide waste-pickers with PPEs.

Mamela Ndamase, spokesperson for the Nelson Mandela Bay Metro told Spotlight all municipal refuse collectors are “regularly provided with work-wear to protect them”. On providing PPEs to waste-pickers, however, she said she will have to consult the relevant department on this matter.

Siyabulela Nciniba (39) calls the Arlington dump the source of his livelihood. “We rely on the dump not only for food but also for other necessities, despite potential health hazards. It is very dirty and on sunny days there is a bad smell, making it difficult to breathe,” he says. Nciniba tells Spotlight he is aware of the health risks. “Even right now I have a recurrent flu. I don’t know whether or not it is Covid-19.”

“Poverty leads us to put our lives in danger,” says Nciniba. “We are working without protective gear to guard us against Covid-19, and no one is providing us with protective gear because we are our own boss. Everyone here is afraid of this deadly virus, but we don’t have a choice but to work with or without them.” 

Regulations and survival

Ndamase explains the regulations on municipal landfill sites. “Both municipal landfills are general sites, not hazardous waste sites. Access to both sites is restricted as per permit conditions. No sleeping is allowed on site. Our notice boards clearly state that any person inside the sites seen eating and sleeping after operation times is trespassing.”

Ndamase says at the beginning of lockdown level 5, waste-pickers were made aware of the regulations. “[We] tried so many times to chase them out of the site. However, as the levels were relaxed, people found their way back to the site through the gaps in the fence. Public Health officials are doing their best to educate and create awareness to all communities, including waste-pickers,” she says.

When Spotlight visited both sites recently there were several makeshift shelters made of plastic sheets and wood that people lived in. The shacks appeared to have been there for quite some time, contrary to municipal regulations. 

“I came here to collect cardboard and other recyclable material but decided to stay on the site because I can’t afford transport money to travel daily from here to home,” says Asanda Tyala (28) from Uitenhage, mother of a 13-year-old boy and two girls aged 14 and 10. “I collect waste to sell for food so that I can feed my children,” she says. “I used to be concerned about the unbearable smell. The smell doesn’t concern me anymore because I’m used to it. I have been breathing in this stench for three years, having no health problem,” she says. Tyala says on “good days” she used to make R700 a day with her recycling, but since numbers of waste-pickers increased with lockdown, she hardly makes R300 a day.

Backbone of recycling industry

 National coordinator of the South African Waste-Pickers Association, Simon Mbata, says waste-pickers are the “backbone of the recycling industry, operating in the informal sector and are self-employed with no one to provide PPE”. “We call on government, private sector and civil society organisations to assist, support, fund and work holistically with waste-pickers during this time and make it easy for waste-pickers to access PPEs,” says Mbata.

“We also call upon national government to make it mandatory for all citizens to separate their waste and phase out [the] mixed waste collection system. We believe that this should be the last generation of waste-pickers working in landfills. We want to see all municipalities building material recovery facilities, run and operated by waste-pickers. All this will go a long way in ensuring that waste-pickers are also protected and practise good hygiene.”

Meanwhile, for most waste-pickers, life remains difficult.

Shelton Tinarwo (44) from Zimbabwe has been working at the Arlington landfill for the last five months. “During the beginning of lockdown, police and municipal security used to chase us away, but we kept coming back until they let us in. It is difficult for us who come from other countries to make a living. Locals always accuse us of taking their bread and butter, but without jobs, we will starve – and poverty knows no nationality.”

*This article was produced by Spotlight – health journalism in the public interest.

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Luvuyo Mehlwana

Labour says the government must “come clean” on PPE procurement process after £120m face shield deals.

• Trigger warnings at the beginning of books or films aim to prepare previously traumatised readers or viewers for potentially upsetting material
• A new study found that this precaution was not helpful to trauma survivors
• The researchers concluded that a prior warning did not lessen the impact of the disturbing material 

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Trigger warnings are meant to alert trauma survivors about unsettling text or content that they might find potentially distressing.

But these words of caution at the start of films or books may provide no help at all – and might even hamper a traumatised person’s ability to grapple with deep psychological scars, a new study reports.

“We found that trigger warnings did not help trauma survivors brace themselves to face potentially upsetting content,” said lead researcher Payton Jones, a doctoral candidate in clinical psychology at Harvard University. “In some cases, they made things worse.”

Trigger warnings seem to increase the extent to which people see trauma as central to their identity, which can exacerbate cases of post-traumatic stress disorder (PTSD) in the long run, Jones and his colleagues found.

Some real soul-searching

“We found evidence that trigger warnings increased the extent to which trauma survivors saw their worst event as central to their life story,” Jones said. “Seeing trauma as central to one’s life is not a good thing.”

The study’s results are strong enough that they should provoke some real soul-searching about who’s really being helped by trigger warnings, said Guy Boysen, a professor of psychology at McKendree University in Lebanon, Illinois.

“It’s a pretty convincing argument that in the population that trigger warnings are supposed to be for, it’s not really doing much,” Boysen said. “It’s time in this research area to flip the question and ask not whether trigger warnings work, but is there any population in which they do anything?”

Previous studies on trigger warnings have had similar findings, but have been criticised because participants were from the general public and not specifically people with a history of trauma, said Boysen, an expert on the topic.

Where did trigger warnings originate?

The concept of trigger warnings evolved from work on PTSD, a condition in which reminders of trauma cause some to experience extreme emotional reactions, Boysen said.

Online discussion groups for survivors of sexual trauma came up with the idea of providing warnings in advance, so people could talk about their experiences without causing pain in others, the researchers said in background notes.

Since then, the concept has flourished. About half of all college professors told National Public Radio in a 2016 survey that they’d used trigger warnings to prepare students for potentially difficult material.

However, the practice has been adopted without any real research to confirm whether it actually helps, Jones said.

To test the effectiveness of trigger warnings, the researchers recruited 600 people who’d been exposed to a traumatic event – actual or threatened death, serious injury, or sexual violence.

Participants were split into two groups. Both read a series of literature passages that ranged from neutral to mildly distressing to markedly distressing.

The only difference was that one group received trigger warnings prior to reading distressing passages, while the other did not. Participants rated their emotions after finishing each passage, and also completed a series of psychological questionnaires at the end.

Overall, both groups appeared to react similarly to the passages. Neither seemed to be spared the emotional impact of reading the text, the researchers said.

Avoidance doesn’t help

But people given trigger warnings were more likely to express the belief that their trauma is an essential part of a survivor’s life story – something that won’t help them overcome their trauma, Jones said.

According to Boysen, “Avoidance is bad. The reason people don’t get over their phobias and traumas and fears is because they don’t allow themselves to be exposed to reminders of them or the things themselves, and that just increases their symptomology.”

Jones said the report is “one of the very first studies to test whether trigger warnings work as intended. The key takeaway for me is not that trigger warnings are ‘bad,’ but that for many years we have been implementing a policy for trauma survivors without testing whether it is actually helpful or harmful.”

Boysen suggested that trigger warnings might not work as intended because there’s simply no way to make them specific enough in a general setting.

He gave the example of a person who has been robbed at gunpoint in their own home by burglars.

“What is the trigger going to be for that? Is it going to be seeing a person who looks like that, is it going to be talking about guns, talking about robbery? It could be anything, right?” Boysen said.

Useful on an individual basis

“The triggers for things that might lead to automatic distress are so diverse, and so individualised, it’s impossible to predict in a general way what’s going to be triggering for people, because it’s 100% totally unique to that person,” Boysen added.

While generalised trigger warnings don’t appear to help, Boysen said they still could be useful on an individual basis – for example, if a student with a solid grasp of their trauma trigger lets a professor know in advance what type of content could cause distress.

“That’s a different thing, because the teacher then has more of a specific idea of what could be effective,” Boysen said.

The new study was published recently in Clinical Psychological Science.

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• Analysis of clinical trials found that tai chi improved the mental state of almost 2 000 people
• This improvement can reduce stress, anxiety and depression among heart disease patients
• Tai chi arguably benefits practitioners’ mental state through the synergy between postures and breathing

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Tai chi might be just what doctors should order for their heart patients, new research suggests.

Many of these folks experience anxiety, stress and depression. For example, depression affects about 20% of people with heart disease or heart failure, 27% of those with high blood pressure, and 35% of stroke survivors.

Tai chi is a mind-body exercise that combines set movements with relaxation and breathing. It requires concentration on posture, relaxation and breathing.

Researchers analysed 15 clinical trials that examined how tai chi affected the mental well-being of more than 1 800 people, average age 66, who had heart disease, heart failure, high blood pressure, or had survived a stroke.

Physical and mental benefits

Overall, tai chi was associated with lower levels of mental distress, reductions in depression, and improved quality of life, including: mental health quality of life (how patients felt and their ability to go out and socialise) and physical health quality of life (walking and ability to do daily activities).

So how does tai chi benefit your mental state? “I think it’s the synergy between postures and breathing. During tai chi, you have good body posture, and research has shown that this enhances mood. We also know that holding your breath can cause stress and anxiety,” explained study author Ruth Taylor-Piliae, from the University of Arizona.

However, the study found no statistically significant association between tai chi and reduced anxiety, and tai chi did not have a noticeable impact on the well-being of stroke survivors. The findings were published on 8 June in the European Journal of Cardiovascular Nursing.

“This is because there were very few studies on psychological well-being or quality of life variables in this group. There is a lot of research on tai chi in stroke survivors, but nearly all of them looked at physical function such as balance and gait,” Taylor-Piliae said in a journal news release.

Further research is needed to learn how tai chi can improve mental health, she noted.

“If you’ve had a heart attack or stroke, or are affected by another heart condition, I would strongly recommend adding tai chi to your recovery and rehabilitation,” Taylor-Piliae said. “There are physical benefits like improved balance, and it’s good for mental health, too.”

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Relatives fear residents with dementia are deteriorating as coronavirus restrictions limit visitors.

A new study published in the American Journal of Obstetrics & Gynecology shows that a University of Rochester Medical Center (URMC) community outreach initiative has helped adolescents in Rochester adopt long-acting reversible contraception (LARC) at a rate far higher than the U.S. overall.

The lab of Jeremy Day, Ph.D., at the University of Alabama at Birmingham, has used single-nucleus RNA sequencing approaches to compare transcriptional responses to acute cocaine in 16 unique cell populations from a portion of the brain called the nucleus accumbens, or NAc. This molecular atlas is “a previously unachieved level of cellular resolution for cocaine-mediated gene regulation in this region,” said Day, an associate professor in the UAB Department of Neurobiology.