Air pollution may trigger Alzheimer’s-like brain changes and speed memory decline in older adults, a new study suggests.

Previous research has implied that exposure to fine particle air pollution increases the risk of Alzheimer’s disease and other types of dementia, but it wasn’t clear how this type of pollution affects the brain and memory.

Exposure to fine particle pollution

“This is the first study to really show, in a statistical model, that air pollution was associated with changes in people’s brains and that those changes were then connected with declines in memory performance,” said researcher Andrew Petkus. He’s an assistant professor of clinical neurology at the University of Southern California’s Keck School of Medicine.

“Our hope is that by better understanding the underlying brain changes caused by air pollution, researchers will be able to develop interventions to help people with or at risk for cognitive decline,” Petkus explained in a university news release.

The study included nearly 1 000 women, aged 73 to 87, who had brain scans five years apart. The researchers also assessed information about where the women lived and environmental data from those locations to estimate the women’s exposure to fine particle pollution.

The results showed that women who were exposed to higher levels of fine particle air pollution had more Alzheimer’s-like changes in brain structure and greater memory declines than those with less exposure to such pollution. But the study only showed an association, and couldn’t prove that air pollution caused brain changes or memory declines.

Tiny air particles

Alzheimer’s is the sixth leading cause of death in the United States. There’s no cure or treatment.

“This study provides another piece of the Alzheimer’s disease puzzle by identifying some of the brain changes linking air pollution and memory declines. Each research study gets us one step closer to solving the Alzheimer’s disease epidemic,” Petkus said.

Fine particle air pollution – which is inhaled easily, and reaches and accumulates in the brain – has been linked with asthma, heart disease, lung disease and premature death. These tiny air particles come from industrial production, forest fires or vehicles, according to the US Environmental Protection Agency.

The findings were published in the journal Brain.

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The phrase “medical xenophobia” is often used to describe the negative attitudes and practices of South African health care professionals towards refugees and migrants. It is used whenever foreign nationals are denied access to any medical treatment or care.

Research on migration and health in South Africa has documented public health care providers as indiscriminately practising “medical xenophobia”. But this dominant, single narrative around migrants and health care is misleading.

My recent research showed that there was more complexity, ambivalence and a range of possible experiences of non-nationals in South Africa’s public health care system. I conducted the research in a public health clinic in Musina, a small town on the border of South Africa and Zimbabwe.

I found that frontline health care workers provided services, including HIV treatment, to black African migrants who are often at the receiving end of xenophobic sentiment and violence. This was in spite of several institutional and policy-related challenges.

Discretion and innovation played a crucial role in inclusive health care delivery to migrants in a country marred by high xenophobic sentiment. This was because health care providers subscribed to an ethos of what was right for the patient.

Public health and individual discretion

There are a few issues with the current framing of “medical xenophobia”. First, the focus on attitudes – and not health care delivery – reflects a particular generalisation of how health providers are perceived to treat African migrants in South Africa.

This framing does not consider challenges facing the health system. These include shortages of medical personnel. Many migrants seeking care in South Africa’s public health system do face challenges arising from being “foreigners”. But there are other grounds beyond citizenship or legal status on which medical care might be denied. Not all cases of poor treatment are “medical xenophobia”.

South Africans also face challenges with the public health care system. These are related to the general shortages of nurses and doctors. Other challenges include high bed occupancy, high workload, low morale among nurses in public health facilities and the burden of the HIV pandemic.

Second, existing policy responses to communicable diseases in South Africa and the southern African region do not adequately cater for migrants. For example, treatment guidelines in South Africa have been found to be incomplete or inapplicable to migrant patients. Policies and programmes in the Southern African Development Community on communicable diseases such as HIV do not extend to migrant patients.

Health care providers often have to operate within these institutional, bureaucratic and policy constraints.

This scenario makes frontline discretion unavoidable. Health care providers have to rely on their own judgement to determine what “best practices” to invoke with relatively little input or interference from other institutions.

In spite of these challenges, frontline health care providers were doing their best to provide health services to black African migrants. They bypassed institutional and policy-related barriers to registering and treating undocumented migrants, non-native speaking migrants and migrants without referral letters.

This suggests that the experiences of non-nationals in South Africa’s public health care system were more complex and varied than implied by the dominant discourse on “medical xenophobia”.

It is true that some health care providers stereotyped migrant patients and blamed them for their destitution. But my research showed that these stereotypes didn’t directly translate to the exclusion of migrant patients from health care services. This was because of the health workers’ strong professional conduct and an awareness of the public health implications of not providing migrant patients with HIV treatment.

Working around the system

Health care providers in the clinic I visited came up with a system of using the date of birth to identify and keep a record of undocumented migrant patients. This replaced the 13-digit South African identity number, which is normally used to open patient files. Several of them used notions of morality, ethics and public service to frame their decision making. They understood health care to be a right for everyone, in line with Section 27 of the country’s constitution.

Others provided HIV treatment to migrant patients without referral letters. This decision was also mediated by how patients professed their “belonging” through “alternative” forms of knowledge and expertise. For example, one nurse claimed that she only provided anteretroviral therapy if migrant patients demonstrated knowledge of their medication, or if they brought a medicine container for a refill.

Health care providers reported difficulties interacting with migrant patients who spoke Swahili, French, Portuguese or Chewa. Staff and local patients worked together to ensure that migrant patients accessed health care services, often in extremely demanding circumstances. Health care providers made the effort to connect with migrant patients through informal interpreters by asking co-workers or patients fluent in these non-native languages to translate in English or other native languages.

These health care providers didn’t use language, documentation and referral letters to discriminate against migrant patients. They used innovation, creativity and compromise to provide services to migrant patients living with HIV.

Way forward

Policymakers need to recognise the importance of human relationships, communication networks, leadership and motivation in strengthening the country’s ailing public health system.

More crucially, activists need to identify the informal, inclusive and innovative practices of health care providers in addressing challenges related to documentation, referrals and language.

This should be coupled with calls to strengthen and invest in these grassroots responses to build greater solidarity. This is what can be done while waiting for policymakers to respond to ongoing calls for public health care systems to adequately engage with mobility.

Kudakwashe Vanyoro, Research Communications Officer and Doctoral Researcher at the African Centre for Migration & Society, University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Kudakwashe Vanyoro

Air pollution can penetrate a pregnant woman’s placenta and potentially threaten the health of a developing foetus, new research warns.

The study is “the first to show that air pollution particles can reach the foetal side of the placenta,” said study author Hannelore Bove, a postdoctoral researcher with the Centre for Environmental Sciences and Biomedical Research Institute at Hasselt University in Diepenbeek, Belgium.

Black carbon particles

The finding follows an analysis of high-resolution images taken of placenta tissue retrieved from 28 women who had just given birth at East-Limburg Hospital in Genk, Belgium.

Five gave birth prematurely, while the remainder carried to term. In each case, placenta tissue was retrieved within 10 minutes after delivery.

Bove and the research team reported detecting black carbon particles – most commonly produced by fossil fuel combustion – in the placenta of all the participating mothers.

But the tissue of those residing in relatively polluted areas had collected notably higher levels of carbon particles in their placenta than those from less polluted locations.

The study was published in Nature Communications.

Whether those particles definitely harm foetal development remains an open question. The researchers only set out to see whether pollution was present in the placenta. “This is the subject for another study,” said Bove.

Barrier against toxicants

Still, the new findings underscore a basic fact: that a mother’s environment is also the foetus’ environment. And the placenta cannot offer fool-proof protection from the outside world.

“The placenta’s principal function is to deliver nutrition and oxygen to the foetus,” explained study corresponding author Tim Nawrot, a professor of environmental epidemiology at Hasselt University. “But to some extent, it also forms a barrier against toxicants.”

In fact, “decades ago it was thought that nothing can cross the placenta,” said Bove. “And that the foetus is completely safe inside the womb.”

But in the 1960s, the thalidomide crisis shattered that belief, she noted. The infamous sleeping pill’s ingredients were found to have crossed the placenta in pregnant women, triggering massive birth defects.

Since then, it’s become clear that all kinds of substances – including alcohol, drugs and now fossil fuel pollution – can and do cross the placenta, said Bove.

Placental inflammation

Once inside the placenta, foetal exposure to pollution rings a number of alarm bells.

For one, “black carbon particles are thought to be especially toxic, since they can absorb toxic compounds like, for example, heavy metals and benzene,” said Bove. Such cancer-causing agents can mix with the oxygen and nutrients that feed a developing foetus.

Ingestion of combustion pollution can also boost infection risk, trigger problematic alterations at the molecular level, and provoke placental inflammation, according to Dr Mitchell Kramer.

Kramer, who was not part of the study team, is chairman of the department of obstetrics and gynaecology at Northwell Health’s Huntington Hospital, in Huntington, New York. He warned that such inflammation “is known to be associated with low birth weight and preterm birth, which lead to adverse developmental and cognitive impairment”.

The bottom line, Kramer suggested, is that it’s “indisputable” that inhalation of smog pollution poses a real danger to foetal health.

Changes in daily routines

What can expectant parents do? Both study authors said there is no easy answer.

“Individuals cannot do much to avoid pollution,” said Nawrot.

And Bove said that “moving homes is not realistic” for most people living in highly polluted areas.

“But small changes in daily routines may already reduce the exposure levels,” she added. Using candles, cooking with gas or wood, barbecues, and walking near busy roads are avoidable, she said, and women should “limit their time in the neighbourhood of these sources”.

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Consumers should be told it takes four hours to walk off the calories in a pizza, researchers say.

You may not be familiar with the name Caroll Spinney, but if you grew up watching Sesame Street, then you know this legendary performer. Spinney was the puppeteer behind iconic characters Big Bird and Oscar the Grouch. He died at age 85 on December 8 “after living with dystonia for some time,” according to a tweet from the official Sesame Street account.

What exactly is dystonia? The condition refers to a group of distinct disorders that are characterized by involuntary abnormal muscle postures, Melisa Petrossian, MD, neurologist and director of the Pacific Movement Disorders Center at Providence Saint John’s Health Center in Santa Monica, California, tells Health.

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“In medical terms, muscle tone refers to the ability of the muscle to properly relax when at rest; it has nothing to do with muscle definition sought out by exercising,” explains Dr. Petrossian. “When the muscles are not properly relaxed, they may show abnormal postures, tightness, or even tremor (shaking).”

These muscle movements can come in the form of spasms, which may be mild or painful, and they can interfere with daily life, according to Mayo Clinic.

In February, just after his appearance at Great Lakes Comic Con with some of his Sesame Street castmates, Spinney announced on Facebook that he was “slowing down” and shared some of the realities of living with dystonia.

“The fact is I’m 85 years old and also battle daily with the devastating symptoms of dystonia,” he wrote. “There is no cure. Some days are better than others.”

He went on to reveal that his symptoms included involuntary muscle contractions, slow repetitive movements, and cramps, which lead to an “abnormal posture at times.”

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Dystonia can be generalized (affecting the whole body) or focal (affecting just one body part), says Dr. Petrossian. Adult-onset dystonia is typically focal, and one of the most common types is cervical dystonia, which tends to present as neck spasm or pain, or as abnormal neck postures and head tremor. (FYI, cervical in this context refers to the neck, and has nothing to do with the reproductive organ.)

Another type of focal dystonia is spasmodic dystonia, which affects the muscles that control the vocal cords, causing a strangled or strained voice; blepharospasm, which strikes the muscles of the eyelids and results in excessive blinking and difficulty keeping the eyes open; and hemifacial spasm, which affects the muscles of one side of the face, leading to twitching or tightening of the muscles around the eye, cheek, or mouth on the affected side.

Spinney also suffered from some “less visible things this disease causes,” as he put it—namely light sensitivity in his eyes, twisting movements, and vocal box spasms. “This is why I can be very softly spoken or wear sunglasses indoors on certain days,” he explained. “It’s all related neurologically and also affects the ability to focus on a task at hand sometimes.”

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As many as 250,000 people in the United States have dystonia, making it the third most common movement disorder behind essential tremor and Parkinson’s disease. It is a condition that knows no age, ethnic, or racial boundaries; it can affect young children to older adults of all races and ethnicities, according to the American Association of Neurological Surgeons. 

The cause of dystonia isn't known, but some forms are inherited, states Mayo Clinic. And while there is no cure for dystonia, as Spinney wrote in his Facebook post, treatment options do exist, and they depend on whether it is focal or generalized.

“Focal dystonia often respond to botulinum toxin, such as Botox, which targets the muscles that have abnormal activity," says Dr. Petrossian. "The injections are typically done every three months and remain effective even after years of therapy,” she explains.

Oral meds, such as baclofen, cyclobenzaprine (Flexeril) and benzodiazepines like diazepam, are often required for generalized dystonia to reduce muscle spasm. A baclofen pump is an alternative to oral meds, Dr. Petrossian says––this inserts the med straight into the spinal canal, and it may result in fewer cognitive side effects, such as imbalance and grogginess.

If botulinum toxin and oral meds don’t improve the symptoms of cervical dystonia, another option may be deep brain stimulation (DBS) surgery. In this procedure, electrodes are placed into the brain, then connected to a pulse generator or battery that is inserted under the skin below the clavicle. 

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In Spinney’s Facebook post, he paid tribute to his “great support team” in Deb, his wife of 40 years, and his agents. “They help me get through these issues that can be tough even under the best circumstances,” he added.

Ultimately, he didn’t let his illness hold him back, even at age 85. “I may have retired but I’m not ready to relegate myself to solitary confinement yet,” he wrote. "Now that I’m not as active with day to day programming on Sesame Street, I have more time to get out and about to meet the world. My fans’ stories, pictures, smiles, and tears are uplifting to the soul and are why I keep going!”

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Over the last three decades, meaning in life has emerged as an important question in medical research, especially in the context of an aging population. A recent study by researchers at University of California San Diego School of Medicine found that the presence of and search for meaning in life are important for health and well-being, though the relationships differ in adults younger and older than age 60.

Diseases of the gut are often notoriously difficult to diagnose, nevermind understand, which is where a network-based approach comes in. Rather than trying to understand individual symptoms, or the role of individual genes, we can use computational methods to get that deeper understanding — looking at how genes work together in complex systems, and how these fail in a disease.

Physicists at the Weizmann Institute of Science in Israel have imaged electrons flowing viscously through a nanodevice, just like water flowing through a pipe. Long predicted but only now visualized for the first time, this curious new behavior for electrons has important implications for future electronic devices.

Is Labour right to say that 17,000 NHS beds have been cut by the Conservatives in England?

Could permanent hair dyes and chemical straighteners raise a woman’s risk of breast cancer? A new study suggests they could.

Researchers analysed data from nearly 47 000 US women, followed for an average of more than eight years as part of the federally funded Sisters Study. All of the women had a sister who’d been diagnosed with breast cancer, but they didn’t have breast cancer themselves at the start of the study.

Higher risk among black women

Although it wasn’t able to prove cause and effect, the study found that women who regularly used permanent hair dye in the year prior to enrolling in the study were 9% more likely to develop breast cancer than those who didn’t use hair dye.

The risk was notably higher among black women. Their use of permanent dyes every five to eight weeks or more was associated with a 60% increased risk of breast cancer, compared with an 8% increased risk for white women, the researchers found.

There was little to no increase in breast cancer risk among women who used semi-permanent or temporary hair dyes, however.

The study also found that women who used chemical hair straighteners at least every five to eight weeks were about 30% more likely to develop breast cancer than those who didn’t use these products.

The association between straightener use and breast cancer was similar among black and white women, but straightener use was much more common among black women, according to researchers at the US National Institute of Environmental Health Sciences (NIEHS).

The findings need to be replicated in other studies, stressed study co-author Dale Sandler, chief of the NIEHS’ Epidemiology Branch. Even so, it might be wise to avoid chemical straighteners and permanent hair dyes, she said.

Debunking myths

“We are exposed to many things that could potentially contribute to breast cancer, and it is unlikely that any single factor explains a woman’s risk,” Sandler said in an NIEHS news release. “While it is too early to make a firm recommendation, avoiding these chemicals might be one more thing women can do to reduce their risk of breast cancer.”

One breast cancer expert said she read the new study with “surprise and dismay”.

“As a breast cancer surgeon of greater than 25 years, I spend a lot of time debunking myths about the causes of breast cancer,” said Dr Alice Police, who directs breast surgery at the Northwell Health Cancer Institute in Sleepy Hollow, New York. “No, it is not caused by your deodorant or your underwire bras or wearing your cellphone in your sports bra when you work out.”

However, the new study “really suggests a plausible link” between certain hair care products and cancer, she said.

“Even when considering age and obesity rates, the trend appears to be real in this very large group of women,” said Police. “The risk with at-home treatments was higher than salon treatments, probably due to increased chemical exposure to the hands and to fumes in an enclosed space,” she noted.

“I am so sad that my youthful ombre may be at risk, as a woman of a certain age who regularly colours her hair,” Police said. “However, as the article readily admits, more study is necessary.”

Varying increased risks

Another breast cancer expert was a little more dubious about the study’s methodology and findings.

“There are many points that I take issue with in this study,” said Dr Lauren Cassell, chief of breast surgery at Lenox Hill Hospital in New York City. She pointed out that the Sisters Study’s population isn’t representative of women as a whole.

“These women were all at varying increased risks based on the virtue of the fact that they had at least one first-degree relative [a sister] with a history of breast cancer, and maybe more,” Cassell noted.

Also, the researchers concluded that “only a one-year period of using hair dye or hair straightener prior to the study was enough to impact breast cancer risk, which does not seem reasonable,” she said. Many women interviewed in the study might also not accurately recall frequency of use, or whether they used permanent or semi-permanent dyes, Cassell reasoned.

“All these chemicals are probably not good for you, but if there was a direct connection, one would think that we would be seeing many more women developing breast cancer because so many women use these products on their hair,” she said.

The study was published online in the International Journal of Cancer.

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