Researchers discover gel reduces scar tissue after surgery in animals

Researchers at Stanford University have found that spraying a gel on the internal tissues of animals after cardiac surgery greatly reduces adhesions, fibrous bands that form between internal organs and tissues. Adhesions can cause serious, even fatal, complications.

The gel, developed at Stanford to deliver medications, was far more effective than adhesion prevention materials currently on the market, the researchers said. It appeared to be safe in the animal study.

“The difference between what we saw after using the gel and what we normally see after surgery was drastic,” said Joseph Woo, MD, professor and chair of cardiothoracic surgery and the Norman E. Shumway Professor.

A paper describing the research published August 7 in Nature Biomedical Engineering. Woo and Eric Appel, PhD, an assistant professor of materials science and engineering, are the senior authors. Lyndsay Stapleton, a graduate student in bioengineering, is the lead author.

Adhesions form after 95% of surgeries. Some are harmless, but after abdominal surgeries, they can twist or compress the intestines, causing life-threatening blockages. Gynecological surgery can also lead to adhesions that cause infertility. In cardiac re-operations, common for those born with heart defects, adhesions increase the risk of complications.

Previous methods, lot of failures

Methods to prevent adhesions — including animal membranes, sheets of rubber and mineral oil — have existed for more 100 years, but they have mostly failed. Current adhesion barriers approved by the Food and Drug Administration are rarely used; they are difficult to deploy and are considered ineffective.

The Stanford researchers had long pondered a solution to the adhesion problem. But one day, when Stapleton was working with lab rats to develop an injectable therapy to reduce tissue damage following a heart attack, Appel suggested she try spraying a polymer-nanoparticle hydrogel onto the hearts and surrounding tissue after surgery to see if it reduced the formation of adhesions. Weeks later, when she operated on the animals again, she saw that no adhesions had formed.

“It was pretty striking,” she said. “I thought, ‘Oh wow, we could be onto something here.'”

The researchers decided to conduct a study. First, they formulated four additional gels with a range of properties. Then, after inducing heart attacks in rats, they randomly divided the animals into eight treatment groups: five that each received a different gel, two that received commercially available adhesion barriers and one that received no treatment.

Four weeks later, the rats that had received no treatment or either of the two commercial adhesion barriers had formed dense adhesions: Their hearts were connected to their chest walls. The rats that were treated with two of the five gels had formed moderate to dense adhesions. The rats treated with the other three gels fared much better, with very few adhesions. PNP 1:10, the gel Stapleton initially tried, completely prevented adhesions.

The researchers then tested PNP 1:10 in sheep, whose hearts are similar in size and shape to human hearts; they found similar results.

Like mayonnaise

PNP 1:10 was stiff enough to stick, but not so stiff it detached from the organs, Appel said. “It was sort of a Goldilocks sweet spot.” He compared PNP 1:10 to mayonnaise: thick, but easily spreadable. That property allows it to be sprayed onto an organ but then immediately reform its original strength.

The gel also has the ideal tension between stickiness and slipperiness: “It covers all of the irregular surfaces of the heart, adhering to the tissues, but not to itself,” Woo said.

And it’s flexible, allowing the heart to beat: “The gel doesn’t prevent tissues from moving around,” Appel said. “It simply provides a physical barrier to keep them from sticking to each other.”

PNP 1:10 dissolves and is absorbed by the body about two weeks after its application — enough time for healing to occur, Appel said. PNP 1:10 is not approved for use in patients, but it is made of components that the Food and Drug Administration has approved. As part of the study, the researchers tested the rats to see if they showed any reaction to the gel; they saw no abnormalities in the surrounding tissues or in the blood.

The researchers next plan to try PNP 1:10 in abdominal surgery in rats. They hope to conduct human trials soon.

Woo and Appel are members of Stanford Bio-X. Woo is associate director of the Stanford Cardiovascular Institute, and Appel is a faculty fellow at the ChEM-H Institute.

Other Stanford study co-authors are graduate students Amanda Steele, Anthony Yu and Gillie Agmon; cardiothoracic surgery residents Hanjay Wang, MD, and Michael Paulsen, MD; postdoctoral scholars Hector Lopez Hernandez, PhD, and Yuko Tada, PhD; visiting scholar Anton Smith, PhD; research assistants Akshara Thakore, Haley Lucian, Anahita Eskandari, Justin Farry and Kevin Jaatinen; undergraduate student Kailey Totherow; clinical veterinarian Sam Baker, DVM; former research assistant Camille Hironaka; medical student Kiah Williams; perfusionists Hunter Bergamasco, Clifton Marschel and Blaine Chadwick; and Michael Ma, MD, assistant professor of cardiothoracic surgery.

The work was funded by Stanford Bio-X Interdisciplinary Initiatives Seed Grants Program, the Stanford-Coulter Translational Research Grants Program, the National Institutes of Health (grant R01HL089315-01), the American Heart Association, the National Science Foundation-funded California Alliance, a Stanford Interdisciplinary Graduate Fellowship and the American Association for Thoracic Surgery Summer.

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Home births as safe as hospital births: International study suggests

A large international study led by McMaster University shows that low risk pregnant women who intend to give birth at home have no increased chance of the baby’s perinatal or neonatal death compared to other low risk women who intend to give birth in a hospital.

The results have been published by The Lancet‘s EClinicalMedicine journal.

“More women in well-resourced countries are choosing birth at home, but concerns have persisted about their safety,” said Eileen Hutton, professor emeritus of obstetrics and gynecology at McMaster, founding director of the McMaster Midwifery Research Centre and first author of the paper. “This research clearly demonstrates the risk is no different when the birth is intended to be at home or in hospital.”

The study examined the safety of place of birth by reporting on the risk of death at the time of birth or within the first four weeks, and found no clinically important or statistically different risk between home and hospital groups.

The study, which is the first systematic review and meta-analyses to use a previously published, peer-reviewed protocol for the research, used data from 21 studies published since 1990 comparing home and hospital birth outcomes in Sweden, New Zealand, England, Netherlands, Japan, Australia, Canada and the U.S. Outcomes from approximately 500,000 intended home births were compared to similar numbers of births intended to occur in hospital in these eight countries.

“Our research provides much needed information to policy makers, care providers and women and their families when planning for birth,” said Hutton.

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6 Things That Happen When You Turn 40

I keep seeing someone's old lady hands sticking out of my sleeves. There I am, just going about my work, and Bam! Old lady hands typing. Reaching for my dishes and Kapow! Old lady hands cooking. These hands are quite confusing, with their veins and sunspots and loose skin. What in the actual heck? Whose grandma is wearing my jewelry?

I turned 40 this year.

Forty! Which is so weird because I've always been young. I've been young my whole life, as a matter of fact. No matter how I dissect this, I've aged out of the "young" category and graduated to the "middle" group. My brain feels confused because I was just in college a minute ago. But much like Shakira: These hands don't lie. And they're not the only harbingers of change.

Through extremely scientific research like looking in a mirror and talking to my friends over wine, I've come up with a few telltale signs you've entered your forties—and no, not all of them are bad news.

RELATED: 11 Secrets of People Who've Lived to 100

You can no longer quit eating bread for a day and lose six pounds

Once upon a time, I could make some minor adjustment, maybe go for a jog, and my too-snug jeans would fit by Tuesday. Apparently, a body gets over this by 40. It just wants to be fat and happy.

After you turn 40, you can eat 400 calories a day for six weeks and your body will release three pounds. The next day you eat half a tortilla and gain 17. Your body isn't interested in your diet or those jeans. It wants yoga pants and your husband's stretched out T-shirts, and it will have them.

I should've enjoyed my young body more. I would have worn my bikini to the grocery store had I known my days with those smooth thighs were numbered.

RELATED: How to Get a Flat Stomach at Any Age

But you finally get a decent handle on who you are

Once you turn 40, you shed the skin of the existential dread. You know what you are good at, what you love, what you value, and how you want to live, and you don't worry about anything else.

These questions used to keep me up at night. I once worried endlessly about purpose and trajectory, identity and worth, but 40 brought me security I couldn't imagine. I know what I am good at now and I do it. I'm not apologetic and uncertain and aw-shucks about running my race. I no longer tiptoe through my own life, doubting my gifts and my place, too scared to go for it, seize it, pray for it, dream it. When you're 40, you no longer wait for permission to live. As Maya Angelou said, "Life loves the liver of it."

RELATED: Happiness Linked to Longer Life

Something weird happens to your brain

This brain has served you well for so long, but it starts punking you when you turn 40. You can't remember directions. You forget why you walked into a room. And for the life of you, you can't recall your third kid's name ("Take out the trash…Um, you!"). You will talk on your cell phone while looking around your house for your cell phone. This is unfortunate because about this time you go back to middle and high school with your spawn. You are expected to help with algebra and chemistry and the remembering of All The Things, but your brain resembles the bottom of your purse: lost pen caps and congealed, undefined filth. It will take a nap while those children work their own stuff out. Your brain already completed 11th grade. It has done its time.

RELATED: 16 Reasons You Have Serious Brain Fog

But you also develop resiliency

I used to desperately need approval. Criticism crushed me. Conflict paralyzed me. Consequently, I took the safest path through every scenario to avoid reproach. As an approval addict, the younger me would have been shocked to find that once I hit 40, I would quit caring so much what others think of me, my parenting, my marriage, my career, my politics, my house, my hair, my church, my dog, my new red front door, my comfortable flats, my stretchy pants, my daughter's hair, my son's weird interest in vintage ska, my new resolve to go vegan, my consistent purchase of Lunchables, my decision to work, my decision to quit, and so on.

If people don't like it, well, whatever. It's not that you become set in your ways. Differing opinions just stop shaking every decision. And critical words won't send you to bed. You develop chops.

RELATED: 21 Reasons You'll Live Longer Than Your Friends

Your skin… changes

When you see a picture of yourself, this is the thought process: "That was terrible lighting, and also the angle is tragic. Plus the shadows made my neck look weird, and do my friends not know how to use Instagram filters?!"

Sometimes I baby-talk parts of my body into resisting gravity's charms: "Come on, shins. I'm counting on you. You've always been good to me. You don't want to be like Neck and Eyelids and Chest, those loose floozies. Hang in there, baby, and you'll be the last part of me to see the light of day."

RELATED: The Anti-Aging Serum That Has More 5-Star Reviews Than Any Other Skincare Product on Amazon

But you also learn what's important

These kids, this husband, this little life I've built, that's what matters.

After 40, you are slower to tell everyone how wrong they are, and quicker to gather your folks and take deep breaths of gratitude. This is your place. These are your people. This is your beautiful, precious life. Probably about halfway through your time here on earth, you lay down angst and pick up contentment.

Annie Dillard was right: "How we spend our days is, of course, how we spend our lives." You realize insecurity, striving, jealousy, and living in comparison will eventually define your entire life, and that is not the legacy you want. You decide your days should contain laughter and grace, strength and security.

RELATED: The Best Time of Day to Do Everything

So sure, our bodies and minds get whack, but we wouldn't return to our twenties for all the unwrinkled skin on earth. At our age, we love better, stand taller, laugh louder. Real life has tempered our arrogance and fear, and this is the best version of us yet.

But damnit, I wish I had worn more sunscreen in my 20s.

Jen Hatmaker's new book is called For The Love: Fighting for Grace in a World of Impossible Standards ($23, amazon.com). Read more from her at jenhatmaker.com.

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Health24.com | Checking your blood pressure could someday be as easy as taking a video selfie

Taking your blood pressure may become as easy as taking a video selfie if a new smartphone app proves itself.

High blood pressure can be a warning sign of a heart attack or stroke, but half of those with hypertension don’t know it. Developing an easy at-home blood pressure screen could potentially save lives.

A new technology called transdermal optical imaging gives a picture of the blood flow in your face, which reveals your blood pressure, researchers say.

“We found, using a smartphone, we can accurately measure blood pressure within 30 seconds,” said lead researcher Kang Lee.

Lee is research chair of developmental neuroscience at the University of Toronto.

“We want to use this technology to help us to make people aware of their blood pressure and monitor it,” he said.

Lee doesn’t intend this technology to replace standard “cuff” blood pressure measuring, but rather to make blood pressure easy to take at home.

So how does it work?

The technology uses light to penetrate the skin and optical sensors in smartphones to create an image of blood flow patterns. These patterns are then used to predict blood pressure, Lee explained.

“Once you know how blood concentration changes in different parts of your face, then we can learn a lot of things about your physiology, such as your heart rate, your stress and your blood pressure,” he said.

Lee discovered the relationship between facial blood flow and blood pressure by accident. He was using transdermal optical imaging to try to develop a way of telling when kids were lying by correlating blood flow to areas of the face with fibbing.

Quite accurate

To test the technology’s blood pressure predictions, Lee and his colleagues tried it out on more than 1 300 Canadian and Chinese adults with normal blood pressure. Each participant had a two-minute video recorded using an iPhone with transdermal optical imaging software.

Lee’s team compared the results of the videos with blood pressure readings taken the standard way.

They found that the video prediction of systolic blood pressure (the upper number) was almost 95% accurate. The prediction of diastolic pressure (the bottom number) was nearly 96% accurate.

The report was published August 6 in the journal Circulation: Cardiovascular Imaging.

But several problems need to be solved before this technique is ready for primetime, Lee said. For one, the recordings made in the study were in highly controlled environments.

Challenges

The researchers hope to make the system work with normal home lighting and to shorten the time needed for the recording to 30 seconds.

They also need to test the technology on people with high and low blood pressure and a variety of skin tones.

“Smartphones are really smart,” Lee said. “We cannot only use it for social networking, it can actually help you become aware of your physiological state.”

But one specialist is sceptical that this system could ever be widely used.

“It would be cool to just look at your phone and then you know your blood pressure,” said Ramakrishna Mukkamala, a professor of electrical and computer engineering at Michigan State University.

Mukkamala said, however, that it’s doubtful that facial video can yield specific information about blood pressure.

“There’s no physics theory behind it,” said Mukkamala, a cardiovascular researcher who wrote an accompanying editorial.

If it were to work, “a lot of technical challenges have to be overcome”, he said. “These include different skin shades, different room temperatures and different lighting. Also, different angles of the face. And those aren’t easy problems.”

Image credit: iStock

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NHS pensions row: Ministers act amid waiting list rise

Overhaul plan comes after the rules were linked to a waiting list rise – and is backed by doctors’ union.

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Edinburgh Children’s Hospital will cost a further £90m

The lifetime price tag of the new hospital is set to top £500m after the extra costs were revealed by Audit Scotland.

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Virtual treasure hunt shows brain maps time sequence of memories

Part of the medial temporal lobe, the entorhinal cortex seems to play an important role. But how exactly does this part of our brain, located close to the amygdala and hippocampus, contribute to building a memory?

To fathom this angle of memory, the scientists had 26 subjects learn a sequence of events by navigating a route through a virtual city. They had to remember when certain objects appeared along the route and where they were in the city. Participants encountered chests along the route, which they were instructed to open. Each chest contained a different object that was displayed on a black screen when the chest was opened.

After learning, the researchers used an MRI scanner to measure how these events were displayed in the brain by showing the participants images of the objects in random order. “Events that occurred in temporal proximity are represented by similar activation patterns in the entorhinal cortex,” explained Jacob Bellmund. “This means that when objects were shown that were temporally close along the route, this part of the brain reacted in a similar way. They were therefore more similar to each other than the activation patterns of events that occured at long intervals.” Thus, the activation patterns of the entorhinal cortex reflected a kind of map of the temporal relationships of events.

The spatial relationships of the events, that is, the distance between the objects as the crow flies, could not be observed by the scientists.

A trick was used to study space and time independently: Three teleporters on the route immediately ‘beamed’ the participants to another part of the city, where participants continued navigating the route. “This manipulation enabled us to vary the temporal and spatial distances between pairs of objects so that the spatial distance could be large, but the temporal distance very small,” explained Bellmund.

The participants’ recall of events in a later memory test was influenced by how distinct the temporal map of events in the entorhinal cortex was. They were asked to freely remember all the objects encountered along the route in the order in which they came to mind. Participants with an exact temporal map in the entorhinal cortex recalled events one after the other that occured in temporal proximity. They listed the objects in order, as if they were mentally walking the route again.

Taken together, these findings show that the entorhinal cortex maps the time sequence of events and that this temporal map influences how we retrieve memories. These findings suggest that our brain stores our memories of experiences in a temporally organised way.

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Materials provided by Max Planck Institute for Human Cognitive and Brain Sciences. Note: Content may be edited for style and length.

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Blood pressure recording over 24 hours is the best predictor of heart and vascular disease

High blood pressure is the most important treatable risk factor for diseases of the heart and the arterial system. Blood pressure recorded over 24 hours predicts these complications more accurately than blood pressure measured on a single occasion. That is the conclusion of an international study coordinated by Professors Jan A. Staessen and Zhen-Yu Zhang of KU Leuven in Belgium. Dr. Gladys Maestre from the University of Texas, Rio Grande Valley School of Medicine, supervised the study in Venezuela, one of the participating countries. The study was published in the Journal of the American Medical Association.

An international consortium of scientists followed 11,135 individuals for 14 years. Study participants included residents of twelve countries in Europe, East Asia, and Latin America. The researchers compared the predictive accuracy of blood pressure measurements made by a healthcare provider in an office setting, to repeated blood pressure measurements recorded for 24 hours, during both day and night. The results showed that the probability of heart and vascular disease during follow-up was closely associated with the blood pressure measured over a 24-hour period.

“Although heart and vascular disease are strongly associated with blood pressure, irrespective of how it is measured, until now we did not know which type of blood pressure measurement captured risk in the most accurate way,” Dr. Maestre said.

At the start of the study, investigators made individual blood pressure measurements using all available approaches, and determined other risk factors. Blood pressure was also recorded over a 24-hour period using automated portable blood pressure monitors. The number of blood pressure measurements averaged 30 during daytime and 10 during sleep. One of the advantages of measuring blood pressure during sleep, with individuals lying down in bed, is that the results are not influenced by daytime activities or meals. This at least partly explains the accuracy of nighttime blood pressure in predicting cardiac and vascular illness.

High blood pressure is the leading treatable risk factor for diseases of the heart and vascular system. Worldwide, high blood pressure causes 10 million deaths each year, with more than half of that mortality attributable to cardiovascular disease. The present study is unique in its large sample size and long follow-up period. The characteristics of participants were similar to those of the populations from which they were enrolled, so the results can be generalized.

“Our research highlights the necessity of using 24-hour measurements to diagnose high blood pressure and to institute and fine tune its treatment,” said Dr. Maestre. “Nevertheless, most health insurers in the US reimburse 24-hour ambulatory blood pressure monitoring only when blood pressure is found to be high in the clinical setting, but is suspected to be normal otherwise, or if undetected or masked hypertension is suspected. However, 24 hour ambulatory blood pressure monitoring is cost effective: It enables the prevention of cardiovascular disease by starting treatment in a timely manner.”

Prevention and improved control of high blood pressure is also cost effective, because hospital-based treatment of the complications of high blood pressure, such as chest pain caused by narrowing of the arteries of the heart, myocardial infarction, and stroke, is expensive. Furthermore, prevention reduces the risk of premature disability and death, thereby avoiding suffering of patients and their families. About 30% of all adults and 60% of people age 60 and over have high blood pressure. Therefore, ambulatory blood pressure monitoring should be available at all levels of the healthcare delivery chain.

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Materials provided by KU Leuven. Note: Content may be edited for style and length.

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Kids might be naturally immunized after C. difficile colonization in infancy

Exposure to C. difficile in infancy produces an immune response that might protect against this gastrointestinal infection later in childhood, according to a study published in Clinical Infectious Diseases journal. Researchers found that infants who were naturally exposed to C. difficile in the environment and became colonized with the bacteria had antibodies in their blood. Analyses using a state-of-the-art assay revealed that these antibodies neutralized toxins that cause C. difficile infection, preventing harmful effects to cells exposed to these toxins. This suggests that a natural immunization occurs, although future studies will need to determine if it would prevent illness years later after another C. difficile exposure.

“We found an immune response in infants colonized with C. difficile, which might be beneficial as they get older, although we are still studying the extent and duration of this natural immunization,” says lead author Larry Kociolek, MD, MSCI, from Stanley Manne Children’s Research Institute at Ann & Robert H. Lurie Children’s Hospital of Chicago, who is an Assistant Professor in Pediatrics-Infectious Diseases at Northwestern University Feinberg School of Medicine and Associate Medical Director of Infection Prevention and Control at Lurie Children’s. “We are optimistic because we know from previous studies that adults with anti-toxin antibodies have a lower risk for illness from C. difficile infection.”

C. difficile is a frequent cause of community- and healthcare-associated infection in adults and children. While roughly half of all infants get exposed, they normally do not get sick from these bacteria. Older children and adults usually get diarrhea that needs to be treated by antibiotics. A more severe form of the infection may cause inflammation of the colon that requires surgery and could be fatal. Children tend to have milder symptoms than adults. The pediatric incidence of C. difficile infection peaks in the 1-to-4-year age group and during teenage years.

“Given our results, we suspect that young children who get sick from C. difficile were probably not exposed as infants and so did not develop immunity,” says Dr. Kociolek. “In adolescents, immunity might be waning. If with more research we can show that this is true, then there might be a role for vaccinating susceptible children and teens against C. difficile.”

Currently, vaccines against C. difficile toxins are in clinical trials for adults. Pediatric clinical trials will be needed before a vaccine is available for children and adolescents.

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Materials provided by Ann & Robert H. Lurie Children’s Hospital of Chicago. Note: Content may be edited for style and length.

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Health24.com | Parent who listens can help kids thrive despite trauma

Heartfelt talks between parent and child are essential to help kids overcome tough times and do their best at school, a new study says.

Traumatic events in a kid’s life can cause the child to neglect school work and increase the odds that they’ll wind up repeating a grade, researchers found.

A sympathetic parent

But having even one parent lend a kind and caring ear appears to help kids work past the toxic stress caused by those events, resulting in better performance at school, according to the study.

A sympathetic parent has a stronger impact on a troubled child’s educational performance than whether they eat regular family meals or live in a safe and well-kept neighbourhood, said lead researcher Dr Angelica Robles. She’s a paediatrician with Novant Health Developmental-Behavioral Pediatrics in Charlotte, North Carolina.

“The parent really had the biggest influence,” Robles said. “Kids were six times more likely to complete homework and six times more likely to care about school” if they had a parent who could share ideas or talk about things that matter.

For their study, Robles and her colleagues analysed data drawn from a 2011–2012 federal survey of more than 65 000 children ages six to 17.

They found that adverse childhood events could seriously affect a child’s interest in school – among them domestic or neighbourhood violence, economic hardship, substance abuse or mental illness in the home, the death or incarceration of a caregiver, and divorce or separation of parents.

Worse, the negative effect on school performance increases with each additional adverse event. Kids with four or more adverse events in their lives were nearly three times more likely to repeat a grade, three times more likely to not care about school and four times more likely to shrug off homework.

Resolving trauma

However, researchers found that positive engagement with a caring parent could go a long way in offsetting the damage caused by life.

A caring parent increased by sixfold a child’s likelihood of completing homework and being engaged in school, and nearly doubled the odds that the kid would never have to repeat a grade.

The findings were published online in the journal Pediatrics.

“A child who had experienced trauma in their life was able to do so much better in school if they said their parent cared about them and that they could talk about things together,” said Dr Rebecca Dudovitz, an assistant professor of paediatrics with UCLA’s David Geffen School of Medicine. She wrote an editorial that accompanied the study.

A caring parent mattered much more than any other factor in either the home or the neighbourhood, researchers found.

For example, having five or more family meals a week only made it about a third more likely that a child would do their homework and care about school, results showed.

“We thought regular family meals would be protective, and they were slightly, but what is more important is if during that meal do you have a conversation or do you have the TV on?” Robles said.

Any caring adult

A safe neighbourhood that is well-kept also had some protective effect for kids, as did supportive neighbours and nearby amenities like parks and community centres, researchers found. None came anywhere near the benefit from having a parent who listens, however.

For example, a supportive neighbour could make a kid 85% more likely to finish homework, 60% more likely to care about school and 40% more likely to never repeat a grade.

Other studies also have shown that having any caring adult in their lives will improve a child’s chances of success, even if it’s just a neighbour, Dudovitz said.

“There’s a lot of studies to suggest that even relationships with people who are not the parents make a huge difference,” Dudovitz said. “Just being able to cite that you have a caring older adult in your life is associated with a whole host of positive health outcomes for kids.”

For example, studies have shown that a positive relationship with a teacher or coach can reduce a kid’s risk of substance abuse, she said.

“Kids are constantly paying attention to adults in their lives, even teenagers who don’t seem to care at all about what we have to say,” Dudovitz said. “They really are watching us and want to be seen as whole individuals.”

Image credit: iStock

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