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covid

New Study Reveals Details Of Lingering Covid-19 Symptoms After Infection 

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A recent study published in Nature Communications has given a larger understanding over lingering Covid-19 symptoms experienced by people who contracted the virus. The study utilized electronic health records from the National Institutes of Health’s RECOVER Initiative. 

The study was led by Dr. Rainu Kaushal, the chair of the Department of Population Health Sciences at Weill Cornell Medicine and physician-in-chief of population health sciences at New York-Presbyterian Hospital. The study gave a deeper insight into the reasoning behind lingering Covid-19 symptoms after one experiences an acute infection. 

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The study also analyzed the likelihood of these symptoms and how they differ throughout various populations and demographics throughout the United States. 

“Long COVID is a new disease that is very complicated and quite difficult to characterize. It affects multiple organs and presents a severe burden to society, making it urgent that we define this disease and determine how well that definition applies among different populations. This paper provides the basis for furthering research on long COVID,” said Dr. Chengxi Zang, an instructor in population health sciences at Weill Cornell Medicine and lead author on the paper. 

The team utilized multiple research outlets to make their conclusions, including health records from two clinical research networks within the National Patient-Centered Clinical Research Network. One set of data included information from 11 million New York-based patients, and another network that was utilized included 16.8 million patients from Florida, Alabama, and Georgia. 

The research conclusions the team came to showed there was a large list of diagnoses that occurred more frequently in individuals who had Covid-19 compared to those who didn’t. In New York City specifically, the researchers found that residents who had Covid experienced more types of symptoms and were at a higher risk of long Covid. 

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Between New York City and Florida, populations had specific conditions including dementia, hair loss, sores in the stomach, fatigue, and blood clots in the lung. 

“Our approach, which uses machine learning with electronic health records, provides a data-driven way to define long COVID and determine how generalizable our definition of the disease is,” Dr. Zang said. 

“Some of the differences between the results from the two populations might be explained by the fact that New York City had a more diverse patient population, endured one of the first waves of the pandemic and faced the lack of personal protective equipment such as masks, compared with Florida,” Dr. Zang said.

“In this new research, we examined a broad list of potential long COVID conditions one by one. These findings can help us better recognize the broad involvement of multiple organ systems in long COVID, and design appropriate plans for patient management and treatment development,” said Dr. Fei Wang, co-senior author of the study.

stroke

New Study Suggests 60% Of Stroke Survivors Could Develop Cognitive Decline Within One Year

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According to a new study and statement from the American Stroke Association, up to 60% of all stroke survivors develop cognitive issues within one year, and one-third develop dementia within five years.

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type2

Study Suggests Global Rise In Type 2 Diabetes Attributed To Refined Carbs And Red Meat Consumption 

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According to a new study recently published in the journal Nature Medicine, consuming too many refined carbohydrates, such as wheat and rice products, as well as a lack of grains is contributing to the global growth rate of type 2 diabetes. 

Senior author Dr. Dariush Mozaffarian, professor of nutrition and medicine at Tufts University said in a statement that the “study suggests poor carbohydrate quality is a leading driver of diet-attributable type 2 diabetes globally.”

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The study also stated that the consumption of red, processed meats is also a contributing factor. The main three conclusions the study cited as primary drivers to over 14 million new cases of type 2 diabetes in 2018 were eating too few whole grains, too many processed carbohydrates/grains, and too much red meat.

“These new findings reveal critical areas for national and global focus to improve nutrition and reduce devastating burdens of diabetes.”

The study estimated that 70% of cases of type 2 diabetes around the world in 2018 were linked to habits relating to food consumption. 

Dr. Mozaffarian and his team involved in the study developed their research model based on dietary intake from 1990 and 2018, and applied the research to 184 countries. When they compared the numbers from 1990 to 2018, they found that 8.6 million more cases of type 2 diabetes brought on by poor diet choices developed. 

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For men, urban residents, and younger individuals especially, the researchers found that eating too many unhealthy foods was a larger contributing factor than not enough healthy foods in some cases. 

Eating too much refined rice, wheat, potatoes, processed/unprocessed meats, and drinking too much sugar-sweetened beverages account for the main dietary habits attributed with 60% of the total global diet-attributable cases of type 2 diabetes. 

On the other end, a lack of fruits, vegetables, nuts, seeds, whole grains, and yogurt attributed to around 39% of cases. 

Individuals in Poland, Russia, and other Eastern/Central European countries where diets tend to focus on red/processed meat and potatoes, had the highest percentage of new type 2 diabetes cases. 

“Our modeling approach does not prove causation, and our findings should be considered as estimates of risk,” the authors wrote.

fungus

CDC Says a Deadly Fungal Infection Is Spreading in the US at an ‘Alarming’ Rate

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The Centers for Disease Control and Prevention issued a warning that a drug-resistant and potentially deadly fungus is spreading rapidly at an “alarming rate” through U.S. health care facilities.

A study conducted by the CDC found that Candida auris has now been detected in more than half of U.S. states. Cases nationwide nearly doubled between 2020 and 2021 from 756 to 1,471 before increasing to 2,377 in 2022. The majority of cases tested were immune to antifungal treatment.

C. auris poses little threat to healthy people but can cause serious illness or death in those with compromised immune systems or those who use medical devices like ventilators or catheters.

The CDC has called the fungus an “urgent antimicrobial resistance threat.” It can spread from “contact with affected patients and contaminated surfaces or equipment.” Common symptoms include fever and chills that do not improve with treatment.

Dr. Meghan Lyman, chief medical officer of the CDC’s mycotic diseases branch and the report’s lead author, told NBC the increase in cases “in the most recent years, are really concerning to us.” She stated the CDC has “seen increases not just in areas of ongoing transmission, but also in new areas.”

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Identifying the fungal infection can be challenging because most patients present with advanced illness and confirmation of infection requires a laboratory test. Moreover, while a significant number of patients with invasive infections die, it can be difficult to assess the exact role C. auris played in these deaths.

According to the CDC data, which was published in the Annals of Internal Medicine, infection by C. auris was first reported in the United States in 2016. The most rapid rise in cases was observed from 2020 to 2021.

The growing number of cases resistant to echinocandins, the most widely prescribed antifungal medication for the infection, is raising the most concern.

Poor infection prevention in health care facilities and better screening efforts have contributed to the increase in reported cases, according to the CDC. The additional strain on health care and public health systems during the pandemic may have also exacerbated the spread of the fungus.

The Mississippi Department of Health has been fighting a growing outbreak of infections. A lead epidemiologist in the state, Dr. Paul Byers, told NBC there had been ongoing transmission at two long-term care facilities. Cases have also been identified at several other facilities in the state.

“Unfortunately, multi-drug resistant organisms such as C. auris have become more prevalent among our highest risk individuals, such as residents in long-term care facilities.”

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Dr. Byers told NBC in an email at least 12 people have been infected with C. auris since November, with four “potentially associated deaths.”

The CDC reports that the fungus can be found both on the skin and throughout the body. The healthy population is not in danger, but about a third of those infected with C. auris die.

The CDC examined information from state and local health departments on C. auris infections and asymptomatic but contagious “colonized” individuals from 2016 to 2021. Between 2019 and 2020, infections increased by 59%. The following year, there was a 95% increase. The number of people “colonized” increased by 21% in 2020 and 208% in 2021.

Dr. Waleed Javaid, an epidemiologist and director of infection prevention and control at Mount Sinai Downtown in New York, called the findings “worrisome.”

“But we don’t want people who watched ‘The Last of Us’ to think we’re all going to die. This is an infection that occurs in extremely ill individuals who are usually sick with a lot of other issues.”

One of the challenges in preventing the fungus spread in hospital ICU units is that C. auris can colonize not only people who come into contact with the fungus but also patient rooms.

“By its nature, it has an extreme ability to survive on surfaces. It can colonize walls, cables, bedding, chairs. We clean everything with bleach and UV light.”

brain

‘Invent Stories’: Neurosurgeon Henry Marsh’s Guide To Keeping Your Brain Healthy As You Get Older

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“The point I would like to emphasize is that it’s about trying to live well, and a better life is really about helping other people or helping the natural world.”

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sugar

Popular Sugar Substitute Linked to Increased Risk of Heart Attack and Stroke

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According to a study published in Nature Magazine on Monday, researchers have found links between erythritol, a common low-calorie sugar substitute, and an increased risk for cardiovascular events such as heart attack and stroke.

In the past, medical researchers have raised concerns about the long-term safety of sugar substitutes companies frequently use in products marketed as sugar-free, low-calorie or light. These products often use polyol (sugar alcohol) sweeteners like erythritol as a common component of diet varietals of foods like yogurt, ice cream, puddings and candies.

Many so-called “natural” stevia and monk fruit products also contain erythritol as their primary, weight-based ingredient. Since even a tiny amount of stevia or monk fruit is 200 to 400 times sweeter than sugar, erythritol is often used as a bulking agent to give the product a sugary, crystalline appearance and texture consumers are used to.

Dr. Stanley Hazen, a cardiologist at the Cleveland Clinic and an author of the study, told The New York Times that while people opt for these diet meals and drinks to make a positive change, “They may inadvertently be doing harm.”

Researchers analyzed the blood erythritol levels of around 4,000 participants from the United States and Europe. They found that those with the highest sugar substitute concentration in their blood were more likely to have a stroke or heart attack.

“If your blood level of erythritol was in the top 25% compared to the bottom 25%, there was about a twofold higher risk for heart attack and stroke. It’s on par with the strongest of cardiac risk factors, like diabetes.”

When mice were given erythritol as part of the study, they were more likely to suffer from blood clots. Erythritol also induced clotting in human blood and plasma.

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The sugar alcohol remained in the blood of eight persons for more than two days after they ingested amounts similar to those found in a pint of keto ice cream or a can of an artificially sweetened beverage.

“Every way we looked at it, it kept showing the same signal,” Dr. Hazen said.

“It has long been believed that used sugar substitutes such as erythritol will reduce calories from carbohydrate intake while still allowing food to taste good,” Dr. Yu-Ming Ni, M.D., a cardiologist at Orange Coast Medical Center in Fountain Valley, California, told Yahoo News. “However, we have seen in repeated studies that sugar substitutes have side effects that go beyond simply imitating the taste of sugar.”

Dr. Ni notes that this work’s most significant contribution is demonstrating a possible mechanism by which artificial sweeteners can damage blood vessels. Until this correlation is confirmed and replicated by other research, we cannot conclude that erythritol consumption causes an increase in heart disease. Until then, it is unknown whether complete abstinence from all artificial sweeteners is required.

“I often advise my patients to eat food as naturally as possible, as that reduces the risk of exposure to potentially harmful chemicals like artificial sweeteners, and to consider sugar substitutes if it serves as a means to help overweight people with weight loss since overall weight loss has clearer evidence for health improvement.”

Dr. Dariush Mazaffarian, a cardiologist and professor of nutrition at the Friedman School of Nutrition Science and Policy at Tufts University, who was not involved with the study, told The New York Times that not enough studies have been conducted to determine the long-term health effects of sugar substitutes definitively.

“That’s the problem. Regardless of this study, there’s just not been enough evidence that they’re really safe.”

The Calorie Control Council, which represents the low and reduced-calorie food and beverage industry, said in a statement that “The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages.”

“Erythritol is a proven safe and effective choice for sugar and calorie reduction and, for more than 30 years, has been used in reduced-sugar foods and beverages to provide sweetness, as well as enhance their taste and texture. Along with exercise and a healthy diet, reduced-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases, such as cardiovascular disease.”

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Dr. Mozaffarian notes that there were several caveats to the study. Most of the participants were over the age of 60 and already suffered from cardiovascular disease or were already at high risk for developing it due to conditions like diabetes and high blood pressure.

The study also did not provide conclusive evidence to suggest erythritol caused heart attacks and strokes, only that it elevated cardiovascular risk.

Dr. Priya M. Freaney, a cardiologist at Northwestern University who was not involved with the study, told The New York Times that she agreed that the study requires further validation. However, “It’s concerning enough that it certainly deserves more investigation.”

Due to their rising popularity over the past decade, sugar substitutes have prompted scientists to research their possible impacts on human health more urgently. New York University emerita professor of nutrition, food studies and public health Dr. Marion Nestle, who was not involved in the study, commented on the large body of literature on artificial sweeteners and its often-contradictory findings.

Past studies examining links between artificial sweeteners and cancer and cardiovascular diseases have concluded that these chemicals may increase the risk of these conditions, but only marginally. They also conclude that more research is needed.

“There are going to be studies that show that it’s good, bad or indifferent. People have been consuming artificial sweeteners for years. It’s really hard to put your finger on any specific problem.”

Dr. Joanne Slavin, professor of food science and nutrition at the University of Minnesota-Twin Cities, told The New York Times that previous research has determined erythritol is a suitable replacement for sugar. However, much of the research was performed on animals. Examining sugar substitutes’ health effects when consumed as part of a larger diet further complicates things.

For example, those who consume high amounts of artificial sweeteners may already be at risk for cardiovascular issues, prompting the switch to sugar substitutes in the first place.

“That’s the really important thing, for people to not say, ‘Hey, this stuff is terrible, it’s giving us heart attacks.’ No. This is another data point that says, ‘Hey, we have to look into this.’”

pt

New Technology Helps Two Patients With Stroke Paralysis Regain Movement in Their Hands

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According to a report in Nature Medicine, two stroke patients were able to regain the use of a paralyzed arm and hand after receiving electrical pulses to a specific area of their spinal cords.

One of the patients, Heather Rendulic, previously could not carry out routine tasks involving her left hand, such as holding a fork or making a fist.

Rendulic had a series of five strokes over a period of 11 months when she was 22 years old due to a rare brain disease called cavernous angioma, which left her paralyzed on her left side.

After volunteering for and undergoing a clinical study in 2021 to improve the lives of people like her, Rendulic opened her hand for the first time in nine years.

“I live one-handed in a two-handed world, and you don’t realize how many things you need two hands for until you only have one good one.”

During the clinical trial, researchers from the University of Pittsburgh and Carnegie Mellon University implanted a pair of thin metal electrodes along the surface of Rendulic’s spinal cord. The electrodes sent tiny electrical pulses to stimulate specific regions and activate nerve cells.

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Study co-author and assistant professor of neurological surgery at the University of Pittsburgh, Dr. Marco Capogrosso, shared how everyone in the room was stunned when Rendulic could “move her hand and arm after nine years from day one.”

“The whole lab was crying because…we didn’t really expect that this could work as fast.”

Rendulic described the stimulation as “kind of like a tickle.” The process did not hurt her, but it initially felt a bit uncomfortable.

“When the stimulation is on, I feel like I now have control of my arm and my hand again that I haven’t had.”

Rendulic can now carry out several mobility tasks, including drawing a spiral, opening a lock, and gripping and lifting a soup can while the device is still on. At the end of the four-week trial, she was even able to cut her own steak. The other patient in the trial saw the same newfound range of motion.

Researchers hope this new technology, paired with targeted physical training, can improve outcomes even further.

Spinal cord stimulation has long been used to treat chronic pain. Prior research has shown that the same technology could restore leg movement after a spinal cord injury. However, upper limb paralysis has always been more challenging to restore since multiple nerves are involved in the movement of shoulders, wrists and arms.

Dr. Capogrosso says that while people still retain some of these neural connections, “They’re just not enough to enable movement.” The messages are weaker than normal.

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Dr. Douglas Weber, another of the study’s co-authors and professor of mechanical engineering at the Neuroscience Institute at Carnegie Mellon University, described how electrical pulses could strengthen those connections.

“The sensory nerves from the arm and hand send signals to motor neurons in the spinal cord that control the muscles of the limb. By stimulating these sensory nerves, we can amplify the activity of muscles that have been weakened by stroke. Importantly, the patient retains full control of their movements: The stimulation is assistive and strengthens muscle activation only when patients are trying to move.”

Dr. Capogrosso looks forward to what these results mean for future stroke treatment.

“We found that after a few weeks of use, some of these improvements endure when the stimulation is switched off, indicating exciting avenues for the future of stroke therapies.”

As of right now, the chronic stage of paralysis, which occurs six months or later after a stroke, cannot be treated effectively. However, this new simulation technology has promising potential, given that the benefits of the simulation persisted for up to four weeks after the end of the procedure with no serious side effects.

Study co-author Dr. Elvira Pirondini, an assistant professor of physical medicine and rehabilitation at the University of Pittsburgh, states, “Creating effective neurorehabilitation solutions for people affected by movement impairment after stroke is becoming ever more urgent.”

“Even mild deficits resulting from a stroke can isolate people from social and professional lives and become very debilitating, with motor impairments in the arm and hand being especially taxing and impeding simple daily activities, such as writing, eating and getting dressed.”

In the meantime, Rendulic has hope for the future. “I really hope and pray that this becomes widely available,” she says, “because I know it’s going to change so many lives.”

norovirus

CDC Warns Stomach Bug Cases Are Up 30% 

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According to the Centers for Disease Control and Prevention, cases of the norovirus, commonly referred to as the stomach bug, are rising across the country.

This flu season, there have been 225 reports of norovirus outbreaks in the US between August and January within the 14 states that provide norovirus data to the CDC. These outbreaks mark a 30% rise in cases when compared to last year’s 172 reported outbreaks. 

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Norovirus is defined as a contagious virus that causes painful stomach cramps, nausea, vomiting, and diarrhea. 

According to the CDC, “everyone is susceptible to the infection, whether by coming into contact with a sick person, consuming contaminated food or water, or touching contaminated surfaces and then putting hands in their mouth. Infections typically occur between November and April.”

“Norovirus can be found in your vomit or feces even before you start feeling sick. The virus can also stay in your feces for two weeks or more after you feel better.”

This is why we all should wash our hands for at least 20 seconds, which noted that hand sanitizer can be ineffective in killing norovirus,” CDC says.

“You can use hand sanitizers in addition to hand washing, but hand sanitizer is not a substitute for washing your hands with warm water and soap,” the CDC says.

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Young children, the elderly, and the immunocompromised are at the highest risk of infection. While infections can be deadly, cases of that extreme are pretty rare. Around 900 Americans are killed by the Norovirus every year; mainly amongst the elderly population. 

Norovirus is also responsible for around 465,000 emergency room visits every year; mostly in young children. 

The bathroom is a prime spot to contract the virus, as people often “get norovirus by accidentally getting tiny particles of feces or vomit from an infected person in your mouth,” the CDC says. 

“You can shed billions of norovirus particles that you can’t see without a microscope. Only a few norovirus particles can make other people sick.”

“People are most contagious when they are displaying symptoms — particularly when still vomiting and in the initial period after recovering from illness.

There is no treatment for norovirus infections. If sick, the key is hydration,” the CDC says.

“If you have norovirus illness, you should drink plenty of liquids to replace fluid lost from vomiting and diarrhea,” the CDC added.

gel

New Study Shows UV Dryers For Gel Manicures May Damage The DNA In Your Hands

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A new study published in Nature Communications shows that getting frequent gel manicures using UV nail polish dryers can cause damage to the DNA in our hands, and potentially lead to skin cancer. 

Ultraviolet (UV) rays are known to cause skin cancer at high exposures, and there isn’t a lot of current research on the potential harms of UV nail polish dryers.  

The University of California San Diego recently released a press release that explained “that the common devices in nail salons generally use a particular spectrum of UV light (340-395nm) to cure the chemicals used in gel manicures. While tanning beds use a different spectrum of UV light (280-400nm) there have been studies that show tanning bed UV light is carcinogenic, or cancer-causing, however, the spectrum used for nail dryers has not been extensively studied.”

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“If you look at the way these devices are presented, they are marketed as safe, with nothing to be concerned about. But to the best of our knowledge, no one has actually studied these devices and how they affect human cells at the molecular and cellular levels until now,” said Ludmil Alexandrov, a professor of bioengineering and cellular and molecular medicine at UC San Diego, and corresponding author of the study. 

Researchers of the study found that using the device for one 20 minute session led to 20-30% cell death, where three consecutive 20 minute exposures caused between 65-70% of exposed cells to die. 

The UV light also caused mitochondrial and DNA damage to the skin cells, resulting in mutations with patterns that can also be seen in skin cancer in humans. 

“We saw multiple things: first, we saw that DNA gets damaged,” said Alexandrov in a press release. 

“We also saw that some of the DNA damage does not get repaired over time, and it does lead to mutations after every exposure with a UV-nail polish dryer. Lastly, we saw that exposure may cause mitochondrial dysfunction, which may also result in additional mutations. We looked at patients with skin cancers, and we see the exact same patterns of mutations in these patients that were seen in the irradiated cells.”

According to the Skin Cancer Foundation “90% of the visible signs of aging come from daily exposure to UV light. This means fine lines, wrinkling, saggy skin, sun spots, uneven skin tone,” says Mona Gohara, M.D., associate clinical professor of dermatology at Yale School of Medicine and Prevention Medical Review Board member. 

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“In addition, it can alter one’s DNA repair mechanisms, making skin cancer possible. In general, more people are diagnosed with skin cancer each year in the U.S. than all other cancers combined.”

UV-cured manicures are safest when one applies a broad-spectrum sunscreen of SPF 30 around 30 minutes before the manicure, as well as when one wears fingerless gloves during the manicure. 

“UV light with manicures can always pose a risk. LED lights pose less of a risk, but could still pose some potential dangers. It’s kind of analogous to smoking a cigarette, the more you do it, the more at risk you are. If you want to be sure that no exposure is happening, use sunscreen, cover your hands with cotton gloves, or avoid manis that involve light devices,” says Dr. Gohara

“The knowledge that UV radiation exposure causes DNA mutation in the skin is not new. We know that UV radiation is a known and proven risk for skin cancer and this is why we wear sunscreen, sun protective clothing, hats, sit in the shade and ideally have regular skin checks with a board-certified dermatologist,” says Dr. Stern. 

“For anyone getting UV gel manicures, it is advisable to protect the skin with a UV protective barrier such as fingertip-less UV protective gloves as well as broad-spectrum sunscreen applied 30 minutes before the gel manicure. It is key that the sunscreen is broad-spectrum in order to protect against UVA rays,” advises Dr. Stern.

isolated

Social Isolation Linked to Higher Risk of Developing Dementia

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A recent study found that the risk of developing dementia is 27% higher among older adults who lack regular social contact and interaction with others.

The study, conducted by researchers from the Johns Hopkins University School of Medicine, was published in the Journal of the American Geriatrics Society. It used data from a group of 5,022 participants aged 65 and older (with an average age of 76) as part of a long-term study titled National Health and Aging Trends.

At the time of the study, the participants were not living in a nursing home, residential care facility or other institution. They were asked to complete a two-hour, in-person interview to assess cognitive function, health status and overall well-being.

Initially, about 23% of the participants were socially isolated but showed no signs of dementia. The other 77% of participants were not considered socially isolated.

According to the study, social isolation is characterized by interacting with others infrequently and having few relationships. The researchers considered if participants lived with others, attended religious services, participated in social events, or discussed “important matters” with two or more people in the past year. Participants who engaged in none of the above were considered socially isolated.

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During the nine years of the study, researchers periodically administered cognitive tests. The study showed that 26% of the participants considered socially isolated developed dementia, compared with 20% of those who were not deemed socially isolated.

In total, 21% of all participants had developed dementia, leading researchers to conclude that the risk of developing dementia over nine years was 27% higher in socially isolated older adults.

“Social isolation among older adults is associated with greater dementia risk. Elucidating the pathway by which social isolation impacts dementia may offer meaningful insights for the development of novel solutions to prevent or ameliorate dementia across diverse racial and ethnic groups.”

Dr. Alison Huang, a senior research associate at the Johns Hopkins Bloomberg School of Public Health, said, “one possible explanation is that having fewer opportunities to socialize with others decreases cognitive engagement as well, potentially contributing to increased risk of dementia.”

Dr. Thomas Cudjoe, an assistant professor of medicine at Johns Hopkins and a senior author of the study, stated  in a news release that “social connections matter for our cognitive health, and it is potentially easily modifiable for older adults without the use of medication.”

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The Centers for Disease Control and Prevention says that around 5.8 million Americans have Alzheimer’s disease, the most common form of dementia.  Being socially isolated “has also been linked to poor mental health and emotional well-being in older people.”

Another study that used data from participants in the same National Health and Aging Trends study “found that more than 70% of people age 65 and up who were not socially isolated at their initial appointment had a working cellphone and/or computer, and regularly used email or texting to initiate and respond to others.”

This second study, conducted over four years, found that older adults who used these technologies showed a 31% lower risk for social isolation than other participants. 

Dr. Mfon Umoh, a postdoctoral fellow in geriatric medicine at the Johns Hopkins University School of Medicine, said that “basic communications technology is a great tool to combat social isolation.” 

“This study shows that access and use of simple technologies are important factors that protect older adults against social isolation, which is associated with significant health risks. This is encouraging because it means simple interventions may be meaningful.”