Health
What we learned about the spectrum this year
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There were several hot-button issues that dominated the headlines this year, but autism was easily one of the most contentious.
Since January, advocacy groups across the country have protested the lack of available services for children with autism. Misinformation continues to run rampant, with some Canadian parents still turning to dangerous “cures” for autism — like bleach — against the advice of medical professionals.
Long wait times for aid and questionable treatment of people with autism also remain top concerns for members of the community.
But it wasn’t all bad. 2019 was also a year of advancement and discovery for autism researchers, and according to experts, this has helped the broader society develop a more meaningful understanding about what it means to have autism.
“I think there’s a movement towards valuing neurodiversity and … acknowledging autism as a form of disability, but also seeing the importance of accepting difference,” said Stephen Gentles, an autism researcher at the Offord Centre for Child Studies in Hamilton, Ont.
“People are starting to see the value in the different ways that people are wired.”
Evdokia Anagnostou, a senior clinician scientist at Holland Bloorview Rehabilitation Centre in Toronto, agrees.
“I’m not saying there is no stigma. There’s plenty of stigma,” she said.
“But I think as a society, we’ve started recognizing that there are strengths that come [with autism] that we could capitalize on.”
Anagnostou believes public figures like Greta Thunberg, who is on the autism spectrum, have greatly contributed to this shift.
Here, Gentles and Anagnostou share what they learned in 2019 — and what they hope will be achieved in 2020.
‘Precision medicine for autism’
How scientists understand the needs of people on the autism spectrum has vastly shifted over the last 12 months.
Through a series of recent studies, doctors and scientists have a better understanding of how both genetics and environment contribute to each individual experience of autism.
“How much do genes contribute versus how much the environment contributes?” said Anagnostou.
“We learned that genes are extremely important … Genes set you on a path [and then] genes and the environment talk to each other.”
Parents shed tears on the last day of the autism program at the Starbright Children’s Development Centre in Kelowna
This was a very important finding because it can provide families with “peace of mind.”
“They worry about whether they’ve done something wrong,” she said. “What we call autism is in our genetic code and [people] don’t have much control over that.”
Anagnostou says these findings indicate the beginning of “precision medicine for autism,” where you “individualize the treatment to the specific biology of the patient in front of you, rather than some diagnostic label within the group.”
Gentles hopes this groundbreaking research will help medical professionals learn more about the many different variations of autism.
Years ago, the diagnostic and statistical manual of mental disorders (DSM) listed four types of autism, and every person who received an autism diagnosis was placed into one of the four types based on their symptoms.
This was changed to a “full spectrum” to account for the “genetic markers [which] can vary so much from person to person,” Gentles said.
As researchers learn more about how genetic coding and the environment combine to create different variations of autism, Gentles predicts the DSM will change again.
“We’re not just starting, but we’re still at early stages of learning,” he said.
“There are many different ways to categorize autism.”
Both Anagnostou and Gentles are hopeful this will make treatment more effective.
More people have autism — but why?
At present, one in 66 Canadian children have autism. The rates are slowly going up, but doctors have yet to figure out why.
“One explanation could be that awareness has gone up,” said Anagnostou. More parents are aware of autism and its unique symptoms, leading more children to be examined for it.
However, since the DSM moved to a “full spectrum” approach, the criteria for autism is more broad. This could also be leading to more diagnoses overall — some of which may actually be misdiagnoses.
“We diagnose more people who have very few difficulties or impairments but meet the criteria with autism now than we did before,” said Anagnostou.
“Lots of kids who got an intellectual disability diagnosis before … get an autism diagnosis now.”
Anagnostou said there’s currently no evidence to suggest that the increase in diagnoses has anything to do with the environment. However, that doesn’t mean it’s impossible.
“Is something in our environment talking to our brain and causing an increase? We don’t have that [proof], but I don’t think we should drop the question,” she said.
Raising awareness
There is a heightened awareness about autism and what it’s like to be autistic, but Anagnostou says there’s a long way to go.
“I think stigma comes from not understanding that the difference [of autism] comes with both strengths and weaknesses,” she said.
“Autism has significant challenges, and we work to try to make life better for people who experience challenges, but we shouldn’t ignore the fact that autism may present some trends in terms of looking at the world from outside the box.”
It’s also true that having autism might make one person better suited for a job than another person.
“We can capitalize on these [benefits] and integrate people with autism in our employment settings, in our school settings and in our families in more meaningful ways,” she said.
Greta Thunberg is an excellent example of this, said Anagnostou.
“Part of her autism characteristics make her very determined and not distracted … [Her autism] actually makes her a very effective advocate for a good cause,” she said.
However, Anagnostou warns that we also need to start giving voice to people with other kinds of autism.
“We tend to put forward people with autism who aren’t representative of all the types of autism,” she said.
Moving forward
In 2020 and beyond, Gentles thinks there will be more attention paid to helping parents navigate the difficult first days, weeks and months after a child receives an autism diagnosis.
“It’s generally hardest at the early stages,” he said. “Soon after diagnosis, there’s this windfall … the parents have to learn about the complex disorder of autism, which does come with disability, and then how it manifests in their child.”
He also hopes that there will be more of a focus on supporting adults with autism.
“We’ve really focused on the needs of young children … but we still have a long way to go to support adults with autism,” he said.
“People over 50 who’ve just been diagnosed with autism … will [have an experience that is] a lot different from the very young children who are diagnosed. We don’t even really know what aging and autism looks like.”
“We have a lot to learn from autism and people with autism about making our society more inclusive in a way that benefits everyone.”
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Having anxiety and depression before a Covid infection increases the risk of developing long Covid
ISLAMABAD, (ONLINE) – Anxiety, depression, and Covid-19 can be a bad combination for your brain — and your long-term health.
Having anxiety and depression before a Covid infection increases the risk of developing long Covid, researchers have found.
Those with long Covid who develop anxiety and depression after an infection may have brain shrinkage in areas that regulate memory, emotion, and other functions as well as disruption of brain connectivity.
While many questions remain about these intertwined relationships, the associations aren’t a complete surprise. Experts already know that depression and anxiety are associated with inflammation and immune dysfunction, perhaps helping to explain the link between these mental health conditions, the risk of long Covid, and the changes in the brain.
Brain changes accompanying a Covid infection have concerned researchers since earlier in the pandemic, when U.K. Biobank researchers found brain atrophy, loss of grey matter, and decline in cognition in those infected with Covid compared with those not infected.
Common conditions
The ramifications of the research linking anxiety, depression and long Covid are far-reaching. According to the CDC, 12.5% of U.S. adults have regular feelings of anxiety (as well as nervousness and worry), and the latest Gallup Poll found that nearly 18% of adults currently have or are being treated for depression.
Managing symptoms of long Covid
WebMD’s Chief Medical Officer, John Whyte, MD, MPH, speaks with Janna Friedly, MD, MPH, a professor of physical medicine and rehabilitation at the University of Washington, about managing the symptoms of long Covid and her personal journey of recovery.
As of May 8, 10% of U.S. infected adults have long Covid, according to the CDC, and among U.S. adults ever infected, 27% have reported long Covid. Long Covid has been defined by the CDC as symptoms such as fatigue, brain fog, and cough that persist longer than 4 weeks and by the World Health Organization as symptoms persisting for 3 months or more.
Here’s a roundup of what the research shows about mental health and long Covid risk — along with other research finding that paying attention to health habits may reduce that risk.
Pre-existing depression, anxiety, and long Covid risk
A history of mental health issues — including depression, anxiety, worry, perceived stress, and loneliness — raises the risk of long Covid if infection occurs, Harvard researchers have found.
The researchers evaluated data from three large, ongoing studies including nearly 55,000 participants to determine the effects of high levels of psychological distress before a Covid infection.
“Our study was purely survey based,” said Siwen Wang, MD, the study’s lead author and a research fellow at Harvard’s T.H. Chan School of Public Health at Harvard University.
At the start of the survey in April 2020, none of the participants reported a current or previous Covid infection. They answered surveys about psychological distress at the start of the study, at 6 monthly time points, then quarterly until November 2021.
Over the follow up, 3,193 people reported a positive Covid test and 43% of those, or 1,403, developed long Covid. That number may seem high, but 38% of the 55,000 were active health care workers. On the final questionnaire, they reported whether their symptoms persisted for 4 weeks or longer and thus had long Covid by the standard CDC definition.
Wang’s team then looked at the infected participants’ psychological status. Anxiety raised the risk of long Covid by 42%, depression by 32%, worry about Covid by 37%, perceived stress, 46%, and loneliness, 32%.
Covid patients with a history of depression or anxiety are also more likely than others to report trouble with cognition in the weeks after a Covid infection and to develop brain fog and long Covid, UCLA researchers found. They evaluated 766 people with a confirmed Covid infection; 36% said their thinking was affected within 4 weeks of the infection. Those with anxiety and depression were more likely to report those difficulties.
Long Covid, then anxiety, depression, brain changes
Even mild cases of Covid infection can lead to long Covid and brain changes in those who suffer anxiety or depression after the infection, according to Clarissa Yasuda, MD, PhD, assistant professor of neurology at the University of Campinas in Sao Paulo, Brazil. She has researched long Covid’s effects on the brain, even as she is coping with being a long Covid patient.
In one of her studies, presented at the 2023 American Academy of Neurology meeting in April, she found brain changes in people with anxiety, depression, and Covid but not in those infected who did not have either mental health issue. She evaluated 254 people, median age 41, after about 82 days from their positive PCR test for Covid. Everyone completed a standard questionnaire for depression (the Beck Depression Inventory) and another for anxiety (the Beck Anxiety Inventory). She further divided them into two groups — the 102 with symptoms and the 152 who had no symptoms of either depression or anxiety.
Brain scans showed those with Covid who also had anxiety and depression had shrinkage in the limbic area of the brain (which helps process emotion and memory), while those infected who didn’t have anxiety or depression did not. The researchers then scanned the brains of 148 healthy people without Covid and found no shrinkage.
The atrophy, Yasuda said, “is not something you can see with your eyes. It was only detected with computer analysis. Visualization on an MRI is normal.”
The number of people in this study with mental health issues was surprisingly high, Yasuda said. “It was intriguing for us that we noticed many individuals have both symptoms, anxiety and depression. We were not expecting it at that proportion.”
The researchers found a pattern of change not only in brain structure but in brain communication. They found those changes by using specialized software to analyze brain networks in some of the participants. Those with anxiety and depression had widespread functional changes in each of 12 networks tested. The participants without mental health symptoms showed changes in just 5 networks. These changes are enough to lead to problems with thinking skills and memory, Yasuda said.
Explaining the links
Several ideas have been proposed to explain the link between psychological distress and long Covid risk, Wang said. “The first and most mainstream mechanism for long Covid is chronic inflammation and immune dysregulation,” she said. “Several mental health conditions, such as anxiety and depression, are associated with inflammation and dysfunction and that might be the link between depression, anxiety, and long Covid.”
Another less mainstream hypothesis, she said, is that “those with long Covid have more autoantibodies and they are more likely to have blood clotting issues. These have also been found in people with anxiety, depression, or other psychological distress.”
Other researchers are looking more broadly at how Covid infections affect the brain. When German researchers evaluated the brain and other body parts of 20 patients who died from non-Covid causes but had documented Covid infections, they found that 12 had accumulations of the SARS-CoV-2 spike protein in the brain tissue as well as the skull and meninges, the membranes that line the skull and spinal cord. Healthy controls did not.
The findings suggest the persistence of the spike protein may contribute to the long-term neurological symptoms of long Covid and may also lead to understanding of the molecular mechanisms as well as therapies for long Covid, the researchers said in their preprint report, which has not yet been peer-reviewed.
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Toronto, June 4
A simple hysterectomy, a surgical procedure where the uterus and cervix is removed, is a safe treatment option that can improve quality of life for women with early-stage, low-risk cervical cancer, according to results from the phase III clinical trial.
The study states that a simple hysterectomy resulted in similar outcomes in terms of keeping them cancer-free, compared to the standard radical hysterectomy, which removes the uterus, cervix, upper parts of the vagina and other nearby tissues.
Because radical hysterectomy is a more complex surgery, it is associated with more acute and long-term side effects, as well as potential impacts on quality of life and sexual health for patients.
“Sexual health and quality of life are very important considerations for patients undergoing cancer treatment,” said Dr. Lori Brotto, a professor of obstetrics and gynaecology at University of British Columbia.
“The findings from this study indicate that patients can expect fewer negative effects on sexual health and many other facets of quality of life with simple hysterectomy while not compromising effects on recurrence and survival rates,” Brotto added.
The study looked at the three-year pelvic recurrence rate and other health outcomes in 700 patients from 12 countries receiving both simple and radical hysterectomies.
The findings, presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, showed that the extra-pelvic recurrence-free survival, the relapse-free survival, and the overall survival were comparable between the two groups.
There were fewer intraoperative urological surgical complications and fewer immediate and long-term bladder problems in the simple hysterectomy group.
Several quality-of-life aspects, such as body image, pain, and sexual health, were consistently more favourable in them.
“These results are important because it demonstrates, for the first time, that a simple hysterectomy is a safe option for women with carefully selected early-stage low-risk cervical cancer,” said Dr. Marie Plante, the study lead and a gynecologic oncologist at Universite Laval in Quebec.
“This trial will likely be practice-changing, with the new standard-of-care treatment for patients with low-risk disease being a simple hysterectomy instead of radical hysterectomy.” Worldwide, cervical cancer is the fourth most diagnosed cancer and fourth most common cause of cancer death in women.
About 44 per cent of women with cervical cancer are diagnosed with early-stage disease, of which a significant proportion will meet low-risk criteria, according to the team.
When detected at an early stage, the 5-year relative survival rate for invasive cervical cancer is 92 per cent.
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By Natalie Grover
LONDON (Reuters) – AstraZeneca’s lung cancer therapy, Tagrisso, cut the risk of death by more than half in patients with a certain form of lung cancer who were diagnosed early enough to have their tumour surgically removed, trial data showed.
Tagrisso is already the crown jewel in the Anglo-Swedish drugmaker’s portfolio, raking in $5.4 billion last year.
The drug has regulatory approvals across multiple geographies for certain patients with so-called non small cell lung cancer (NSCLC) who have a mutation of the EGFR gene.
The latest data, presented at the American Society of Clinical Oncology (ASCO) meeting, establishes Tagrisso as the backbone treatment for EGFR-mutated lung cancer, said Susan Galbraith, executive VP of oncology R&D at AstraZeneca in a statement.
In a 682-patient trial called ADAURA, Tagrisso was evaluated against a placebo in earlier-stage EGFR-mutated NSCLC patients who had undergone surgery to remove their primary tumour.
The majority of such patients eventually see their cancer return despite surgery and add-on chemotherapy.
In the trial, Tagrisso or a placebo was given to patients to assess whether the AstraZeneca therapy could keep their cancer at bay.
Data showed Tagrisso slashed the risk of death by 51% compared to placebo.
“This is a pretty dramatic and remarkable improvement,” said Dave Fredrickson, executive vice president of oncology at AstraZeneca in an interview with Reuters.
An estimated 88% of patients treated with Tagrisso were alive at five years compared to 78% on placebo, trial data also showed.
Outside of chemotherapy, there are no drugs apart from Tagrisso that have shown to help patients with EGFR-mutated lung cancer live longer, Fredrickson highlighted, adding that there are probably a third of eligible patients who are not yet being prescribed Tagrisso.
“We would hope that we would be able to use these data to be able to close that gap,” he said.
AstraZeneca is also expecting to provide details on the impact of combining Tagrisso with chemotherapy in patients with advanced EGFR-mutated lung cancer later this year.
(Reporting by Natalie Grover in London; Editing by Angus MacSwan)
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