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What it takes to achieve world-changing scientific breakthroughs

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In science, advances are a daily occurrence, but true breakthroughs are rare. What does it take to achieve world-changing scientific breakthroughs? Some are the result of a lucky accident, combined with curiosity: scientists traveling down one road suddenly find reason to veer onto another road, one they never planned to travel — a road that may well lead nowhere.

Other major breakthroughs stem from scientists pursuing a very specific dream. One day, usually early in their career, they get an idea that they can’t stop thinking about. It’s crazy, they say to themselves, but is it really impossible? They talk to respected colleagues who often remind them of all the reasons their idea might not work, and how damaging this could be for their career. It’s a sobering message, yet the idea won’t die. So, they scramble to find financial support and seek out colleagues willing to risk traveling that road with them — a road that may well lead nowhere. But sometimes the road leads to major breakthroughs like penicillin and mRNA vaccines.

Breakthroughs due to lucky accidents and curiosity

One day in 1928, Dr. Alexander Fleming at St. Mary’s Hospital in London was growing bacteria in a laboratory dish. Fleming was not pursuing a scientific dream. He was a microbiologist, just doing his job.

Then he noticed something odd: overnight, another kind of microbe, a fungus, had traveled through the air, landed on the laboratory dish, and started to grow and spread on the dish where the bacteria were growing. Fleming soon noticed that the growing fungus seemed to be killing the bacteria. He surmised that it was making some substance that killed the bacteria. Because the name of the fungus was Penicillium rubens, he called the substance the fungus was making “penicillin.”

When Fleming published a paper about his discovery, few were interested. It took another 10 years before other scientists tried to generate large amounts of penicillin to see if it might be able to cure bacterial infections and save lives. We all know how that worked out.

Fleming’s scientific breakthrough, like some others, occurred not because Fleming had a brilliant idea and exclaimed “Eureka!” Instead, it occurred because he noticed something and said, “That’s odd,” and then tried to figure it out.

Breakthroughs due to persistence and resilience in pursuit of a dream

The story of mRNA vaccines, like the Pfizer/BioNTech and Moderna vaccines for COVID-19, is very different from the story of penicillin. For 30 years, a small group of scientists believed that mRNA vaccines would have great advantages over traditional vaccines — if only several obstacles could be overcome. Many of these scientists gave up as they encountered those obstacles, but a few persisted and, ultimately, succeeded. (I described what mRNA vaccines are, how they work, and how obstacles were overcome in a previous blog post.)

One scientist, Dr. Katalin Karikó, joined the faculty of the University of Pennsylvania in the early 1990s with the dream of creating an mRNA vaccine. She applied for grants to support her work, but was repeatedly rejected: the reviewers stated that it was so unlikely that she or anyone could overcome the obstacles that supporting her research would be a wasted investment. Her university only agreed to continue supporting her work if she accepted a demotion and a pay cut. She accepted both, and doggedly pursued her dream.

One major obstacle to mRNA vaccines particularly fascinated her: the violent reaction of the immune system when it encounters mRNA from a virus. Ten years of dogged work helped Karikó and her colleague Drew Weissman figure out how to make a small change in mRNA that prevented that violent immune response — a major step in making all mRNA vaccines possible. Without this, the world wouldn’t have mRNA COVID vaccines today.

Two other scientists who created the Pfizer/BioNTech COVID vaccine, Uğur Şahin and Őzlem Turëci, are Turkish immigrants to Germany who met, fell in love with the idea of creating an mRNA vaccine, and then fell in love with each other. According to The Wall Street Journal, one day in 2002 they took a break for lunch, got married, and then returned in the afternoon to their laboratory to finish an experiment — just one more among many conducted over 30 years. Each experiment was one more possible step toward their ultimate dream until finally, in 2020, they achieved that dream: their mRNA vaccine for COVID-19 proved to be very safe and effective.

Holding hard to their dreams

Whichever path scientists who achieve lifesaving breakthroughs travel, they often endure disinterest, like Fleming, or repeated skepticism, ridicule, and rejection, like Karikó, Weissman, Şahin, and Turëci. Only through sheer persistence did these scientists bring their dreams to life. They have been rewarded with fame and wealth and something even more valuable: the knowledge that because of their work hundreds of millions of people around the world never got sick, and millions never died before their time.

Of course, a relentless obsession with an improbable dream fails to pay off for many scientists. Their ideas, while quite brilliant, in the end are proved wrong: nature doesn’t turn out to operate the way they predicted. In the end, their beautiful theory is murdered by a brutal gang of facts.

Still other scientific dreamers ultimately prove to have been on the right track all along and would have achieved their dream — if only they had done the experiment a little differently, if only they had persisted a little longer, or if only the support for their work had not run out. As a result, neither they nor the rest of us benefitted from what would have been — until other scientists rediscovered their work years later.

Ultimately, scientific breakthroughs are possible only if a society is willing to invest in dreamers, recognizing that not all investments will lead to major breakthroughs. However, the investments that do lead to breakthroughs bring an economic return that is far greater than the investment — as well as preventing suffering and death and changing the world.

Want to participate in COVID-19 research? Download the COVID Symptom Study app to help researchers track symptoms and hot spots across the US. Click here for information.

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How to get your child to put away toys

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If you frequently find yourself stepping on a building block, tripping over a doll, or stumbling over a race car, then you know the challenges of getting younger children to put away their toys. Below are a few strategies to encourage children to clean up after themselves and keep the house tidy.

Make specific and focused requests

Asking your child to put many different things away all at the same time can leave room for children unintentionally to forget at least one of your requests — or intentionally skip a few. Make one specific request at a time, such as "Please put your blocks back in the bin on the shelf." After your child has finished one task, then you can request that your child puts a different toy away.

Make requests in the form of a command, not framed as a question like "Will you please clean up your blocks?" Asking a question leaves room for the child to reply, "No." Also, unless you want this to be a group activity, frame the request for just your child: "Please put your blocks back in the bin on the shelf" instead of "Let’s clean up the blocks."

Give your child time to comply, and repeat yourself only once

Children, especially young children, take more time than adults to process information. Count to five in your head after you make an initial request, to give a child time to process what you said and to comply.

If you don’t see the required action after five seconds, repeat your request in a neutral tone followed by a potential logical consequence. For example, "If you do not put your blocks away in the bin on the shelf, then you will not get to play with the blocks for the rest of the day. You can play with them tomorrow."

Count to five in your head again. If your child still does not do what you asked, say the following in a neutral tone: "Okay, you did not put the blocks away in the bin on the shelf, so you do not get to play with them for the rest of the day. You can play with them tomorrow." You can then put the blocks away and out of reach from the child so that the toys are not in use for the remainder of the day.

Stay calm and choose logical consequences

Two key elements of this approach are to remain as calm as possible and create a logical consequence.

  • Staying calm helps. Understandably, you may be very frustrated. However, it’s best to give as little attention to noncompliance as possible. Attention, even in the form of a negative tone, can make the behavior happen more often.
  • Logical consequences matter. Creating consequences that are for extensive periods of time and do not make sense to the child may spark more frustration and refusals. For example, it would not be logical for the child to lose TV time for a week if the child did not put their blocks away. Instead, limiting access to the toy is a logical consequence.

Praise behaviors you want to see

Shine attention on behaviors you’d like to see more often. Any time your child does put toys away, praise them specifically. "Good job" can confuse: the child will not know exactly what was good — sitting quietly, putting toys away, or something else. Instead, say, "Great job putting the blocks in the bin on the shelf!"

Praise with enthusiasm, and use touch, such as a pat on the back, to strengthen a behavior. If you have a child who has sensory processing difficulties, especially with tactile stimuli like a pat on the back, you can reinforce the behavior with a nonverbal gesture, such as a thumbs up.

Your days of repeating commands until you’re blue in the face and cleaning up after your children do not have to continue. The steps above can give you a breather and help your children learn to pick up after themselves.

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Menopause and memory: Know the facts

By 2050, 13.8 million people in the US will likely have Alzheimer’s disease, and two-thirds will be women. The economic cost is staggering, as it is estimated to rise to more than $2 trillion. Women are at the epicenter of this because the economic threat is especially dire for women, given they are an increasingly powerful element of our global economy and the vast majority of unpaid caregivers. Thus, maintaining intact memory starting early in midlife with the transition to menopause is critical not only for women themselves, but also for their families, society, and our economic health.

Preventing memory decline starts in early midlife

The decline in cognitive ability is not limited to neurodegenerative diseases like Alzheimer’s disease (AD), but also part of healthy aging, with consequences for our quality of life. Most studies of aging and cognitive decline, particularly studies of AD, begin in people in their 70s. However, understanding factors that happen earlier in life, and how they impact age-related brain changes, is critical for developing prevention strategies for one of the major public health challenges of our time.

What happens to women’s brains through the transition into menopause?

In addition to chronological aging, women undergo reproductive aging in early midlife: menopause, during which they experience a depletion over time of ovarian hormones such as estradiol, the primary form of estrogen that works in the brain. Our research team and others have demonstrated that estradiol directly relates to changes in memory performance and reorganization of our brain circuitry that regulates memory function. Thus, women and men undergo different aging processes, especially in early midlife when reproductive aging is more critical for women than chronological aging. However, cognitive aging is rarely considered a women’s health issue. This is essential, because viewing brain aging as beginning in early midlife, and understanding the impact of menopause on the brain, will allow for development of strategies to prevent memory loss for women.

On average, women perform better than men on measures of verbal memory, beginning as early as post-puberty. However, women’s advantage for verbal memory performance is reduced with menopause. Many women report increased forgetfulness and “brain fog” during the menopausal transition. All women eventually undergo menopause, but there is a large age range for when it begins (from late 40s to early 60s), and substantial variation in women’s experience of its impact.

Over the last 15 years, an increasing number of studies are mapping out the intricate ways in which menopause affects the brain and what helps maintain intact memory. For example, menopause can affect how brain cells are generated, connect with each other, and even die, and these processes impact brain regions that are critical for memory. Menopause also lowers the level of glucose in the brain, the primary fuel used by brain cells. The brain then looks to other metabolic sources to provide the necessary fuel to function — that is, the brain adapts to a new hormonal environment in order to maintain functioning.

Further, women with other medical conditions like diabetes and hypertension are at increased risk for cognitive decline. Research into understanding this is focusing, in part, on how the brain and body share similar processes to produce energy to function (metabolism), and how blood pressure and other aspects of the vascular system function similarly in the brain and body.

Can hormone replacement treatment help?

Research shows that timing matters. Initiation of hormone replacement (HR) in perimenopause (roughly four to eight years before menopause) or early menopause may have positive effects on brain activity and memory function, although systematic HR trials have not been conducted during perimenopause. Initiation of HR in late menopause may have adverse effects on the brain, and increase risk of disorders like Alzheimer’s disease. Research is critically needed to establish the most effective timing of administration, hormonal formula, dose, route of administration (for example, orally or by skin patch), and duration.

Further, to date much of the HR research has been conducted in healthy women, and little is known about its impact in women with chronic diseases such as diabetes and hypertension. Finally, there may be differences in responses in women who are genetically at high risk for brain disorders, like AD, that show increased benefits for using HR. Research shows us that one size does not fit all, and precision medicine is needed to identify which women may benefit the most. One example is for women with bilateral removal of the ovaries, particularly at a young age, for whom HR has been found to be very beneficial for brain function. In some women HR may not be an option, and alternative mechanisms may need to be identified, such as targeting levels of glucose and other effects associated with estradiol regulation of the brain.

What can women do to maintain brain health?

There are three major pillars for maintaining intact memory: effortful physical activity, effortful cognitive activity, and social contact. Research shows that the first two of these have direct beneficial effects on the brain, even at the level of cellular function. Social contact is another form of keeping our brains active by external stimuli, novel experiences, and perspectives outside of ourselves. Dietary habits (such as the Mediterranean diet, or intake of omega-3 fatty acids like in fish oil) have also had beneficial effects on memory function. The good news is that these are modifiable lifestyle habits, which may be particularly important for women with hypertension or diabetes who are at higher risk for cognitive decline.

Finally, adequate sleep (currently suggested as seven hours a night) is critical for brain health. Research has shown that during certain periods of sleep, learning is consolidated; that is, sleep plays a key role in storing and maintaining what we learned during the day, and even helps in clearing the brain of amyloid, one of the markers of potential AD pathology. More research is required to fully understand the beneficial impacts of these modifiable lifestyle factors. However, the time to start incorporating them into your life is now.

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Walnuts: A worthy addition to your daily diet?

What can you add to a wide variety of foods, from cereals to salads, that’s crunchy, filling, and flavorful — and good for your heart? The answer is nuts. While all varieties of nuts are chock full of important nutrients, walnuts may be especially good for protecting cardiovascular health, according to a recent study in the journal Circulation that supports earlier research in this realm.

What is the study?

The Walnuts and Healthy Aging study is a randomized controlled trial supported by a grant from the California Walnut Commission that tracked healthy older adults living in two communities. For the study, researchers recruited 708 adults ages 63 to 79 living in Loma Linda, California, or Barcelona, Spain, and split them into two groups. One group added a half-cup of walnuts to their daily diet for two years, while the other group ate no walnuts.

After two years, average levels of harmful low-density lipoprotein (LDL) cholesterol were modestly lower in the walnut group. Of note: nearly a third of the participants were taking cholesterol-lowering statins, so the average cholesterol levels of both groups were already in a normal range. The researchers speculate that the cholesterol-lowering benefits from walnuts might be more pronounced in people with elevated cholesterol levels. There is no way to know from the current data if this is true.

"This recent trial confirms what earlier studies have found, namely, that that adding walnuts to your diet appears to improve your cholesterol levels," says Dr. Deirdre Tobias, an obesity and nutritional epidemiologist at Harvard-affiliated Brigham and Women’s Hospital. The new trial also lasted much longer than past walnut studies. However, it’s not clear what foods were being replaced by the walnuts in the participants’ diets, which might affect the magnitude of benefits the researchers saw. For example, replacing unhealthful, ultra-processed snacks with walnuts would presumably have a greater benefit than a lateral move from healthy options to walnuts, Dr. Tobias explains.

Lower levels of harmful blood fats, no additional weight

The researchers also analyzed the concentration and size of the LDL particles. Smaller, more dense LDL particles are more likely to trigger atherosclerosis, the buildup of fatty plaque inside arteries that’s the hallmark of most cardiovascular disease that results in heart attacks or strokes.

The walnut eaters had lower levels of these smaller particles. They also had decreased levels of intermediate-density lipoproteins (IDL), which are also linked to a rise in cardiovascular-related risks. And even though a half-cup of walnuts contains about 185 calories, the walnut eaters did not pack on any extra pounds.

Earlier research has found that people who eat nuts regularly are less likely to have heart disease, and many studies have focused specifically on walnuts. In 2018, Dr. Tobias and colleagues published a meta-analysis and systematic review of studies that examined how eating walnuts affects a person’s blood lipids and other heart-related risks. The review included 26 controlled trials involving a total of more than 1,000 people. It found that walnut-enriched diets led to lower total cholesterol, LDL cholesterol, and triglycerides, the most common form of fat in the bloodstream.

What’s special about walnuts?

Although all nuts are good sources of healthy unsaturated fats, walnuts are especially rich in alpha-linolenic acid (ALA). This is a precursor to the omega-3 fatty acids EPA and DHA found in fatty fish that are known for their heart-protecting powers. Our bodies convert ALA to EPA and DHA, although the efficiency of this varies from person to person.

What’s more, walnuts are usually eaten raw. So they have greater antioxidant abilities than nuts that are usually eaten roasted. (Antioxidants help prevent or reduce the artery-damaging oxidation that contributes to heart disease).

Adding walnuts to your diet

If a half-cup of walnuts a day sounds like a lot, it’s good to know that eating even half that much may still be beneficial. In fact, the FDA allows a qualified health claim on some nuts (including walnuts). Foods made with them are permitted to include the following statement: "Eating a diet that includes one ounce of nuts daily can reduce your risk of heart disease." An ounce of walnuts is about a handful, or one-quarter cup.

You can sprinkle walnuts onto oatmeal or other hot or cold cereals; stir them into pancakes, muffins, or other quick breads; or toss them with vegetables or into salads. If high cholesterol is a health concern for you, there are other foods that may help lower your LDL cholesterol and boost your heart health.

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Can vaping help you quit smoking?

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Lately it seems like everywhere I look, someone is vaping as they walk by, stand outside a store, or roll up in the car next to me at a stoplight. It’s not surprising: e-cigarette use, or vaping, has become remarkably popular in recent years. About 6% of adults in the US now report vaping. That’s about 15 million people, double the number from just three years ago. Of course, regular cigarettes are known to cause cancer and a host of other health problems.

While considered less harmful than smoking tobacco, vaping isn’t risk-free. We know some, but not all, of its risks. We also know vaping is increasingly popular among teens and young adults, and this makes the recent FDA announcement authorizing sales of three additional vaping products surprising.

A surprise announcement from the FDA

In its announcement, the FDA authorized the R. J. Reynolds Vapor Company to market and sell its Vuse Solo device with tobacco-flavored vaping liquid to adults.

The FDA denied marketing authorization for 10 flavored products made by the same company. It also reports having denied more than a million flavored vaping products from other companies.

By the way, the agency emphasizes it is not actually approving these vaping products, or declaring them safe. The announcement states that marketing authorization will be reversed if

  • the company directs advertising to younger audiences
  • there is evidence of “significant” new use by teens or by people who did not previously smoke cigarettes
  • R. J. Reynolds does not comply with extensive monitoring requirements.

Why did the FDA take this action?

The decision was reportedly based on data from the company — unfortunately not provided in the press release — demonstrating these products would benefit individuals and public health. How? By helping smokers quit.

Some studies have suggested that e-cigarette use can be modestly helpful for smokers trying to quit. For example, an analysis of 61 studies found that e-cigarette use was more effective than other approaches to quitting smoking. The study authors estimated that out of every 100 people who tried to quit smoking by vaping, nine to 14 might be successful. When only using other methods, such as nicotine patches or behavioral counselling, only four to seven smokers out of 100 might quit. A separate study suggests vaping may help smokers who aren’t able to quit reduce the number of cigarettes smoked per day — at least for six months, the duration of the study.

Does vaping harm health less than smoking cigarettes?

Despite claims that vaping is less harmful than smoking cigarettes and that it might help smokers quit, concern about its risks is well deserved.

  • Nicotine addiction. Whether in cigarettes or vapes, nicotine is highly addictive. And the amount of nicotine in many vaping products is much higher than in regular cigarettes. Side effects include reduced appetite, increased heart rate and blood pressure, nausea, and diarrhea.
  • Harm to lungs and heart. Vapors from e-cigarettes may contain cancer-causing toxins, metals, and lung irritants. Vaping raises risk for lung diseases, such as emphysema, asthma, chronic bronchitis, and chronic obstructive pulmonary disease. It’s also linked to an increased risk of heart attacks. Even secondhand exposure to e-cigarette vapors may trigger asthma.
  • Severe, potentially fatal lung injury. In 2019, doctors began seeing people who had recently vaped and developed shortness of breath, cough, fever, and extensive lung damage. Dubbed EVALI (e-cigarette or vaping product use-associated lung injury), more than 2,800 cases and 68 deaths were reported. The condition has been linked to vapors containing THC and a form of vitamin E (called vitamin E acetate) used as a thickening agent when vaping THC. Cases have fallen markedly since 2020. Possibly because of falling case numbers, the FDA announcement of new vaping products didn’t even mention EVALI, which seems odd. If you do vape, see these recommendations to reduce the risk of EVALI.
  • Health risks during pregnancy. Nicotine can damage a baby’s developing brain and lungs; some flavorings may be harmful as well. As a result, experts recommend that people who are pregnant not vape.

For teens and children, vaping has additional risks

An alarming number of middle-school and high-school age kids report vaping, despite the nationwide prohibition against selling e-cigarette products to anyone under age 18 (21 in some states). Its popularity is partly related to the marketing of flavors known to appeal to minors, such as bubblegum and berry-flavored products. According to one national survey, approximately 85% of teen vaping involved non-tobacco flavored products.

It’s important to know that

  • nicotine negatively affects the developing brain
  • the high exposure to nicotine and other toxic chemicals through vaping may be particularly harmful to kids because of their smaller body size
  • the addictive potential of nicotine may mean that kids who vape are more likely to become cigarette smokers.

The bottom line

For nonsmokers and teens, there is no controversy: don’t start smoking and don’t vape.

If you’re an adult smoker trying to quit, be aware that the balance of risks and benefits and the long-term health consequences of vaping are uncertain. We need more solid research to help people make decisions. Meanwhile, the FDA has come down on the side of a limited authorization to help adult smokers quit. We’ll know only in retrospect if that was the right move.

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A conversation about reducing the harms of social media

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Editor's note: In this blog post, Dr. Sharon Levy interviews her son Isaiah Levy, a college student. We appreciate Isaiah’s insights and comments on social media's impact on teens and young adults.

It is hard to remember (or for younger people, hard to imagine) a world without social media, but indeed such a world once existed — and in fact, it is the world humans evolved in.

Humans are social animals. Friendly interactions release dopamine in our brains’ reward centers to get us to repeat the behavior. Until recently, that feedback loop suited us very well, with little opportunity to get off track. Social media changed things by providing the opportunity for nearly infinite interactions. This excess exploits our natural inclination for social contact in the same way that sweets exploit our natural drive to eat ripe fruit. Too much refined sugar can cause a cascade of medical problems; too much social media can also affect health — especially mental health.

Beyond sheer volume, social media interactions are qualitatively different from in-person meetings. For one thing, social media platforms have developed easy opportunities for viewers to react to content, resulting in objective feedback metrics for the content creator. Because the denominator is essentially infinite, no matter how many likes a post gets, the numerator may not feel like enough. Feeling insufficient, not liked enough, judged by others, or excluded from an "in group" takes a heavy toll on mental health.

For perspective from a digital native, I posed questions about social media to my son Isaiah Levy, a computer science major at New York University.

What do you see as the benefits of social media?

Theoretically, social media can connect people across the globe at scale, presenting an opportunity for users to form relationships beyond their geographic boundaries. Popular social media platforms can also provide a stage with a potential audience of one billion eyes. Social media offers tremendous potential for people who want to be noticed. However, most connections are extensions of our real-life relationships, and many users say that social media enriches friendships. For example, a Pew survey found that a majority of teenage respondents said that Instagram enhanced their connections with people they already knew (many of whom are classmates).

Why is Instagram so popular with young people?

Web developers and graphic designers created Instagram using sophisticated algorithms and attractive visual presentation, to keep users engaged and interacting with its nearly limitless content for as long as possible. According to surveys done by Facebook (owner of Instagram), youth describe Instagram as current, friendly, trendy, and creative. Many teens say that Instagram helps define who they are and makes them feel more connected to the people they know. Another significant source of Instagram's allure, particularly for younger users, are the objective feedback measures that can make users feel important or of high social status.

The flip side is that the drive for attention creates its own problems. The Pew survey linked to above found that more than one-third of teen Instagram users said they feel pressure to post content that will get a lot of likes and comments, and more than 40% feel pressure to only post content that makes them look good. According to Facebook’s own internal surveys, more than 13% of teen girls said that Instagram worsens suicidal thoughts, and 17% said their eating disorders got worse with Instagram use.

As the government considers regulating social media, what suggestions do you have in regard to protecting mental health?

Government regulations should protect our freedom of expression while mediating risks, especially to children. The government could consider regulating some of the advanced algorithms that social media corporations use to increase user time expenditure (and thus profits). For example, "infinite swiping" is a design feature that continuously pushes forward new content after a user has exhausted content from the people they follow. These tactics pose serious threats. Just like use of alcohol, nicotine, or drugs, the act of swiping triggers neurological reward. Over time, the brain learns to seek social media instead of more natural rewards, putting users at risk of dissociation with meaningful priorities. As with drug addiction, younger users are at greatest risk. Government regulation of the most sticky algorithms would help promote a healthier balance for users. Deciding which algorithms to ban and how to implement such a ban is certainly a difficult task, and the solution will not be perfect; however, given what we know of the impact of social media on children’s mental health, it should be a federal priority.

While the government grapples with regulation, parents can step in. First, set a good example by putting your own screens down when interacting with your children. Talk to your teen about the pros and cons of social media: while it can be fun, it can also become a distraction. Set limits on your child’s social media use. Most importantly, talk to your children about their experiences, including who they are interacting with and what they are talking about. We know social media can harm mental health, so be on the lookout and intervene if you have concerns.

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Stuttering in children: How parents can help

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When a child starts to stutter, it can be alarming for parents. But most of the time, it’s nothing to worry about.

Stuttering is very common. In fact, according to the National Institute on Deafness and other Communication Disorders (NIDCD), 5% to 10% of all children stutter at some point, usually between 2 and 6 years of age.

Stuttering takes different forms

Children who stutter know what they want to say; they simply run into trouble when saying it. There are three different kinds of stuttering:

  • Repetitions, when children repeat a word or parts of a word (“Can I pet your d-d-d-d-dog?”)
  • Prolongations, when they stretch a sound for a long period of time (“Sssssssssstop it!”)
  • Blocks, when they have a hard time getting words out.

Stuttering is more common in boys than girls and can run in families. We do not understand exactly what causes it. Most likely, it occurs due to a combination of factors, which may differ in each child who stutters.

Developmental stuttering, the most common form of this speech disorder, happens as children are learning speech and language skills. Stuttering can be caused by a brain injury, but that’s far less common. Contrary to what many people believe, it is rare for stuttering to be caused by psychological factors.

Helping your child manage stuttering

Nonetheless, stuttering can cause distress and stress for children and parents alike. That’s why the best way to manage stuttering is not to focus on it, but rather to be patient and supportive. For example, the NIDCD suggests that parents of children who stutter should

  • create relaxed environments for conversation: set aside time each day to catch up with your child
  • speak in a slow and relaxed way yourself
  • resist the temptation to finish your child’s words or sentences yourself; let them finish
  • focus on the content of the message rather than how it is delivered.

To the extent that you can, ignore the stuttering — but if your child brings it up or seems bothered by it, be open and accepting. Acknowledge that it is happening, but tell your child that it is fine and they shouldn’t worry. Also see additional tips from the American Academy of Pediatrics on ways parents can help toddlers and preschoolers with stuttering.

When to get more help with stuttering

Most stuttering goes away by itself within about six months; overall, 75% of children who stutter stop completely. You should talk to your pediatrician or a speech-language pathologist if

  • the stuttering has continued for more than 6 to 12 months
  • the stuttering started after ages 3 to 4 years, as this may make it more likely to continue
  • the stuttering has increased in severity or frequency
  • there is a family history of stuttering that continued past early childhood
  • your child is upset or frustrated by the stuttering.

Follow me on Twitter @drClaire

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Wondering about COVID-19 vaccines for children 5 to 11?

Last week, the FDA authorized the Pfizer/BioNTech COVID vaccine for children ages 5 to 11. After conducting their own review, the CDC now recommends this vaccine for children in this age range, who can begin receiving their first dose within the week.

While many families have been eagerly awaiting the opportunity for their children to be immunized, others are hesitant. And most parents have questions about how COVID-19 affects younger children, vaccine safety in this age range, and whether the benefits outweigh potential risks. As a pediatric infectious disease specialist, I hear certain questions crop up repeatedly. Here’s what we know so far.

How does COVID-19 affect children in this age range?

While children continue to be much less likely than adults — especially adults 65 and older — to get severely ill from COVID-19, some children do get very sick. Thousands of children 5 to 11 have been hospitalized or need ICU-level support to recover from this infection. Almost 150 children in this age range have died from COVID-19. Additionally, over 5,000 cases of a serious inflammatory condition known as MIS-C that can follow COVID-19 infection have been reported. The majority of cases of MIS-C have occurred in children in this age range.

How has the Delta strain of the virus affected children?

The Delta strain of the virus that causes COVID spreads easily, particularly among people who haven’t received the vaccine. Children ages 5 to 11 remain more susceptible to infection, given their ineligibility to be vaccinated. In fact, more than one in five new cases recorded over the past two months while Delta infections surged in the US occurred in this age group, according to weekly reports from the American Academy of Pediatrics and the Children’s Hospital Association.

Can children spread the virus to others?

Several detailed reports describing outbreaks associated with settings such as summer camps, daycares, and schools, and those tracing transmission of COVID-19 within households, clearly demonstrate that children can spread this virus and infect others with whom they come into close contact.

Which COVID vaccines and doses are authorized for children ages 5 to 11?

Pfizer/BioNTech is the first COVID vaccine authorized by the FDA for this age group, based on results from a randomized controlled trial evaluating safety and immune responses. A separate trial launched by Moderna is being considered separately.

In a small number of children, the Pfizer/BioNTech trial compared three doses:

  • 30 micrograms (the dose adults receive)
  • 20 micrograms
  • 10 micrograms.

This part of the trial showed that 10 micrograms, the smallest dose, resulted in fewer side effects while still generating robust immune responses similar to responses achieved with higher doses.

In the next part of the trial, more than 2,200 children ages 5 to 11 were randomly assigned to receive either a 10-microgram dose of the vaccine (two-thirds of participants) or a placebo dose (one-third of participants). All received two shots, spaced three weeks apart.

Those given the vaccine had similar immune responses as 16-to-25-year-olds who had received the full-dose series of two shots.

When Pfizer/BioNTech submitted data to the FDA, there were not many cases of symptomatic COVID-19 infections in trial participants. Out of 19 documented cases, most had received the placebo shots. Estimates suggest the efficacy rate of the vaccine is 90%. (Efficacy measures how much a vaccine reduces infection in a controlled trial.) Tests confirmed that the Delta viral strain had caused the infections.

What do we know about side effects for children this age?

Most children had no side effects other than pain at the injection site. Those who did have side effects most commonly experienced fatigue, headaches, and/or muscle aches after the second dose rather than the first dose. For example, only 6% of children had fever after the second vaccine dose. There were no cases of severe allergic reaction to the vaccine.

What is not yet known?

In very rare instances, the Pfizer/BioNTech COVID-19 vaccine is linked to myocarditis, which is an inflammation of the heart. When this occurs, it is mostly seen in young males following their second dose of an mRNA vaccine (Pfizer/BioNTech or Moderna). Most cases are mild, and children show no signs of long-term injury to the heart.

Among the 5-to-11-year-olds who received the Pfizer vaccine during the trial, there were no cases of myocarditis. However, this side effect is very rare and might not be noted until the number of children receiving the vaccine is much higher. The FDA and Pfizer/BioNTech will continue to closely monitor this age group for any occurrence of this rare side effect.

Can children get vaccinated against COVID-19 and influenza at the same time?

Yes. Children and adults can safely get both vaccines at the same time. The CDC urges everyone to get flu shots to help stay healthy during this flu season.

A randomized, controlled trial in the UK evaluated adults who received a flu shot or placebo shot in one arm and their second dose of the Pfizer/BioNTech vaccine in the other arm. The researchers reported in Preprints with The Lancet that side effects and immune responses were similar, whether the flu shot or a placebo shot was given at the same time as the COVID vaccine.

What other steps can parents take to protect children against COVID-19?

Parents should remember that an individual is not fully immunized and protected by the vaccine until 14 days after the second dose of the Pfizer vaccine. Masks are recommended for anyone who is unvaccinated, or not fully immunized, when indoors with people outside of their household. If rates of COVID-19 are high where you live, masks may be recommended indoors for vaccinated individuals as well.

Parents can continue to encourage other simple habits that help prevent colds, flu, and COVID-19, such as washing hands often, coughing or sneezing into an elbow, throwing away used tissues quickly, and avoiding crowded places and people who are ill when possible.

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Cancer survivors’ sleep is affected long after treatment

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Once the stress of a cancer diagnosis and its intensive treatments have passed, the hope is that life can return to normal. But we know that this is not true for many people who have had treatments for cancer, and sleep is often impacted for a long time after treatment.

Researchers at the American Cancer Society studied responses from 1,903 cancer survivors from across the US. These survivors were diagnosed with cancers such as breast cancer or prostate cancer about nine years before the study. As part of the research, these cancer survivors were asked questions about their sleep and cancer history, and their overall physical, mental, and social health. Even though these men and women had been diagnosed with cancer almost a decade ago, a staggering 51% reported that their sleep had been disturbed over the prior month!

Why do sleep problems continue after cancer?

Findings suggest that the residual effects of cancer may continue to negatively affect a survivor’s sleep. Not surprisingly, poor sleepers were more likely to report that they had more physical and emotional distress. Perhaps more unexpected were results that showed survivors who were sleeping poorly were also more likely to be having some economic hardship, and expressed worries about money and a fear of cancer recurrence.

These are common burdens for cancer survivors. Financially, cancer survivors not only have to shoulder the medical costs associated with their initial treatments, but also ongoing bills from managing the lasting effects of those treatments. Additionally, survivors may have had to change their work situation, or leave their job entirely, in order to manage their health.

Other research has shown that fear of cancer recurrence is common among survivors. Despite having completed their treatments many years prior, people struggle with chronic distress regarding their health and well-being, often at levels equal to that experienced when they were initially diagnosed with cancer.

What can cancer survivors do to improve their sleep?

It is critical that cancer survivors raise the issue with their medical team. There are a number of different sleep disorders that require thorough evaluation and accurate diagnosis. For example, insomnia disorder and obstructive sleep apnea are common among middle-aged and older men and women. If sleep disorders are left untreated, they can lead to a host of negative health outcomes, including cognitive dysfunction, mood disorders, cardiovascular disease, and more.

Medication is a common treatment to help sleep, but it’s not always the best choice, as there are concerns about medication tolerance (needing a larger dose to get the same effect), dependence, and daytime side effects. In the study previously mentioned, 28% of respondents reported using a sleep medication within the past month. While there is certainly a time and a place for medications designed to help with sleep, long-term use is not advised for cancer survivors, especially if the problem is insomnia disorder.

Rather, cognitive behavioral therapy for insomnia (or CBT-I) is recommended as first-line treatment by both the American Academy of Sleep Medicine and the American College of Physicians. Instead of masking the symptom (poor sleep), CBT-I targets the problematic sleep behaviors and thoughts that continue to cause a person to sleep poorly. For example, a patient receiving radiation therapy may be fatigued during the day and take extended naps. During active treatment, this can be helpful. But they may develop a habit of continuing to take naps, which can affect their ability to fall asleep at night. As part of CBT-I, cancer survivors can expect to track their sleep, develop a sleep period that is better aligned with how much sleep they need, learn to avoid problematic sleep behaviors in the bedroom, and change the thoughts that can make it more difficult to fall asleep or stay asleep.

What are the key takeaway messages?

Sleep difficulties are common among cancer survivors, even if they were successfully treated for their cancer years ago. Sleep disorders should be evaluated by a medical provider trained in sleep medicine. There are a number of excellent treatment options that can improve sleep for cancer survivors, such as CBT-I. With increasing virtual access to medical care, telemedicine and online interventions are exciting possibilities for cancer survivors struggling with their sleep.

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What to do when elective surgery is postponed

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Each time a wave of COVID-19 engulfs a community, overwhelmed hospitals wind up postponing elective surgeries. The schedule changes are needed to make room for COVID patients, allow all hands on deck for crisis care, and shield people in the community from unnecessary COVID exposure. This scenario may grow worse if the flu season isn’t mild this year –– a good reason to get that flu shot!

Postponement of an elective surgery is upsetting, and automatically presents you with two dilemmas:

  • You’ll have to cope with your ailment while you wait for the all-clear.
  • You’ll have to be prepared for your surgery when you get the call that’s it’s back on.

Read on for steps you can take to cope with both situations.

First, what’s considered elective surgery?

All surgical procedures involve cutting skin and tissue using a variety of tools and techniques. But unlike heart surgery done in response to blocked arteries, elective surgery is not an emergency. It’s a procedure that can be safely scheduled in advance. That’s not to say it isn’t important.

An elective surgery could be

  • major, such as a hip or knee replacement, or surgery to repair a prolapsed (fallen) uterus
  • minor, such as surgery to relieve carpal tunnel syndrome (an entrapped nerve in the wrist), or surgery to remove a cataract (cloudy lens) in the eye.

The determination of whether surgery is elective isn’t always clear-cut. Sometimes it depends on your health circumstances. For example, surgery to replace a heart valve might or might not be an emergency, depending on the person’s condition.

Coping while you wait for elective surgery

Waiting for your surgery has potential consequences. Maybe you won’t be able to work, or maybe your condition, pain, or anxiety about the situation — or all three — will get worse.

While you’re in limbo, here are four steps you can take:

  • Keep lines of communication open with your health care providers. That could mean having important phone numbers for your physician on hand, or logging onto your patient portal and emailing your doctor or nurse. Ask your doctor how often you should check in. 
  • Report changes in symptoms. When you scheduled your surgery, your condition wasn’t life-threatening. But things can change. Don’t wait until you experience an emergency; report symptom changes as soon as you notice them.
  • Get prescriptions refilled. You don’t want to be without medications when you need them, especially if you’ll need your doctor to sign off on refills.
  • Arrange for additional help. Perhaps a friend or family member can assist you with grocery shopping, meal preparation, housekeeping, or getting through daily activities. If you can afford it, consider hiring someone to assist you temporarily. Prices average about $25 per hour in the US, with a minimum of several hours per week.

When surgery is back on schedule

Eventually, you’ll get the call that your surgery is a go. That doesn’t mean it will occur soon. Most likely there will be a backlog of postponed surgeries, which may add more time to your wait. Prepare for the possibility that you’ll need to extend the arrangements that have been getting you through your waiting period.

It’s equally wise to prepare for the chance that your surgery will happen with little notice. Alert friends, family members, or your private-duty care agency about this possibility, so they can arrange to jump in to help when you need them.

And make sure you have the answers to these questions ready well in advance:

  • How will you get to and from surgery? (Will you count on a friend, a ride service, or a hired health aide?) 
  • How will you obtain medications prescribed after surgery?
  • Which equipment (if any) will you need after your surgery? For example, if you’re going to have a joint replacement, you’ll need a walker and shower chair afterward. See if you can arrange to get it now, so you’ll have it ready.

It may not be easy dealing with your condition until your surgery takes place, but at least you’ll have both a plan A and a plan B. That preparation may give you a little peace of mind and a feeling of some control over your situation.