Experimental technology can ‘smell’ disease on your breath

Smell is a primary human sense, key to our survival.

Like a super-sensitive human nose, an experimental technology can “smell” and identify the chemical composition of a person’s breath and then diagnose up to 17 potential diseases, according to the scientists who developed it.

These researchers, led by Hossam Haick of the Technion-Israel Institute of Technology, say their Na-Nose, which uses nanorays to analyze breath, can identify Parkinson’s disease, various cancers, kidney failure, multiple sclerosis and Crohn’s disease with 86% accuracy.

“I would say our technology in many cases (is) equivalent to the accuracy of the currently available invasive technology,” Haick said, adding that for some diseases, including gastric cancer, Na-Nose has a “much higher” accuracy rate than currently available technologies. And, unlike most screenings, including standard blood tests, breath analysis technology is noninvasive — a benefit most patients would appreciate.

The theory behind the technology is that each of us has a unique chemical “fingerprint.” Each disease also has a particular chemical signature, which can be detected on our breath. The Na-Nose technology, which consists of a sensor chamber with a breathing tube and software, is able to detect this precise chemistry of disease by interpreting the impact on our usual chemical fingerprint.

Seven companies have licensed the underlying research for the technology from Technion in hopes of creating a commercial product, Haick said. He hopes that the companies, each specializing in a different application, will translate the science and technology from the lab to mass production.

One application, for example, would turn smartphones into “sniffphones” that would monitor our health routinely.

But with further testing and regulations to meet, neither the Na-nose device nor any variations will be available on the market — or in our doctor’s offices — for a number of years, said Haick.

Dogs, flies and rats

Though Na-Nose may seem revolutionary, smell was recognized as a potential diagnostic tool in antiquity.

“The ancient Greeks used breath and urine scent to diagnose disease,” said Dr. Mangilal Agarwal, director of the Integrated Nanosystems Development Institute and an associate professor at Richard L. Roudebush VA Medical Center in Indianapolis. “Thucydides said there was a specific scent to plague victims in Athens, and Hippocrates cataloged a specific disease because it caused bad breath and bad-smelling sweat.”

Agarwal, who is not involved with the Na-Nose technology, said he is working on a number of projects that analyze scents to diagnose diseases, including hypoglycemia (low blood sugar), prostate cancer and breast cancer.

“Breath has the scents or volatile biomarkers necessary to identify many diseases,” he said. “We know this from canines who can detect hypoglycemia and epileptic seizures, fruit flies (and canines) that can detect cancer, and from giant rats that detect tuberculosis in Africa.”

Similar research is being conducted in Spain, Latvia, Belgium, England, Italy and various corners of the United States.

“Dr. Haick’s group is certainly ahead of our group in terms of getting close to doctor’s visit tests,” Agarwal said, adding that an important aspect to breath analysis is that it “excels at capturing changes in human health in a noninvasive manner.”

“Quick diagnosis can help in identifying the most appropriate treatment response,” he said. He added that prostate cancer grows on a longer time-scale, but the prostate biopsy is such “a sufficiently unpleasant experience” that a noninvasive test would be beneficial and lower health-care costs.

The high accuracy claims of Haick’s research group is “very reasonable, if the signal is not masked by environmental fluctuations in some manner,” Agarwal said, though he cautions that some “breath-based tests have had difficulty duplicating results in different regions, likely because the sensor has difficulty adjusting to different background air signals.”

Other scientists raise additional concerns.

Not ready for prime time?

Dr. George Preti, a faculty researcher at Monell Chemical Senses Center, a nonprofit scientific institute in Philadelphia, said it’s hard to distinguish body chemicals from environmental chemicals in breath samples because “most of the compounds detected in breath are also detected in room air and their levels are similar to each other.”

Until scientists “understand the origin and biochemical pathways leading to disease-related” markers in human breath, reliable results from a diagnostic breath test will be difficult to achieve, he stated in a recent review of studies.

In fact, there are more than a few issues that must be addressed before effective technologies will be produced, according to Dr. Lisa Spacek, an adjunct assistant professor at Johns Hopkins School of Medicine, and Terence Risby, professor emeritus at the Johns Hopkins University Bloomberg School of Public Health.

Using breath to diagnose disease first requires a profile of breath molecules for normal health to be established, Spacek and Risby say in a recently published paper. These must take into account variables such as age, gender, ethnicity and body mass index.

Researchers also need to investigate the factors that might contaminate breath results, such as what someone ate within eight hours of breath collection or whether they used a mouth rinse, say Spacek and Risby. Another issue: How do you store breath that is not immediately analyzed?

Advances in instrumentation, particularly portable monitors, is one factor inspiring and enabling the new research into breath analysis.

Though the field is growing and results are promising, translation of the work into meaningful tests is another matter: “I take every claim by manufacturers … with a grain of salt,” Risby wrote in an email.

Today’s widespread interest in breath analysis stems from the relatively recent discovery — within the past 20 years or so — that nitric oxide, a common pollutant, works as a signaling molecule in the cardiovascular system, Risby observes. The three scientists who made the discovery won a Nobel Prize for their efforts in 1998.

So despite ancient roots, Risby says, “clinical breath analysis remains in its infancy.”

Surrogate mom delivers two babies, one her own

The lives of Jessica Allen and her husband, Wardell Jasper, were changed permanently and for the better by a rare medical phenomenon. Their unique story begins with the hope of extending a lifeline to another couple around the globe.

Allen, 31, a California mom with two growing boys, decided to become a surrogate mother and carry the baby of another couple, she told the New York Post. Although the $30,000 paycheck (plus expenses) would benefit her family, she also yearned to share the joy she knew by helping a woman who struggled to give birth.

“No woman in the world should have to live their life without experiencing the love and the bond from a mother and a child,” she told ABC News.

Working with a San Diego-based surrogacy agency, Omega Family Global, Allen was matched with a couple from China, where the use of surrogates is illegal.

In April 2016, a single male embryo from the couple was implanted in Allen’s uterus at an Irvine-based in vitro fertilization center. Nine days later, blood tests confirmed the pregnancy.

Unexpected news arrived six weeks later during her checkup; while examining her, her doctor said, “Well, I definitely see that there is another baby,” she told ABC News.

Allen said her doctor explained to her that “the chance of an embryo splitting is very small, but it does happen,” and this split meant the second baby was an identical twin of the first. Allen felt surprised but also happy for the Chinese couple.

A bonus was that her payment was increased by $5,000 for the second child.

At 38 weeks’ gestation, on December 12, 2016, Allen delivered what she believed to be identical twin boys via cesarean section at Riverside Community Hospital, she told the New York Post. Though she never saw the babies herself, she was shown a photo.

“I did notice one was much lighter than the other — you know, obviously,” she told ABC News. “They were not identical twins.”

A month later, there was some shocking news. A DNA test confirmed that the second baby was not a twin to the implanted embryo — but actually Allen and her husband’s biological son.

“I don’t know how to describe it. We were floored. We were like, how did this happen?” she told ABC News.

Omega Family Global’s lawyer, Matthew Faust, said the agency is unable to address any particular facts of this story.

CNN has not been able to reach the California couple.

An unusual occurrence of superfetation might explain what happened, but one expert believes it may be more complicated than that.

Rare phenomena

“Superfetation is generally defined as becoming pregnant while the mother is already pregnant,” David Haig, a professor of biology at Harvard University who was not involved in the surrogacy, wrote in an email. However, he added, “the surrogacy means that it doesn’t fit neatly into the classical definition of superfetation.”

Superfetation is sometimes suspected when twins, at birth, are very different sizes and so apparently different ages.

In such cases, Haig said, the mother is believed to have conceived a second time during an ongoing pregnancy.

“I can remember reading about an old case where the twins were delivered at different times,” Haig said. “The mother came to the doctor with abdominal pains. He said you are in labor. She said, I cannot be — I delivered a month ago.”

Despite her protests, the twice-pregnant woman delivered a second child one month after the first, Haig said.

Another phenomenon, heteropaternity, occurs “when a woman produces twins with different fathers,” he said. Sometimes, this has been called superfecundation.

In such cases, a woman would have had intercourse with two men, presumably at different times, Haig explained. “But then two eggs are fertilized by the mixed sperm within her reproductive tract,” he added.

“This case is a bit of the mix of the two situations. I did not see a suggestion that the ‘twins’ were different gestational ages but they were conceived by different men and had different mothers as well.”

Allen told the Post that she and her husband “did not have sexual intercourse until we were given permission by the IVF doctor, who recommended the use of condoms.”

The rare phenomenon she experienced, then, may have also included another infrequent occurrence: a condom fail.

Both superfetation and heteropaternity are rare phenomena, according to Haig.

Part of the family

After confusion and some difficulty in getting her baby returned to her, Allen and Jasper were reunited with their son in February. Allen told ABC News that her son, renamed Malachi and now 10 months old, is part of their family.

“We didn’t plan this,” Jasper told ABC News. “It’s an emotional situation.”

Surprise, though, does not diminish the family’s joy.

“He’s just so smart, so intelligent, you know,” Allen told ABC News. “He’s learning fast. He’s got two big brothers to run after and learn from.”

Experimental gene therapy for blindness considered by FDA

When her son was just 3-months-old, Elizabeth Guardino began to notice that he never responded when she smiled. Dangling a toy in front of his face, Christian did not follow it with his eyes.

“He also started to stare at the sun wide-eyed,” said Guardino of Patchogue, New York. “That also shook us quite a bit.”

These “triggers” sent her to get Christian’s vision tested when he was 6 months old.

The diagnosis was Leber’s congenital amaurosis (LCA), a rare inherited eye disease that causes severe visual impairment beginning in infancy. Scientists have identified at least 13 different types of LCA with separate genetic causes.

“How it was explained to me is I would have to carry a gene and so would my husband, so it’s that rare of an occurrence,” said Guardino. Still, there was some hopeful news that day.

Christian had the type of LCA that would remain stable or slightly improve with age.

“No one knew what his diagnosis really meant,” she recalled. “Including ourselves.”

She clung to the hope that her son’s impairment wouldn’t worsen with age. As he grew, he developed his natural gift for music, which served as a consolation when he struggled to keep up with friends. However, when Christian reached age 12 or so, Elizabeth started seeing a decline in his vision.

On Facebook she happened upon an LCA support group. “I thought this cannot be, because it’s so, so rare,” said Guardino. A family conference in Philadelphia was scheduled for July 2012.

“We jumped on that bandwagon,” she said. Talking to the specialist there, she learned that Christian, 12 at the time, would go completely blind.

“It took every ounce of strength for me to not go running out of that room screaming. It was devastating,” she said.

Later, when tests confirmed a mutation of the RPE65 gene, she consented to treating Christian with an experimental drug made by Philadelphia-based Spark Therapeutics, Inc.

Luxturna (voretigene neparvovec), an untried gene therapy, would be her gamble to save what little vision her son still had.

Drug safety and effectiveness

“We very much included Christian in that decision because, I mean, that’s a heck of a decision for someone to make for another human being when you don’t know what the outcome could be,” she said. “Christian was gung ho, right from the get-go.”

“Our goal going in was just to stop the progression of the disease, but we wound up getting so much more,” she said.

The life-changing therapy Christian experienced may now be poised to make history.

On Thursday, a Food and Drug Administration advisory committee will meet to review Luxturna. Outside experts will present research and recommendations on the safety and effectiveness of the treatment for patients with retinal dystrophy caused by a confirmed RPE65 mutation. Patients will also make a case by sharing their personal experiences.

Monique da Silva, a spokeswoman for Spark Therapeutics explained that the company believes the total “population in the US, Europe and select additional markets in the Americas and Asia/Pacific is up to approximately 6,000 individuals” who have RPE65 mutations. The US National Library of Medicine estimates that LCA occurs in 2 to 3 per 100,000 newborns, though not all of these are RPE65 mutations.

The public meeting will conclude with a vote on whether or not to recommend the treatment for approval. This will be followed by a decision from the FDA. While the agency frequently follows the recommendations of its advisory committees, it is not required to when making approval decisions.

A greenlight for Luxturna would be historic. If approved, it would become the first gene therapy for the treatment of an inherited disease in the United States.

How it works

Luxturna works by supplying a third gene — a normal RPE65 gene — to retinal cells. It is a liquid that is injected directly into the eye with a microscopic needle during a surgical procedure, explained Dr. Vinit B. Mahajan, an associate professor of ophthalmology, Vitreoretinal Surgery and Disease Byers Eye Institute at Stanford University.

“In those drops of liquid that we’re injecting is a gene therapy virus … a virus that contains a healthy version of the gene,” said Mahajan, who was involved in the phase 3 clinical trial of the drug while teaching at the University of Iowa, one of the testing centers for the treatment.

Essentially then, the drug adds a third version of the gene, a normal version, to the cell, while the two mutated genes causing the disease remain inside the cell as well, explained Mahajan. They are not removed or replaced.

“We make the healthy gene in a lab” in the form of DNA, said Mahajan. DNA is essentially a chemical made up of four separate molecules (commonly referred to as G, A, T and C), and in labs around the world scientists have been synthesizing DNA for many years now, he explained.

“The trick here was how do we get it inside the cell and how do we deliver it to the eye?” he said. To solve this problem, the researchers at Children’s Hospital of Philadelphia and the University of Pennsylvania engineered a virus capable of delivering the healthy gene into the cells.

The virus is then injected under the retina to get the gene near the cells Mahajan said. Recovery from any eye surgery usually takes several weeks to a few months, yet, some of the patients from the clinical trial recovered visual function almost immediately.

This was true for Christian who, like other patients, wore a patch for a couple of days after the surgery, his mother said.

“They removed the patch in a dimly lit room,” recalled Elizabeth. “And he turned and he noticed us sitting there and he said, ‘Mom, is that you and Papa?’ He would never have seen us sitting there prior to that.”

Christian is not unusual in this positive result. Overall, most of the more than 30 patients who have received treatment with Luxturna during clinical trials have “done great,” said Mahajan. “Patients who had essentially been blind were seeing. It was surprisingly quick. It’s remarkable.”

In the Phase 3 clinical trial, 27 out of 29 participants — 93% — who received the gene therapy demonstrated a gain in functional vision as assessed by a mobility test performed in a maze, according to da Silva. Meanwhile the eight patients who received the drug in an earlier clinical trial have also shown improved vision.

Importantly, the drug caused no terrible side effects in participants and so far they have maintained their visual improvements.

Potential downsides

“So the biggest concern is this is a virus, and even though we want it to go to a specific cell — cells in the eye — the concern is that the virus can go get into other cells in the body where you don’t want it,” said Mahajan. “So instead of just replacing a gene, it might damage some of your normal genes.”

Another possibility is the wayward virus might cause an allergic reaction — an immune reaction where it is not tolerated by the body. Worst case scenario, such an immune reaction could lead to death.

However, the virus is not delivered into blood cells which travel the entire body, it is delivered into the eye, which is self-contained and isolated. What you inject in the eye mostly stays in the eye,” said Mahajan, adding that the surgical delivery helps this as well. “The eye isn’t 100% leak-proof but it’s not very leaky,” said Mahajan.

Another risk, according to Dr. Stephen H. Tsang, an associate professor of ophthalmology and associate professor of pathology and cell biology at Columbia University’s Institute for Genomic Medicine, is the vision improvements may not last.

Tsang, who was not involved in the clinical trial, has reviewed other experimental gene-based therapies for retinal disease being developed by other companies and research institutes. Some are similar to Luxturna in that they use a virus to deliver the gene.

While the participants in clinical trials for similar gene therapies “did really well” at first, said Tsang, “three years later, they went to baseline” — their eyesight reverted to its original poor condition.

Christian Guardino, who is now five years out from treatment with Luxturna, has maintained his newfound vision. However, his mother said that whenever he’s sick or tired, his vision weakens. “It’s almost like his Achilles’ Heel,” she said.

“It’s difficult to compare the trials because the preparation of the viruses is different in each case,” said Tsang. Still, he questions whether Luxturna is a one-time drug for patients. Maybe, he speculated, “it’s not going to be once, but twice or thrice … it could be that every three years, patients might need a boost.”

Future therapies

Despite his misgivings, Tsang believes the new gene therapy is “very exciting” because a “favorable result from the FDA” would mean doctors will soon have a treatment to offer patients with this rare retinal disease. “Before, we had nothing,” he said.

If approved, the new gene therapy would be another victory for combating rare diseases, also known as orphan diseases.

“If you told me a few years ago that this therapy is only good for (so few) people, I would not have thought anyone would want to work on it,” said Tsang.

Mahajan said the new drug is a pioneering effort that opens the door for other companies working toward new genetic therapies for other diseases, both rare and common.

“We’ve been doing gene therapy in the mouse for many years — we’ve cured lots of mice,” said Mahajan. “Bringing it to patients is a watershed moment.”

Certainly it has been so for Christian Guardino, now 17 years old, whose visual impairment once meant the falling snow and the moon crossing the night sky were unseen mysteries.

Today he’s seen snowflakes, the moon … and more.

Christian’s dream to become a singer took flight during season 12 of “America’s Got Talent,” when he auditioned in an episode that aired in June. Though he was eventually eliminated in the semifinals, he told his mother the ability to walk unaided onto the stage and see faces in the audience gave him confidence.

He wears special glasses and uses assistive technologies to help him see the blackboard and enlarge the print of written materials for his classes at Patchogue-Medford High School. “He’s doing really well in mainstream (classes),” said his mother.

She added that Christian recently told her he is still learning to use his newfound vision.

“If I could tell you how many times I had to sit and wait because he would just stop and stare at something,” said Elizabeth Guardino.

After 15 years in vegetative state, man responds to nerve stimulation

A car accident at 20 years old left a French man in a vegetative state for 15 years. But after neurosurgeons implanted a vagus nerve stimulator in his chest, the man, now 35, is showing signs of consciousness, according to a study published Monday in the journal Current Biology.

Vagus nerve stimulation is already used to help people with epilepsy and depression. This cranial nerve runs from the brain to other parts of the body, including the heart, lungs and gut; vagus means “wandering” in Latin.

The study results challenge ideas that consciousness disorders lasting longer than 12 months are irreversible, the researchers believe.

A demonstration of what’s possible

Vagus nerve activity is “important for arousal, alertness and the fight-or-flight response,” wrote Dr. Angela Sirigu in an email. She is an author of the study and neuroscientist at the Institut des Sciences Cognitives Marc Jeannerod in Lyon, France.

Sirigu and her colleagues decided to test the ability of vagus nerve stimulation to restore consciousness in a patient in a vegetative state. Patients in a vegetative state show no evidence of consciousness, mental function or motor function. Unlike a coma, a vegetative state includes intermittent periods of eye opening; this seemingly hopeful sign, though, is not a normal waking, just a random physiological occurrence.

Vagus nerve stimulation begins with a surgeon implanting a device in the chest and threading a wire under the skin. This wire joins the vagus nerve and the device, which sends electrical signals along the nerve to the brain stem (where the spinal cord and brain connect) and in turn this transmits impulses to certain areas in the brain.

Stimulating the vagus nerve activates “a natural physiological mechanism,” wrote Sirigu in an email.

Sirigu and her colleagues selected the man, who had been in a vegetative state for 15 years “showing no sign of change since his car accident,” she wrote. “We therefore put ourselves in a difficult challenge by selecting a patient with the worst outcome.”

The reason for that choice is that if any changes occurred in the patient after vagus nerve stimulation, then “these could not be the result of chance,” she added.

After a single month of stimulation, the patient’s attention, movements and brain activity significantly improved, according to the authors.

“Our results show major changes at the brain level,” Sirigu said. One electroencephalogram or EEG signal, “a brain rhythm previously shown to distinguish vegetative from minimally conscious state patients, significantly increased,” she wrote, particularly in areas important for “movement, body sensations and awareness.” A PET scan, a type of imaging test, showed increases in metabolic activity in the brain, as well.

Dr. Nicholas Schiff, a neuroscientist at Weill Cornell Medicine and NewYork-Presbyterian who also researches consciousness, said some will look at this case and say, “It’s one patient, and they didn’t really move him into a new functional category. And then they will say, ‘What’s the point here?’ ” said Schiff, who was not involved in this study.

Yet the new study is “another demonstration of what is possible to do, and it’s a new technique, and it might have some real advantages for some patients,” he said.

The human brain’s ‘greater potential’

“The general point here is that taken together with all the other information that we have now, it’s very clear that the severely injured human brain has greater potential than it’s given credit for,” Schiff said. “So you can lay around for years and, in principle, still be responsive to medications, devices and other things.”

Even with that much brain injury, you can still “move the dial,” said Schiff.

What’s new in this study is stimulation of the vagal nerve on the outside of the brain, he said. “The nerve sends impulses down into the stomach area,” he explained. Instead, the researchers send impulses up through the nerve, and that activates the brain through multiple synaptic pathways.

In the United States, an estimated 50,000 patients are in a vegetative state, and about 300,000 are in a minimally conscious state, Schiff said.

“We’ve now known for a long time that we can do something for very severely injured brains, but the science has not been met with any kind of infrastructure to catch up with it,” he said. More funding for research is needed, he added.

Dr. James L. Bernat, a professor of neurology and medicine at the Geisel School of Medicine at Dartmouth, referred to the new case report as “provocative” and “exciting.”

Bernat, who also was not involved in the research, praised Sirigu and her colleagues for their choice of patient: someone in a long-term vegetative state.

“If they had, for example, chosen someone who had been in a vegetative state for three months after a traumatic brain injury and then showed improvement a month later with the intervention, a critic might say, ‘Well, wait a minute. We know that a lot of people who are vegetative for three months spontaneously improve in that time period, so it may not be the intervention,’ ” Bernat said.

He noted that every case of vegetative state is unique based on what caused damage to the brain, how severe that injury was and what regions were harmed.

A vegetative state can be caused by a variety of injuries, including traumatic brain injury, injury to neurons caused by a lack of oxygen and blood flow during cardiac arrest or meningitis, he explained.

For these reasons, the vagus nerve stimulation technique will not work with all patients, Bernat noted, still it’s worth doing more studies to find out which patients will benefit from it.

A better understanding of how brain damage harms consciousness would involve learning about how the brain maps the pathways of normal consciousness, said Bernat. “How does normal consciousness occur? And how does unconscious occur?” Bernat asked. “There’s a lot of basic work that needs to be done.”

Plausibly, this work would also contribute to explaining neurodegenerative diseases, like Alzheimer’s disease, as well as cognitive impairment resulting from traumatic brain injury.

New research of consciousness “has the potential to extend beyond the relatively small group of people who have these conditions,” said Bernat. Consciousness disorders are, in a sense, “an orphan group of diseases that has been somewhat neglected, not entirely, but somewhat by funding agencies,” Bernat said. “I would like to see more funding for research.”

Sirigu said she is planning a large study involving collaboration with several research centers to confirm and extend the therapeutic potential of the vagus nerve stimulation technique.

“More basic research will also be important for advancing our understanding of this fascinating capacity of our mind to produce conscious experience,” she said.

An easy opportunity to screen moms for postpartum depression

After giving birth, some mothers experience extreme sadness, anxiety and other symptoms of postpartum depression.

Screening mothers for depression during early well-child visits led to significantly fewer reports of depression at nine months postpartum, a new study of 3,000 Dutch women found.

Just 3% of the screened mothers experienced minor or major depression at nine months postpartum, compared with 8.4% of the mothers who weren’t screened during the visits, according to the research, published Thursday in the journal Pediatrics.

When it goes unrecognized, postpartum depression can grow serious. If untreated, symptoms may worsen, and recovery may take longer, lead author Dr. Angarath I. van der Zee-van den Berg explained in an email.

“In the worst of cases, a mother could commit suicide. The depression can lead to stress in her relationships, especially in the relationship with her partner,” wrote van der Zee-van den Berg, who is completing a Ph.D. in Health Technology and Services Research at the University of Twente. “Also, mothers with postpartum depression have an increased risk of future depressive episodes. Finally, it may take a long time to accept that the period, often expected to be joyful, turned out to be so different.”

Wellness for babies — and mothers

In the Netherlands, well-child care centers offer free visits — commonly, one at-home visit two weeks after the birth of a child and then about seven subsequent visits at the center itself — to parents of all newborns. These visits, which boast a 95% participation rate, include monitoring a child’s growth, development, health and vaccinations.

For the study, 1,843 mothers visiting Dutch well-child care centers between December 1, 2012, and April 1, 2014, received screening for symptoms of depression at one, three and six months postpartum. Mothers who showed signs of being at risk for major depression at those times were referred to their family physician or a mental health professional.

A separate group of 1,246 mothers received only the usual care during their well-child care visits during the same period.

At two weeks postpartum, all the mothers answered questions on the Edinburgh Postnatal Depression Scale, a well-known screening tool. This depression scale “is not a diagnostic instrument; when a mother scores above the threshold, further diagnosis is necessary,” van der Zee-van den Berg noted.

Nine months later, the same scale was used to test for symptoms of depression. At 12 months, each mother’s mental health and quality of parenting was evaluated along with her child’s socioemotional development.

“It is not easy for mothers to share their feelings, so it is important that the professional is able to build a trust relationship,” van der Zee-van den Berg said. “Well child care professionals have this opportunity, as they have frequent contact with the mother.”

The results at nine months postpartum showed that fewer mothers in the screening group experienced symptoms of major depression compared with unscreened mothers: 0.6% versus 2.5%. This represents a reduction “by more than 60%” in the likelihood of depression among the screened mothers compared to the usual care group, wrote van der Zee-van den Berg.

Screened mothers also showed better mental health, less anxiety and higher-quality parenting.

Negligible differences in the children’s socioemotional development could be seen across the two groups.

“Implementing screening is a simple and effective way to reduce the burden of postpartum depression — provided that diagnosis and treatment can be offered,” van der Zee-van den Berg wrote.

Treatment options for moms

US Centers for Disease Control and Prevention research shows that about one in nine women experiences postpartum depression.

Mothers who have a family history of depression, those who abuse alcohol and those with a personal history of depression are more likely than others to experience postpartum symptoms. Other factors — including stress, low social support, pregnancy and birth complications, being a teen mom, preterm birth, birth to multiples and birth to a child requiring hospitalization — also put women at higher risk of depression.

Kate Jolly, a professor of public health and primary care at the University of Birmingham in the United Kingdom, wrote in an email that the new study was “pretty good quality.” Still, Jolly, who was not involved in the research, pointed out a few flaws.

A main problem was imbalance, she said: Mothers with certain traits, particularly those who reported previous episodes of depression, were not equally divided between the two groups.

“A past history is the greatest predictor of postnatal depression, and rates were higher in the usual care group,” Jolly wrote.

In her own published research, she and her co-authors reported that exercise is effective in reducing postpartum depressive symptoms.

For women experiencing postpartum depression, “cognitive behavioral therapy or other evidence based counseling is the therapy of choice,” van der Zee-van den Berg wrote, basing her opinion on the most recent advice from the US Preventive Services Task Force.

Jolly wrote that “we can’t be sure whether exercise means depression can be avoided, but symptoms can be reduced. Trials have generally not included women with the most severe depression, so I think it is accurate to say that exercise is a useful tool for women with mild to moderate depression.”

Still, she said, the most important thing to help women with postnatal depression might be “to reduce the stigma around the condition.”

“Many women are reluctant to admit they have a problem because they fear they will be judged as a bad parent,” Jolly said.

‘Somebody cared enough to ask’

Dr. Marian F. Earls, director of pediatric programs for Community Care of North Carolina, found the new study to be “really exciting.”

Earls was not involved in the research, though she was the lead author of a 2010 report from the American Academy of Pediatrics that recommended postpartum depression screening for mothers during infant wellness visits.

Extensive studies have not been done, so there’s scant information about how well this is implemented throughout the United States. However, based on Medicaid billing data in her own state of North Carolina, 73% of mothers there are being screened at the one-month child wellness visit.

“That doesn’t mean people are doing it at all the recommended ages,” Earls said, noting that “we’ve asked folks to screen at the one-, two-, four- and six-month infant wellness visits — based on when depression might peak, minor or major.” Just as in the Netherlands, practitioners in the United States generally use the same easy-to-score Edinburgh scale, she said.

She noted that, in the new study, infants of mothers with depression did not show differences in their level of social and emotional development compared with babies of mothers with no symptoms.

“One of our recommendations is that if you have moms for whom depression screening was positive, then you should follow their infants closely for their social-emotional development,” Earls said. “That relationship is so important.”

Overall, she believes and hopes that screening for postpartum depression during wellness visits “will continue to grow. I think people understand the importance of this.”

Plus, screening has “other positive effects,” she said.

It’s not only helpful for moms who have depression. Feedback from other moms indicates they appreciated that “somebody cared enough to ask,” she said.

“It has really strengthened the relationship between the primary care clinician and the family,” Earls said. “It also helps people understand that if (depression) occurs, this is a safe place to bring up those concerns.”

Yes, sitting too long can kill you, even if you exercise

Take a movement break every 30 minutes, say experts. No matter how much you exercise, sitting for excessively long periods of time is a risk factor for early death, a new study published Monday in Annals of Internal Medicine found.

There’s a direct relationship between time spent sitting and your risk of early mortality of any cause, researchers said, based on a study of nearly 8,000 adults. As your total sitting time increases, so does your risk of an early death.

The positive news: People who sat for less than 30 minutes at a time had the lowest risk of early death.

“Sit less, move more” is what the American Heart Association encourages all of us to do. But this simplistic guideline doesn’t quite cut it, said Keith Diaz, lead author of the new study and an associate research scientist in the Columbia University Department of Medicine.

“This would be like telling someone to just ‘exercise’ without telling them how,” Diaz wrote in an email.

Exercise guidelines are precise, he explained. For example, the US Centers for Disease Control and Prevention recommends adults do moderate-intensity aerobic exercise for two hours and 30 minutes every week, plus muscle strengthening activities on two or more days a week.

“We need similar guidelines for sitting,” said Diaz.

“We think a more specific guideline could read something like, ‘For every 30 consecutive minutes of sitting, stand up and move/walk for five minutes at brisk pace to reduce the health risks from sitting,’ ” he said, adding the study “puts us a step closer to such guidelines,” but more research is needed to verify the findings.

Aging means more sitting

To understand the relationship between sedentary behavior and early death, Diaz and his colleagues at Columbia, NewYork-Presbyterian/Weill Cornell Medical Center and other institutions turned to the REasons for Geographic and Racial Differences in Stroke (REGARDS) project, a study sponsored by the National Institutes of Health.

“The REGARDS study was originally designed to examine why blacks (and particularly blacks in the Southern US) have a greater risk for stroke than whites,” said Diaz. He and his co-researchers tracked for an average of four years 7,985 black and white adult participants, age 45 or older, who had signed on to participate in the REGARDS project.

To measure sedentary time for these adults, the research team used hip-mounted accelerometers. During the study period, the team recorded 340 total deaths considered “all-cause mortality” — any death, regardless of cause.

Analyzing the data, the team found that sedentary behavior, on average, accounted for about 12.3 hours of an average 16-hour waking day.

“As we age, and our physical and mental function declines, we become more and more sedentary,” wrote Diaz.

Previous studies of adults have found daily sitting time to average just nine to 10 hours per day. The higher average in his own study is likely “due to the fact we studied a middle- and older-aged population,” Diaz wrote. “It could also be partly due to the fact that we used an activity monitor to track sedentary time rather than using self-report.”

Measuring duration, the researchers clocked participants sitting, on average, for 11.4 minutes at a stretch.

As total sedentary time increased, so did early death by any cause, the results indicated. And the same was true for longer sitting stretches. Overall then, participants’ risk of death grew in tandem with total sitting time and sitting stretch duration — no matter their age, sex, race, body mass index or exercise habits.

“We found that there wasn’t a threshold or cutoff where one’s risk for death dramatically increased,” said Diaz, explaining that risk of death increased with more sitting. “To give you a specific number, those who sat for more than 13 hours per day had a 2-fold (or 200%) greater risk of death compared to those who sat for less than about 11 hours per day.”

“Bout duration is a little trickier,” said Diaz. Still, he said, the study results indicate that those who frequently sat in stretches less than 30 minutes had a 55% lower risk of death compared to people who usually sat for more than 30 minutes at a stretch.

Finally, people who frequently sat for more than 90 minutes at a stretch had a nearly two-fold greater risk of death than those who almost always sat for less than 90 minutes at a stretch, he said.

Underlying reasons ‘unclear’

How sedentary behavior impacts our health in negative ways is “unclear and complex,” wrote Dr. David A. Alter, an associate professor at the University of Toronto in Ontario, in an editorial published with the study. Alter, who did not contribute to Diaz’ research, said some scientists theorize that more sitting leads to reductions in insulin sensitivity, while others believe net calorie expenditures decline as sitting increases.

The study was not designed to reveal why sitting increases the risk of early death, noted Alter, who described the study as “methodologically rigorous,” and its findings “robust.”

Arguably, he said, the study’s most important contribution involved disentangling two sedentary behaviors: total daily sedentary time and uninterrupted sedentary bout duration.

“Persons with uninterrupted sedentary bouts of 30 minutes or more had the highest risk for death if total sedentary time also exceeded 12.5 hours per day,” noted Alter. “Conversely, in those whose daily sedentary volumes were low, uninterrupted bout lengths had little if any associated effects on mortality.”

By teasing out these two threads, the findings show excessive sitting is bad and even worse if it is accumulated in lengthy, uninterrupted bouts throughout the day, noted Alter.

Dr. Suzanne Steinbaum, director of women’s heart health at Lenox Hill Hospital in New York said, “The more we sit the worse it is. The longer the duration of sitting, the more negative the impact on our cardiovascular health.”

Steinbaum, who was not involved in the study, said moving around every 30 minutes is recommended.

“The first time we do this, the positive effects are immediate,” she said. “We need to pay more attention to moving.”

Asked if, say, a standing desk might be helpful for those who work desk jobs, Diaz said “there is limited evidence to suggest that standing is a healthier alternative to sitting.”

“So if you have a job or lifestyle where you have to sit for prolonged periods, the best suggestion I can make is to take a movement break every half hour,” said Diaz. “Our findings suggest this one behavior change could reduce your risk of death.”

The average American dad is getting older, study finds

Today’s American dad is slightly older — roughly 3½ years — than his counterpart from four decades ago, according to a study published Wednesday in the journal Human Reproduction. The average age of a father of a newborn in the United States increased from 27.4 years old to 30.9 years old between 1972 and 2015, found Stanford University School of Medicine researchers led by Dr. Michael Eisenberg.

Men who want to become fathers might want to think about the implications of their choices, Eisenberg suggests.

“There is data that a man’s fertility declines with age,” Eisenberg, an assistant professor of urology, wrote in an email. “As such, it may make sense to not wait too long as it may be more difficult to conceive. In addition, there are some potential risks to children.”

More dads over 40

Eisenberg and his colleagues analyzed 168,867,480 births — all the live births reported in the US Centers for Disease Control and Prevention’s National Vital Statistics System from 1972 to 2015.

The system records births and deaths reported by all 50 states and includes parents’ self-reported ages, education levels, races and ethnicities.

“Most data on rising parental ages in the US has been restricted to mothers,” Eisenberg wrote, which makes sense because birth certificate data are generally collected from mothers. “We wanted to examine trends in paternal demographics based on the data available on birth certificates since the 1970s.”

Over the study period, the portion of newborns’ fathers who are 40 or older doubled from 4.1% to 8.9%. Meanwhile, the proportion of dads who were 50 or older rose from half a percent to nearly one in every 100.

The youngest dad for the period studied was just 11 years old, while the oldest was 88.

Asian-American dads — in particular, men of Japanese and Vietnamese descent — were the oldest fathers, the study found. Their ages ranged upward of 36 years old, on average. More years of education also correlated with fatherhood happening at an older age during the 44-year study period. Typically, fathers with college degrees are just over 33 years old.

“Take home points” noted by Eisenberg included the fact that paternal age in the United States has risen “across all race/ethnicities, educational attainment levels, and regions of the country.” That said, some regional differences existed. Northeastern and Western states showed the highest paternal ages on average, the study found.

“A surprise to me was that more than 10% of birth certificates in the US lack paternal data,” Eisenberg said, although the reasons for that aren’t clear.

Though mothers tend to be younger than fathers, “the difference between paternal and maternal age has decreased over time,” Eisenberg noted. This suggests that both mothers and fathers of newborns are older today, but the average age of mothers is increasing slightly faster than that of fathers.

“These demographic trends reflect our society so if men are delaying fatherhood there are likely many implications such as smaller family sizes,” he wrote. “Another possible implication is a higher risk of certain diseases which are more prevalent among older fathers.”

One 2012 study estimated that the male germline — the genes a father will pass on to his children — develops two mutations every year; with an advancing average paternal age, inherited mutations in the general population will also rise, noted Eisenberg and his co-authors. Numerous reports have linked older fatherhood with an increased risk of autism, psychiatric illness, neurologic disease such as neurofibromatosis, pediatric cancer and chromosomal abnormalities in children.

“As such, these trends may suggest that we should be seeing more of these occur in children over time,” he said.

However, there are positives when older men become fathers, Eisenberg noted. Generally, they are more likely to be stable, with better jobs and more resources, and perhaps most important, they are more likely to live with their children and help with child-rearing.

No need to worry — yet

Magdalena Janecka, postdoctoral fellow at the Seaver Autism Center at the Icahn School of Medicine at Mount Sinai in New York, referred to the new study as “huge” in an email and said it offers “interesting insights into reproductive trends among different ethnicities and across the states.” Janecka, who was not involved in the research, published her own study of older dads this year and found that the sons of older dads had, on average, better educational and career prospects.

Overall, the new study’s findings “are in line with the trends observed in other Western countries,” Janecka wrote in an email, citing data from the United Kingdom indicating that average paternal age has risen from 30.6 years in 1991 to 33.2 in 2015.

However, the authors’ explanation for this upward trend in the ages of fathers, “including increased use of contraception, increased entry of women into the labor force, and longer life expectancy, may not represent an exhaustive list of possible causes for older parental age,” Janecka added.

“Such increase is not just a recent phenomenon,” she explained. One historical study found that the average paternal age in 18th- and 19th-century Sweden was 34.37 years, she wrote. “Similarly, in the UK, women’s age at motherhood in 1938 was only a year lower than in 2013,” with a dip occurring between those years, she said.

Speculating about underlying causes for the older ages of dads is difficult, she added, given that the new study does not include information about whether these older average ages resulted from delaying fatherhood or extending it.

When it comes to this upward trend in the age of fathers, Janecka does not believe worry is necessary — at least not yet.

As she sees it, a number of negative outcomes have been reported — including disorders like achondroplasia, a form of dwarfism, and autism — but there are possible positive results, including higher IQ for the baby, which may occur when men become fathers at older ages, she wrote. “We still do not know to what extent those associations are due to the effects of age itself and to what extent due to age-independent traits of men who decide to delay fatherhood.”

The role of maternal age with respect to these disorders is also unclear.

“One clear message” still emerges from the studies to date, Janecka said: “Contribution of paternal age to those disorders/traits is overall negligible and should not influence individuals’ decisions about the timing of parenthood.”