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Newswise — Adults who were born pre-term (under 37 weeks gestation) are less likely to have a romantic relationship, a sexual partner and experience parenthood than those born full term. The meta-analysis by researchers at the University of Warwick with data from up to 4.4 million adult participants showed that those born preterm are 28% less likely to ever be in a romantic relationship. A meta-analysis conducted by researchers from the Department of Psychology at the University of Warwick has published ‘Association of Preterm Birth/Low Birth Weight with Romantic Partnership, Sexual Intercourse and Parenthood in Adulthood: A Systematic Review and Meta-Analysis’ in JAMA Open today, 12th of July. They have found that adults who were born pre-term are less likely to form romantic relationships than full-term peers. In the analysis 4.4 million adult participants those born preterm were 28% less likely to form romantic relationships and 22% less likely to become parents, when compared to those born full term.  Those studies that looked at sexual relations of pre-term children found that they were 2.3 times less likely to ever have a sexual partner when compared to full terms. Those adults who were born very (<32 weeks gestation) or extremely preterm <28 weeks gestation) had even lower chances of experiencing sexual relationships, finding a romantic partner or having children at the same age as those born full term, with   the  extremely pre-term born adults being 3.2 times less likely to ever having sexual relations. Close and intimate relationships have been shown to increase happiness and well-being both physically and mentally. However, studies also show that forming those relationships is harder for pre-term born adults, as they are usually timid, socially withdrawn and low in risk-taking and fun seeking. Despite having fewer close relationships, this meta-analysis also revealed that when preterm born adults had friends or a partner, the quality of these relationships was at least as good in pre-terms compared to full term born adults. First author of the paper, Dr Marina Goulart de Mendonça from the Department of Psychology at the University of Warwick comments: “The finding that adults who were born pre-term are less likely to have a partner, to have sex and become parents does not appear to be explained by a higher rate of disability. Rather preterm born children have been previously found to have poorer social interactions in childhood that make it harder for them to master social transitions such as finding a partner, which in turn is proven to boost your wellbeing.” The senior author, Professor Dieter Wolke, from the Department of Psychology at the University of Warwick adds: “Those caring for preterm children including parent’s health professionals and teachers should be more aware of the important role of social development and social integration for pre-term children. As preterm children tend to be more timid and shy, supporting them making friends and be integrated in their peer group will help them to find romantic partners, have sexual relationships and to become parents. All of which enhances wellbeing.”
Reach of tobacco industry corrective statements even lower among certain groups with higher smoking rates Newswise — The tobacco industry’s court-ordered anti-smoking advertisements reached just 40.6% of U.S. adults and 50.5% of current smokers in 2018, according to new research from The University of Texas MD Anderson Cancer Center. Exposure to the advertisements was even lower among certain ethnic and socioeconomic subgroups historically targeted by tobacco industry marketing.  The findings, published today in JAMA Network Open, should be considered when planning future anti-smoking ads to reach youth and at-risk populations, explained senior author Sanjay Shete, Ph.D., professor of Biostatistics and Epidemiology and deputy division head of Cancer Prevention & Population Sciences. “When compared to other nationally funded anti-smoking campaigns, the reach and penetration of these industry-sponsored ads were suboptimal,” said Shete. “Our hope, as cancer prevention researchers, is for more people to see these ads and to avoid tobacco or consider quitting. Based on our findings, future efforts in this space need to be more targeted to reach key populations.” According to the Centers for Disease Control and Prevention (CDC), tobacco use remains the leading preventable cause of death in the U.S., claiming an estimated 480,000 lives each year. Tobacco use also is the leading preventable cause of cancer, responsible for roughly 30% of all cancers and 90% of all lung cancers. The ‘corrective statements’ were mandated in a 2006 judgment by U.S. District Judge Gladys Kessler, and began to run on prime-time television and in 50 key U.S. newspapers in November 2017. MD Anderson applauded these advertisements as an important step to inform Americans about the harms of tobacco use. The current study assessed data from 2018 Health Information National Trends Survey, a nationally representative, population-based cross-section survey of U.S. adults sponsored by the National Cancer Institute. The study analyzed responses from 3,484 adults, including 450 current smokers, collected between January and May 2018 on self-reported exposure to the anti-smoking advertisements. Exposure was lowest among adults 18-34 (37.4%), those with a high-school or lower education (34.5%) and those with a household income less than $35,000 (37.5%). Among current smokers, exposure was lowest in the Hispanic population, at just 42.2%. “Historically, certain ethnic groups and those of lower socioeconomic status have been targets of tobacco industry marketing, which has led to high rates of tobacco use and tobacco-related diseases in these populations,” said first author Onyema Greg Chido-Amajuoyi, M.B.B.S., a postdoctoral fellow in Epidemiology. “These at-risk groups should, ideally, have had the most exposure to these advertisements, but on the contrary, they have had the least.” The researchers did find that exposure rates increased as the campaign’s duration increased, with 41.3% exposure reported in February 2018 and 46.8% exposure reported in May 2018. This underscores the need for sustained advertising to see long-term public-health impact, explained Shete. The authors recognize certain limitations in the study inherent to using a survey of this type. Responses were self-reported and therefore prone to recall and certain biases. Also, the survey is cross-sectional, so a causal link between exposure and cessation attempts cannot be made. Finally, there was no distinction between exposure to television or to print advertisements, which may have enabled further insight. Co-authors with Shete and Chido-Amajuoyi are Robert K. Yu, of Biostatistics; and Israel Agaku, D.M.D., Ph.D., of the Harvard School of Dental Medicine, Boston, MA. The authors report no conflicts of interest. The study was funded by the National Cancer Institute (P30CA016672), the Barnhart Family Distinguished Professorship in Targeted Therapy, the Cancer Prevention and Researcher Institute of Texas (RP170259), the Mrs. Harry C. Wiess Cancer Research Fund, and the Laura and John Arnold Foundation.
Newswise — PHILADELPHIA, PA — An online training program called HeadCoach increases managers' confidence in their ability to prevent and manage mental health issues among their staff, reports a trial in the July Journal of Occupational and Environmental Medicine. HeadCoach offers "a suite of both responsive and preventive strategies to help managers better understand and support the mental health needs of their staff," according to the report by Aimée Gayed, MCrim, of University of New South Wales, Sydney, and colleagues. In the study, 87 managers at Australian companies were assigned to the online training program; another 123 managers were assigned to a waiting list control group. About 37 percent of managers assigned to HeadCoach completed all modules of the program. This group had increased confidence in their ability to create a workplace that supported the mental health needs of their direct-report employees. The improvement remained significant at four months after training. Managers who completed training also used more responsive and preventive behaviors to create a mentally healthy working environment. The study wasn't able to show a significant impact on employees' psychological symptoms, based on follow-up questionnaires in 173 employees. Mental health problems such as anxiety, depression, and stress-related disorders are a major contributor to work absences and disability. Factors in the workplace may precipitate mental health conditions. Managers can play a key role in reducing the impact of work-related mental health risk factors, but they are uncertain of how to do so. "HeadCoach online mental health training is an effective and scalable way to improve managers' confidence and workplace practices around mental health," Ms. Gayed and coauthors conclude. They acknowledge the need for more research to show an impact on employees' mental health symptoms, including studies comparing online and face-to-face training programs.
Newswise — PHILADELPHIA -- Nearly a million Americans live with thyroid cancer and doctors will diagnose more than 50,000 new cases this year. Fortunately, the survival rate for this kind of cancer is one of the best. Five years after diagnosis, more than 98 percent of patients are survivors. Now a team of researchers led by Alliric Willis, MD, a thyroid surgeon in the Department of Surgery in the Sidney Kimmel Medical College at Thomas Jefferson University and researcher with the Sidney Kimmel Cancer Center – Jefferson Health, finds nearly a quarter of low-risk thyroid cancer patients receive more treatment than necessary. The practice carries potential long-term risk to the patient and added financial costs. The discovery could help to shift how doctors treat thyroid cancer patients. “Just as a patient can be at risk of under treatment, a patient can be at risk of over treatment,” says Dr. Willis, who published the work in the journal Surgical Oncology. “Our research really shines light on the fact that we are not treating all patients the same.” The thyroid is a butterfly-shaped gland that sits over the airway in the neck. The gland makes hormones that help to control heart rate, blood pressure, body temperature and how the body uses energy. When cells grow out of control in the thyroid, cancer develops. Typical treatment for thyroid cancers that have not spread to other parts of the body begins with surgical removal of the gland. After completing surgery, patients can then go on to receive a second therapy known as radioactive iodine ablation. Radioactive iodine ablation is therapy taken as a pill. Because iodine is preferentially taken up by the thyroid gland, which relies on iodine to produce hormones, the radiation dose becomes concentrated there. The high amount of radioactivity in the iodine kills off any lingering cancer cells. Historically, patients have had fantastic results with radioactive iodine ablation treatment, Dr. Willis says. But the therapy does not come without costs. Experts estimate the financial cost of radioactive iodine ablation exceeds $9 million dollars  per year across the country. Additionally, for several days to weeks after surgery, patients who receive the radioactive iodine treatment must stay away from small children and pets. “They’re virtually in isolation because the radioactivity will be on their clothing and on their sheets,” Dr. Willis says. The dose of radioactivity in the treatment is so high that airport security has picked up radioactivity from patients as well as their spouses. The treatment also carries the risk of permanent long-term side effects such as altering patients’ perception of taste and the development of other cancers, particularly leukemia. Yet patients who have low-risk thyroid cancer—cancers that are small and have not spread to other parts of the body—do not benefit from the additional treatment. “Low-risk thyroid cancer patients have a five-year survival rate that is greater than 97 percent, whether they receive radioactive iodine ablation after appropriate surgery or not,” Dr. Willis says. In 2015, the American Thyroid Association released guidelines for thyroid cancer treatment that indicated radioactive iodine ablation is not always necessary for patients with low-risk thyroid cancer. Based on the guidelines, Dr. Willis and team sought to identify groups of patients that are most at risk of being overly treated for thyroid cancer. “This is really important when we're talking population health and managing the  increasing cost of health care by more effectively and efficiently using our resources,”  says Dr. Willis. The researchers analyzed more than 32,000 thyroid cancer cases identified through the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) database. They found more than half of patients were low-risk. About 25 percent of the low-risk patients received radioactive iodine ablation treatment, the researchers report. Patients younger than 65 years old were most at risk of overtreatment, according to the study. Men were also more at risk of over treatment as were Hispanic and Asian patients. “Young healthy patients are certainly going to be willing to receive whatever treatment may benefit them, but again we're talking about something that's been demonstrated to be over treatment,” Dr. Willis says. Some low-risk patients had their lymph nodes removed in addition to the thyroid gland, even when the cancer had not spread to the lymph nodes. These patients were more likely to go on and have radioactive iodine ablation treatment. “That's particularly interesting because that tells you they may be in a setting where people are more aggressive in their approach to surgery and subsequent treatments,”  Dr. Willis says. “This is where guidelines such as those outlined by the American Thyroid Association, can really help. The guidelines can say this more extensive treatment is unnecessary. You will not have better outcomes because of it.” Dr. Willis hopes that his team’s research will make people more aware of the fact that some patients are at risk of over treatment. “I think it will make people more mindful of following recommended guidelines with all patients so that we can give each patient the most effective treatment and get the best outcomes possible,” he says.   Article reference: Ambria S. Moten, Huaqing Zhao, Alliric I. Willis, “The overuse of radioactive iodine in low-risk papillary thyroid cancer patients,” Surgical Oncology, https://doi.org/10.1016/j.suronc.2019.05.011, 2019.
Newswise — WASHINGTON—Women exposed to triclosan are more likely to develop osteoporosis, according to a study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.Triclosan is an endocrine-disrupting chemical being widely used as an antibacterial in consumer goods and personal care products, including soaps, hand sanitizers, toothpaste, and mouthwash. A person can be exposed to triclosan via consumer products and contaminated water. The FDA also banned triclosan from over-the-counter hand sanitizer in recent years.“Laboratory studies have demonstrated that triclosan may have potential to adversely affect the bone mineral density in cell lines or in animals. However, little is known about the relationship between triclosan and human bone health,” said the study’s corresponding author, Yingjun Li, Ph.D., of Hangzhou Medical College School of Public Health in Hangzhou, China. “As far as we know, this is the first epidemiological study to investigate the association between triclosan exposure with bone mineral density and osteoporosis in a nationally representative sample from U.S. adult women.”In this study, researchers analyzed data from 1,848 women in the National Health and Nutrition Examination Survey to determine the link between triclosan and bone health. They found women with higher levels of triclosan in their urine were more likely to have bone issues.Other authors of the study include: Shaofang Cai of The Second Affiliated Hospital of Xiamen Medical College in Xiamen, China; Jiahao Zhu, Chunhong Fan, Yaohong Zhong, and Qing Shen of Hangzhou Medical College; and Lingling Sun of The Second Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, China.The study received funding support from the National Natural Science Foundation of China and the Medical Science and Technology Project of Zhejiang Province.The study, “Association Between Urinary Triclosan with Bone Mass Density and Osteoporosis in the US Adult Women, 2005-2010,” will be published online, ahead of print.
Penn Medicine pilot finds increased job fulfillment, decreased burnout for critical care physicians working seven- versus 14-day rotations Newswise — PHILADELPHIA – Shortening the length of rotations in a medical intensive care unit (MICU) from the traditional 14-consecutive day schedule to only seven days helps mitigate burnout among critical care physicians, according to a new Penn Medicine pilot study. The study, published today in the American Journal of Respiratory and Critical Care Medicine, is the first to validate the efficacy of a truncated rotation in reducing the rate of burnout among critical care physicians. The team found the shorter rotations not only led to lower burnout rates – by as much as 41 percent – but the change also resulted in increased job fulfillment. “In critical care medicine, periods of extreme stress can contribute to high burnout. Our study shows that organizations can implement new strategies, such as shorter staffing rotations, that have a real impact on burnout rates and job fulfillment,” said the study’s lead author, Mark E. Mikkelsen, MD, MSCE, chief of Medical Critical Care and an associate professor of Medicine. “Based on our findings, we changed our scheduling approach to limit the number of consecutive days per rotation, and ensure adequate non-clinical time between rotations.” Work-related burnout, characterized by emotional or physical exhaustion as well as feeling cynical or detached, is common among physicians – particularly, intensivists, or critical care physicians, who care for critically ill patients. Recent research shows nearly half of the 10,000 critical care physicians practicing in the United States reported symptoms of severe burnout, which can lead to compassion fatigue, decreased quality of care and job turnover. In May 2018, Penn Medicine launched a pilot initiative across four critical care rotations, spanning the Hospital of the University of Pennsylvania (HUP) and Penn Presbyterian Medical Center, to identify effective strategies to mitigate burnout and maximize fulfillment. The team, who had found high rates of burnout among intensivists at the end of 14-day rotations, tested a strategy proposed by the Critical Care Societies Collaborative that called for limiting the maximum number of days worked consecutively. As a part of the pilot, intensivists in one unit, the Founders 9 MICU at HUP, had the option to attend for the traditional 14-day rotation or change their schedule to a seven-day rotation. Rotations in two other units were capped at seven consecutive days, while intensivists in the fourth unit worked a two-week rotation, with one weekend off. From May 2018 to February 2019, the team administered more than 180 surveys to 29 physicians at different points throughout the rotations, including on day seven of a 14-day rotation and between clinical rotations. They found burnout and fulfillment varied by the clinical rotation and length of rotation. For example, intensivists in in the Founders 9 MICU, a 24-bed unit staffed by two critical care physicians, fellows and internal medicine residents, responded with 61 percent burnout and 47 percent fulfillment rates. Meanwhile, the intensivists working a seven-day rotation in the Donner 3 MICU at HUP – an 8-bed unit, staffed by one critical care physician and two advanced practice providers – responded with a 24 percent burnout and 76 percent fulfillment rates. “While our main focus was measuring burnout and fulfillment rates, we also wanted to ensure the shorter rotations did not negatively impact our ability to educate the next wave of physicians whom are training here,” said author Meeta Prasad Kerlin, MD, MSCE, an assistant professor of Medicine and associate fellowship program director in the division of Pulmonary, Allergy and Critical Care. “Based on feedback from our critical care physicians, fellows, and residents, we found the shorter rotations may have, in fact, led to better education, as faculty felt they could be more engaged and energetic.” Additional Penn authors on the study include Brian J. Anderson, Lisa Bellini, William D. Schweickert and Barry D. Fuchs.
Newswise — Charlottesville, Va. (June 24, 2019)—Metabolomics, the study of small molecules the body produces during metabolism (metabolites) may be a future key to identifying diabetes-related kidney disease. The finding will be presented today at the American Physiological Society (APS)/American Society of Nephrology (ASN) conference, Control of Renal Function in Health and Disease, in Charlottesville, Va. Diabetes-related kidney disease is a common complication associated with type 2 diabetes. Diagnosis typically requires surgical biopsy of the kidney, “therefore, seeking noninvasive biomarkers to aid diagnosis and management is urgently needed,” wrote researchers from Nanfang Hospital of Southern Medical University in China and University of Pittsburgh School of Medicine. The research team studied metabolites in the blood of three groups of adults with diabetes. One group had type 2 diabetes without kidney disease. One group had early-stage diabetes-related kidney disease. One group had advanced diabetes-related kidney disease. The three groups were compared with healthy adults without diabetes. Using a current database containing numerous known metabolites, the researchers identified only seven metabolites shared among all the groups. Although all the volunteers had the same differentially expressed metabolites, the metabolites varied according to whether or not they had diabetes or early- and late-stage kidney disease. “Surprising differences in small-molecule metabolites may reflect underlying [diabetes-related kidney disease] and serve as biomarkers for [its] occurrence and development,” the researchers wrote. These results may help “establish an early warning system for [type 2 diabetes] patients to monitor the onset of [diabetes-related kidney disease] in the clinic setting,” said Dong Zhou, MD, PhD, of the University of Pittsburgh School of Medicine and co-author of the study. Haiyan Fu, MD, PhD, of Nanfang Hospital of Southern Medical University in China, and Dong Zhou, MD, PhD, of the University of Pittsburgh School of Medicine, will present “Metabolomics reveals signature of diabetic kidney disease” in the session “Renal Consequences of Obesity, Metabolic Syndrome and Diabetes” on Monday, June 24, at the Boar’s Head Resort.  
In normal human liver cells (left), Plasmodium parasites (red) develop into a circular, exoerythrocytic form that gives rise to malaria. But in cells lacking CXCR4 (right), the parasite remains trapped in its rod-shaped sporozoite form. Newswise — Researchers in Japan have discovered that the Plasmodium parasites responsible for malaria rely on a human liver cell protein for their development into a form capable of infecting red blood cells and causing disease. The study, which will be published June 12 in the Journal of Experimental Medicine, suggests that targeting this human protein, known as CXCR4, could be a way to block the parasite’s life cycle and prevent the development of malaria. According to the World Health Organization, there were an estimated 219 million cases of malaria in 2017, resulting in the deaths of approximately 435,000 people. Infected mosquitoes transmit Plasmodium parasites to humans in the form of rod-shaped sporozoites that travel to the liver and invade liver cells (hepatocytes). Once inside these cells, the Plasmodium sporozoites develop into spherical exoerythrocytic forms (EEFs) that eventually give rise to thousands of merozoites capable of spreading into red blood cells and causing malaria. “It seems likely that the transformation of Plasmodium sporozoites into EEFs is tightly controlled so that it only occurs in hepatocytes and not at earlier stages of the parasite’s life cycle,” says Masahiro Yamamoto, a professor at the Research Institute for Microbial Diseases of Osaka University. “However, we know very little about the host factors that regulate the differentiation of sporozoites in infected hepatocytes.” In the new study, Yamamoto and colleagues discovered that a hepatocyte protein called CXCR4 helps Plasmodium sporozoites transform into EEFs. Depleting this protein from human liver cells reduced the ability of sporozoites to develop into EEFs. Moreover, mice pretreated with a drug that inhibits CXCR4 were resistant to malaria, showing reduced levels of parasites in the blood and significantly higher survival rates following Plasmodium infection. Yamamoto and colleagues also identified a cell signaling pathway that causes hepatocytes to produce more CXCR4 in response to Plasmodium infection and determined that the protein aids the parasite’s development by raising the levels of calcium inside the cells. “Our study reveals that CXCR4 blockade inhibits Plasmodium sporozoite transformation in hepatocytes,” Yamamoto says. “Most anti-malaria drugs targeting Plasmodium-derived molecules eventually lead to drug resistance in these parasites. However, inhibitors targeting human proteins such as CXCR4 might avoid this problem and could be used prophylactically to prevent the development of malaria. Moreover, the CXCR4 inhibitor used in this study is already widely used in humans undergoing treatment for blood cancers, which could accelerate its repurposing as a new way of combating malaria.” Bando et al. 2019. J. Exp. Med. http://jem.rupress.org/cgi/doi/10.1084/jem.20182227?PR
Newswise — Researchers at the Fralin Biomedical Research Institute at Virginia Tech Carilion have revealed how a genetic message to produce healthy heart tissue is altered in the body during stress and aging to contribute to sudden cardiac death. The discovery published in today’s (Tuesday, May 28) Cell Reports centers on communication between heart cells and allows for the potential of developing targeted therapies to help people at risk of arrhythmias and heart attacks. Led by senior author James Smyth, an assistant professor with the Fralin Biomedical Research Institute’s Center for Heart and Reparative Medicine Research, scientists focused on how generally overlooked, untranslated regions of RNA that flank the genetic code become shorter during aging or while under stressful conditions. The slight change influences how the cell reads a genetic message to make proteins and build important cellular structures including channels that electrically couple the cells of the heart together to allow for coordinated contractions and the resultant efficient pumping of blood. “Typical understanding of the biology used to be as straightforward as ‘here’s the message, make a protein,’” said Smyth, who is also an assistant professor in the Department of Biological Sciences of the College of Science. “We know it is not that simple anymore.  It's actually dynamically regulated. If the cell is stressed, that message will be read differently.” “Using traditional means of detecting levels of message or levels of RNA in cells during stress or aging, you wouldn't see the changes we saw,” Smyth said. “We focused on how this untranslated region could be changed during stress and how that could influence how the cell reads the message.” During stress, such as conditions of oxygen deprivation that occur during ischemic heart disease or stroke, the untranslated regions become shorter, which changes how the cell synthesizes the encoded protein products and limits intercellular communication in heart cells. Researchers focused on a gene called GJA1, which provides instructions to make Connexin 43, the gap junction protein. Gap junctions directly couple the contents of adjacent cells and are essential to normal heart function, where they enable the rapid and organized spread of electrical impulses between cells that cause contractions of the heart muscle. Malfunctions in this electrical communication can cause signals in the heart to become disorganized and lead to irregularities that can lead to sudden cardiac death. “The more we identify these molecular, very fundamental mechanisms, the sharper we're going to get in therapeutics,” Smyth said. “By manipulating this biology, we are figuring out the downstream factors acting on the DNA or RNA. Hopefully we have found a powerful angle to develop therapeutics, such as small molecules for precise, safer treatments.” Researchers studied cardiac cells, mouse cell lines, and aged mouse heart tissue where they found increases in the major GJA1-encoded protein — which should spell healthier conditions between heart cells — but they also observed increased, but truncated, untranslated regions of RNA that shut down synthesis of other GJA1-encoded proteins that modulate gap junction formation. Scientists also exposed cardiac cells derived from human-induced pluripotent stem cells to reduced oxygen, which also revealed an increase in truncated, untranslated regions, demonstrating that this is a common response of untranslated regions of RNA to physiological stress that is conserved across species. The response also takes place in a variety of cells. “This activity occurs in cancer, heart, and brain cells,” Smyth said. “When we saw that, we knew it was a powerful piece of biology, because it was happening everywhere.” The study is the latest resulting from more than four years of work by members of the Smyth lab and others at Fralin Biomedical, a university-level research institute of Virginia Tech. Michael Zeitz, a research scientist at Fralin Biomedical Research Institute, is the first author of the study, which also involved Stefanie Robel, an assistant professor at Fralin Biomedical Research Institute and the School of Neuroscience of the Virginia Tech College of Science; postdoctoral associate Thomas Taetzsch, and associate professor Gregorio Valdez of the Fralin Biomedical Research Institute and the Virginia Tech College of Science.  Fralin Biomedical Research Institute graduate students Patrick Calhoun of the Department of Biological Sciences; and Carissa James and Kijana George of the Translational Biology, Medicine and Health graduate program, were also members of the research team.  The work was supported by the National Institute of Health and the American Heart Association.
Newswise — People who drink alcohol while using medications that interact with it are higher risk of harm from overdose, falls, and traffic accidents. In recent years, there has been a documented increase in alcohol-related adverse drug reactions and acute emergency room admissions. One group of medicines, known as central nervous system (CNS) depressants, was implicated in over 40% of alcohol-related adverse drug reactions between 2005 and 2011. CNS depressants include the ‘sedative─hypnotic’  medications (anxiolytics and sleeping medications) as well as prescription opioids such as hydrocodone and oxycodone.  To further investigate the interplay of alcohol and prescription medications, researchers at Washington University have assessed the changing prevalence of CNS depressant use among regular drinkers. They analyzed data from over 37,000 adults who participated in the US National Health and Nutrition Examination survey (which is overseen by the Centers for Disease Control and Prevention) between 1999 and 2014. They found that among participants who reported drinking regularly (once a week or more), the proportion that used sedative─hypnotic medications doubled to 6% between 1999 and 2014 ─with the increase driven by a large rise in prescribed sleep medications. The prevalence of prescribed opioid use among regular drinkers remained relatively high at around 4%, despite the known risks. While regular drinkers were less likely than infrequent or non-drinkers to use anxiolytics or opioid medications, they were just as likely to use sleep medications. The research also showed that people aged 40 plus were up to five times as likely as those in their twenties to use sedative─hypnotic medications; rates of binge drinking are also known to have increased in the over 40 age group in recent years. The number of people at risk for adverse alcohol─drug reactions has therefore risen markedly. Exposure to sedative─hypnotic medications may still be increasing, whereas prescription opioid use is stable but alarmingly common among regular drinkers. The over forties in particular continue to face an unnecessarily high risk of alcohol-related adverse drug reactions and poor outcomes.