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The Cancer Risk Hiding in Your Patient's Glass

The Cancer Risk Hiding in Your Patient's Glass

Medscape27-05-2025

Nathaniel Chin, MD
Associate Professor, Department of Medicine, Division of Geriatrics and Gerontology; Associate Program Director, UW Health Memory Clinic; Medical Director, Wisconsin Alzheimer's Disease Research Study; Medical Director, Wisconsin Registry for Alzheimer's Prevention Study; Medical Director, ADRC Consortium for Clarity in ADRD Research Through Imaging (CLARiTI), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Disclosure: Nathaniel Chin, MD, has disclosed the following relevant financial relationships:Serve(d) as a consultant or advisor for: New Amsterdam Pharma Inc (1-day advisory panel, July 2023); Eli Lilly Inc (2-day advisory panel, January 2025)
Serve(d) as a volunteer board member for: Medical and Scientific Board, Wisconsin Alzheimer's Association; Alzheimer's Foundation of America

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A systematic review of 14 studies found that most neurodevelopmental outcomes showed no association with antenatal corticosteroids. While modest decreases were noted in nonverbal intelligence and visual memory scores, studies with a strong design showed no link to adverse development. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 14 studies, comprising eight randomized controlled trial follow-up studies (n = 2233) and six quasi-experimental studies (n = 277,679). Analysis utilized random-effects meta-analyses to synthesize outcomes based on blinded adjudication of appropriateness for pooling by clinical experts in child neurodevelopment. Investigators evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology. A total of 23 neurodevelopmental outcomes were examined. TAKEAWAY: Most neurodevelopmental outcomes (19/23) showed no association with antenatal corticosteroid administration. Children exposed to antenatal corticosteroids showed modestly decreased nonverbal intelligence scores (standardized mean difference [SMD], -0.16; 95% CI, -0.32 to -0.01) and visual memory scores (SMD, -0.29; 95% CI, -0.51 to -0.07). Randomized trial follow-ups indicated a nonsignificant trend toward protective effects for general development, while quasi-experimental studies suggested increased risk. Studies with low or moderate risk for bias revealed no association between antenatal corticosteroid administration and adverse child neurodevelopment. IN PRACTICE: 'Among studies with low or moderate risk of bias, we found no association between antenatal corticosteroid administration and adverse child neurodevelopment. There is no consistent evidence that antenatal corticosteroids are associated with an increased risk of impaired childhood neurodevelopment among studies with a strong design to control for confounding,' wrote the authors of the study. SOURCE: The study was led by Jessica Liauw, MD, Department of Obstetrics and Gynaecology at University of British Columbia in Vancouver, Canada. It was published online in Obstetrics & Gynecology . LIMITATIONS: Most randomized controlled trial follow-up studies had significant losses to follow-up, with the two largest studies experiencing 66% and 40% attrition rates, leading to potential selection bias. Researchers noted that few studies specifically investigated the effects of antenatal corticosteroids administered in the late preterm period, limiting understanding of the timing-specific impacts. Additionally, the authors acknowledged that sibling-comparison studies did not adequately control for differences in pregnancy complications that determine why corticosteroids were administered in one pregnancy but not another. DISCLOSURES: The study was supported by a project grant from the Canadian Institutes of Health Research. Liauw received a Michael Smith BC Health Professional Investigator Award, and Jennifer Hutcheon, PhD, was supported by a Canada Research Chair in perinatal population health. The funders had no role in the research design or manuscript submission decisions. The authors reported no potential conflicts of interest.

Ultrahuman's absurdly expensive Home monitor doesn't do much
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Sometimes it can feel like whatever is stressing you out — that deadline, a big meeting, the news cycle — is showing up first thing in the morning. You may wake up with a pit already forming in your stomach and your anxiety high before you even get out of bed. 'It can feel like this fog of confusing and unpleasant emotion,' said Kate Wolitzky-Taylor, an associate professor of psychiatry at UCLA. Bushra, a 22-year-old student at University of Texas at Dallas, said every day she wakes up feeling anxious. 'It's a very physical sensation,' said Bushra, who asked her full name not be used to protect her medical privacy. 'My chest feels like a crushed can of coke.' Usually, Bushra said she's stressed about the day ahead or worried she didn't get enough sleep the night before 'Once I get out of bed and start my day, it tends to simmer down,' she said. 'It really is just this anticipatory anxiety.' We asked experts in clinical psychiatry, sleep and anxiety the reasons why some people wake up anxious and tense — and what someone can do to work past the early-morning wave of emotion. Morning anxiety isn't a technical term or a clinical diagnosis, said Wolitzky-Taylor. But she said many of her patients with generalized anxiety disorder say they wake up feeling anxious. However, not all of them — many say their anxiety is more likely to keep them up at night, she said. Anxiety can peak in the morning, but also in the midafternoon and evening, depending on the person, said Rebecca Cox, an assistant professor of psychological and brain sciences at Washington University. Cox has found one reason may be individual differences in circadian rhythms. People who are 'early birds' tend to feel the most anxious in the morning and less so later in the day, according to Cox's research Whereas, 'night owls' — people who naturally fall asleep later in the evening — tend to report more feelings of anxiety in the evening. It might seem logical to blame the rise and fall in anxiety on cortisol, the so-called 'stress hormone,' which tends to go up in the morning and declines throughout the day. But it's not that simple. Experts say the relationship between the hormone and the emotion is more complex. 'The research literature on cortisol is really quite mixed and messy. Some studies show a higher cortisol awakening response is associated with higher in-the-moment anxiety,' said Cox. 'But other studies don't show that effect.' People who are anxious can also have an increased cortisol waking response but cortisol doesn't cause morning anxiety, according to Douglas Mennin, a professor of clinical psychology at Teachers College Columbia University. 'It's not causal — it's an index,' he said. 'It shows an indication of something being dysregulated.' Anxiety can also turn into a habit that you may unconsciously foster over time, said Judson Brewer, a professor at Brown University's School of Public Health and the author of the book 'Unwinding Anxiety.' Brewer offers three steps to break the habit. 1. Recognize you're in an anxious loop. Then, think about what might be causing you to feel anxious. 2. Ask yourself: 'What am I getting from this?' This question helps people recognize the anxiety and realize worrying isn't rewarding or beneficial. 3. Approach your anxiety with curiosity. Instead of reacting to anxiety with alarm, reflect on how the emotion makes you feel. 'Don't underestimate the power of curiosity in helping to break free from that habit of morning anxiety,' Brewer said. 'That is a game changer.' Although it's often easier said than done, researchers say one of the most important ways to reduce morning anxiety is to get enough sleep the night before. 'Sleep is medicine,' Cox said. 'Of the things that we've talked about that are associated with morning anxiety, sleep is the factor people have the most control over.' If you do wake up with anxiety, get out of bed and occupy yourself with a task so you don't associate the bed (and the morning) with worrying, Cox said. What happens the night before and the day prior does matter, Mennin said. If you're up late working, or 'you're really fired up,' even if you have no trouble falling asleep, you'll likely be asleep for less time. Mennin said he works with patients to really change 'the nature of the night,' reducing the amount of screentime and light exposure, to ease into bed. 'Anxious people are very good at sensing when dawn is happening. They also have very good biological clocks,' Mennin said. 'So trying to reduce [light exposure] can create sleep.' Breathing exercises help, as well, he said. It can consist of counting your breaths or deep breathing. Imagine you're turning down a dial or pulling down a lever to relax the body. 'There is also progressive muscle relaxation work you can do to relax each of your muscles,' Mennin said. 'That can feel more grounding and take people out of their minds.' Anxiety is just another human emotion, Wolitzky-Taylor said. It's not harmful or dangerous to feel anxious, she said. But the emotion can become a problem when it becomes pervasive, out of proportion to the threat, and it impairs your day-to-day life. Around three percent of the U.S. population have generalized anxiety disorder, which is defined as having a difficult-to-control amount of daily worrying for at least six months, with three or more symptoms, like having a sense of impending doom, fatigue, irritability and trouble sleeping. People may overestimate the likelihood something bad is going to happen, which is known as catastrophizing. Just because you have morning anxiety for a period of time, doesn't mean you have an anxiety disorder. But if your anxiety starts to affect your day to day, or your quality of life, that's a sign you might want to seek help. 'There's nothing wrong with going just to talk to someone,' Mennin said. If you or someone you know needs help, visit or call or text the Suicide and Crisis Lifeline at 988 or go to

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