The Washington Post - USA (2022-02-22)

TUESDAY, FEBRUARY 22 , 2022. THE WASHINGTON POST EZ EE E3

HEALTH NEWS

BY BRITTANY SHAMMAS AND AMY CHENG

Coronavirus vaccinations giv-
en during pregnancy might pro-
vide protection to babies after
they are born, according to a
study released last week by the
Centers for Disease Control and
Prevention.
The study found that infants
whose mothers were fully vacci-
nated with mRNA shots while
pregnant were 61 percent less
likely to be hospitalized for the
virus in their first six months of
life. That protection appeared to
be stronger if the vaccination
occurred after the first 20 weeks
of pregnancy.
It’s the first real-world evi-
dence demonstrating that mater-
nal vaccination generates corona-
virus antibodies that could be
passed on and become protective
to the baby. This conclusion was
previously theorized by scientists
after antibodies were found in
umbilical cords, which act as a
conduit for nutrients and waste
between the mother and the baby.
“The bottom line is that mater-
nal vaccination is a really impor-
tant way to help protect these
young infants,” said Dana
Meaney-Delman, chief of the
CDC’s infant-outcome monitor-
ing, research and prevention
branch. The news “is highly wel-
come, particularly in the back-
drop of the recent increase in
hospitalizations among very
young children.”
The study included data on 379
infants at 20 pediatric hospitals
in 17 states between July and
January, including 176 who had
covid-19.
The CDC has for months rec-
ommended vaccination for those
who are pregnant, breastfeeding

or planning to become pregnant, noting that pregnancy increases the risk of severe problems from the virus. Studies have found a higher risk of hospitalization, in- tensive-care admission and death compared with the nonpregnant population. The risk of preterm birth and stillbirth is greater without coronavirus vaccination. Additional- ly, a study conducted by researchers in Scotland found that unvac- cinated mothers are more likely to see their newborns die less than a month after birth. Research into other diseases, such as whooping cough and the flu, has found that immunization in pregnancy can provide protection to infants in the first six months of life. Meaney-Delman said this period is especially cru- cial for infants because they could develop serious illnesses but are not eligible to be vaccinated. But despite repeated calls from health experts, pregnant people lag behind other demographic groups in getting vaccinated. Only a little more than 42 percent of pregnant people ages 18 to 49 were fully vaccinated as of Jan. 15, according to CDC data. Pregnancy and parenting apps and discussion forums have become a hot spot for vaccine misin- formation. Fearmongering and widespread falsehoods linking infertility and pregnancy compli- cations to coronavirus vaccines have deterred many from getting the shots. While further research on the best timing is needed, Meaney- Delman said that, given the risks covid-19 poses, “as soon as a pregnant woman is willing to be vaccinated, we recommend that she go ahead and do so.”

Vaccination during pregnancy may give infants

protection against coronavirus, CDC study says

HEALTH SCAN

BY ERIN BLAKEMORE

When it comes to hip fractures,
time is of the essence.
Delays in surgery are associat-
ed with the risk of death and
pressure sores, and patients with
broken hips should ideally get
surgery within 48 hours.
But radiologists are in short
supply, and the national shortage
is exacerbated by a spiking de-
mand for radiology services. And
rushed radiologists and human
error can lead to the improper
identification classification of hip
fractures.
AI could help, suggests a recent
study. When researchers pitted
machine learning against human
radiologists, the computer won,
classifying hip fractures 19 per-
cent more accurately than human
experts.
The study, published in Nature
Scientific Reports, was conduct-
ed in the United Kingdom. Like
the United States, it has an aging
population, and hip fractures rise
along with age. There are an
estimated 300,000 hip fractures
every year in the United States
alone, and that number is expect-
ed to rise to more than 500,000 by
2040.
Researchers had a minimum of
two clinicians classify over 3,600
hip radiographs. But they were no
match for a pair of computer
models trained to do the same
task. The algorithms located hip

joints with overwhelming accuracy, and showed what researchers call “an impressive, and potentially significant” ability to classify the fractures. The algorithms’ accuracy var- ied depending on the type of fracture, but overall their diagnoses were accurate 92 percent of the time compared with 77.5 percent of the time for the clinicians. The researchers say their new algorithm could clear up the U.K.’s huge radiology bottleneck. Like U.S. radiologists, those clinicians simply have more work than they can complete quickly. “This new technique we’ve shared has great potential,” said Richie Gill, a co-author of the paper who leads the Centre for Therapeutic Innovation and the Institute for Mathematical Inno- vation at the University of Bath, in a news release. The method could achieve greater access and speed diagnoses, he said. AI is increasingly used to beef up radiologists’ expertise. Ac- cording to a 2020 study conducted by the American College of Radiology, an estimated 30 percent of radiologists use AI tools on the job, and even more are contemplating the switch.

MEDICAL TECH

Artificial intelligence outdoes radiologists when

it comes to identifying broken hips, study says

Machine learning outperforms clinical experts in classification of hip fractures Nature Scientific Reports

BY SALLY WADYKA

It’s no surprise that many of us believe a bar of dark chocolate is essentially a health food. Head- lines have touted its nutritional benefits for years. But much of the scientific evidence to date has been contradictory. It’s true that potent antioxidants called flavanols are plenti- ful in the cacao beans used to make chocolate. And the darker the chocolate, the more cacao — and potentially the more flavanols — it contains. Like other antioxidants, flavanols have been shown to help blood vessels “relax,” reduce inflammation and lower cholesterol. “Giving people chocolate or cocoa flavanols is going to have an effect on blood-vessel function and can improve blood flow,” says Diane McKay, an assistant profes- sor at the Friedman School of Nutrition Science and Policy at Tufts University in Boston. It seems logical that better blood flow would be good for both your heart and your brain, but “we don’t yet know definitively that eating chocolate is going to help prevent heart disease or improve cognitive function,” she says. Research indicates that you may need high doses of cocoa flavanols to see an effect, which would probably require taking flavanols in pill or powder form, not as chocolate candy. For example, you’d probably need to eat 600 calories’ worth of dark chocolate to get the 500 mg a day of pure cocoa flavanols that researchers at Brigham and Wom- en’s Hospital in Boston are test- ing for their effect on heart attack and stroke risk. “If you want the health benefits of flavanols, there are other ways to get them,” says the study’s lead author, JoAnn Manson, chief of the hospital’s division of pre- ventive medicine. Some of these include green tea, berries, grapes, apples and other antioxidant- rich foods. If you’re going to eat chocolate, however, a bar with a higher cacao percentage is a better treat than a milk- or white-chocolate one. Milk chocolate not only has less cacao and fewer flavanols but also contains about twice as much sugar as dark chocolate. White chocolate has cocoa butter but no cacao solids, and as a result, it has no flavonols. Its sugar content is comparable to that of milk chocolate. Dark chocolate also contains a

surprising amount of nutrients, making it a healthier dessert option than cookies or cake, which are typically higher in sugar and made with refined flour. An ounce of dark chocolate can have 3 to 5 grams of fiber, about the same amount as a 6-ounce apple. It also supplies about 65 mg of magnesium (almost as much as a half-cup of cooked spinach) and 203 mg of potassi- um (the amount in a half-cup of cooked broccoli). Dark chocolate is higher in fat than milk chocolate, but much of it is a combina- tion of the heart-healthy mono- unsaturated kind and stearic acid, a type of saturated fat that doesn’t raise cholesterol. Still, many people enjoy their chocolate sweet and milky, and dismiss dark chocolate as bitter, grainy, dry and chalky. If that has been your experience, you might want to give it another try. “There are more high-quality bars available now made in small batches using beans that have been carefully harvested, roasted and processed to enhance flavor,” says Michael Laiskonis, chef and director of the Chocolate Lab at the Institute of Culinary Educa- tion in New York. The result? Bars that taste smooth, creamy, fruity and even surprisingly sweet.

Healthy ways to eat chocolate If you’re going to work dark chocolate into your diet, the fol- lowing strategies can help you get the most benefits — and enjoy- ment — out of it. Transition to dark. Milk chocolate can have as little as 10 percent cacao, and a high-quality bar has only about 27 percent. So milk-chocolate lovers may need

to ease into the dark side. Start with a bar that has about 60 percent cacao. It can also help to look for cocoa butter in the ingredients list. Cocoa beans are 50 percent fat, and many chocolate producers use extra cocoa butter to create a smoother, creamier texture, Laiskonis says. Another tip: Try a “single ori- gin” bar, which is made with cocoa beans from one country or region. Beans grown in Madagas- car, Belize and the Dominican Republic are most likely to have berry and dried-fruit notes, which can make the chocolate taste sweeter, says Megan Giller, author of “Bean-to-Bar Choco- late: America’s Craft Chocolate Revolution” and founder of Choc- olate Noise, a tasting company. Buy better bars. Buying high- quality chocolate is similar to buying fine wine or good coffee. The ingredients, where and how they’re grown and harvested, and how they’re processed and turned into a chocolate bar all play a huge role in the taste of the final product. “The skill and mas- tery of the chocolate maker can help transform even a 100 percent cacao bar into something rich and creamy that doesn’t taste like baker’s chocolate,” Giller says. Eat it mindfully. Tasting the subtlety of the flavors will allow you to get the most satisfaction out of even a small portion. “Put a small piece in your mouth, chew a couple of times, but mostly let it melt over your tongue,” Laiskonis says. Pair it. A dark bar that contains bits of dried fruit, nuts or sea salt can taste sweeter than a plain dark bar, even if both con- tain the same cacao percentage. But beware of other sweet add-

ins — such as caramel and marsh- mallow — that significantly increase the sugar content. You can also eat dark chocolate with some fresh berries or dried apricots (both of which pack additional flavanols), blending the bitter and sweet tastes in your mouth. Tea, even unsweetened, is another great dark-chocolate com- panion. Combining the two bal- ances out the slight bitterness of the chocolate.

Chocolate with a conscience Cocoa beans can be grown in ways that harm the environment, exploit workers or are otherwise unethical. Many terms on labels are used to indicate that a company doesn’t engage in those practices, but some labels carry more weight than others. Here’s what these terms promise — and what they don’t. Fair Trade: There are three main certified fair-trade seals on chocolate: Fair for Life, Fairtrade and Fair Trade Certified. These ensure that farmers are paid more than market price for cocoa and that no serious labor viola- tions occur on the farms, such as child labor or substandard wag- es. Rainforest Alliance: This seal indicates that some or all of the chocolate is sourced from farms that have met Rainforest Alliance standards for protecting farmers, forests, wildlife and local com- munities. Sustainable: This is a broad term intended to convey that the chocolate was produced using environmentally responsible practices. Because the term is vague and unregulated, it’s diffi- cult to know for certain whether it’s meaningful. Direct trade: This indicates that the cocoa farmer and the cocoa buyer work with each other directly (rather than through a third party) to set terms and conditions. While this in theory reduces the chances of exploita- tion, what those terms and conditions are can vary.

FROM CONSUMER REPORTS

The real deal on dark chocolate

ISTOCK Thanks to the nutrients that dark chocolate contains, it’s a healthier dessert option than cookies or cake

Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. CR has no financial relationship with advertisers in this publication. Read more at ConsumerReports.org.

27

percent greater risk

For older women, being lonely and
socially isolated can increase the
chance of developing heart disease by
as much as 27 percent, according to
research published in the journal JAMA
Network Open. The finding adds heart
disease to a list of potential health
effects of loneliness and isolation that
include dementia and mental health
issues such as anxiety and depression. Data from nearly 58,000
postmenopausal women who were tracked for more than a decade
showed that, independently, social isolation increased heart disease
by 8 percent and loneliness increased it by 5 percent, but the effect
was much stronger for those who reported high levels of both
feelings, giving them a 13 to 27 percent higher risk for cardiovascular
problems than women with low levels of both. Heart disease is the
leading cause of death for U.S. women, responsible for 1 in 5 deaths,
according to the Centers for Disease Control and Prevention. The
researchers said that one-fourth of adults 65 and older are socially
isolated (women more often than men) and one-third of those 45 and
older feel lonely. Although similar, loneliness and social isolation are
not the same. One of the researchers described social isolation as
“physically being away from people,” whereas loneliness is a feeling
“that can be experienced even by people who are regularly in contact
with others.” A socially isolated person is not always lonely, and a
lonely person may not be socially isolated.
— Linda Searing

THE BIG NUMBER

BY DAWN FALLIK

When Dani Donovan stepped into her doctor’s waiting room in Omaha, she was surprised and pleased to see a stack of cards with bold black letters stating: “Please Don’t Weigh Me Unless It’s (Really) Medically Necessary.” Underneath were smaller red letters saying, “If you really need my weight, please tell me why so I can give you my informed con- sent.” “I didn’t even know that saying ‘no’ to being weighed was a thing you could do,” said Donovan, 30, an attention-deficit/hyperactivi- ty disorder advocate who has a binge-eating disorder and often avoided doctor’s appointments because being weighed was so stressful. The card led to a good conversation with her doctor, Donovan said, that helped build trust and make her feel empowered. She posted a picture of the card on Twitter, explaining that “saying ‘no’ when you’re asked to step on the scale at the doctor’s office can feel so intimidating.” More than 26,000 people noticed her post, with comments ranging from supportive to flat-out cruel. The cards are a tool created by an eating disorder advocacy group that believes most health conditions can be addressed without weight numbers, and doctors’ constant focus on weight, no matter why the patient is there, is shameful, not helpful. Some doctors agreed, saying that they welcomed the chance to let the patient lead nutrition and weight discussions. Others em- phatically said it’s a necessary data point and needs to be taken every time, no matter what. There have been many studies showing that the medical world — and the world in general — has a bias against people who have obesity. One piece published in the British Medical Journal found that weight stigma actually led to increased mortality and other chronic diseases and “most ironi- cally, (weight stigma) actually be- gets heightened risk of obesity.” Umbereen S. Nehal, a former chief medical officer for Commu-

nity Healthcare Network in New York and a board-certified pedia- trician, strongly believes patients need to be weighed every time, regardless of when they were last weighed or why they are in the doctor’s office. She said there’s no question that studies have shown the prev- alence of weight stigma in the medical community, and she has a lot of sympathy and empathy for the intention behind the cards. But she would like to see data on how this particular intervention results in better outcomes before allowing patients to opt-out of the scale. “Is the hypothesis that some- body who is obese, let’s say, if we don’t weigh them, fatphobia will go away? Those visual cues will not go away,” said Nehal. “So my beef with this is that it disrupts processes in the system for effi- cient data collection and that data are used for a variety of things.” The cards were created in 2019 by Ginny Jones, 46, a Los Angeles- based eating disorder coach who works with the parents of children with eating disorders. A survivor of several eating disorders including anorexia and bulimia, the cards are a response to experiences she had at the doctor’s offices. She was praised when she lost weight, even when her chart clearly stated that she had an eating disorder, Jones said. She said the cards — which are for sale on her website — clearly say that if a weight is needed, to just tell the patient, and that patients recognize there are situations when the scale is necessary. “I wish I could say I was surprised by the ‘controversy’ around the cards,” Jones said. “I created them to address weight stigma, and it’s basically fatphobia to jump to conclusions and say blanketly that asking not to be weighed is unhealthy.” At Element Primary Care in Omaha, where Donovan found the cards, the medical partners decided to ask patients if they wanted to get weighed when the practice opened about 18 months

ago, said Ann Wieseler, a nurse practitioner trained in family practice. About half of patients decline, she said, but often weigh themselves at home and give their weight that way. Some open up later if they have concerns about nutrition or weight. There are some situations which require monitoring weight, such as checking for fluid retention with heart failure, or before surgery for anesthesia pur- poses, but they talk about those situations with the clients, and they can step on the scale back- ward. “It’s not like we’re never going to obtain their weight and get that measurement, it’s just on the patient’s terms,” Wieseler said. “The cards help patients feel safe and empowered with their health, and help them be an advocate for themselves.” She said these discussions about weight are particularly sen- sitive now, when many people have gained pounds while stuck at home during the pandemic. Often, there are other issues such as anxiety and depression that are underlying factors, something that needs a discussion, not a lecture. Fatima Cody Stanford, an in- ternist and a specialist in obesity medicine at Massachusetts Gen- eral Hospital who teaches at Har- vard Medical School, emphasized that weight is an important measurement. Many people don’t go to the doctor that often, she said, so when they do, getting on the scale is a way to see changes. Stanford also mentioned that,

in her experience, some patients don’t want to accept that weight can sometimes have consequenc- es on their health. For example, she said, someone might point out that they are concerned about diabetes because it runs in their family, but when the doctor asks if everyone in the family also has obesity, the patient doesn’t want to see the connection. She emphasized that the cards don’t change the explicit and implicit biases that physicians have toward people who have obesity, and they don’t address that medical schools do a poor job of teach- ing about weight. In one 2020 study, she found that there are “literally zero countries” who have stellar programs for medical schools or residents to address weight. Stanford said she herself was mocked by a former program director for going into “fat” medicine. All of these factors can make addressing weight a fraught situ- ation for the entire eating disorder spectrum, from people who have anorexia to people who have obesity. “What winds up happening is the biases that these physicians have, due to their lack of knowl- edge about this disease that we call obesity, yields very negative, explicit and implicit bias toward those that have obesity, right? So patients come in, I’m exaggerat- ing here, but say they have a hangnail, and it’s like: ‘Well, you know, if you got that weight under control ...’” said Stanford. “They may have excess weight that is contributing to other things, but the way it’s approached and the judgment that comes along with it, is why people are probably requesting these cards.” Stanford suggested a card that said “I’m happy to get weighed but please do not provide any negative or derogatory comments associated with my weight.” That way, the doctor gets their data point but also a pointed remind- er. “So then the doctor gets that card,” she said, “and they might think, ‘Oh, I need to really think about what I’m saying and be more mindful.’”

Some patients want option of not getting weighed

MORE-LOVE.ORG The cards are a tool created by a group that believes most health conditions can be addressed without weight numbers.

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