The $7 Billion Nicotine-Pouch Market's Next Target? Women
At Odenplan Square in central Stockholm, high school students move in packs, enjoying a day off and the early spring weather. Even though graduation is still weeks away, some seniors are already sporting their celebratory caps, per Swedish tradition. One of them is 19-year-old Olivia Persson, who, in addition to wearing the sailor-style hat, carries a bright tin of nicotine pouches. So do most of the other girls in her crew, each in turn showing off colorful containers with peach and apple-mint flavors tucked into pockets and purses.
'It's just fun,' Persson says of the Chiclet-size packets, or tobacco-free snus, that users tuck between their gums and lips for a quick hit of nicotine. 'You feel more alert, and everyone does it, so it's easy to think, 'How bad can it be?' '
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Medscape
a day ago
- Medscape
Hydroxychloroquine May Tame Preeclampsia in Lupus Patients
Use of hydroxychloroquine during pregnancy in patients with systemic lupus erythematosus (SLE) is associated with a reduced risk for preeclampsia, according to a recent nationwide cohort study. A population-based analysis from Sweden found that women with SLE taking hydroxychloroquine had about half the risk for preeclampsia compared with those not taking it, but there was no clear association between hydroxychloroquine use and preterm birth risk. 'These findings suggest possibly favorable, or at least not harmful, associations between hydroxychloroquine and preeclampsia and preterm delivery in pregnancies in women with SLE, supporting the current recommendations for hydroxychloroquine treatment during pregnancy in these patients,' wrote Ngoc V. Nguyen, MPH, a PhD candidate at the Karolinska Institutet in Stockholm, Sweden, and his colleagues in The Lancet Rheumatology . '[Hydroxychloroquine] may actually reduce the risk of preeclampsia,' Nguyen told Medscape Medical News . Joshua Copel, MD, a professor of obstetricis, gynecology, and reproductive sciences and of pediatrics at Yale School of Medicine, New Haven, Connecticut, told Medscape Medical News the findings show that 'hydroxychloroquine certainly doesn't seem to cause an increased risk for spontaneous preterm birth, and it probably reduces the risk for preeclampsia or at least delays the onset of preeclampsia.' The researchers used the Swedish Medical Birth Register to identify all 959 singleton pregnancies among 685 women with SLE in Sweden between January 2007 and December 2022. Using the Prescribed Drug Register, they determined which patients had received at least two dispensations between 3 months before pregnancy through the end of the first trimester. Among the 42% of pregnancies that were nulliparous, 43% were exposed to hydroxychloroquine and 57% were unexposed. Among the other 58% of pregnancies that were parous, 40% were exposed and 60% were unexposed. Patients had an average age of 32 years and an average first-trimester BMI ranging from 23.7 to 24.9 across the different groups. They had been diagnosed with lupus for 5.4-6.8 years, and rates of prior miscarriages ranged from 19% to 38% across the groups. Preeclampsia occurred in 11% of exposed and 13% of unexposed nulliparous pregnancies and in 5% of exposed and 6% of unexposed parous pregnancies. Preterm birth occurred in 19% of exposed and 15% of unexposed nulliparous pregnancies and in 12% of exposed and 12% of unexposed parous pregnancies. After adjustment for confounders, these numbers translated to an overall 49% reduced risk for preeclampsia in those exposed to hydroxychloroquine (95% CI, 0.31-0.79; P = .003). Stratified by parity, however, the 59% preeclampsia risk reduction in nulliparous pregnancies exceeded the threshold for statistical significance (95% CI, 0.33-1.08; P = .085). The 44% reduction in parous pregnancies was significant (95% CI, 0.22-0.89; P = .02). Questions Remain Though these findings 'add to a growing body of evidence suggesting hydroxychloroquine may help lower the risk of preeclampsia,' Nguyen told Medscape Medical News , 'it's worth noting that not all studies have shown statistically significant effects [potentially because of] how hydroxychloroquine use was defined, how well patients adhered to it, or whether key factors like BMI and smoking were accounted for.' Alfred Kim, MD, PhD, an associate professor of rheumatology at Washington University Medicine in St. Louis, told Medscape Medical News that hydroxychloroquine 'has a well-established antithrombotic property,' as seen with antiphospholipid syndrome, and 'preeclampsia is a prothrombotic condition due to substantial endothelial dysfunction, driving complement and coagulation cascade activation.' 'It is not completely clear how hydroxychloroquine attenuates thrombosis, though,' Kim said. 'There are nice data suggesting that hydroxychloroquine inhibits platelet activation and thrombus formation, both of which can promote a preeclamptic state.' Other possibilities, Nguyen added, include antioxidant activity, improved placental perfusion, and stabilization of endothelial function, any of which could also, in theory, reduce the risk for preterm birth in certain cases. However, this study found no association with preterm birth overall (risk ratio [RR], 0.95; 95% CI, 0.67-1.34; P = .76), in nulliparous births (RR, 1.1; P = .69), or in parous births (RR, 0.75; P = .28). Adherence Barriers Present Challenges Grégoire Martin de Frémont, Gaëlle Guettrot-Imbert, and Nathalie Costedoat-Chalumeau of Paris City University in Paris wrote in an accompanying editorial in The Lancet Rheumatology that 'by suggesting a beneficial effect on preeclampsia, the rigorous and valuable findings reported by the authors provide an additional rationale for the use of hydroxychloroquine in all pregnant women with SLE, as currently recommended.' They add, however, that 'obstacles to its optimal use persist, including drug unavailability, lack of prescription, and, in many cases, patients' reluctance to take it.' Kim agreed that many barriers remain to hydroxychloroquine adherence during pregnancy. 'Sometimes it's due to the patient not fulfilling the prescription, whether this is due to cost — which is typically not an issue with hydroxychloroquine — to inadequate comprehension due to low literacy, cognitive issues, language or visual barriers to a lack of trust in the medication or the medical team prescribing hydroxychloroquine,' Kim said. Nguyen agreed that the challenge of adherence is complex, with hurdles that include misinformation about safety, mixed messages from providers, and challenges such as age, disease severity, or pill burden. 'Our study might help chip away at some of these barriers by offering strong evidence for benefit, not just safety. If we can reframe hydroxychloroquine as something that's protective during pregnancy — not just 'safe enough' — that might help patients feel more comfortable and providers more proactive,' he said. The research was funded by the US National Institutes of Health and the Ingegerd Johansson Donation. The authors reported no disclosures. Costedoat-Chalumeau reported grants from UCB and Roche and honoraria from Bristol Myers Squibb. Copel serves on the advisory board for Janssen Pharmaceuticals, Nuvo, SimHawk, and Pulsenmore; receives royalties from Elsevier and UpToDate; and owns a company that manufactures prenatal vitamins. Kim receives royalties from Kypha Inc.; sponsored research agreements with AstraZeneca, Bristol Myers Squibb, CRISPR Therapeutics, and Novartis; and has done consulting or speaking for AbbVie, Amgen, Atara Biotherapeutics, Aurinia Pharmaceuticals, Cargo Tx, Exagen Diagnostics, GlaxoSmithKline, Genentech/Roche, Hinge Bio, Invivyd, Johnson & Johnson, UpToDate, and Zenas BioPharma.
Medscape
a day ago
- Medscape
Diminishing Returns With Broader Use of ADHD Meds?
It's well known that medications used to treat attention-deficit hyperactivity disorder (ADHD) do more than address the core symptoms of inattention, hyperactivity, and impulsivity. They have also been associated with significant reductions in the risk for serious real-world outcomes such as self-harm, unintentional injury, car crashes, and crime. However, a large-scale Swedish study has found that the magnitude of associations between ADHD medication use and these real-world outcomes appears to have weakened, in parallel with rising prescription rates. 'The declining strength of the associations of ADHD medication and real-world outcomes could be attributed to the expansion of prescriptions to a broader group of individuals having fewer symptoms or impairments,' first author Lin Li, PhD, Karolinska Institutet, Stockholm, Sweden, and colleagues wrote. The findings were published online on June 25 in JAMA Psychiatry. Waning Real-World Impact? The rate of ADHD medication use has risen substantially in many countries over the past two decades. With treatment now reaching a broader population of individuals who may have less severe symptoms, an emerging question is whether there remains a meaningful reduction in real-world harm. To investigate, Li and colleagues analyzed health data from Swedish national registers for 247,420 individuals aged 4-64 years who were prescribed ADHD medications between 2006 and 2020. They employed a self-controlled case series design, which allowed individuals to serve as their own controls. Outcomes included rates of self-harm, unintentional injury, traffic crashes, and crime measured during medicated vs nonmedicated periods. Over the 14-year study period, ADHD medication use rose sharply in Sweden — from 0.6% to 2.8% in children and from 0.1% to 1.3% in adults. ADHD medication use was consistently linked to reduced risks for self-harm (incidence rate ratio [IRR] range, 0.77-0.85), unintentional injury (IRR range, 0.87-0.93), traffic crashes (IRR range, 0.71-0.87) and crime (IRR range, 0.73-0.84) across all analyzed time periods, age groups, and sexes. However, the magnitude of risk reduction for these real-world outcomes diminished significantly over time ( P < .01) and was not fully explained by the age and sex distribution of people taking ADHD medication. The study team noted that the strongest associations between ADHD medication and reduced risk for real-world outcomes were consistently observed in women during the earliest study period (2006-2010), a time when only the most severe ADHD cases in women were being diagnosed and treated. Over time, as more women were prescribed ADHD medication, the sex differences on the various real-world outcomes narrowed, investigators said. In an accompanying editorial in JAMA Psychiatry , Ryan S. Sultan, MD, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York City, and colleagues said it's 'critically' important to remember that the purpose of ADHD treatment is not primarily to prevent arrests, car crashes, or self-harm crises but to improve patients' daily functioning and quality of life. 'The accumulation of evidence makes one thing clear: When used appropriately, ADHD medications can help affected people not just feel better but live safer, more productive lives. This message is important as many individuals with ADHD still do not receive medication as their first-line treatment, despite medications having the most robust evidence for ADHD,' the editorialists wrote.
Yahoo
2 days ago
- Yahoo
There is no loneliness epidemic – so why do we keep talking as if there is?
Most people experience periods of loneliness, isolation or solitude in their lives. But these are different things, and the proportion of people feeling lonely is stable over time. So why do we keep talking about an epidemic of loneliness? Before the COVID pandemic, several studies showed that rates of loneliness were stable in England, the US, Finland, Sweden and Germany, among other places, over recent decades. While COVID changed many things, loneliness levels quickly returned to pre-pandemic levels. In 2018, 34% of US adults aged 50 to 80 years reported a lack of companionship 'some of the time' or 'often'. That proportion rose to 42% during the pandemic but fell to 33% in 2024. That's a lot of lonely people, but it is not an epidemic. In some countries, such as Sweden, loneliness is in decline – at least among older adults. Despite these statistics, the idea that loneliness is increasing is pervasive. For example in 2023, the US surgeon general warned about an 'epidemic of loneliness and isolation'. The UK even has a government minister with an explicit responsibility for addressing loneliness. Loneliness is a problem, even if it is not an epidemic. Social connection is important for physical and mental health. Many people feel lonely in a crowd or feel crowded when alone. In 2023, the World Health Organization announced a 'Commission on Social Connection'. The WHO is right: we need to reduce loneliness in our families, communities and societies. But the idea that loneliness is an 'epidemic' is misleading and it draws us away from sustainable solutions, rather than towards them. It suggests that loneliness is a new problem (it is not), that it is increasing (it is not), that it is beyond our control (it is not), and that the only appropriate reaction is an emergency one (it is not). In the short term, loneliness is an undesirable psychological state. In the long term, it is a risk factor for chronic ill health. Loneliness is not a sudden crisis that needs a short-term fix. It is a long-term challenge that requires a sustained response. An emergency reaction is not appropriate – a measured response is. Initiatives by the US surgeon general and WHO are welcome, but they should be long-term responses to an enduring problem, not emergency reactions to an 'epidemic'. Conceptual clarity is essential if true loneliness is to be addressed. Pathologising all instances of being alone risks medicalising normal human experiences such as solitude. Some people feel alive only in crowds, but others were born lighthouse keepers. In a hyper-connected world, loneliness should be solvable, but solitude must be treasured. So, if there is no loneliness epidemic, why do we keep talking as if there is? Media framing of the issue and the human tendency to panic reinforce each other. We click into news stories based on subjective resonance rather than objective evidence. Human behaviour is shaped primarily by feelings, not facts. We dramatise, panic, and overstate negative trends. If trends are positive, we focus on minor counter-trends, ignore statistics and make things up. In the case of loneliness, the problem is real, even if the 'epidemic' is not. Loneliness is part of the human condition, but alleviating each other's loneliness is also part of who we are – or who we can become. Addressing loneliness is not about solving a short-term problem or halting an 'epidemic'. It means learning to live with each other in new, more integrated ways that meet our emotional needs. Loneliness is not the problem. It is a consequence of living in societies that are often disconnected and fragmented. The solution? We cannot change the essentials of human nature – and nor should we try. But we can be a little kinder to ourselves, speak to each other a little more, and cultivate compassion for ourselves and other people. We need to connect with each other better and more. We can. We should. We will. This article is republished from The Conversation under a Creative Commons license. Read the original article. Brendan Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
