New research covers social media and depression symptoms, pre-term children and school, monkeypox

With an abundance of medical journals and research studies that are relevant to DOs and the work they do, keeping abreast of the latest medical research can be challenging.

Because staying up to date with the latest medical research is an important part of a career in medicine, we have searched through the latest information to find four new studies that many DOs will find significant. See below for summaries and links to the original research.

“Association Between Social Media Use and Self-reported Symptoms of Depression in US Adults,” JAMA Network Open, Nov. 2021

Social media plays a huge part in many of our lives. However, this recent study published by JAMA suggests that social media use is associated with subsequent increases in depressive symptoms among adults.

To test this theory, this study surveyed 5,395 individuals across all ages, genders and races and ethnicities who reported minimal depressive symptoms upon initial survey. These participants also reported use of social media platforms such as Facebook, Instagram, LinkedIn, Pinterest, TikTok, Twitter, Snapchat and YouTube.

Participants were also asked to identify any sources of COVID-19-related news they consumed in the past 24 hours, such as cable TV, network TV or news websites. Furthermore, the participants were asked to report the number of social supports available “to talk to if you had a problem, felt sad or depressed” and face-to-face meetings with non-household members in the prior 24 hours.

In adjusted regression models, Snapchat, Facebook and TikTok use reported in the first survey were significantly associated with a greater risk of increase in self-reported depressive symptoms.

Incorporating television or internet news consumption, the number of social supports and the number of daily face-to-face interactions during the initial survey did not meaningfully impact these associations, with the notable exception of Snapchat.

Upon analysis of the survey data, this study found that some forms of social media use—in particular Snapchat, Facebook and YouTube—were associated with greater levels of self-reported depressive symptoms during subsequent surveys.

“School Readiness Among Children Born Preterm in Manitoba, Canada,” JAMA Network, Aug. 2022

This study aimed to answer the question “Does prematurity affect school readiness in a population-based cohort of children?” The researchers analyzed 63,277 children in the province of Manitoba, Canada, and involved two cohorts of children in kindergarten at the time of data collection.

The population-based cohort included children born between Jan. 1, 2000 and Dec. 31, 2011. These children had their school-readiness assessed in kindergarten using the Early Development Instrument (EDI) data. Furthermore, the sibling cohort was comprised of children born preterm and their closest-in-age siblings born full term. The data was analyzed between March 12 and Sept. 28, 2021.

Of the 63,277 eligible children, 4,352 were born preterm, while 58,925 children were born full-term. Overall, 35% of children born preterm were vulnerable in the EDI compared with 28% of children born full-term.

Compared with children born full-term, those born preterm had a higher percentage of vulnerability in each of the five EDI domains. In the population-based cohort, prematurity, male sex, small for gestational age and various maternal medical and sociodemographic factors were associated with EDI vulnerability.

However, in the sibling cohort, EDI outcomes were similar for both children born preterm and their siblings born full-term with the exception of communication skills, general knowledge domain and Multiple Challenge Index, and male sex and maternal age at delivery were associated with EDI vulnerability in this group.

The results of this study suggest that, in a population-based cohort, children born preterm had a lower school-readiness rate than children born full-term. However, this difference was not observed in the sibling cohort. Additionally, child and maternal factors were associated with lack of school readiness among the population-based cohort.

“About Monkeypox,” Centers for Disease Control and Prevention, July 2022

According to the recent information shared by the CDC, monkeypox is a rare disease that is caused by infection with the monkeypox virus, which is part of the same family of viruses as variola virus, the virus that causes smallpox.

Monkeypox symptoms are similar to smallpox symptoms but are milder; monkeypox is rarely fatal. Monkeypox was first discovered in 1958. The first human case of monkeypox was recorded in 1970; prior to the 2022 outbreak, monkeypox had been reported in people in several central and western African countries.

Individuals infected with monkeypox get a rash that may be located on or near the genitals or anus, and could be on other areas like the hands, feet, chest, face or mouth. The rash goes through several stages, including scabbing, before healing, and the rash can initially look like pimples or blisters and may be painful or itchy. Other symptoms of monkeypox can include:

• Fever
• Chills
• Swollen lymph nodes
• Exhaustion
• Muscle aches and backache
• Headache and respiratory symptoms (sore throat, nasal congestion, cough)

Some may experience flu-like symptoms before the rash, while others may get the rash first, followed by other symptoms; it is also possible to only experience a rash. Monkeypox symptoms usually start within three weeks of exposure to the virus.

If an infected individual experiences flu-like symptoms, they usually develop a rash one to four days later. Monkeypox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off and a fresh layer of skin has formed.

At this time, testing is only recommended if an individual has a rash consistent with monkeypox. During testing, the health care provider will use a swab to vigorously rub across lesions of the infected individual’s rash. They will take swabs from more than one lesion. Next, the specimens will be tested in a lab to see if the monkeypox virus is detected; results are typically available within a few days.

Monkeypox can spread to anyone through close, personal, often skin-to-skin contact. This includes direct contact with monkeypox rash, scabs or body fluids from a person with monkeypox; touching objects, fabrics (clothing, bedding, towels) and surfaces that have been used by someone with monkeypox; and contact with respirator secretions. Direct contact can happen during intimate contact, including:

• Oral, anal and vaginal sex or touching the genitals or anus of a person with monkeypox
• Hugging, massage or kissing
• Prolonged face-to-face contact
• Touching fabrics and objects during sex that were used by a person with monkeypox that have not been disinfected

Additionally, a pregnant person can spread the monkeypox virus to their fetus through the placenta. It also may be possible for people to get monkeypox from infected animals, either by being scratched/bitten by the animal or by preparing or eating meat or using products from an infected animal. Scientists are still researching additional ways the virus may be spread.

There are precautions that can help prevent the spread of monkeypox. Unfortunately, there are no treatments specifically for monkeypox infections; some individuals may be given an antiviral drug developed to fight smallpox. If an individual is experiencing symptoms of monkeypox, they should contact their health care provider immediately. Most people infected with monkeypox fully recover within two to four weeks without the need for medical treatment.

“COVID vs. Monkeypox: A Tale of Two Pandemics,” Medscape, Aug. 2022

This commentary explores the differences and similarities between COVID-19 and monkeypox. The COVID virus is a single-stranded RNA virus and is considered to be small, with just 30 kilobases of nucleic acid inside. The monkeypox virus is larger; a double-stranded DNA virus with nearly 200 kilobases of nuclear material.

RNA is much less stable than DNA. For example, monkeypox can live on surfaces for up to two weeks, which is much longer than COVID can, according to the CDC. Generally, DNA is subject to less mutations than RNA. The mutation rate of SARS-CoV-2 (the COVID virus) is significantly higher than that of monkeypox. However, some recent data suggests an uptick in the monkeypox mutation rate.

SARS-CoV-2 is essentially an airborne virus. In enclosed space, it can easily infect many people. Monkeypox, in part because of its larger size, is not transmitted as easily through this route; most of the current outbreak is due to skin-to-skin contact.

SARS-CoV-2 has what has been referred to as a “superpower,” in that it has the ability to transmit before symptoms occur. This is one major distinction between the current COVID pandemic and the SARS-1 outbreak of 2002. At this time, it is unclear whether monkeypox can spread before symptoms develop. It is clear, however, that it can spread before the rash develops.

SARS-CoV-2 is a highly contagious virus. Estimates of the basic reproduction number (R0) for monkeypox, prior to the current outbreak, tended to be lower than 1, sometimes as high as 1.2. The World Health Organization (WHO) places the R0 for the current monkeypox outbreak somewhere just lower than 2 among communities of men who have sex with men, and is probably lower in the general population, but it is too soon to tell.

Regardless, it seems that while the R0 is substantially lower than that of the SARS-CoV-2 virus, which has been estimated to be as high as 10-15, the monkeypox virus may still have a high enough R0 to sustain a pandemic.

With both viruses, those infected can experience fatigue and fever. However, COVID is more lethal, with an approximate 0.5% mortality rate. The current outbreak gives monkeypox a mortality rate of 0.02%.

Hospitalization rates for both monkeypox and SARS-CoV-2 infections are similar, at around 10%, but the reason for hospitalization differs: SARS-CoV-2 individuals often are hospitalized for respiratory issues like hypoxemia while monkeypox-related hospitalizations are related to the need for pain control.

Additionally, the CDC reports that children under the age of eight may be more at risk for severe outcomes from monkeypox infection, due to a less-developed immune system.

Both viruses have vaccines that can mitigate the worst outcomes. However, the best monkeypox vaccine, Jynneos, is in very short supply. Both viruses have effective pill-based regimens; however, the antiviral drug for monkeypox is actually a smallpox drug that has not been widely used on people with monkeypox.

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