Features

PARIS — Some of fashion’s biggest stars and celebrity fans paid a joyous tribute on Thursday to the late great Karl Lagerfeld in the vast Paris venue that witnessed his greatest triumphs.

US singer Pharrell Williams, actresses Helen Mirren and Tilda Swinton, artist Jeff Koons, designers Valentino and Stella McCartney, models Claudia Schiffer and Gigi Hadid as well as Carla Bruni and Monica Bellucci all paid him homage at the Grand Palais where Lagerfeld staged his spectacular Chanel shows.

It was quite a turnout for a man who declared that he’d “rather die” than have a big sendoff.

The show they called “Karl For Ever” had all the hallmarks of the big-budget productions that Lagerfeld loved to stage in the Belle Epoque Grand Palais — stars, breathtaking set pieces and style in spades. 

Vogue maven Anna Wintour began the tributes in front of the most powerful man in fashion, LVMH owner Bernard Arnault, who gave Lagerfeld a job for life at Italian label Fendi.

The reclusive Alain Wertheimer, who co-owns Chanel with his brother Gerard, signed a similar “till death do us part” contract with the German, and it made him one of the richest men in France.

He gave his first interview for the occasion, praising Lagerfeld’s legendary erudition. Filmed sitting in front of the Kaiser’s vast private library, he said, “It is not worth talking about the things that Karl Lagerfeld did not know.”

Chopin, tango and cats

A procession of the designer’s friends, including the lady who looked after his cat Choupette — now apparently the richest feline in the world — were shot against the same backdrop reminiscing about the sometimes waspish wit who died aged 85 in February.

Their testimony on a giant video screen was intercut with live readings, dance and musical performances from artists that Lagerfeld loved.

French first lady Brigitte Macron, who Lagerfeld adored for her culture and acute sense of style, was also among the guests, while the model and actress Cara Delevingne played his favourite creature, a cat.

Swinton recited a passage from Virginia Woolf’s “Orlando” and the Chinese pianist Lang Lang played Chopin on a Steinway Lagerfeld designed.

The creator had a particular weakness for tango, and the acclaimed Argentine troupe German Cornejo flew to Paris from Buenos Aires to perform what Lagerfeld call his “Latin rap”.

The American dancer Lil Buck gave the dying swan a street twist — combining high and street culture, something at which Lagerfeld was also expert — while Williams sang “Gust of Wind” backed by two dancers.

But the show, as Lagerfeld would have wanted, was more about laughs than tears, with Mirren reading some of his acidly funny “Karlisms” to the strains of Paganini played by British violinist Charlie Siem.

The French actress Fanny Ardant recited the Stephane Mallarme poem “The Fan”, a wink at the object Lagerfeld used as his conductor’s baton as well as to bat away smoke when he went to parties.

“I am very much down to earth. Just not this earth,” as the aristocratic dandy with the curious common touch once said.

WASHINGTON — Ever wondered how dogs learned to use their “puppy eyes” to bend us to their will?

It turns out our pet pooches have evolved human-like eyebrow muscles, which let them make the sad faces that melt our hearts, according to a new study published on Monday in the Proceedings of the National Academy of Sciences.

It involved dissecting the cadavers of domestic dogs and comparing them to those of wild wolves, our best friends’ ancestors, whom they branched off from around 33,000 years ago (do not worry, no animals were killed for the research).

A separate part of the study saw scientists videotaping two-minute interactions between dogs and a human stranger, then repeating the experiment with wolves, to closely track how much they used a specific muscle around the eye that produced an inner eyebrow raise.

The researchers found two muscles around the eye were routinely present and well formed in the domestic dogs, but not the wolves, and only dogs produced high-intensity eyebrow movements as they gazed at the human.

“It makes the eye look larger, which is similar to human infants,” Professor Anne Burrows of Duquesne University in Pittsburgh, who was one of the co-authors, told AFP. “It triggers a nurturing response in people.”

Since the muscles were robust in the dogs but not wolves, “that tells us that that muscle and its function are selected,” she added.

The current study was led by Juliane Kaminski at the University of Portsmouth and also included researchers from Howard University in Washington and North Carolina State University.

It builds on past work, including a notable 2015 paper by a group of researchers in Japan that demonstrated that gaze exchange between humans and their pet dogs led to a mutual spike in the so-called love hormone oxytocin, similar to an effect seen between human mothers and their babies.

But the latest work could explain how dogs are able to capture our attention in the first place.

The paper also posits two other explanations for what is going on — eyebrow movement may be significant for human-dog bonding “not just because it might elicit a caring response, but also because it might play a role during dog-human communicative interactions”.

Humans tend to pay attention to the upper facial areas of fellow humans during communication, and the dogs could be responding to this dynamic.

A final hypothesis is that exaggerated eyebrow movements expose the white sclera of the dogs’ eyes, which humans also have and find appealing in other animals (other primates have darkened sclera to camouflage their gaze).

Intriguingly, a Siberian Husky that was dissected did not possess one of the two muscles that were present in other dog breeds, which pulls the corner of the eyelid toward the ears.

That may be because Huskies are an ancient dog breed and the best living representative of what the link between dogs and wolves may have looked like.

“We’re also going to drill down into that interesting variation we saw in the Husky,” she said.

Mid-life women with weak upper and lower body fitness may be more prone to depression and anxiety, a study from Singapore suggests. 

In particular, poor handgrip strength and needing a long time to stand from a chair were associated with higher depression or anxiety symptoms, the study authors reported in the journal Menopause. 

“Mid-life women globally are in an incredibly difficult position: sandwiched between children, aging parents, husband and work commitments,” said senior study author Eu-Leong Yong of the National University of Singapore. 

“They sacrifice themselves in face of all these demands, and sometimes neglect their own needs,” he told Reuters Health by e-mail. “Anxiety and depression may go unrecognised.” 

Yong and colleagues studied more than 1,100 women, ages 45-69, who had routine gynaecology appointments at the National University Hospital in Singapore. During the appointments, the researchers measured upper body physical performance as reflected by handgrip strength, which requires the women to squeeze a hand-held dynamometer as hard as they could. The researchers measured lower body physical performance through gait speed, standing balance, and a repeated chair stand test, which records the time it takes to stand up from a seated position five times without using the arms. 

The research team used internationally-accepted questionnaires to assess whether and how often women experienced symptoms associated with anxiety and depression during the past week, including sadness, uncontrollable worrying, loss of interest, fatigue, sleep problems and poor appetite. 

Overall, 180 women, or about 16 per cent, had depressive or anxiety symptoms. Women ages 45 to 54 were more likely to report symptoms. 

Symptoms were not linked with menopause status, sociodemographic characteristics or lifestyle variables such as smoking or alcohol consumption. 

Physical characteristics and physical performance did make a difference, however. Women with depressive and anxiety symptoms were more often classified as having moderate-to-low physical performance. Weak handgrip strength was associated with a 68 per cent increased likelihood of having elevated symptoms. Taking longer on the sit-to-stand test was associated with 33 per cent increased odds of symptoms. 

“Our study shows an interesting correlation between the mind and body, indicating that physical strength is closely associated with mental health,” Yong said. 

Future studies should determine whether strengthening exercises that improve physical performance could help reduce depression and anxiety symptoms, he added. 

“While a causal association between depression and physical strength cannot be determined from this correlational study, there is strong evidence from clinical trials showing the benefits of exercise, particularly aerobic exercise, on mood in women,” said Pauline Maki of the University of Illinois at Chicago. Maki, who was not involved with this study, directs the Women’s Mental Health Research programme and has researched psychological well-being in mid-life women. 

Maki pointed out that rates of depression and anxiety tend to be lower in Singaporean women than in Western women. “Still,” she told Reuters Health by e-mail, “the study is an important reminder that in addition to hot flashes, mood symptoms during the menopausal transition are very common. Clinical guidelines recommend psychotherapies, anti-depressant treatment and physical exercise for mood symptoms.” 

Despite busy lives, mid-life women should prioritize muscle strengthening and resistance exercises, the study authors wrote. 

“Exercise is fun and cost free. It lightens your mood,” Yong said. “Make time for it, and make it part of the family routine.” 

Listening to music at home may reduce cancer patients’ pain and fatigue and ease symptoms like loss of appetite and difficulty concentrating, according to research in Taiwan.

In the study, breast cancer patients assigned to 30 minutes of music listening five times a week had “noticeably” reduced side effects of cancer and its treatment over 24 weeks, researchers report in the European Journal of Cancer Care.

The patients said the music helped their physical and psychological well-being because it distanced them from negative thoughts about cancer.

“Music therapy is convenient, does not involve invasive procedures and can easily be used by people in the comfort of their homes,” said senior study author Kuei-Ru Chou of Taipei Medical University. 

“Home-based music interventions can also be used with no cost,” Chou told Reuters Health by email. “Healthcare services have become expensive in the present time.”

The researchers recruited 60 breast cancer patients and randomly assigned half of them to a group that would listen to music at home on an MP3 player provided by the study team with a selection of classical, parlour, popular, Taiwanese and religious music to choose from. The other patients were also given a player and the same instructions about how often to listen, but their selections were various types of ambient music, mainly consisting of environmental sounds, which research has shown does little to reduce pain or symptoms, the study team notes.

Before the women had surgery, and after six, 12 and 24 weeks of music listening, all patients rated the severity of 25 physical symptoms on a five-point scale, as well as rating five categories of fatigue on a separate five-point scale, and the level of pain they felt on a 100-point scale. 

The average symptom severity scores of the music therapy group had dropped by five points at the six-week assessment, seven points at 12 weeks and nearly nine points after 24 weeks. Pain scores and overall fatigue scores fell at each assessment as well. 

For those listening to music, physical and mental fatigue had also dropped at six weeks but not later. 

In contrast, pain and symptom severity scores in the control group increased and remained higher than at the start of the trial. 

Based on the results, music therapy may not relieve long-term physical and mental fatigue, the study authors caution. And future studies should use objective measures of pain and fatigue, in addition to the subjective measures used in this study, Chou said. 

The researchers are also interested in learning how and why music therapy reduces symptoms and pain. Because listening to music promotes endorphins, dopamine and serotonin in the brain, the chemicals may spark joy and positive emotions that distract patients from the negative emotions, the study authors speculate. 

Music could affect functions of the cardiovascular, respiratory, muscular, skeletal, nervous and metabolic systems as well, relieving muscle tension and pain, they add. 

“From the neurophysiological point of view,” said Tereza Alcantara-Silva of the Federal University of Goias in Brazil, music-evoked emotions can modulate activity in a variety of brain areas. 

“Music plays a major role in self-regulation of emotional contexts,” said Alcantara-Silva, who was not involved in the study, by e-mail. “Music therapy can bring several benefits to cancer patients, helping them to find ways to deal with stress, fear and loneliness.” 

A smartphone-based relaxation app could help migraine sufferers reduce the number of headaches they get each month, a small study suggests. 

Using the app twice a week was associated with an average of four fewer headache days per month, according to the report in Nature Digital Medicine. 

“Migraine is now the second most disabling condition in terms of disability-adjusted years lost,” said lead author Dr Mia Minen of NYU Langone Health in New York City. 

Migraines affect about 1 in 6 adults in the US, with women most at risk. 

“Previous research has shown that the best treatment for preventing migraine is a combination of migraine medication and behavioral therapy,” Minen told Reuters Health by e-mail. However, “patients have significant difficulty accessing these safe, top evidence-based treatments”. 

Minen and colleagues created RELAXaHEAD, an app based on the technique of progressive muscle relaxation, a proven method of migraine prevention, the authors note. The study team analysed whether patients recruited from a neurology clinic would use the app regularly and whether they’d have fewer headache days. 

During the study, 51 patients in their 30s and 40s who typically had 13 or more headache days per month were asked to complete a daily headache diary and to do progressive muscle relaxation with the app for 20 minutes a day for 90 days. Nearly one-third of the participants were considered to have severe migraine disability when they enrolled, meaning they had missed considerable amounts of work, school and family activities due to the headaches. 

On average, participants used the app on 22 days per month, for about 11 minutes per day. Roughly half used it once per week and a third used it two or more times per week. Overall, those who used the app twice per week had four fewer headache days the following month, and those who used it once per week had two fewer headaches days. Use of the app tended to drop over time. 

Patients with higher depression scores were less likely to use the daily headache diary, and those with higher anxiety scores were more likely to use it. 

“The number of mobile health apps available in the iOS and Google Play stores has ballooned, and recent studies show that most people download an app but then rarely use it,” Minen said. “Importantly, we were able to get a considerable number of study participants to use the app.” 

The researchers have received inquiries about the app from patients with migraines outside the NYU Langone system, she noted. Although it was created as a research tool, Minen’s team is exploring ways to expand access to the app or include it in office visits. They’re also studying whether the app can help healthcare providers who do not know where to refer patients with migraines who want behavioural therapy. 

“I would encourage people who live with migraines to consider a behavioural treatment,” said Alice Pressman of Sutter Health in Walnut Creek, California, who wasn’t involved in the study. 

“The great thing about starting a [behavioural therapy] BT is that you don’t have to stop your other treatments if you feel they are effective,” Pressman said by email. “BTs can be used as add-ons with no added side effects.” 

However, an in-person a mindfulness-based stress reduction programme targeting migraines that was offered at her centre was difficult for some patients to attend due to time and location, Pressman said, so an online programme may help. At the same time, patients should know that apps are still new and not fully studied.

“Research here is important to enable therapeutically effective and safe smartphone apps. Lots of apps are offered that are not based on any scientific evidence,” said Thomas Dresler of the University of Tuebingen in Germany, who wasn’t involved in the study.

 “There are a lot of migraine apps out there, but customers need to know that the availability of an app per se does not guarantee effectiveness, safety or the developers’ adherence to specific quality standards,” Dresler said by e-mail.

Low, wide, highly stylised and built on a transverse front-drive based platform, the original Evoque proved equally controversial with Land Rover traditionalists and popular with a newer, younger and more fashion-conscious clientele when first launched in 2011. 

Influencing the design of almost every Land Rover since, the second generation arrived earlier this year and is instantly recognisable as an Evoque, yet blends seamlessly into the brand’s modern model line-up. The new Evoque also incorporates improved luxury, space, efficiency, and significant tech advances including standard mild hybrid technology for most models.

Keeping up appearances

Echoing the original’s design cues yet with more rounded surfacing replacing stark edges and angular lines, the new Evoque looks bulkier and more upright owing to its higher waistline and bonnet, but is only slightly bigger. Retaining its predecessor’s main design cues including a rakishly descending and floating effect coupe-like roofline, sense of width, and clamshell bonnet, the new model receives even slimmer front and rear lights. Offered only as a 5-door, with the 3-door coupe version ditched, it also gains a standard pop-out door handles and a more prominently ridged side character line.

Offered with three petrol and variations regionally, the Evoque can also be had in several specification levels including additional sporty R-Dynamic and Black Pack styling variations. Driven in four variations during its recent Middle East launch is at first glance seemingly most desirable in top spec First Edition guise with the most aggressive styling, biggest alloy wheels, most luxurious cabin and optional adaptive suspension. It was, however, the P300 S specification, mating the most powerful engine with the least adorned styling and most basic — albeit still very generously luxurious — equipment specification that proved best.

Seamless and smooth

Driven by the most powerful of Jaguar Land Rover’s turbocharged 2-litre 4-cylinder Ingenium engines, the Evoque P300 utilises a 48v mild hybrid electric vehicle (MHEV) system, which is subtle and seemingly seamless in its driving contribution during acceleration and in traffic. Recovering kinetic energy on deceleration and, the MHEV system allows the engine to switch off automatically at under 17km/h when coming to a stop. In combination with a smooth and responsive 9-speed automatic gearbox with a broad range of ratios, MHEV helps the hefty 1,850kg P300’s achieve moderate 8.1l/100km combined cycle fuel efficiency. 

Developing 296BHP at 5,500rpm and
295lb/ft torque throughout a broad and flexibly accessible 1,500-4,500rpm rev band the Evoque P300 drives with brisk and responsive versatility. Accelerating through 80-120km/h in 4.5-seconds, the P300 overtakes and climbs inclines with confident easy and an athletic pace. Capable of 242km/h, the P300 is also brisk on acceleration, with its four-wheel-drive sending power to the rear axles for additional traction when needed, while its MHEV driving contribution seems to compensate for turbo lag to make it more responsive as its races through 0-100km/h in 6.6-seconds.

Better basics

Driven in three versions in P300 guise, the Evoque proved refined and reassuringly stable at speed, tidy into and grippy through corners where it was amenable to cornering line corrections. Meanwhile its steering was quick and direct, and its MacPherson strut front and integral link rear suspension well balanced ride comfort and handling. However, it was the less aggressively decorated base S specification that proved the best drive. Slightly slimmer, taller and more forgiving the P300 S’ 235/60R18 tyres were more absorbent than the R-Dynamic’s firm 235/50R20s and the First Edition’s yet firmer 245/45R21 tyres.

Comfortably absorbing bumps, lumps and imperfections in a natural and fluent manner as paired with fixed rate dampers, the P300 S’s character was more consistent than the First Edition’s use of three-mode adaptive dampers to alternately provide both a softer and firmer ride. Settled and with good vertical and lateral control, the S version’s more restrained tyre size also provided better road feel, which made it seem more agile, nimble and connected through narrow winding roads. With minor steering feel improvement, one felt more confident placing, manoeuvring and hustling the S through such switchbacks.

Ability and equipment

Normally driving front wheels to reduce consumption but engaging all four wheels when necessary, the road-biased Evoque is, as Land Rovers are, nevertheless adept off-road, with generous off-road angles, 212mm clearance and 600mm water wading ability. Moreover, it features a sophisticated suite of off-road driving assistance systems including All-Terrain Progress Control and four-mode Terrain Response system that utilises and adapts different electronic driver aids, gearbox and throttle for different off-road situations. Numerous other features include blind spot monitoring, autonomous emergency braking, 360° reversing camera, high mounded rear camera projecting a clearer image in the rearview mirror and an optional low front camera for improved off-road visibility.

Classy, well-equipped and with comfortably supportive driving position and uncluttered design inside, the Evoque’s functions are concentrated in its infotainment screens, while materials are mostly high quality. Rear room is fairly sized but rear ingress could be slightly better for larger occupants, while boot capacity is generous. Offered with various trim levels and colours including sportier, darker and contrasting schemes for upscale versions, the base S version’s grey fabric upholstery, tactile and grippy steering material and light use of wood, however, made for a more fresh and airy ambiance.

TECHNICAL SPECIFICATIONS

Engine: 2-litre, turbocharged, transverse 4-cylinders

Bore x stroke: 83 x 92.3mm

Compression ratio: 9.5:1

Valve-train: 16-valve, DOHC, continuously variable valve timing, direct injection

Electric motor: Synchronous claw pole rotor

Battery: 46.2v lithium-ion 

Gearbox: 9-speed automatic, four-wheel-drive

Ratios: 1st 4.713; 2nd 2.842; 3rd 1.909; 4th 1.382; 5th 1.0; 6th 0.808; 7th 0.699; 8th 0.58; 9th 0.48

Reverse/final drive: 3.83/4.544

Power, BHP (PS) [kW]: 296 (300) [221] @5,500rpm

Specific power: 148.1BHP/litre

Power-to-weight ratio: 153.7BHP/tonne (kerb)

Torque, lb/ft (Nm): 295 (400) @1,500-4,500rpm

Specific torque: 200.2Nm/litre

Torque-to-weight ratio: 207.8Nm/tonne (kerb)

0-100km/h: 6.6-seconds

80-120km/h: 4.5-seconds

Top speed: 242km/h

Fuel economy, combined: 8.1-litres/100km

CO2 emissions, combined: 186g/km

Fuel capacity: 67-litres

Wheelbase: 2,681mm

Track, F/R: 1,625/1,631mm

Ground clearance: 212mm

Approach/break-over/departure angles: 25/20.7/30.6 degree

Ascent/descent gradient: 45 degree

Side slope gradient: 35 degree

Towing, braked/unbraked: 1,800/750kg

Aerodynamic drag co-efficiency: 0.33

Boot capacity, min/max: 591-/1,383-litres

Unladen/kerb weight: 1,850/1,925kg

Suspension, F/R: Double wishbones/integral multi-link, anti-roll bars

Steering: Electric-assisted rack & pinion

Turning circle: 11.6-metres

Lock-to-lock: 2.31-turns

Brake discs, F/R: 349mm/325mm

Tyres: 235/60R18

By Mariam Hakim

Relationships and Couples Therapist

Depression is an isolating experience that can leave both partners feeling lost and afraid as it can seem very hard to understand for a person who has not experienced it.

A person suffering through it may exhibit some or all of the following: 

• Feelings of sadness, hopelessness and fearfulness 

• Anxiety and agitation

• Changes in appetite and weight; weight gain or weight loss

• Loss of energy and constant fatigue; small everyday mundane tasks can seem difficult to accomplish

• Sleep disturbances; too much or too little sleep

• Feeling down, worthless or guilty

• Irritability and angry outbursts

• Social withdrawal and isolation

• Apathy and a lack of interest or pleasure in previously enjoyable activities

• Difficulty thinking, concentrating or making decisions

• Thoughts of death and or suicide

• Unexplained physical symptoms such as muscle pain, headaches or stomach pain

Even when depression is not severe, it can be quite overwhelming and debilitating for the person who is depressed. Here are tips on how to best help and support a partner:

Not attempting to coax or persuade a partner out of depression

Saying things like “just cheer up,” “life is good; you have nothing to be depressed about”, “be grateful for what you have” or “you’re not making enough of an effort” will only invalidate a partner’s illness and feelings. 

Depression is not about the person being negative or not counting their blessings; it is a complex illness caused by a combination of biological, genetic and environmental factors. Similarly, one would not tell a partner to just snap out of it if they were suffering from diabetes; one needs to learn more about depression.

Not taking a partner’s negativity personally

A partner with depression will often look, act and talk in negative ways. 

This should not be taken personally as being positive is not a choice; negativity is a symptom of illness and not something one can control.

Being there

A supportive partner often feels the need to know all the answers and find a solution, but just being present is enough to help a partner not feel alone. 

Cues should come from the depressed partner, but one can ask what and how to help. 

Being overprotective and worried are counterproductive; this will only make them feel worse because they are making one feel sad and anxious.

Encouraging and helping with treatment

People who suffer from depression do not always understand their symptoms nor recognise that they are going through depression. 

They often think this is something they just need to endure, but depression seldom becomes better on its own. 

A discussion about the symptoms and encouraging discussion about feelings is a good idea. 

You can also show an article that explains depression and the symptoms and treatment options. 

A psychotherapist can evaluate and diagnose depression, and advise if medication is needed.

Taking baby steps

Depression can be debilitating where every small task feels like a considerable effort. A loved one is not being difficult, stubborn or lazy; they should not be shamed or made to feel inadequate. 

One can encourage a depressed partner to set small goals and support themin their efforts towards achieving them. 

Showing understanding is better than showing disappointment when things do not go as planned because people with depression can easily feel guilty as they might believe that they are a burden on the people around them.

Taking care of one’s self

Supporting a partner through any kind of physical or mental illness can take a massive toll on physical and psychological well-being. 

One cannot pour from an empty cup so self-care must also be made a priority.

Reprinted with permission from Family Flavours magazine

Children who are exposed to tobacco smoke from their fathers while they are in the womb may be more likely than those who are not to develop asthma by age six, according to a study of chemical changes to DNA. 

While prenatal smoke exposure has long been linked to an increased risk of childhood asthma, the current study offers fresh evidence that it is not just a pregnant mother’s smoking that can cause harm. 

Researchers followed 756 babies for six years. Almost one in four were exposed to tobacco by fathers who smoked while the child was developing in the womb; only three mothers smoked. 

Overall, 31 per cent of kids with fathers who smoked during pregnancy developed asthma by age 6, compared with 23 per cent of kids without fathers who smoked, the study found. 

Asthma was also more common among kids whose fathers were heavier smokers, senior study author Dr Kuender Yang of the National Defence Medical Centre in Taipei said by e-mail. 

“Children with prenatal paternal tobacco smoke exposure corresponding to more than 20 cigarettes per day had a significantly higher risk of developing asthma than those with less than 20 cigarettes per day and those without prenatal paternal tobacco smoke exposure,” Yang said. 

About 35 per cent of the kids with fathers who were heavier smokers developed asthma, compared with 25 per cent of children with fathers who were lighter smokers and 23 per cent of kids with fathers who did not smoke at all during pregnancy. 

Smoking by fathers during pregnancy was also associated with changes in methylation — a chemical code along the DNA strand that influences gene activity — on portions of genes involved in immune system function and the development of asthma. 

Researchers extracted infants’ DNA from cord blood immediately after birth and examined methylation along the DNA strand. The more fathers smoked during pregnancy, the more methylation increased on stretches of three specific genes that play a role in immune function. 

Children who had the greatest methylation increases at birth, affecting all three of these genes, had up to almost twice the risk of having asthma by age six as other kids in the study. 

While smoking by fathers during pregnancy was linked to childhood asthma, it did not appear to impact children’s sensitivity to allergens or total levels of IgE, an antibody associated with asthma. 

This suggests that the risk of asthma from tobacco exposure is unlike allergic asthma, which is driven by allergies or allergic sensitisation via IgE antibody, said Dr Avni Joshi, a researcher at the Mayo Clinic Children’s Centre in Rochester, Minnesota, who was not involved in the study.

The study was not designed to prove whether or how prenatal smoking exposure might directly cause so-called epigenetic changes, or how those changes cause asthma in children.

It is not yet clear how the alterations seen along the DNA strand where methylation increased might cause asthma, the study team notes in Frontiers in Genetics.

Still, the message to parents should be clear, Joshi said by e-mail.

 “Smoking is bad at ANY point in time: before the baby is born and after the baby is born,” Joshi said. “Many parents defer quitting until the baby is born, but this study stresses that the prenatal exposure to tobacco creates changes to the unborn child’s immune system, hence it is best to quit as a family decides to have children, even before the conception happens.”

More than three-quarters of antibiotic prescriptions written by dentists before dental procedures are unnecessary and might do more harm than good, a new US study found. 

Dentists write one of every ten antibiotic prescriptions in the United States, and despite national declines, antibiotic prescribing by dentists has held steady over the years, researchers wrote. 

Dentists need to be included in the public health conversation regarding appropriate antibiotic use and antimicrobial resistance, lead author Katie Suda of the University of Illinois, Chicago, told Reuters Health by phone. 

Antibiotics before dental procedures are recommended for a small subset of patients with certain medical conditions, to prevent a serious heart infection that might arise from the release of oral bacteria into the bloodstream during the procedures. The infection, endocarditis, is an inflammation of the lining of the heart’s chambers and valves. 

To see if antibiotics are being prescribed for dental patients according to established guidelines, Suda and her team used an insurance database to analyse prescriptions written during 168,000 dental visits from 2011 to 2015. 

They found that 80.9 per cent of prescriptions for antibiotics to be taken before procedures were unnecessary. 

Among the 91,438 patients in the study, only 20.9 per cent had a cardiac condition that put them at the highest risk of developing endocarditis and warranted an antibiotic prescription. 

Patients with artificial joint implants had more than double the odds of receiving unnecessary antibiotic prescriptions compared with patients who did not have the implants. This is despite the fact that the American Academy of Orthopaedic Surgeons and the American Dental Association now say people with prosthetic joint devices do not need antibiotics before dental procedures. 

In particular, the antibiotic clindamycin was highly likely to be unnecessarily prescribed. Clindamycin has been linked with a severe form of diarrhea known as Clostridium difficile (C. diff). A single dose of clindamycin carries the same risk of C. diff infection as a prolonged course of the antibiotic, the researchers wrote, making it all the more alarming that clindamycin was among the overused antibiotics. 

Misuse and overuse of antibiotics encourages bacteria to evolve and find ways to resist the medicines. The World Health Organisation has called antibiotic resistance a global health emergency. 

Why is there so much over-prescribing by dentists? Experts say dentists may face pressure from patients or patients’ cardiologists and orthopaedic surgeons, who insist on antibiotics. 

“Dentists feel like they are in a really tough position,” said Dr Emily Spivak of the University of Utah School of Medicine, who wrote an editorial that was published with the study. 

“They’re not physicians and they feel like they have to give [antibiotics] because they will be held accountable from the surgeon or the cardiologist if the patient gets an infection,” she told Reuters Health. 

Other factors driving unnecessary prescribing may include dentists’ lack of awareness of the most recent guidelines, lack of agreement with these guidelines and the practice of “defensive medicine”, experts said. 

Spivak, however, believes the current study may over-inflate the numbers as it includes only commercially insured patients. 

The “worried well” or those who suffer from health anxiety may be driving some of this prescribing, she added. 

Experts say patients should feel empowered to ask questions when their dentists prescribe antibiotics, and they should not pressure dentists to provide them with the drugs. 

 “An informed patient who asks questions can allow for a discussion between the dentist and the patient to truly understand whether they need an antibiotic,” Dr Salim Virani of the Baylor College of Medicine, told Reuters Health by e-mail.