TIME medicine

How an Italian Boy Survived 42 Minutes Underwater

It’s unusual, but not impossible to survive that long while submerged

An Italian boy who fell into a canal in Milan is the latest “miracle” drowning survivor. The 14 year old was jumping off a bridge with friends into 6.5-foot water when he failed to come up. It took rescuers creating a human chain and 42 minutes before they could find him in the murky water and bring him back up; he had no pulse and was unconscious.

After a month in the hospital, where doctors attached him to a machine that took over for his lungs and heart to keep his body oxygenated, he woke, apparently alert and able to talk to his parents (and ask about his favorite professional soccer team).

But how did he survive underwater for nearly an hour?

MORE: How the Teen Stowaway Survived His Trans-Pacific Flight in a Wheel Well

Michael isn’t the first to recover from being underwater for so long; there’s a report of a person surviving after being submerged for an hour. Other young boys have recovered after going under in frigid lakes, ponds and oceans for anywhere from 15 to 45 minutes.

Experts say it’s no accident that most of the survivors are young; the automatic reflex to drop the heart rate and divert oxygen to the brain, especially in cold water, is more robust in younger children than in adults. Keeping the brain bathed in oxygen is critical; after about four minutes without oxygen, brain damage can occur.

And the colder the water, the more likely the brain is to be sustained in this way; frigid temperatures help the body divert its resources primarily to the brain. The canal into which Michael fell was about 59 degrees.

Doctors say there is no way to fully explain how the boy survived, much less how his brain remained relatively intact. But Michael’s case, and those of the other survivors, stress how important it is to administer emergency CPR as soon as possible after a drowning.

TIME medicine

Newer Birth Control Pills Raise the Risk of Blood Clots

A new study puts a number on the risk of developing potentially fatal blood clots after using the pill

Blood clots have been a known risk of oral contraceptives since the 1990s, but for most women, the chances seemed small enough to justify taking the Pill. Now, in a report published in The BMJ, scientists led by Yana Vinogradova, a research fellow at the University of Nottingham, found that using the Pill was linked to anywhere from a two- to more than four-fold increased risk of developing clots compared to women who didn’t take oral contraceptives.

“Our study suggests that the newer contraceptives have a higher risk of [blood clots] than the older agents,” Vinogradova tells TIME in an email. Overall, the risk for women on the Pill was nearly three times that of women not taking the medication. The risk was highest for people taking Pills that contain newer types of the progestogen hormone, such as drospirenone, desogestrel, gestodene, and cyproterone, as compared to people taking the Pill with first-generation versions of the hormone (levonorgestrel and norethisterone).

The difference essentially boils down to the progesterone part of the drug; since the original pill was introduced in 1960, drug developers have tweaked the progesterone to lower side effects such as acne, headache, weight gain and breakthrough bleeding. But the price for those modifications may be more blood clots.

Even after Vinogradova and her team adjusted for the potential contributions of things like cancer, heart disease, varicose veins, arthritis, smoking and obesity on the risk of blood clots, the link between the newer contraceptives and increased risk remained strong.

“While [blood clots] are a relatively rare problem, they are serious and potentially avoidable with the appropriate drug choice,” says Vinogradova. “Doctors need to consider all health issues when prescribing contraceptives, selecting a drug type associated with the lowest risk for patients with particular susceptibilities.”

Whether that means that doctors should start with prescribing the older formulations first—as well non-hormonal birth control like the copper IUD—isn’t clear yet, since the newer forms have certain advantages, including the fact that they disturb the cholesterol system less, which may be important for diabetic women.

The blood clot risk, however, is something that doctors should consider when prescribing the Pill. And since there are different formulations available, Vinogradova says doctors should monitor their patients for any potential symptoms of poor circulation and switch to other formulations if needed.

TIME Heart Disease

How Much Alcohol Is Too Much? A New Study Has Answers

Alcohol, at least in moderation, can help the heart, but too much can be toxic. The latest study tells you where to draw the line

For decades, there’s been a steady line of literature welcomed by anyone who enjoys a regular drink or two: that moderate drinking can actually protect you from having a heart attack by keeping your vessels clear and relatively plaque-free. But there’s another set of data that shows too much alcohol can start to poison the heart. So where does the line between good-for-you and bad-for-you lie?

Researchers led by Dr. Scott Solomon, professor of medicine at Harvard Medical School and director of non-invasive cardiology at Brigham and Women’s Hospital, and his colleagues provide some clues Tuesday in their latest report in the journal Circulation: Cardiovascular Imaging. The scientists combed through data collected from 4,466 elderly people about their alcohol consumption. They also agreed to echocardiograms of their hearts. Solomon wanted to see if there were any changes in the structure of the heart that had anything to do with how much the volunteers reported they drank each week.

MORE: Should Alcohol Be Forced to List Calories?

The not-so-good news: The more the participants drank, the more likely they showed abnormal changes in their heart structure and function. In men, the changes started accumulating after more than two drinks per day, or 14 or more drinks a week. In these men, the pumping chambers of their hearts increased slightly compared to those in non drinkers, a sign that the heart had to work harder to pump the same amount of blood, which can cause it enlarge and weaken. In women, these changes appeared when women drank much less, just above the one drink a day. In addition, among the women who imbibed more than a drink a day, the scientists found slight drops in heart function compared to women who drank less.

“A little bit of alcohol may be beneficial, but too much is clearly going to be toxic,” says Solomon. “Once you get beyond two drinks a day in men, you get into the realm where you start to see subtle evidence of cardiotoxic effects on the heart that might over the long term lead to problems. And that threshold might be lower in women.”

The study provides valuable information about how alcohol affects the heart, and how much alcohol exposure can trigger changes to the heart’s structure and more importantly, how it functions. But where the tipping point lies with each individual between the benefits and harms of a having a few drinks isn’t clear yet. More studies investigating which genetic factors may predispose people, and in particular women, to the toxic effects of alcohol will need to done before more refined advice about how much is too much can be discussed.

Those investigations might start with potential differences in the way men and women process alcohol. The effects Solomon and his team saw remained strong even after they adjusted for body mass index, and other studies have hinted, for example, that the different hormone environments in men and women might be responsible for the increased vulnerability of women’s heart tissues to the toxic effects of alcohol.

Future work may also delve deeper into the question of how long people drink; like any exposure, the effects of alcohol may also be cumulative. Because the participants in the study were relatively elderly, with an average age of 76, their heart changes reflected decades of exposure to alcohol but it’s not clear whether there is a threshold for when the harmful effects dominate over the potentially beneficial ones.

“What is clear is that at more than two drinks a day is the point at which we start to think we are beyond the safe level for men, and with women, it’s likely to be even lower than that,” says Solomon.

TIME Research

Why Moms Are Better at Baby Talk Than Dads

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Do dads baby talk to their little ones? Researchers recorded hours of audio of parents interacting with their toddlers to find out

Most mothers do it without thinking: cooing to their young children in a sing-songy, high pitched way that seems to help them connect better with their youngsters. But do fathers who spend time with their toddlers do the same?

MORE: Who’s Better at Baby Talk, Mom or Dad?

Mark VanDam, a professor in speech and hearing sciences at Washington State University, wanted to find out in his new study presented at the annual meeting of the Acoustical Society of America. While previous studies have looked at how moms and dads interact with their preschoolers, most of these have been in the rather artificial setting of a lab. So researchers led by VanDam strapped recording devices on both parents and their toddlers for an entire day in order to hear what parents were really saying to their children—and how they were saying it—in a more natural setting.

They found that mothers do indeed adopt “motherese” when addressing their preschoolers, but fathers did not—even those who spent more time with their children. In fact, the fathers talked to their young children in the same way they conversed with adults.

MORE: How to Improve a Baby’s Language Skills Before They Start to Talk

That may be because mothers vary their intonation more and tend to speak in a more infantile way in order to bond better with their toddlers, according to a theory proposed in the 1970s. Mothers are supposed to teach their children how to connect on a more intimate level, and speaking in a more melodic way introduces children to this way of communicating, the theory goes. Fathers, on the other hand, are the bridge for preschoolers to the outside world, and fathers’ more varied vocabulary and adult intonations help to familiarize them with this way of connecting with others. “The basic idea is that moms provide the link to the domestic, more intimate type of talk, while dads provide the link to the outside world,” says VanDam. “In that sense, moms and dads provide different kinds of experiences that give kids more comprehensive exposure to what kinds of language they need in the real world.”

In his present study, both parents lived full time with the child, and in some families, mothers worked outside of the home. VanDam is hoping to extend the study to look at single-parent families, as well as same-sex households, to see if the gender-specific ways of interacting with toddlers stay the same.

TIME Cancer

Why Women With Dense Breasts May Not Need More Screening

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The debate over how much screening women with dense breasts should get continues

For several years now, there been a growing push to advise women with dense breast tissue to get more than just an annual mammogram. And there’s good reason for it—studies show that dense breast tissue can mask small potential tumors on a mammography image, and dense breast tissue may also be a risk factor for breast cancer.

But the latest study shows that not all women with dense breasts may be at higher risk of cancer. In a report published in the Annals of Internal Medicine, Dr. Karla Kerlikowske, professor of medicine and epidemiology/biostatistics at the University of California San Francisco, and her colleagues provide much-awaited data on exactly what the risk of cancer is for these women.

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

The researchers studied 365,426 women 40 to 74 years old who had more than 831,000 mammograms total. They also had information on the number of breast cancer cases among the women within 12 months of their mammogram. When the team then applied different models for predicting which women would develop cancer—including just their dense breasts, or combinations of their dense breasts and evaluations of their five-year breast cancer risk with factors such as their age, race, family history of the disease, recent breast biopsy and breast density—they found that breast density alone was not a good indicator of cancer risk.

Dense breast tissue is determined by radiologists reading a mammogram and is relatively subjective. About half of the women in the study with dense breasts turned out to have low risk of developing cancer. And of those with higher risk, only 24% would have benefited from additional screening such as having an MRI or ultrasound. Overall, that means only 12% of the population of women getting screened by mammograms, including those with dense breast tissue, would need additional screening.

MORE: New Genetic Test for Breast Cancer Would Be Cheaper and Easier

That’s a dramatic difference from the current practice, in which almost all women with dense breasts are advised to consider supplemental screening. In fact, 22 states now mandate that doctors who receive a report that their patient’s breasts contain dense tissue must discuss potential additional screening with their patients. A federal law requiring the same discussion is currently under review. Not all insurers cover this extra screening, however, which raises questions about how cost effective and useful it might be.

The latest results hint that the practice may not be justified. About 42% to 45% of women who get screened will have dense breast tissue, and “you can’t do supplemental screening for 45% of the population,” says Kerlikowske. “It’s just not realistic, neither from a time or cost standpoint.”

MORE: Many Breast Cancer Patients Get Unnecessary Radiation

As the study shows, it’s possible to figure out which women with dense breasts are more likely to develop cancer by considering not just their breast density but other risk factors as well. “I think people right now are looking at the density report from the mammogram and not taking into account age and other factors,” says Kerlikowske. “But you can’t; you have to look at the risk factors together.”

If everyone with dense breasts received additional screening, 1,124 women would have to be screened to catch one potential case of cancer. By incorporating the other risk factors, that number drops to 694.

Now that Kerlikowske and her team have zeroed in on a way to identify the women with dense breasts at highest risk of developing cancer, they plan to look at whether MRI and ultrasound tests can help these women to avoid aggressive disease and live longer.

TIME medicine

How Human Bones Have Changed—For the Worse

A new study investigates why modern humans have lighter bones than our ancestors

We’re definitely heavier than we’ve ever been — about two-thirds of adults are now overweight or obese — but our bones aren’t as strong as those of our forebears. In fact, they’re not even as strong as the bones of our closest living relatives, the chimps.

What caused this thinning of modern man’s skeleton? We could blame our shift from hunter-gatherer lifestyles to a more sedentary way of life, and the ensuing change in our diet. Or we could place the blame on modernization, pointing the finger at buggies, cars, planes, trains and other technological advances for keeping us off our feet and less mobile.

MORE: Milk Might Not Save Your Bones, Study Says

A report in the Proceedings of the National Academy of Sciences may provide some answers. Researchers led by Christopher Ruff, professor in the center for functional anatomy and evolution at the Johns Hopkins University School of Medicine, and his colleagues decided to find out which force was responsible for driving the lightening of our bones. Using bone samples from 1,842 people collected from all over Europe from the Paleolithic period (11,000 to 33,000 years ago) to the 20th century, they found that the biggest shift in bone strength came with the move from a hunter-gatherer way of living to an agricultural one. The move to more settled and permanent living arrangements had a dramatic effect on changes in the human skeleton. Since that time, the bones of Homo sapiens have remained relatively similar.

Ruff’s team looked at the long bones in the legs and arms, and used arm strength as a control. Any changes in mobility would be more likely reflected in the leg bones, specifically in their front-to-back bending strength. These are the parts of the legs that would show the most adaptation to walking, running and any forces provided by movement. During the Mesolithic era, 10,000 years ago, homo sapiens gradually began settling in villages and adopting a more sedentary lifestyle, and leg bones reflect this change with a decline in strength. The side-to-side strength of the leg bones changed little in this time. Arm bones also didn’t change much in strength, suggesting that it wasn’t something like diet driving the decline, but the lack of mobility that was likely responsible for the lightening of the bones.

This drop in bone strength in the lower limbs remained constant throughout the Iron Age and the Roman era, he says, and into the 20th century. That implies that urbanization, and the domestication of horses for transport and the invention of the car had little effect on the bone strength of modern man — certainly not as much as the shift to an agricultural way of life. “It was really becoming settled and living in villages and towns and agriculture that really had the primary effect on bones,” says Cullum.

That doesn’t mean, however, that our bones can’t regain some semblance of their former robustness. Bone strength is dependent on use, and that’s evidence in tennis players and baseball pitchers, who show dramatically stronger bones in their swinging or pitching arms. “Bone still have the ability to respond to more force on them,” says Cullum. “It’s not like there has been some genetic change that we can’t do anything about that has lightened the bones.” But it does take consistent and weight-bearing exercise to spur bone strength — which might be worth the effort if it helps us avoid fractures and osteoporosis.

TIME Brain

Concussions Continue to Plague Retired NFL Players

A study shows that a concussion during their playing years may have lasting effects on NFL players’ memory years later

While there may be more questions than answers about how best to protect football players from the effects of concussions, there’s more data suggesting that the negative effects of head injuries can be long lasting.

In the latest report, one of the first to combine both anatomical screening of the brain with performance on standard memory and cognitive tests, researchers found that retired NFL players who suffered a concussion may continue to experience cognitive deficits many years later.

Munro Cullum, a professor of psychiatry and neurology at University of Texas Southwestern Medical Center, and his colleagues report in JAMA Neurology that having a concussion, and in particular losing consciousness after a concussion, can have long-lasting effects on the brain. The team studied 28 former NFL players, all of whom had a history of concussion, who were compared to 21 matched volunteers who did not have a history of concussion. Eight of the retired players were diagnosed with mild cognitive impairment (MCI), which meant they had some deficits in memory but weren’t prevented from living their daily lives by these changes, and they were compared to six participants with MCI who did not have a history of concussion.

MORE: How Concussions Can Lead to Poor Grades

Overall, the retired players performed worse on average on standard tests of memory than health controls, suggesting that their history of concussion affected their memory skills in some way. This was supported by imaging data of the hippocampus, the region in the brain responsible for coordinating memory. On average, the athletes showed smaller hippocampal volumes than the controls. (The scientists did not, however, collect data on the player’s hippocampal volume before the concussion, although the comparison to the non-athletes suggests that the concussions may have influenced shrinkage in this region.) The volumes of retired players who were knocked unconscious after a concussion were even smaller than those of healthy controls, and the same was true for the athletes with MCI when compared to non-athletes with MCI.

“We know that normal aging itself is associated with some declines in both hippocampal volume as well as memory function,” says Cullum, “but it seems that those declines are accentuated when there is a concussion, and when there is a concussion with loss of consciousness.”

MORE: Judge OKs 65-Year Deal Over NFL Concussions That Could Cost $1B

The findings don’t address another big question in the field, which is how best to treat people who have had a concussion. The data is conflicting on how much rest following a head injury is ideal; most experts recommend a day or two and then gradual return to normal activities, with a break if symptoms like headaches and dizziness return.

While Cullum says that most patients with concussions recover completely within weeks of the injury, football players may be at increased risk of longer lasting cognitive deficits because of their repeated exposure to the danger. And that risk increases if they lose consciousness following a concussion. Documenting concussions and any blacking out afterward is critical for helping future physicians to manage the care of someone with such head injuries, he says.

TIME Developmental Disorders

The Kids Most Likely to Have ADHD In the U.S.

The latest report on attention deficit hyperactivity disorder shows higher risk by gender, race and family income

Using data collected from parent reports of the developmental disorder attention deficit hyperactivity disorder (ADHD), the Centers for Disease Control and Prevention says that boys, white children and kids living in poverty have the highest rates of the condition in the U.S.

The information on ADHD, collected from a representative sample of U.S. families between 2011 and 2013 as part of the National Health Interview Survey, shows that 9.5% of children ages four to 17 were diagnosed with ADHD. The diagnosis was more common among older children than in younger ones.

Twice as many boys as girls were diagnosed, and more white children than any other race were told they had ADHD.

Family income also seemed to contribute in some way; children on public insurance had the highest rates of ADHD at 11.7%, compared to those with private insurance (8.6%) and children without insurance (5.7%). More children from families with incomes less than 200% of the federal poverty line were diagnosed with the condition than those from families living at about that threshold.

While the survey only showed a snapshot of the rates of ADHD broken down by gender, race and family income, the information could help public health officials better understand who is being diagnosed with the condition and potentially find better ways of providing support to those families, both in school and at home. “In view of the economic and social costs associated with ADHD and the potential benefits of treatment, the continue surveillance of diagnosed ADHD is warranted,” the report authors from the CDC’s National Center for Health Statistics write.

TIME Research

The New Science of How to Quit Smoking

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Two studies shed light on promising new ways to make kicking the habit easier, using both biology and behavior

Studies show that most smokers want to quit. So why are some people more successful at cutting out nicotine than others? The latest studies looking at the brains and behavior of smokers may provide some explanations.

Some people may be hardwired to have an easier time giving up their cigarettes, suggests one new trial described in the journal Neuropsychopharmacology. It turns out that some smokers start out with a particularly rich network of brain neurons in an area called the insula, which regulates cravings and urges and communicates cues: like seeing a cigarette or smelling tobacco smoke, then wanting to light up. Joseph McClernon, an associate professor of psychiatry and behavioral sciences at Duke University School of Medicine, ran MRI scans of 85 smokers who puffed more than 10 cigarettes a day. The smokers were then randomly assigned to continue smoking their brand or to smoke low-nicotine cigarettes, along with nicotine replacement therapy, for 30 days. All of the people in the study were then told to stop smoking and given nicotine replacement for 10 weeks.

MORE The Best Way to Quit Smoking Isn’t E-Cigs

Those who relapsed during that time tended to have lower activity in the insula, particularly in the connections between the insula and other motor areas that translate cravings into action, while those who successfully kicked the habit showed more robust activity in this brain region. The pattern remained strong despite how many cigarettes the smokers smoked.

“We’ve known for a while that some people seem to be able to quit and other people can’t,” says McClernon. “This gives us a better sense of what neural mechanisms might underlie those differences.”

The results suggest that it might be possible to identify people who may have a harder time quitting—a quick MRI scan of their brains would reveal how much activity they have in their insula—and provide them with more support in their attempts to quit. “Some smokers might benefit from more intensive, longer duration or even different types of interventions to stop smoking,” says McClernon. “They might need a higher, different level of care to help them make it through.”

But how much this system can be manipulated to help smokers quit isn’t clear yet. Previous studies show how potentially complicated the insula’s connections may be—smoking patients who have strokes and damage to the insula suddenly lose their desire to smoke and quit almost cold turkey. McClernon believes that the richer connections may not only promote interactions between cravings and behavior, but also enhance the connections that can inhibit or suppress those urges as well. Having a more intense communication in the insula may help strengthen the ability to quiet urges and inhibit the desire to smoke, despite cues and the urge to light up.

MORE Taking Medication May Make It Easier to Quit Smoking

But even if you’re not blessed with a brain that’s wired to make quitting easy, you still have options. In another study, published in the New England Journal of Medicine, scientists studied one of the oldest and most reliable ways to motivate people: money. In that trial, Dr. Scott Halpern from the University of Pennsylvania and his colleagues assigned 2,538 employees of CVS Caremark to one of five different smoking cessation programs. All received free access to nicotine replacement and behavioral therapy, and some were also assigned to an individual reward program in which they could earn up to $800 if they remained abstinent at six months. Another group was assigned another individual deposit program which was similar, except they had to pay $150 to participate, which they got back if they remained abstinent. Others were assigned to group versions of the reward and deposit programs so that what they received depended on how many in their group quit successfully.

Not shockingly, more people who were assigned to the reward program (90%) agreed to participate than people who were assigned to the deposit strategy (14%), likely because most people weren’t wiling to put their own money on the line. But when Halpern looked more closely at those who did enroll, the smokers in the deposit programs were twice as likely to be abstinent at six months than those in the reward group and five times as likely to be smoke-free than those who received only free counseling and nicotine replacement.

MORE Paying People Could Help Them Quit Smoking

That’s not entirely surprising, says Halpern, since having some of their own money at risk provided more motivation for the smokers to quit. When it comes to incentivizing smoking cessation, “adding a bit of stick is better than having just a pure carrot,” he says.

Finding the perfect balance of stick and carrot, however, may be more challenging. Halpern believes that from the perspective of an employer, insurer or government, offering even higher rewards than the $800 in the study and lowering the deposit slightly might still provide benefits to all parties. Smokers cost an average of $4,000 to $6,000 more each year in health services than non-smokers, he says, so offering even as much as $5,000 can still result in cost savings for employers, many of whom are now dangling financial incentives in front of their smoking employees to motivate them to quit.

How the financial carrot is proffered is also important, says Halpern. Now, most employers or insurers reward quitting in more hidden ways, with bonuses in direct deposit accounts or with lower premiums. While helpful, these aren’t as tangible to people, and humans respond better to instant gratification. “They’re rewarding people in ways that are essentially blind to the way human psychology works,” he says. “The fact that the benefits occur in the future make them a whole lot less influential than if people were handed money more quickly. Our work suggests that in addition to thinking about the size of the incentive, it’s fundamentally important to think about how to deliver that money.”

Another factor that can make financial incentives more powerful is to make the experience more enjoyable, either by introducing some competition in a group setting or encouraging smokers along the way. In the study, smokers in the group programs were not any more successful than those in the individual regimes, but that may be because the employees didn’t know each other. Grouping colleagues in the same office might have more of an effect, says Halpern. Either way, he says, incorporating such incentives to help more people quit smoking is “really a win-win.”

Read next: The Best Way to Quit Smoking Isn’t E-Cigs

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