Author: MIL-OSI Publisher

Source: The Conversation – UK – By Johny Daniel, Associate Professor, School of Education, Durham University

Two children sit in different schools. Both struggle to read. Both have similar low scores on national tests. But while one gets a diagnosis of specific learning difficulties and a package of support, the other is left to fall behind.

My colleagues and I have carried out new research analysing the records of around 540,000 primary school children across England. It reveals a troubling picture. Whether a child gets identified with specific learning difficulties – an umbrella term for conditions involving difficulties with reading and mathematics – depends not just on how they perform academically, but on the school they go to, their gender, their family’s income, their first language, and even the average ability of their classmates.

Fewer than 2% of pupils in England are identified as having a specific learning difficulty. That figure sits well below international estimates suggesting that between 5% and 10% of children are affected. Some researchers put the true prevalence of reading difficulties as high as one in five. Clearly, in England, a large number of children are not getting the support they need.

Our study found that where a child goes to school plays a role in whether they get identified or not. We observed that children in high-achieving schools were actually more likely to be identified, even with the same test scores as peers elsewhere who weren’t identified. Findings suggest that when a child falls behind in a school where most pupils do well, they get noticed. In schools where low attainment is more common, the same child simply blends in. Same academic struggles, different school, different outcome.

Children being missed

One of the most striking findings concerns gender. After accounting for academic scores, boys were twice as likely as girls to be identified with specific learning difficulties. This isn’t simply because boys struggle more. It likely reflects how difficulties present differently by gender. Boys who struggle often act out while girls are more likely to struggle quietly with anxiety and inattention, which are far less visible in a classroom setting. Our findings suggest that a child who is silently struggling may go unnoticed and miss out on the support they need.

Children who speak a language other than English at home, around one in five pupils in England today, face the starkest disparity. Accounting for their actual test scores, these pupils were dramatically less likely to be identified with specific learning difficulties.

Read more:
Developmental language disorder can have life-long effects – and it’s easily missed in multilingual children

This is because assessment tools are largely designed for monolingual English speakers. When a child struggles to read, it can be easy for teachers to attribute the difficulty to language acquisition rather than a potential learning difficulty. But the two can coexist. Missing that distinction means missing a child.

Children from more deprived neighbourhoods were also less likely to be identified. In England, the most common route to a specific learning difficulty diagnosis such as dyslexia involves private assessment, a process that can cost hundreds of pounds. Affluent families can navigate and afford this – many others cannot.

What needs to change

England’s special educational needs and disabilities code of practice acknowledges specific learning difficulties, but offers no clear guidelines for how to identify pupils. The result is a system where practice varies enormously by school. That variability is not random. It follows fault lines of gender, language and poverty.

The most urgent priority is a national framework that sets out clearly what specific learning difficulties are and how schools should identify them. This was not addressed in the government’s recent policy paper on schools, which covered special educational needs provision. Alongside that, teachers need better training to recognise their own biases in referral. But training alone is not enough – identification should not be left to teacher judgement.

Standardised, objective reading and maths screening tools, applied consistently to all children, are the most reliable way to ensure every child who needs support is identified early, regardless of how they behave in class. Until then, which children get help will continue to depend far too much on luck.

Johny Daniel 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.

– ref. Why some children with learning difficulties get identified – and others don’t – https://theconversation.com/why-some-children-with-learning-difficulties-get-identified-and-others-dont-276433

Source: The Conversation – UK – By Michael Woods, Professor of Human Geography, Aberystwyth University

Future plans for renewable energy are emerging as a key issue in the election for Wales’s parliament, the Senedd, on May 7.

Proposals for new infrastructure, including windfarms and pylon lines, required to meet targets for low carbon energy are facing opposition in many parts of rural Wales, with campaigners suggesting that the issue will influence how some people vote in the election.

With a far greater divide among parties over green issues than in past elections, windfarms and pylons have shot up the political agenda.

The Labour-run Welsh government signed a new deal in March to speed up progress towards its target of 100% of Wales’s electricity consumption being met from renewable sources by 2035. Meeting this target requires a significant expansion of on- and off-shore windfarms, solar parks and tidal energy schemes, prompting an increase in proposals. New power lines are also needed to carry the electricity generated to consumers in cities, with current proposals for new transmission lines across Carmarthenshire and Powys, largely to be carried above ground by steel pylons.

The Conservatives made opposition to new pylon lines a focal point of their 2024 general election campaigns in Carmarthenshire and Powys, with former Welsh secretary Simon Hart featuring anti-pylon symbols on his signs in the Caerfyrddin constituency. This position is reiterated in the party’s 2026 Senedd manifesto, which calls for a “bury cables first” approach as well as a moratorium on industrial wind and solar energy developments.

Reform UK, currently running second in the polls in Wales, is also calling for new onshore wind to be banned and for solar farms to be banned on “productive arable land” and cables to be buried underground where possible.

Read more:
Have we passed ‘peak sheep’?

For right-wing parties, opposition to windfarms and pylons is consistent with their broader scepticism towards net zero. This issue is challenging for Plaid Cymru, currently leading in the polls and the Liberal Democrats, who generally back action on climate change, but see local opposition to pylons and windfarms in several of their traditionally stronger rural electoral areas in mid and west Wales.

Plaid Cymru has already announced that it would introduce a “strong presumption in favour of undergrounding” electricity cables.

Windfarms have operated in Wales since the 1990s. By 2024, 865 onshore wind power sites produced 3,152 gigawatt-hours of electricity. In 2024 renewable electricity generation was equivalent to 54% of Welsh electricity consumption.

Part of the conflict is because wind turbines are prohibited in Wales’s national parks, clustering projects in other parts of rural Wales.

Protesters cite a perceived over-concentration of wind turbines in areas such as Radnorshire.

Expanding capacity for renewable energy involves not only new windfarms (and solar farms and tidal power), but also new transmission lines to the carry the electricity produced in rural Wales to cities. Several lines are proposed, including the Tywi Teifi and Towy Usk networks in Carmarthenshire and south Powys, mostly carried by pylons up to 30 metres high.

As with windfarms, new pylon lines are controversial for their impact on the landscape and disruption during construction. Campaign groups such as community action body CaruTeifi and Re-THINK have plastered affected districts with signs opposing pylons, lobbied politicians, including a protest at the Senedd in February, calling for the transmission lines to be put underground.

Undergrounding power lines has also been backed by organisations including the Campaign to Protect Rural Wales and the Farmers’ Union of Wales increasing pressure on politicians.

What is not yet clear is whether voters will prioritise local concerns around windfarms and pylons or worries over climate change. A survey by the Countryside Alliance in 2025 suggested that 93% of respondents in Wales opposed pylon construction in their area. But a YouGov poll for Friends of the Earth in March found that 60% of Welsh voters were worried about climate change and 65% had a positive view of onshore wind.

Challenges for power line planning

Current Welsh government planning guidance states that “where possible” new power lines “should be laid underground”. However, it also allows that “that a balanced view must be taken against costs which could render otherwise acceptable projects unviable”. Plaid Cymru plans to remove this caveat. Reform UK pledges to maintain the current guidance.

In practice, not putting transmission lines underground has been justified on grounds of access, construction disruption, and above all cost. The Independent Advisory Group on Future Electricity Grid for Wales quotes evidence that the cost is 2.2 – 2.8 times greater for underground 132Kv cables installed by digging open trenches, but notes that differentials vary by voltage and technique.

Plaid Cymru has not been clear how the additional costs would be met. Increased project costs are typically passed on to billpayers, which can be a deterrent for companies to underground cables, especially as they have a legal obligation to deliver value for money to consumers. However, any effect on the price of electricity may become more acceptable if rising oil and gas prices lead to renewable sources being considered more cost effective by the public.

Impact on climate goals

There are concerns that increasing costs or cancelling or delaying projects will affect Wales’s ability to take necessary action on climate change. Labour has criticised Plaid Cymru for its policy changes and for rowing back on a pledge to make Wales’s carbon emissions net zero by 2035. Labour’s manifesto reaffirms its targets, outlines policies to make approval easier for renewable energy projects, and does not mention pylons.

The Green party also sees renewable energy as an issue that differentiates it from Plaid Cymru. The Welsh Green leader Anthony Slaughter told journalist Will Hayward that Plaid had “tied themselves in knots over the discussion about infrastructure. This is infrastructure that’s needed to deliver the renewable energy revolution that Wales needs, and that is a key area.”

The Greens’ manifesto states that: “Renewable energy must be developed responsibly. Infrastructure such as pylons and grid upgrades will be carefully planned to avoid damage to sensitive ecosystems and protected landscapes”.

The difference between the Greens and Plaid on this issue may become more significant if the two parties need to form a coalition after the election, as some commentators predict.

Michael Woods receives funding from UKRI. He is a member of the Liberal Democrats.

– ref. Why windfarms and electricity pylons have become a major issue in the Welsh election – https://theconversation.com/why-windfarms-and-electricity-pylons-have-become-a-major-issue-in-the-welsh-election-279789

Source: The Conversation – UK – By Adriana Allen, Professor of Development Planning and Urban Sustainability, UCL

Across Europe, housing is in crisis.

Limited social housing and a 93% rise in short-term rentals are driving prices up while wages stagnate, leaving millions unable to afford secure homes. Beyond the current geopolitical crisis, extreme temperatures continue to account for rising energy bills. As buildings account for 36% of EU CO₂ emissions, Europe needs to deliver more energy-efficient homes without deepening this social and environmental crisis.

In Spain, where social and affordable housing remains below 3%, the challenge is particularly acute. But across Catalonia in north-eastern Spain, an alternative housing system is emerging: one that recognises housing as a human right, a pillar of the welfare state and a path to addressing inequality and climate change.

Spain’s housing system has long relied heavily on home ownership. Its low stock of social housing leaves public authorities with limited power to intervene on price rises. When Spain’s property bubble burst in 2008, it exposed a housing system built on speculation rather than stability. More than 3.4 million homes were left empty and hundreds of thousands of families were evicted.

The echoes of the financial crash still reverberate today: declining access to homeownership has pushed more households into the rental market, increasing pressure on rents. The same forces have seen speculative investors and lucrative tourist rentals displacing long-term residents. By the 2010s, housing costs rose nearly 70%. In 2024, more than 27,564 households were evicted across Spain, with an estimated 700,000 people across Europe forced from their homes involuntary each year.

Meanwhile, 80% of tenants in Madrid and Barcelona report serious issues with the condition of their housing. This leaves a greater number more exposed to hotter summers, colder winters and rising energy bills, with the poorest most exposed to inadequate building conditions and rising energy costs. If the low-carbon transition does not address these social issues or exacerbates socio-economic inequalities, it will fail.

In part, a just transition involves decarbonising buildings and the urban environment while enhancing existing homes and infrastructure to strengthen communities rather than displacing them. Affordable energy retrofitting programmes can reduce CO₂ emissions, tackle energy poverty and address health inequalities.

Catalonia’s “just” response to its housing crisis involves collaboration. Public authorities, non-profit providers, businesses and cooperatives share responsibility for building and retrofitting homes that are affordable, low-carbon and socially impactful.

In Barcelona, Casa Bloc is an early 20th-century complex restored by the non-profit housing association Hàbitat3. The 17 flats combine sustainability features, like triple-glazed windows and a communal heat pump, with social support for vulnerable families.

In Sitges, a coastal town south-west of Barcelona, average rents are around €18 (£15) per square metre. One affordable eco-housing scheme has buildings with an AA energy rating with rentals of just €6 per square metre.

Adela Barquín, a rental building for over-65s, promotes physical and social wellbeing by incorporating active‑ageing principles. This includes low-maintenance, well-planned layouts that foster movement and social activity. The building also uses ultra-low-energy passive heating and cooling systems that keep indoor temperatures comfortable. This costs residents just €500 per month, less than half the going rate of Barcelona’s average rents of €1,193.

Over the past decade, partnerships have been formalised through networks like Cohabitac, a Catalan coalition of non-profit housing organisations managing around 5,000 affordable homes. Cohabitac is now a trusted partner to public authorities.

The success of initiatives like these relies on public policy that reduces risk, protects the social function of housing and encourages collaboration between public authorities, civil society, businesses and investors.

Municipal governments have played a central role. Barcelona City Council’s public-social partnership mobilises non-profit providers to develop and manage affordable housing on public land under long-term arrangements.
Similar approaches operate in cities such as Vienna or Lyon.

Meanwhile, investment from public, cooperative and mission-driven investors supports housing models that focus on long-term affordability and sustainability. Collective efforts that bring together residents, policymakers and non-profit organisations could be replicated in other housing systems too.

The bumpy road ahead

The Catalan model does face hurdles. Land values are high. Construction costs are rising. Many projects still depend on time-limited EU COVID recovery funds. Balancing ecological performance with affordability continues to be a delicate task.

But the direction of travel is clear. Catalonia’s housing system is being reimagined as social infrastructure for a low-carbon age. This is backed by public policy and long-term investment, including a €31 million Council of Europe Development Bank loan.

Energy retrofits completed since 2020 are saving 18,000 tonnes of CO₂. One Barcelona study found that every euro spent on retrofits saved €2.30 in health and energy subsidies. These initiatives are making housing a right for everyone, challenging the commodification of housing while contributing to decarbonisation, people’s wellbeing and social cohesion

More than 1.6 billion people worldwide lack access to adequate housing. That figure is expected to rise to 3 billion by 2030.

Catalonia’s ten-year shift from housing “market” to housing “system” demonstrates how embedding human rights in decarbonisation unlocks social-economic change. Improving housing equality is linked to building climate resilience. Emission-cutting insulation prevents weather-related illness. Retrofitting by socially inclusive coalitions reduces energy bills and creates jobs.

The Catalan model is small-scale yet distinctive. It cultivates public-private-social collaborations to reduce CO₂ emissions and challenges the view of homes as financial assets over places to live.

The authors partnered with the Institute for Human Rights and Business for this article as part of JUST Stories – a global project telling stories of promising just transitions.

Montserrat Pareja-Eastaway is currently the chair of the European Network for Housing Research.

– ref. Europe needs affordable, low-carbon homes – here’s how Barcelona is reimagining its housing system – https://theconversation.com/europe-needs-affordable-low-carbon-homes-heres-how-barcelona-is-reimagining-its-housing-system-269136

Source: The Conversation – UK – By Susie Kilshaw, Professor in Medical Anthropology, UCL

I heard about the new BBC drama Babies the week before it aired and was keen to watch it, not least because miscarriage is so rarely portrayed on screen – particularly as a central storyline. I enjoyed it, insofar as that word can be applied to such a devastating subject. The series offers a raw, nuanced and deeply realistic account of recurrent miscarriage and it gets a great deal right.

Lisa (Siobhán Cullen) and Stephen (Paapa Essiedu) are a young couple in their thirties navigating the heartbreak caused by repeated miscarriages. The pacing of the show – at times almost painfully slow – mirrors the real experience of conception, early pregnancy and reproductive loss.

It allows the viewer to sit with emotional complexity – the shifting feelings, the uncertainty and the drawn-out liminality of making a family. Time appears suspended for the couple, even as life continues around them. We see Lisa returning to work increasingly detached, exhausted and withdrawn, while other pregnancies progress, babies are born and the world moves on.

Stephen’s insistence that they “must think positive” is familiar – the partner adopting a supportive role while masking their own grief. When Lisa challenges his suggestion that others don’t realise she has “been through so much,” reminding him that it has happened to both of them, the moment is ambiguous. Is she inviting him to share in the grief, or expressing frustration that he is not experiencing the loss in the same way? These tensions echo accounts shared by women I have interviewed through my work on fertility, reproduction and pregnancy endings.

Throughout the series, Lisa and Stephen navigate layers of distress – at times drawing close, at others remaining emotionally distant. Their oscillation between hope and despair, and between the need to “keep moving” and the pull of grief, reflects patterns commonly found in miscarriage stories.

Visceral realities of baby loss

I was most interested in how the physical experience of miscarriage would be portrayed. Early in the first episode, I felt a familiar disappointment. The miscarriages occur off-screen, with the focus placed almost entirely on emotional aftermath, with little attention paid to the reality of pain and bleeding. However, this shifts with Lisa’s third miscarriage, which is one of the most accurate portrayals I have seen.

We see blood, albeit briefly and only a very small amount. Lisa’s pain is audible in her cries and moans. The movement through different spaces – her place of work before returning home, then their bedroom, the bathroom, the living room – marks escalating levels of distress, capturing the duration and inconsistency of miscarriage.

This is not a quick or contained event, but an unfolding process. Stephen’s growing panic as he seeks help, culminating in the arrival of paramedics (seemingly against Lisa’s wishes), underscores the seriousness of the situation, the lack of preparation and the couple’s helplessness.

The series also conveys the diversity of miscarriage experience and response. Lisa’s first loss is a “spontaneous” miscarriage at seven weeks; the second, a missed miscarriage managed surgically; the third unfolds “naturally” after the onset of pain and bleeding. Importantly, the viewer witnesses these experiences in ways that may feel recognisable to many – this is not “just a heavy period”.

That said, I would have welcomed more detail on miscarriage management. While we learn that Lisa undergoes an “ERPC” (evacuation for retained products of conception) for her second miscarriage, the absence of discussion around her options and decision-making represents a missed opportunity to depict clinical care more fully, and to foreground women’s agency.

The series doesn’t shy away from the visceral reality of loss. Lisa’s anguished description of “my baby dripping into the toilet”, is confronting but important. Miscarriage is often sanitised in public debate, and frequently unfolds in private domestic spaces. Babies portrays the reality of miscarriage, including toilets, where most miscarriages occur and are disposed of. The drama also gives a sense of the range of feelings that accompany miscarriage: hope, fear, anger, frustration, optimism, sadness and grief.

While Babies succeeds in many respects, the portrayal of clinicians is more problematic. The first doctor’s casual “Yup, yup, yup, all gone” during a scan devastates, with no sense that for Lisa what is “gone” is her longed-for baby.

During the second pregnancy the sonographer refers to their “baby” and suggests they look at the screen before becoming excruciatingly quiet. The abrupt shift from shared excitement to silence and blunt disclosure, and the GP’s depiction is emblematic of an unfeeling NHS system, all contributing to a narrative of insensitive care.

Some viewers may recognise these experiences. Over 15 years of research in Qatar and the UK, I have encountered accounts of poor and insensitive miscarriage care. However, more recent research suggests that particularly within the NHS, care has improved significantly, with women reporting compassionate and sensitive support. During 20 months of fieldwork in a large NHS foundation trust in England, I consistently observed responsive and empathetic clinical care.

This is not to suggest uniformity across and within settings, but rather to question whether Lisa’s experience reflects the norm in many NHS contexts today. As I have argued elsewhere, an understanding of miscarriage as bereavement increasingly underpins NHS care, reflecting a broader cultural shift that recognises miscarriage as a significant loss.

While Babies contributes to this important recognition, it also reinforces a dominant narrative in which miscarriage is always experienced as traumatic and devastating. While this will resonate with many – and such validation is important – it risks marginalising those whose experiences fall outside this, including some of the women I have interviewed in my work.

The involvement of consultants from Tommy’s Charity contributes to the series’ sensitivity and accuracy, underscoring the value of such collaborations. Cullen and Essiedu deliver compelling performances, conveying emotional complexity and intimacy with subtlety and depth.

Babies is slow, thoughtful and often heartbreaking. Despite some limitations, it is a welcome and important contribution – one that lays bare the realities of miscarriage with honesty and compassion.

Susie Kilshaw receives funding from the Wellcome Trust as part of a University Award in the Social and Historical
Science (Award number: 212731/Z/18/Z) and also holds a AHRC Curiosity Award (Award number: UKRI1126)
She has also received funding from ESRC Impact Acceleration grant (Award number: KEI2024-01-53 ESRC IAA KEIF).

– ref. Babies: raw, nuanced, real – what this BBC drama gets right about recurrent miscarriage – https://theconversation.com/babies-raw-nuanced-real-what-this-bbc-drama-gets-right-about-recurrent-miscarriage-280134

Source: The Conversation – UK – By Debra Ferreday, Senior Lecturer in Sociology, Lancaster University

The Testaments, now streaming on Disney+, has big shoes to fill. It arrives in a post-MeToo media landscape still shaped by the seismic impact of Margaret Atwood’s previous adaptation, The Handmaid’s Tale. Released in 2017, The Handmaid’s Tale quickly transcended its source material to become a feminist touchstone, inspiring a vivid visual and cultural language of resistance across politics, performance, music and the arts.

In Atwood’s world of Gilead, women are reduced to archetypes within a patriarchal rape culture: complicit, privileged wives; submissive house servants known as “Marthas”; or the Handmaids themselves, stripped to mere breeding stock for the regime.

As life in the US seemed eerily to catch up with Atwood’s vision, the hallmark red dress, white cap and down-turned gaze of the handmaids became iconic. For protesters, it provided a graphic symbol of the fate awaiting women in a world where the president has described himself as the “fertilisation president” “protecting” women whether they “like it or not”.

When Atwood returned to Gilead in 2019 with follow-up book The Testaments, she did so in the shadow of renewed assaults on women’s and LGBTQIA+ rights worldwide. The release of this adaptation of her sequel challenges viewers not only to face that reality, but to think about what popular culture can do in the face of cultural regression.

The Testaments also has to resolve the plot dilemmas established in The Handmaid’s Tale. Many fans had been disappointed that, after following along for six seasons, they did not get to see protagonist June (Elisabeth Moss) reunited with her daughter Hannah. Nor did we see an end to Gilead.

The Testaments returns to these themes while probing why Atwood’s world still grips us amid escalating crises. Can the series offer anything fresh, or has original show-runner Bruce Miller’s vision – mixing extreme violence with striking visuals – already run its course?

The aesthetics of Gilead

The Testaments looks strikingly different from its predecessor, although the two shows share a visual DNA.

Much like our own world, Gilead has become, in some ways, inured to tyranny. For the privileged at least, there is a sort of everyday acceptance recognisable from real-world examples of life under dictatorship.

Like the young audience it courts, Gilead’s young women – including protagonist Hannah, played with tensile calm by One Battle After Another’s Chase Infiniti – have grown up in a world where political violence and control of the reproductive body are explicitly intertwined. We pick up the story some years after the original show, although since girls in Gilead are not allowed calendars they don’t know exactly how long. We are told this in voice-over by Hannah, now renamed Agnes.

Another resonance with our own times is the importance of style as a means of both escape and control.

The costume and set designs of new Gilead resemble a contemporary AI-authored Pinterest board. For all its pretensions to timelessness, this world has fashion. The handmaids’ Puritan-plain red line dresses have been replaced by neat Kennedy-era ensembles in gentler tones of plum, pink and white.

The scarcity we saw in The Handmaid’s Tale has been superseded by a pastel-toned, cottagecore fantasy of colonial mansions and horses’ manes flowing in golden sunlight. Images of containment abound. Characters fill the frame or are seen through frames, gates, tantalisingly half-open windows and a dolls’ house which uncannily mirrors the home of commander Kyle, Agnes’ absent adopted father, in which she is held captive.

For all the old money theatrics, obsession with bodies is never far from the surface. “The Plums” are so called because they are ripe fruit, waiting to be plucked by much older, powerful men – a fate which becomes assured when a girl has her first period. Violence is never far away either. While the girls attend a sort of finishing school run by disappointed ideologue turned resistance figure Aunt Lydia (Anne Dowd, reprising her breakout villain role from The Handmaid’s Tale), the peacefulness of their education is disrupted by constant threats of corporal punishment.

Female friendship and hope

The Gilead of The Testaments is a fun-house mirror version of our own times. People are entertained by watching violence against groups treated as less than human – but instead of TikTok or constant news coverage, it’s public punishments like mutilations and executions.

“God’s justice is beautiful”, the girls are told, as they view a scaffold (a public hanging site) which they are told holds members of a supposed sex trafficking gang, though they are also told the victim was really to blame.

Obsessed with cleanliness, order, and control, this world is nastily prurient. It is fixated on spotting and rooting out impurity. It reminds us what is at stake when the state polices reproductive bodies.

Ultimately, though, it is the power of young women’s friendship and the inherent, ebullient anarchy of teen girls that holds the potential finally to bring down Gilead. This is what makes the show original.

Atwood has said she wrote The Testaments to offer hope. Hope, in 2026, seems like a dangerous thing: it can seem naïve given the demands of the current moment. But as the American writer and activist Rebecca Solnit puts it: “If the word hope doesn’t work for you, try ‘Never fucking surrender.’”

Aided by its talented young cast, The Testaments reworks Gilead into a space where resistance emerges spontaneously in a world structured to make it unthinkable. In this setting, girls’ friendships, their laughter and their power become seeds of rebellion. The result is a timely, absorbing reflection how we might at last burn the dolls’ house to the ground.

This article features references to books that have been included for editorial reasons, and may contain links to bookshop.org. If you click on one of the links and go on to buy something from bookshop.org The Conversation UK may earn a commission.

Debra Ferreday 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.

– ref. The Testaments: female friendship fuels resistance in this Handmaid’s Tale sequel – https://theconversation.com/the-testaments-female-friendship-fuels-resistance-in-this-handmaids-tale-sequel-280062

Source: The Conversation – UK – By Pia Lindberg, PhD Candidate, Department of Medicine, Karolinska Institutet

Most people who get COVID recover within a few weeks. But for some, symptoms persist for months – a condition now known as long COVID. While it’s often associated with fatigue, breathlessness and “brain fog”, growing evidence suggests it may also affect something less visible, but potentially more serious: the heart.

In our recent study, we found that people with long COVID had higher risk of developing cardiovascular disease – including cardiac arrhythmias, heart attack and heart failure. Importantly, the increased risks were seen in people who had never been hospitalised during their initial COVID infection.

Much of the early research on long COVID and heart health focused on patients who were hospitalised, particularly those treated in intensive care. These patients often had multiple risk factors for cardiovascular disease such as being overweight and having hypertension or diabetes. This made it difficult to separate the effects of severe acute illness from the long-term effects of the infection.

However, the majority of people who had COVID were never admitted to a hospital – yet many still developed chronic symptoms of so-called long COVID. To explore the potential risks in this much larger group, we focused specifically on patients who had experienced a mild-to-moderate COVID infection which they managed at home.

We used healthcare data from more than 1.2 million adults living in Stockholm, Sweden. Among them, 9,000 were diagnosed by a doctor with long COVID. We then followed up these patients over time and compared occurrence of new cardiovascular disease – including heart attack, heart failure, arrhythmias, stroke and peripheral arterial disease – with people who did not have long COVID and had no previous cardiovascular disease.

After a follow-up period of up to four years, cardiovascular disease was more common among people with long COVID.

Among women with long COVID, 18% experienced some form of cardiovascular event, compared with 8% of women without long COVID. Among men, the corresponding figures were 21% versus 11%.

These results did not substantially differ even when we adjusted analyses for age, socioeconomic status and underlying health status – including conditions such as high blood pressure, diabetes, high cholesterol, obesity, depression, smoking and alcohol consumption which are known risk factors of cardiovascular disease.

Women with long COVID had more than double the risk of developing cardiovascular disease overall compared with women without long COVID, while men had around a 30% higher risk.

The strongest associations were seen for irregular heart rhythm and coronary heart disease. In women, we also observed an increased risk of heart failure and peripheral arterial disease. However, we did not find an association between long COVID and stroke risk.

Why long COVID might affect the heart

It’s not fully understood why long COVID is associated with cardiovascular disease, but several biological mechanisms have been proposed.

The virus can affect the lining of blood vessels, leading to what is known as endothelial dysfunction. It may also trigger long-lasting inflammation and changes in the immune system. Together, these processes can affect how blood flows through the body and how the heart functions.

There’s also growing evidence that long COVID can disrupt the autonomic nervous system – the automatic mechanisms that control heart rate and blood pressure. This may potentially explain why irregular heart rhythms and conditions such as postural orthostatic tachycardia syndrome (Pots) are more common in long COVID patients.

Another possibility is that long COVID may not necessarily cause entirely new disease, but rather reveal underlying conditions that had not yet been diagnosed. In some cases, symptoms such as chest pain or palpitations may lead to further medical evaluation, increasing the likelihood that cardiovascular disease is detected.

Our findings suggest that long COVID is not simply a transient condition, even among people who were never severely ill during the acute infection. Instead, it may have longer-term implications for cardiovascular health.

At the same time, it’s important to put the results into context. The overall risk of cardiovascular disease remains relatively low at the population level. But the relative increase in risk is meaningful and comparable to that seen with established cardiovascular risk factors such as hypertension or diabetes.

The increased cardiovascular risk in long COVID has also important implications for healthcare. Patients with long COVID – particularly women and younger patients – may benefit from more structured follow-up, including assessment of cardiovascular symptoms and better management of cardiovascular risk factors

It also suggests that long COVID should be included in future strategies for cardiovascular risk assessment and prevention, not only in specialist care but also in primary care settings where most of these patients are managed.

More research is now needed to understand the long-term trajectory of these risks and whether they persist, decrease or increase over time. Future studies should also explore whether early identification and management of cardiovascular symptoms in long COVID could help reduce the risk of more serious complications later on.

As the number of people living with long COVID continues to grow, understanding its broader health consequences will be essential – not only for each patient, but for healthcare systems as a whole.

Artur Fedorowski received funding from the Swedish Heart Lung Foundation.

Axel Carl Carlsson and Pia Lindberg do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. Long COVID associated with higher risk of heart disease – https://theconversation.com/long-covid-associated-with-higher-risk-of-heart-disease-279883