Tag: Pandemic

Southern expansion of hemorrhagic fever virus in Sweden linked to bank voles

[ad_1]

Researchers have discovered that bank voles in Skåne, southern Sweden, carry a virus that can cause hemorrhagic fever in humans. This finding was made more than 500 km south of the previously known range. The virus strain discovered in Skåne appears to be more closely related to strains from Finland and Karelia than to the variants found in northern Sweden and Denmark. This is revealed in a new study from Uppsala University, conducted in collaboration with infectious diseases doctors in Kristianstad and published in the scientific journal Emerging Infectious Diseases.

We were surprised that such high proportion of the relatively few voles that we caught were actually carrying a hantavirus that makes people ill. And this was in an area more than 500 km south of the previously known range of the virus.”

Elin Economou Lundeberg, infectious diseases doctor at Kristianstad Central Hospital, one of the study’s first authors

Hantaviruses are a family of viruses naturally found mainly in rodents such as mice, rats and voles. Certain hantaviruses are able to infect people and cause two main groups of diseases: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Both types of disease are notifiable under the Communicable Diseases Act, as they can cause serious problems and even death. In northern and central Europe, a variant of the virus, Puumala hantavirus, causes a relatively mild form of HRFS popularly known as ‘vole fever’ (nephropathia epidemica). However, studies have shown that this hantavirus can also cause very severe HRFS, which in the worst case can be fatal. In Sweden 100-450 cases of vole fever require hospital care each year, exclusively in the northern part of the country.

In 2018, a locally contracted case of vole fever was reported in Skåne, more than 500 km south of the previously known southernmost incidence of the disease in Sweden, which was north of Uppsala. Another case was discovered in 2020, also in Skåne. In both cases, the patients concerned had not been away travelling and were infected in their home area. In an attempt to understand how this was possible, bank voles were caught in the vicinity of the patients’ homes and analysed for any occurrence of hantavirus. It turned out that 9 of the 74 bank voles caught carried hantavirus genes. Genetic studies have now shown that the virus differs markedly from the virus variants that circulate in northern Sweden and Denmark, and that it is most closely related to viruses from Finland and Karelia.

The next step in the research is to find out where the virus comes from and map its distribution in the southern parts of Sweden.

“If the virus has existed in the area for a long time and has simply not been discovered, why haven’t more people become ill? Or, has it become established in Skåne recently and only just begun to spread? And how did it get there?” wonders Professor Åke Lundkvist of Uppsala University, a co-author of the study. “Unfortunately the COVID-19 pandemic intervened, which considerably delayed the completion of this study. These findings are very interesting and show how important it is to investigate the causes as quickly as possible when we see an infectious disease in a new geographical area.”

The study was financed by the EU (Horizon 2020) and SciLifeLab (Pandemic Laboratory Preparedness), along with local R&D funding from Kristianstad Central Hospital.

Source:

Journal reference:

Ling, J., et al. (2024). Nephropathia Epidemica Caused by Puumala Virus in Bank Voles, Scania, Southern Sweden. Emerging Infectious Diseases. doi.org/10.3201/eid3004.231414.

[ad_2]

Source link

March 23, 2024

California’s expanded health coverage for immigrants collides with Medicaid reviews

[ad_1]

Medi-Cal health coverage kicked in for Antonio Abundis just when the custodian needed it most.

Shortly after Abundis transitioned from limited to full-scope coverage in 2022 under California’s expansion of Medi-Cal to older residents without legal immigration status, he was diagnosed with leukemia, a cancer affecting the blood cells. The soft-spoken father of three took the news in stride as his doctor said his blood test suggested his cancer wasn’t advanced. His next steps were to get more tests and formulate a treatment plan with a cancer team at Epic Care in Emeryville. But all of that was derailed when he showed up last July for bloodwork at La Clínica de La Raza in Oakland and was told he was no longer on Medi-Cal.

“They never sent me a letter or anything telling me that I was removed,” Abundis, now 63, said in Spanish about losing his insurance.

Abundis is among hundreds of thousands of Latinos who have been kicked off Medi-Cal, California’s Medicaid program for low-income people, as states resume annual eligibility checks that were paused at the height of the covid-19 pandemic. The redetermination process, as it is known, has disproportionately affected Latinos, who make up a majority of Medi-Cal beneficiaries. According to the California Department of Health Care Services, more than 653,000 of the more than 1.3 million residents who have been disenrolled over eight months identify as Latino. Some, including Abundis, had only recently gained coverage as the state expanded Medi-Cal to residents without legal residency.

The collision of state and federal policies has not only set off enrollee whiplash but swelled demand for enrollment assistance as people are dropped from Medi-Cal, often for procedural issues. Health groups serving Latino communities report being inundated by requests for help, but at the same time, a state-sponsored survey suggests Hispanic households are more likely than other ethnic or racial groups to lose coverage because they’re less knowledgeable of the renewal process. They may also struggle to advocate for themselves.

Some health advocates are pressing for a pause. They warn that disenrollments will not only undercut the state’s effort to reduce the number of uninsured but could exacerbate health disparities, particularly for an ethnic group that bore the brunt of the pandemic. One national study found that Latinos in the U.S. were three times as likely to contract covid and twice as likely to die of it than the general population, in part because they tend to live in more crowded or multigenerational households and work in front-line jobs.

“These difficulties place all of us as a community in this more fragile state where the safety net means even more now,” said Seciah Aquino, executive director of the Latino Coalition for a Healthy California, a health advocacy organization.

Assembly member Tasha Boerner, an Encinitas Democrat, has introduced a bill that would slow disenrollments by allowing people 19 and older to keep their coverage automatically for 12 months and extend flexible pandemic-era policies such as not requiring proof of income in certain cases for renewals. That would benefit Hispanics, who make up nearly 51% of the Medi-Cal population compared with 40% of the overall state population. The governor’s office said it does not comment on pending legislation.

Tony Cava, a spokesperson for the Department of Health Care Services, said in an email that the agency has taken steps to increase the number of people automatically reenrolled in Medi-Cal and does not consider a pause necessary. The disenrollment rate dropped 10% from November to December, Cava said.

Still, state officials acknowledge more could be done to help people complete their applications. “We’re still not reaching certain pockets,” said Yingjia Huang, assistant deputy director of health care benefits and eligibility at DHCS.

California was the first state to expand Medicaid eligibility to all qualified immigrants regardless of legal status, phasing it in over several years: children in 2016, young adults ages 19-26 in 2020, people 50 and older in 2022, and all remaining adults this year.

But California, like other states, resumed eligibility checks last April, and the process is expected to continue through May. The state is now seeing disenrollment rates return to pre-pandemic levels, or 19%-20% of the Medi-Cal population each year, according to DHCS.

Jane Garcia, CEO of La Clínica de La Raza, testified before the Alameda County Board of Supervisors’ health committee that disenrollments continue to pose a challenge just as her team tries to enroll newly eligible residents. “It’s a heck of a load on our staff,” she told supervisors in January.

Although many beneficiaries no longer qualify because their incomes rose, more have been dropped from the rolls for failing to respond to notices or return paperwork. Often, renewal packets were sent to old addresses. Many find out they’ve lost coverage only upon seeking medical care.

“They knew something was happening,” said Janet Anwar, eligibility manager at Tiburcio Vasquez Health Center in the East Bay. “They didn’t know exactly what it was, how it was gonna affect them until actually the day came and they were disenrolled. And they were getting checked in or scheduling an appointment, then, ‘Hey, you lost your coverage.’”

But reenrollment is a challenge. A state-sponsored survey published Feb. 12 by the California Health Care Foundation found 30% of Hispanic households tried but were unable to complete a renewal form, compared with 19% for white non-Hispanic households. And 43% of Hispanics reported they would like to restart Medi-Cal but did not know how, versus 32% of people in white non-Hispanic households.

The Abundis family is among those who don’t know where to get their questions answered. Though Abundis’ wife submitted the family’s Medi-Cal renewal paperwork in October, his wife and two children who still live with them were able to maintain coverage; Abundis was the only one dropped. He hasn’t received an explanation for being disenrolled nor been notified how to appeal or reapply. Now he worries he may not qualify on his own based on his roughly $36,000 annual income since the limit is $20,121 for an individual but $41,400 for a family of four.

It is likely an eligibility worker could check if he and his family qualify as a household or assist him with signing up for a private plan that can run less than $10 a month for premiums on Covered California. The health insurance exchange allows for special enrollment when people lose Medi-Cal or employer-based coverage. But Abundis assumes he won’t be able to afford premiums or copays, so he hasn’t applied.

Abundis, who first visited a doctor in May 2022 about unrelenting fatigue, constant pain in his back and knees, shortness of breath, and unexplained weight loss, worries he’s unable to afford medical care. La Clínica de La Raza, the community health clinic where he received blood testing, worked with him that day so he didn’t have to pay upfront, but he has since stopped seeking medical care.

More than a year after his diagnosis, Abundis still doesn’t know which stage cancer he has, or what his treatment plan should be. Though early cancer detection can lead to a higher chance of survival, some types of leukemia advance quickly. Without further testing, Abundis does not know his outlook.

“I’ve mentally prepared,” Abundis said of his cancer. “What happens, happens.”

Even those who seek help run into challenges. Marisol, a 53-year-old immigrant from Mexico who lives in Richmond, California, without legal permission, tried to reestablish coverage for months. Although the state saw a 26% drop in disenrollments from December to January, the share of Latinos disenrolled during that period remained nearly the same, suggesting they face more barriers to renewal.

Marisol, who requested her last name be withheld out of fear of deportation, also qualified for full-scope Medi-Cal during the state expansion to all immigrants 50 and older.

She received a packet in December letting her know that her household income exceeded Medi-Cal’s threshold — something she believed was an error. Marisol’s husband is out of work due to a back injury, she said, and her two children primarily support their family with part-time jobs at Ross Dress for Less.

That month, Marisol visited a Richmond branch office of the Contra Costa County Employment and Human Services Department, hoping to speak to an eligibility worker. Instead, she was told to leave her paperwork and to call a phone number to check her application status. Since then, she made numerous calls and spent hours on hold, but has not been able to speak with anyone.

County officials acknowledged longer wait times due to increased calls and said the average wait time is 30 minutes. “We understand community members’ frustration when they have difficulty getting through at times,” spokesperson Tish Gallegos wrote in an email. Gallegos noted the call center increases staffing during peak hours.

After El Tímpano reached out to the county for comment, Marisol said she was contacted by an eligibility worker, who explained that her family was dropped because their children had filed taxes separately, so the Medi-Cal system determined their eligibility individually rather than as one household. The county reinstated Marisol and her family on March 15.

Marisol said regaining Medi-Cal was a joyous but bittersweet ending to a months-long struggle, especially knowing that other people get dropped for procedural issues. “Sadly, there has to be pressure for them to fix something,” she said.

Jasmine Aguilera of El Tímpano is participating in the Journalism & Women Symposium’s Health Journalism Fellowship, supported by The Commonwealth Fund. Vanessa Flores, Katherine Nagasawa, and Hiram Alejandro Durán of El Tímpano contributed to this article.

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

[ad_2]

Source link

March 22, 2024

LungVax vaccine uses DNA technology to prevent lung cancer

[ad_1]

Developed by scientists from the University of Oxford, the Francis Crick Institute and University College London, the LungVax vaccine uses technology similar to the highly successful Oxford/AstraZeneca COVID-19 vaccine.

The team will receive funding for the study over the next 2 years to support lab research and initial manufacturing of 3,000 doses of the vaccine at the Oxford Clinical BioManufacturing Facility.

Lung cancer cells look different from normal cells due to having “red flag” proteins called neoantigens. Neoantigens appear on the surface of the cell because of cancer-causing mutations within the cell’s DNA.

The LungVax vaccine will carry a strand of DNA which trains the immune system to recognize these neoantigens on abnormal lung cells. The LungVax vaccine will then activate the immune system to kill these cells and stop lung cancer.

In this study, the scientists are developing this vaccine in the lab to show that it successfully triggers an immune response. If this work is successful, the vaccine will move straight into a clinical trial. If the subsequent early trial delivers promising results, the vaccine could then be scaled up to bigger trials for people at high risk of lung cancer. This could include people aged 55-74 who are current smokers, or have previously smoked, and currently qualify for targeted lung health checks in some parts of the UK.

There are around 48,500 cases of lung cancer every year in the UK. 72% of lung cancers are caused by smoking, which is the biggest preventable cause of cancer worldwide.

Kidani Professor of Immuno-oncology at the University of Oxford and research lead for the LungVax project, Professor Tim Elliott, said:

“Cancer is a disease of our own bodies and it’s hard for the immune system to distinguish between what’s normal and what’s cancer. Getting the immune system to recognize and attack cancer is one of the biggest challenges in cancer research today.

“This research could deliver an off-the-shelf vaccine based on Oxford’s vaccine technology, which proved itself in the COVID-19 pandemic. If we can replicate the kind of success seen in trials during the pandemic, we could save the lives of tens of thousands of people every year in the UK alone.”

When given to people with cancer at its earliest stages, anti-cancer treatments are more likely to be successful.

We are developing a vaccine to stop the formation of lung cancer in people at high risk. This is an important step forward in preventing this devastating disease.”

Professor Sarah Blagden, Professor of Experimental Oncology at the University of Oxford and founder of the LungVax project

Professor Mariam Jamal-Hanjani of University College London and the Francis Crick Institute, who will be leading the LungVax clinical trial, said:

“Fewer than 10% of people with lung cancer survive their disease for 10 years or more. That must change. This research complements existing efforts through lung health checks to detect lung cancer earlier in people who are at greatest risk.

“We think the vaccine could cover around 90% of all lung cancers, based on our computer models and previous research, and this funding will allow us to take the vital first steps towards trials in patients.

“LungVax will not replace stopping smoking as the best way to reduce your risk of lung cancer. But it could offer a viable route to preventing some of the earliest stage cancers from emerging in the first place.”

Chief Executive of Cancer Research UK, Michelle Mitchell, said:

“The science that successfully steered the world out of the pandemic could soon be guiding us toward a future where people can live longer, better lives free from the fear of cancer.

“Projects like LungVax are a really important step forward into an exciting future, where cancer is much more preventable. We’re in a golden age of research and this is one of many projects which we hope will transform lung cancer survival.”

President of CRIS Cancer Foundation, Lola Manterola, said:

“We are at a crucial moment in the history of cancer research and treatment. For the first time, technology and knowledge of the immune system are allowing us to take the first steps towards preventing cancer.

“This groundbreaking study represents a firm step in that direction, and we at CRIS consider it essential to support it.”

[ad_2]

Source link

March 22, 2024
Study sheds new light on the link between women’s menstrual cycles, emotions, and sleep patterns
[ad_1]
Women experience disruptions in their sleep patterns and report heightened feelings of anger in the days leading up to their period, according to new research.

The study sheds new light on the intricate relationship between women’s menstrual cycles, emotions, and sleep patterns.

Our research provides valuable insights into the complex interplay between menstrual cycles, emotions, and sleep and the impact of hormonal fluctuations on women’s well-being.

By understanding how these factors interact, we can better address the unique needs of women in terms of sleep health and emotional well-being.”

Dr. Jo Bower, Co-author of the University of East Anglia’s School of Psychology

The study analyzed data from 51 healthy women aged between 18 and 35, who had regular periods and were not taking hormonal contraception.

Utilising ecological momentary assessment (EMA) methodology, reproductive-aged women completed daily self-reports on their sleep and emotion measures and wore actiwatches (a sleep/wake tracking watch) to track sleep across two menstrual months.

The researchers discovered compelling associations between menstrual phases, emotional states, and sleep quality.

Key findings from the study include:
- Women experience disruptions in their sleep patterns in the days leading up to and during their period (peri-menstrual phase), spending more time awake at night, with a lower proportion of time spent in bed that is asleep (lower sleep efficiency).
- During the peri-menstrual phase, women report heightened feelings of anger compared to other phases of their menstrual cycle.
- Sleep disturbances during the peri-menstrual phase correlate with reduced positive emotions such as calmness, happiness, and enthusiasm.
This contributes to a growing body of evidence suggesting that menstrual cycles may play a significant role in women’s vulnerability to insomnia and mental health issues.

Dr Bower added: “The findings underscore the importance of considering hormonal fluctuations when addressing sleep disorders and emotional distress in women.

“The implications of this research reach further than just the controlled setting, providing potential pathways for interventions and treatments aimed at enhancing sleep quality and emotional resilience in women.”

Although the study had unique strengths, such as the use of both objective and subjective prospective data across two menstrual cycles, the researchers said the findings must be interpreted within the context of several limitations.

For example, the data was collected between May 2020 and January 2021, and precisely how the Covid-19 pandemic impacted outcomes cannot be fully known.

Although the researchers did not find strong effects for pandemic stress on outcome variables, they cannot discount the fact that the pandemic likely impacted participants’ emotional experiences and sleep-wake behaviours.

The research was led by Dr Jessica Meers at the Center for Innovations in Quality, Effectiveness and Safety, which is a collaboration between the Michael E. DeBakey VA Medical Center and the Baylor College of Medicine, which are both based in Houston, Texas. The University of East Anglia and the University of Houston were also partners in the research.

Source:

University of East Anglia

Journal reference:

Meers, J. M., et al. (2024) Interaction of sleep and emotion across the menstrual cycle. Journal of Sleep Research. doi.org/10.1111/jsr.14185.
[ad_2]

Source link
March 22, 2024

Rapid rise in syphilis hits Native Americans hardest

[ad_1]

From her base in Gallup, New Mexico, Melissa Wyaco supervises about two dozen public health nurses who crisscross the sprawling Navajo Nation searching for patients who have tested positive for or been exposed to a disease once nearly eradicated in the U.S.: syphilis.

Infection rates in this region of the Southwest — the 27,000-square-mile reservation encompasses parts of Arizona, New Mexico, and Utah — are among the nation’s highest. And they’re far worse than anything Wyaco, who is from Zuni Pueblo (about 40 miles south of Gallup) and is the nurse consultant for the Navajo Area Indian Health Service, has seen in her 30-year nursing career.

Syphilis infections nationwide have climbed rapidly in recent years, reaching a 70-year high in 2022, according to the most recent data from the Centers for Disease Control and Prevention. That rise comes amid a shortage of penicillin, the most effective treatment. Simultaneously, congenital syphilis — syphilis passed from a pregnant person to a baby — has similarly spun out of control. Untreated, congenital syphilis can cause bone deformities, severe anemia, jaundice, meningitis, and even death. In 2022, the CDC recorded 231 stillbirths and 51 infant deaths caused by syphilis, out of 3,761 congenital syphilis cases reported that year.

And while infections have risen across the U.S., no demographic has been hit harder than Native Americans. The CDC data released in January shows that the rate of congenital syphilis among American Indians and Alaska Natives was triple the rate for African Americans and nearly 12 times the rate for white babies in 2022.

“This is a disease we thought we were going to eradicate not that long ago, because we have a treatment that works really well,” said Meghan Curry O’Connell, a member of the Cherokee Nation and chief public health officer at the Great Plains Tribal Leaders’ Health Board, who is based in South Dakota.

Instead, the rate of congenital syphilis infections among Native Americans (644.7 cases per 100,000 people in 2022) is now comparable to the rate for the entire U.S. population in 1941 (651.1) — before doctors began using penicillin to cure syphilis. (The rate fell to 6.6 nationally in 1983.)

O’Connell said that’s why the Great Plains Tribal Leaders’ Health Board and tribal leaders from North Dakota, South Dakota, Nebraska, and Iowa have asked federal Health and Human Services Secretary Xavier Becerra to declare a public health emergency in their states. A declaration would expand staffing, funding, and access to contact tracing data across their region.

“Syphilis is deadly to babies. It’s highly infectious, and it causes very severe outcomes,” O’Connell said. “We need to have people doing boots-on-the-ground work” right now.

In 2022, New Mexico reported the highest rate of congenital syphilis among states. Primary and secondary syphilis infections, which are not passed to infants, were highest in South Dakota, which had the second-highest rate of congenital syphilis in 2022. In 2021, the most recent year for which demographic data is available, South Dakota had the second-worst rate nationwide (after the District of Columbia) — and numbers were highest among the state’s large Native population.

In an October news release, the New Mexico Department of Health noted that the state had “reported a 660% increase in cases of congenital syphilis over the past five years.” A year earlier, in 2017, New Mexico reported only one case — but by 2020, that number had risen to 43, then to 76 in 2022.

Starting in 2020, the covid-19 pandemic made things worse. “Public health across the country got almost 95% diverted to doing covid care,” said Jonathan Iralu, the Indian Health Service chief clinical consultant for infectious diseases, who is based at the Gallup Indian Medical Center. “This was a really hard-hit area.”

At one point early in the pandemic, the Navajo Nation reported the highest covid rate in the U.S. Iralu suspects patients with syphilis symptoms may have avoided seeing a doctor for fear of catching covid. That said, he doesn’t think it’s fair to blame the pandemic for the high rates of syphilis, or the high rates of women passing infections to their babies during pregnancy, that continue four years later.

Native Americans are more likely to live in rural areas, far from hospital obstetric units, than any other racial or ethnic group. As a result, many do not receive prenatal care until later in pregnancy, if at all. That often means providers cannot test and treat patients for syphilis before delivery.

In New Mexico, 23% of patients did not receive prenatal care until the fifth month of pregnancy or later, or received fewer than half the appropriate number of visits for the infant’s gestational age in 2023 (the national average is less than 16%).

Inadequate prenatal care is especially risky for Native Americans, who have a greater chance than other ethnic groups of passing on a syphilis infection if they become pregnant. That’s because, among Native communities, syphilis infections are just as common in women as in men. In every other ethnic group, men are at least twice as likely to contract syphilis, largely because men who have sex with men are more susceptible to infection. O’Connell said it’s not clear why women in Native communities are disproportionately affected by syphilis.

“The Navajo Nation is a maternal health desert,” said Amanda Singer, a Diné (Navajo) doula and lactation counselor in Arizona who is also executive director of the Navajo Breastfeeding Coalition/Diné Doula Collective. On some parts of the reservation, patients have to drive more than 100 miles to reach obstetric services. “There’s a really high number of pregnant women who don’t get prenatal care throughout the whole pregnancy.”

She said that’s due not only to a lack of services but also to a mistrust of health care providers who don’t understand Native culture. Some also worry that providers might report patients who use illicit substances during their pregnancies to the police or child welfare. But it’s also because of a shrinking network of facilities: Two of the Navajo area’s labor and delivery wards have closed in the past decade. According to a recent report, more than half of U.S. rural hospitals no longer offer labor and delivery services.

Singer and the other doulas in her network believe New Mexico and Arizona could combat the syphilis epidemic by expanding access to prenatal care in rural Indigenous communities. Singer imagines a system in which midwives, doulas, and lactation counselors are able to travel to families and offer prenatal care “in their own home.”

O’Connell added that data-sharing arrangements between tribes and state, federal, and IHS offices vary widely across the country, but have posed an additional challenge to tackling the epidemic in some Native communities, including her own. Her Tribal Epidemiology Center is fighting to access South Dakota’s state data.

In the Navajo Nation and surrounding area, Iralu said, IHS infectious disease doctors meet with tribal officials every month, and he recommends that all IHS service areas have regular meetings of state, tribal, and IHS providers and public health nurses to ensure every pregnant person in those areas has been tested and treated.

IHS now recommends all patients be tested for syphilis yearly, and tests pregnant patients three times. It also expanded rapid and express testing and started offering DoxyPEP, an antibiotic that transgender women and men who have sex with men can take up to 72 hours after sex and that has been shown to reduce syphilis transmission by 87%. But perhaps the most significant change IHS has made is offering testing and treatment in the field.

Today, the public health nurses Wyaco supervises can test and treat patients for syphilis at home — something she couldn’t do when she was one of them just three years ago.

“Why not bring the penicillin to the patient instead of trying to drag the patient in to the penicillin?” said Iralu.

It’s not a tactic IHS uses for every patient, but it’s been effective in treating those who might pass an infection on to a partner or baby.

Iralu expects to see an expansion in street medicine in urban areas and van outreach in rural areas, in coming years, bringing more testing to communities — as well as an effort to put tests in patients’ hands through vending machines and the mail.

“This is a radical departure from our past,” he said. “But I think that’s the wave of the future.”

[ad_2]

Source link

March 21, 2024

AI analyzes lung ultrasound images to spot COVID-19

[ad_1]

Artificial intelligence can spot COVID-19 in lung ultrasound images much like facial recognition software can spot a face in a crowd, new research shows.

The findings boost AI-driven medical diagnostics and bring health care professionals closer to being able to quickly diagnose patients with COVID-19 and other pulmonary diseases with algorithms that comb through ultrasound images to identify signs of disease.

The findings, newly published in Communications Medicine, culminate an effort that started early in the pandemic when clinicians needed tools to rapidly assess legions of patients in overwhelmed emergency rooms.

We developed this automated detection tool to help doctors in emergency settings with high caseloads of patients who need to be diagnosed quickly and accurately, such as in the earlier stages of the pandemic. Potentially, we want to have wireless devices that patients can use at home to monitor progression of COVID-19, too.”

Muyinatu Bell, senior author, the John C. Malone Associate Professor of Electrical and Computer Engineering, Biomedical Engineering, and Computer Science at Johns Hopkins University

The tool also holds potential for developing wearables that track such illnesses as congestive heart failure, which can lead to fluid overload in patients’ lungs, not unlike COVID-19, said co-author Tiffany Fong, an assistant professor of emergency medicine at Johns Hopkins Medicine.

“What we are doing here with AI tools is the next big frontier for point of care,” Fong said. “An ideal use case would be wearable ultrasound patches that monitor fluid buildup and let patients know when they need a medication adjustment or when they need to see a doctor.”

The AI analyzes ultrasound lung images to spot features known as B-lines, which appear as bright, vertical abnormalities and indicate inflammation in patients with pulmonary complications. It combines computer-generated images with real ultrasounds of patients -; including some who sought care at Johns Hopkins.

“We had to model the physics of ultrasound and acoustic wave propagation well enough in order to get believable simulated images,” Bell said. “Then we had to take it a step further to train our computer models to use these simulated data to reliably interpret real scans from patients with affected lungs.”

Early in the pandemic, scientists struggled to use artificial intelligence to assess COVID-19 indicators in lung ultrasound images because of a lack of patient data and because they were only beginning to understand how the disease manifests in the body, Bell said.

Her team developed software that can learn from a mix of real and simulated data and then discern abnormalities in ultrasound scans that indicate a person has contracted COVID-19. The tool is a deep neural network, a type of AI designed to behave like the interconnected neurons that enable the brain to recognize patterns, understand speech, and achieve other complex tasks.

“Early in the pandemic, we didn’t have enough ultrasound images of COVID-19 patients to develop and test our algorithms, and as a result our deep neural networks never reached peak performance,” said first author Lingyi Zhao, who developed the software while a postdoctoral fellow in Bell’s lab and is now working at Novateur Research Solutions. “Now, we are proving that with computer-generated datasets we still can achieve a high degree of accuracy in evaluating and detecting these COVID-19 features.”

Source:

Journal reference:

Zhao, L., et al. (2024). Detection of COVID-19 features in lung ultrasound images using deep neural networks. Communications Medicine. doi.org/10.1038/s43856-024-00463-5

[ad_2]

Source link

March 21, 2024
Second-hand vape smoke linked to more asthma symptoms in kids
[ad_1]
In a recent study published in the journal Children, researchers retrospectively investigated the impacts of second-hand e-cigarette smoke exposure on childhood asthma, especially in home environments. They carried out a pilot, monocenter, observational study of 54 young asthma patients, half of whom experienced second-hand exposure (SHE) to second-hand aerosols (SHAs).

Study: Association between Second-Hand Exposure to E-Cigarettes at Home and Exacerbations in Children with Asthma. Image Credit: Prostock-studio / Shutterstock

Despite finding no statistically significant association between electronic nicotine delivery systems (ENDSs) and asthma exacerbations (no difference in the number of patients requiring clinical intervention step-up), this study suggests that asthmatic children exposed to elevated levels of second-hand e-cigarette smoke may experience increases in their number of asthma symptomatic days. This highlights the need for heightened awareness, both amongst adolescents and their parents, of the psychological harms of the ‘safe’ vape.

The ENDs pandemic and what this means for asthma patients

Extensive research and medical reports highlight tobacco smoking as the single most preventable cause of global mortality and morbidity, with the habit associated with significant increases in the risks of numerous cancers, cardiovascular diseases (CVDs), respiratory ailments, and psychiatric disorders. Long-term global efforts have resulted in substantial reductions in tobacco use prevalence amongst adults and adolescents, representing one of the most noteworthy accomplishments of modern public health.

Unfortunately, in recent years, tobacco smoking has been replaced by the use of electronic nicotine delivery systems (ENDSs). Commonly called ‘vapes,’ these devices are marketed as low- or no-risk alternatives to conventional smoking. While they are devoid of tar and a majority of the heavy metal components that make tobacco smoke harmful, recent research presents a growing body of evidence suggesting that ENDs are not as safe as we may think. Even non-smokers who take up vaping have been shown to develop adverse and often chronic respiratory symptoms, including bronchoconstriction and severe cough.

Asthma is a respiratory condition characterized by difficulty breathing, chest pain, cough, and wheezing, which in severe cases may lead to life-threatening suffocation. Caused by the inflammation or narrowing of a patient’s airways or excessive mucus secretions along the respiratory tract, the condition is most common in young children. It presents the most common pediatric disease worldwide. Unfortunately, while a few studies have investigated the associations between e-cigarette exposure and asthma in adults and found that the former can exacerbate the latter, the impacts of second-hand exposure on pediatric asthma have hitherto remained unexplored.

“Establishing evidence of adverse health effects caused by second-hand nicotine vaping exposure could represent a valid motivation for minimizing household exposure and imposing restrictions on vaping in public spaces.”

About the study

Aerosols produced by ENDs are known to contain volatile aldehydes and oxidant metals, some of which have been shown to produce adverse outcomes in adult patients’ lungs, both asthmatic and non-asthmatic. Unfortunately, the effects of these volatile organic compounds (VOCs) on children’s lungs remain unknown. The present study aims to fill this knowledge gap by retrospectively elucidating the associations between childhood ENDs exposure and asthma symptom progression.

The observational study was carried out between January and May 2023 at “Gaetano Martino” Hospital, University of Messina, Italy, and comprised children or adolescents aged five to 17 with medically confirmed asthma. Data collection included demographics (age, sex, gender, and race), clinical (comorbidities), parents’ socioeconomic status, and the education levels of both parents and children. Additionally, ENDs exposure was recorded in terms of presence (yes/no) and frequency. All data was collected using a custom-designed questionnaire.

The Asthma Control Test (ACT) and the children-Asthma Control Test (c-ACT were administered at the time of initial study enrolment. Patients were assigned to asthma or no-asthma cohorts (n = 27 per cohort), with analyses stratified to account for age – two age cohorts (5-11 [n = 65%] and 12-17 [n = 35%]). Continuous data variables were analyzed using descriptive statistics (expressed as means and standard deviations [SDs]), while ordinary variables were expressed as percentages. Fisher’s tests were used to compare cohorts qualitatively, while independent t-tests computed differences between continuous variables across cohorts.

Study findings and conclusions

The total sample size for the present study was 54, equally divided between children whose parents indulge in e-cigarette consumption at home and those whose parents do not. Of these, 39 were diagnosed with intermittent, nine with moderate, and six with severe asthma, respectively.

While the dataset was too small to provide statistically significant differences between asthma and non-asthma cohorts, descriptive statistics reveal that ENDs had more profound impacts on younger children (Group A – 5 to 11 years) compared to their older counterparts (Group B – 12 to 17 years) with the former group needing six times more rescue therapy and 15% more therapeutic step-up than the former. These results are in concordance with the conventional assumption that younger children are at higher risk of asthma contraction due to their undeveloped immune systems and narrower respiratory passages.

Despite not yielding statistically significant results, the proceeds of this study highlight the risk posed by household END usage to children. While not as harmful as conventional tobacco smoke, vaporization of e-liquids is known to release significant qualities of aldehydes, including formaldehyde, known for being respiratory irritants and carcinogens. Previous research comparing harmful aerosol concentrations in home environments raises cause for concern – ultrafine particulate matter produced by e-cigarettes matches. It sometimes exceeds that produced by an equivalent amount of tobacco smoke.

“…our data highlight the importance of the prevention of the vaping epidemic and passive exposure to e-cigarettes, even among children and adolescents. Implementing educational programs to increase awareness about the risks of vaping among children and emphasizing the potential impact on respiratory health, especially for those with asthma, should be a priority. Launching targeted campaigns to inform parents about the dangers of vaping and its specific implications for children with asthma should be strengthened.”
Journal reference:

Costantino, S., Torre, A., Foti Randazzese, S., Mollica, S. A., Motta, F., Busceti, D., Ferrante, F., Caminiti, L., Crisafulli, G., & Manti, S. (2024). Association between Second-Hand Exposure to E-Cigarettes at Home and Exacerbations in Children with Asthma. Children, 11(3), 356, DOI – 10.3390/children11030356, https://www.mdpi.com/2227-9067/11/3/356
[ad_2]

Source link
March 21, 2024
New analysis provides a comprehensive policy solution to bolster intensive care capacity in rural America

[ad_1]

A new policy analysis led by the Harvard Pilgrim Health Care Institute describes the intensive care crisis in rural America and provides a comprehensive policy solution to bolster intensive care capacity.

The paper, “Improving rural intensive care infrastructure in the USA,” was published in The Lancet Respiratory Medicine on March 12, 2024.

Despite efforts to support rural health in the past 20 years, rural hospitals continue to close at alarming rates. While patients in rural areas began to feel the effects of hospital closures and reduction of intensive care capacity prior to the pandemic, increased pandemic-driven demand for care intensified the rural-urban disparities in intensive care.

The study team highlights one especially stunning disparity: today, rural communities have almost half as many intensive care unit (ICU) beds as their urban counterparts (1.7 vs 2.8 per 10,000 people). This lack of community critical care services has been associated with higher mortality rates and exacerbates geographical disparities in care. Together with rural communities’ higher prevalence of comorbidities, lower socioeconomic levels, lower levels of insurance coverage, and a greater percentage of adults older than 65 years, rural ICUs face increasing demand with fewer resources to provide services.

The intensive care crisis in rural America is multifaceted and requires a wide-ranging solution. Our work focused on achievable, sustainable strategies to improve intensive care access that prioritize quality, affordable care.”

Hao Yu, senior author, Harvard Medical School associate professor of population medicine, Harvard Pilgrim Health Care Institute

The study authors note two well-studied solutions for sustainable care provision in rural areas: reducing uninsured populations through the ACA Medicaid expansion and increasing the health workforce. Their work points to additional policies that make use of recent advances in technological applications, including remote patient monitoring, payment delivery innovation such as global budgeting, new delivery models such as telemedicine, and lessons internationally. They suggest these policies can be effective tools to strengthen rural intensive care capacity.

“This problem is not unique to the U.S., and our global counterparts have launched promising initiatives,” adds Dr. Yu. “There are sound policy reasons for Congress to address this problem by going beyond the Consolidated Appropriations Act of 2021, which helps preserve emergency care in rural areas through a new rural emergency hospital designation but does not comprehensively address the burgeoning intensive care crisis in rural America. Policy makers can make further advances in supporting rural intensive care by adopting hybrid ICU models and alternative payment strategies to better equip rural hospitals and improve critical care in rural communities.”

Source:

Harvard Pilgrim Health Care Institute

Journal reference:

Ramesh, T., et al. (2024). Improving rural intensive care infrastructure in the USA. The Lancet Respiratory Medicine. doi.org/10.1016/s2213-2600(24)00031-6.

[ad_2]

Source link

March 20, 2024

Health workers fear it’s profits before protection as CDC revisits airborne transmission

[ad_1]

Four years after hospitals in New York City overflowed with covid-19 patients, emergency physician Sonya Stokes remains shaken by how unprepared and misguided the American health system was.

Hospital leadership instructed health workers to forgo protective N95 masks in the early months of 2020, as covid cases mounted. “We were watching patients die,” Stokes said, “and being told we didn’t need a high level of protection from people who were not taking these risks.”

Droves of front-line workers fell sick as they tried to save lives without proper face masks and other protective measures. More than 3,600 died in the first year. “Nurses were going home to their elderly parents, transmitting covid to their families,” Stokes recalled. “It was awful.”

Across the country, hospital leadership cited advice from the Centers for Disease Control and Prevention on the limits of airborne transmission. The agency’s early statements backed employers’ insistence that N95 masks, or respirators, were needed only during certain medical procedures conducted at extremely close distances.

Such policies were at odds with doctors’ observations, and they conflicted with advice from scientists who study airborne viral transmission. Their research suggested that people could get covid after inhaling SARS-CoV-2 viruses suspended in teeny-tiny droplets in the air as infected patients breathed.

But this research was inconvenient at a time when N95s were in short supply and expensive.

Now, Stokes and many others worry that the CDC is repeating past mistakes as it develops a crucial set of guidelines that hospitals, nursing homes, prisons, and other facilities that provide health care will apply to control the spread of infectious diseases. The guidelines update those established nearly two decades ago. They will be used to establish protocols and procedures for years to come.

“This is the foundational document,” said Peg Seminario, an occupational health expert and a former director at the American Federation of Labor and Congress of Industrial Organizations, which represents some 12 million active and retired workers. “It becomes gospel for dealing with infectious pathogens.”

Late last year, the committee advising the CDC on the guidelines pushed forward its final draft for the agency’s consideration. Unions, aerosol scientists, and workplace safety experts warned it left room for employers to make unsafe decisions on protection against airborne infections.

“If we applied these draft guidelines at the start of this pandemic, there would have been even less protection than there is now — and it’s pretty bad now,” Seminario said.

In an unusual move in January, the CDC acknowledged the outcry and returned the controversial draft to its committee so that it could clarify points on airborne transmission. The director of the CDC’s National Institute for Occupational Safety and Health asked the group to “make sure that a draft set of recommendations cannot be misread to suggest equivalency between facemasks and NIOSH Approved respirators, which is not scientifically correct.”

The CDC also announced it would expand the range of experts informing their process. Critics had complained that most members of last year’s Healthcare Infection Control Practices Advisory Committee represent large hospital systems. And about a third of them had published editorials arguing against masks in various circumstances. For example, committee member Erica Shenoy, the infection control director at Massachusetts General Hospital, wrote in May 2020, “We know that wearing a mask outside health care facilities offers little, if any, protection from infection.”

Although critics are glad to see last year’s draft reconsidered, they remain concerned. “The CDC needs to make sure that this guidance doesn’t give employers leeway to prioritize profits over protection,” said Jane Thomason, the lead industrial hygienist at the union National Nurses United.

She’s part of a growing coalition of experts from unions, the American Public Health Association, and other organizations putting together an outside statement on elements that ought to be included in the CDC’s guidelines, such as the importance of air filtration and N95 masks.

But that input may not be taken into consideration.

The CDC has not publicly announced the names of experts it added this year. It also hasn’t said whether those experts will be able to vote on the committee’s next draft — or merely provide advice. The group has met this year, but members are barred from discussing the proceedings. The CDC did not respond to questions and interview requests from KFF Health News.

A key point of contention in the draft guidance is that it recommends different approaches for airborne viruses that “spread predominantly over short distances” versus those that “spread efficiently over long distances.” In 2020, this logic allowed employers to withhold protective gear from many workers.

For example, medical assistants at a large hospital system in California, Sutter Health, weren’t given N95 masks when they accompanied patients who appeared to have covid through clinics. After receiving a citation from California’s occupational safety and health agency, Sutter appealed by pointing to the CDC’s statements suggesting that the virus spreads mainly over short distances.

A distinction based on distance reflects a lack of scientific understanding, explained Don Milton, a University of Maryland researcher who specializes in the aerobiology of respiratory viruses. In general, people may be infected by viruses contained in someone’s saliva, snot, or sweat — within droplets too heavy to go far. But people can also inhale viruses riding on teeny-tiny, lighter droplets that travel farther through the air. What matters is which route most often infects people, the concentration of virus-laden droplets, and the consequences of getting exposed to them, Milton said. “By focusing on distance, the CDC will obscure what is known and make bad decisions.”

Front-line workers were acutely aware they were being exposed to high levels of the coronavirus in hospitals and nursing homes. Some have since filed lawsuits, alleging that employers caused illness, distress, and death by failing to provide personal protective equipment.

One class-action suit brought by staff was against Soldiers’ Home, a state-owned veterans’ center in Holyoke, Massachusetts, where at least 76 veterans died from covid and 83 employees were sickened by the coronavirus in early 2020.

“Even at the end of March, when the Home was averaging five deaths a day, the Soldiers’ Home Defendants were still discouraging employees from wearing PPE,” according to the complaint.

It details the experiences of staff members, including a nursing assistant who said six veterans died in her arms. “She remembers that during this time in late March, she always smelled like death. When she went home, she would vomit continuously.”

Researchers have repeatedly criticized the CDC for its reluctance to address airborne transmission during the pandemic. According to a new analysis, “The CDC has only used the words ‘COVID’ and ‘airborne’ together in one tweet, in October 2020, which mentioned the potential for airborne spread.’”

It’s unclear why infection control specialists on the CDC’s committee take a less cautious position on airborne transmission than other experts, industrial hygienist Deborah Gold said. “I think these may be honest beliefs,” she suggested, “reinforced by the fact that respirators triple in price whenever they’re needed.”

Critics fear that if the final guidelines don’t clearly state a need for N95 masks, hospitals won’t adequately stockpile them, paving the way for shortages in a future health emergency. And if the document isn’t revised to emphasize ventilation and air filtration, health facilities won’t invest in upgrades.

“If the CDC doesn’t prioritize the safety of health providers, health systems will err on the side of doing less, especially in an economic downturn,” Stokes said. “The people in charge of these decisions should be the ones forced to take those risks.”

[ad_2]

Source link

March 19, 2024

Lower grades for students who use both tobacco and cannabis, California survey reveals

[ad_1]

Several reports have raised the issue of increasing absenteeism and lower grades in American public schools after they reopened following the coronavirus disease 2019 (COVID-19) pandemic. These predict higher rates of mental illness and dropout from high school. Substance use is also linked to poor outcomes, including vaping, tobacco, and cannabis, perhaps because of their effects on the developing brain.

Study: Co-Use of Tobacco Products and Cannabis Is Associated with Absenteeism and Lower Grades in California High School Students. Image Credit: Solid photos/Shutterstock.com

A recent study published in The Journal of Pediatrics examines the odds of these outcomes when tobacco and cannabis are co-used after compensating for other risks. With the rise in legalized cannabis, there has been an increase in the national (but not California) proportion of young people who vape, from 11% to 21% over the period 2017 to 2022. Again, the proportion of cannabis users went up from 5% to 15%.

The current study sought to dissociate this risk in a sample of high school students in California surveyed in 2020-21, immediately after post-COVID school reopening.

About the study

The study utilized the California Healthy Kids Survey (CHKS), performed by the WestEd, the California Department of Education, and the Department of Health Care Services, on students in grades 9 and 11 in California. Only public school students were included, numbering about 353,000, who responded to survey questions about tobacco and cannabis use during the 30 days just before the survey and were attending school in person.

The sample was equally split between males and females, grades 9 and 11, and those with highly educated parents vs others. Almost half were Hispanic, a quarter non-Hispanic White, and 15% Asian. Over one in three said they had felt depressed sometime in the past year, while 6% reported feeling endangered at school.

Almost a tenth used alcohol, while 2% used tobacco alone. About 4% used cannabis, and the same proportion used both substances. Almost double these numbers were reported as having used these substances at any time.

Co-use of both substances was linked to 35% absenteeism vs 29% in cannabis-only users, 26% among tobacco-only users, and 17% among those who used neither. Risk factors for absenteeism and/or poor grades that needed to be adjusted for included bullying, poor health, and change of residence if the student is a caregiver for others or comes from a family with food insecurity. Unsafe school conditions or poor educational climates at school also play a role in this phenomenon.

After adjustment, co-users had a 40% higher risk of absenteeism, the highest among all categories. Compared to tobacco-only users, co-use and cannabis-only users both were ~20% and 15% more likely to report absenteeism, respectively. Similar findings were obtained among ever-users, too.

The mean grade was 6.16, that is, mostly Bs. Co-use was associated with a mean grade of 5.08 vs 5.61 for tobacco-only users, 5.54 for cannabis-only users, and 6.24 among non-users. If using tobacco only was the reference group, co-users, and cannabis-only users had a decrease of 0.39 points, but it fell by a mean of 0.87 points when co-users were matched to non-users. Cannabis-only and tobacco-only users had no difference in their mean grades.

Dangers of absenteeism

School funding suffers when students are absent. Thus, co-use has roughly cost the school $300 per absent student on average.

With over 8,000 students reporting substance use, absences may potentially have cost the school almost $2.5 million in annual funding, provided all of these absences were due to substance use, though this is an unlikely event.

What are the implications?

The drop in grades by almost one category, from Bs to Bs and Cs, associated with co-users compared to non-users, is an important adverse effect. This was accompanied by 40% higher odds of absenteeism (being absent three or more days within the past month) in the co-user group vs non-users and 20% higher odds than among tobacco-only users.

This novel study supports the hypothesis that substance abuse, especially the dual use of tobacco and alcohol, worsens educational outcomes. Several mechanisms have been speculated about. For instance, these substances could affect cognitive processing and disrupt learning and memory pathways.

Cannabis heightens nicotine addiction when used during adolescence, making quitting very difficult. Also, the use of either or both of these substances can cause illness, physical or mental, resulting in skipping school. Co-use has been linked to changes in the sleep pattern.

Finally, vaping at school may distract students, reducing their ability to learn. Another possibility is that vaping or co-use may result in suspension from school. The occurrence of such events is mirrored in the list of reasons for absenteeism, such as illness, anger, sadness, stress, or inadequate sleep.

Future studies should assess potential interventions to improve educational outcomes with the help of full-spectrum efforts to reduce or eliminate substance use among students.

[ad_2]

Source link

March 18, 2024

Tag: Pandemic

The ENDs pandemic and what this means for asthma patients

About the study

Study findings and conclusions

About the study

Dangers of absenteeism

What are the implications?