Tag: Public health

Do we simply not care about old people?

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The covid-19 pandemic would be a wake-up call for America, advocates for the elderly predicted: incontrovertible proof that the nation wasn’t doing enough to care for vulnerable older adults.

The death toll was shocking, as were reports of chaos in nursing homes and seniors suffering from isolation, depression, untreated illness, and neglect. Around 900,000 older adults have died of covid-19 to date, accounting for 3 of every 4 Americans who have perished in the pandemic.

But decisive actions that advocates had hoped for haven’t materialized. Today, most people — and government officials — appear to accept covid as a part of ordinary life. Many seniors at high risk aren’t getting antiviral therapies for covid, and most older adults in nursing homes aren’t getting updated vaccines. Efforts to strengthen care quality in nursing homes and assisted living centers have stalled amid debate over costs and the availability of staff. And only a small percentage of people are masking or taking other precautions in public despite a new wave of covid, flu, and respiratory syncytial virus infections hospitalizing and killing seniors.

In the last week of 2023 and the first two weeks of 2024 alone, 4,810 people 65 and older lost their lives to covid — a group that would fill more than 10 large airliners — according to data provided by the CDC. But the alarm that would attend plane crashes is notably absent. (During the same period, the flu killed an additional 1,201 seniors, and RSV killed 126.)

“It boggles my mind that there isn’t more outrage,” said Alice Bonner, 66, senior adviser for aging at the Institute for Healthcare Improvement. “I’m at the point where I want to say, ‘What the heck? Why aren’t people responding and doing more for older adults?’”

It’s a good question. Do we simply not care?

I put this big-picture question, which rarely gets asked amid debates over budgets and policies, to health care professionals, researchers, and policymakers who are older themselves and have spent many years working in the aging field. Here are some of their responses.

The pandemic made things worse. Prejudice against older adults is nothing new, but “it feels more intense, more hostile” now than previously, said Karl Pillemer, 69, a professor of psychology and gerontology at Cornell University.

“I think the pandemic helped reinforce images of older people as sick, frail, and isolated — as people who aren’t like the rest of us,” he said. “And human nature being what it is, we tend to like people who are similar to us and be less well disposed to ‘the others.’”

“A lot of us felt isolated and threatened during the pandemic. It made us sit there and think, ‘What I really care about is protecting myself, my wife, my brother, my kids, and screw everybody else,’” said W. Andrew Achenbaum, 76, the author of nine books on aging and a professor emeritus at Texas Medical Center in Houston.

In an environment of “us against them,” where everybody wants to blame somebody, Achenbaum continued, “who’s expendable? Older people who aren’t seen as productive, who consume resources believed to be in short supply. It’s really hard to give old people their due when you’re terrified about your own existence.”

Although covid continues to circulate, disproportionately affecting older adults, “people now think the crisis is over, and we have a deep desire to return to normal,” said Edwin Walker, 67, who leads the Administration on Aging at the Department of Health and Human Services. He spoke as an individual, not a government representative.

The upshot is “we didn’t learn the lessons we should have,” and the ageism that surfaced during the pandemic hasn’t abated, he observed.

Ageism is pervasive. “Everyone loves their own parents. But as a society, we don’t value older adults or the people who care for them,” said Robert Kramer, 74, co-founder and strategic adviser at the National Investment Center for Seniors Housing & Care.

Kramer thinks boomers are reaping what they have sown. “We have chased youth and glorified youth. When you spend billions of dollars trying to stay young, look young, act young, you build in an automatic fear and prejudice of the opposite.”

Combine the fear of diminishment, decline, and death that can accompany growing older with the trauma and fear that arose during the pandemic, and “I think covid has pushed us back in whatever progress we were making in addressing the needs of our rapidly aging society. It has further stigmatized aging,” said John Rowe, 79, professor of health policy and aging at Columbia University’s Mailman School of Public Health.

“The message to older adults is: ‘Your time has passed, give up your seat at the table, stop consuming resources, fall in line,’” said Anne Montgomery, 65, a health policy expert at the National Committee to Preserve Social Security and Medicare. She believes, however, that baby boomers can “rewrite and flip that script if we want to and if we work to change systems that embody the values of a deeply ageist society.”

Integration, not separation, is needed. The best way to overcome stigma is “to get to know the people you are stigmatizing,” said G. Allen Power, 70, a geriatrician and the chair in aging and dementia innovation at the Schlegel-University of Waterloo Research Institute for Aging in Canada. “But we separate ourselves from older people so we don’t have to think about our own aging and our own mortality.”

The solution: “We have to find ways to better integrate older adults in the community as opposed to moving them to campuses where they are apart from the rest of us,” Power said. “We need to stop seeing older people only through the lens of what services they might need and think instead of all they have to offer society.”

That point is a core precept of the National Academy of Medicine’s 2022 report Global Roadmap for Healthy Longevity. Older people are a “natural resource” who “make substantial contributions to their families and communities,” the report’s authors write in introducing their findings.

Those contributions include financial support to families, caregiving assistance, volunteering, and ongoing participation in the workforce, among other things.

“When older people thrive, all people thrive,” the report concludes.

Future generations will get their turn. That’s a message Kramer conveys in classes he teaches at the University of Southern California, Cornell, and other institutions. “You have far more at stake in changing the way we approach aging than I do,” he tells his students. “You are far more likely, statistically, to live past 100 than I am. If you don’t change society’s attitudes about aging, you will be condemned to lead the last third of your life in social, economic, and cultural irrelevance.”

As for himself and the baby boom generation, Kramer thinks it’s “too late” to effect the meaningful changes he hopes the future will bring.

“I suspect things for people in my generation could get a lot worse in the years ahead,” Pillemer said. “People are greatly underestimating what the cost of caring for the older population is going to be over the next 10 to 20 years, and I think that’s going to cause increased conflict.”

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.

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February 9, 2024

‘It reflects the society we live in where a young person does not feel that life is worth living’

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Sponsor message: 00:00

This Working Scientist podcast series is sponsored by the University of Queensland where research is addressing some of the world’s most challenging and complex problems. Take your research further at UQ. Visit uq.edu.au

Juliana Gil: 00:25

Hello, this is How to Save Humanity in 17 Goals, a podcast brought to you by Nature Careers, in partnership with Nature Food.

I am Juliana Gil, chief editor at Nature Food. Welcome again to the series where we meet the scientists working towards the global development targets brokered by the United Nations.

In 2015, world leaders pledged to solve a range of economic, environmental and social issues. A package of 17 development goals were agreed upon.

Since then, in a huge effort, thousands of researchers all over the world have been tackling the biggest problems that the planet faces today.

In episode three, we look at Sustainable Development Goal number three: How to ensure health and well-being for all. And meet a psychiatrist who is determined to push mental health further up the agenda.

Shekhar Saxena: 01:25

So my name is Shekhar Saxena. I am a psychiatrist by training, and have involvement in public mental health. Currently, I teach at Harvard Chan School of Public Health, at Harvard University.

Earlier, I worked at the World Health Organization for several years, and I was directing the department of mental health and substance abuse.

The Sustainable Development Goals of the United Nations was actually a landmark achievement and an agreement of all countries, which was very much more advanced than the previous Millennium Development Goals. And I would refer to two reasons why I say it was a major change.

One is that SDGs apply to all countries, rather than only to the so-called developing countries.

And the second areas is that SDGs included, were many more than MDGs. So it was more comprehensive. And it was applicable to all countries.

And I’m very happy to say that SDG 3, which is about health and wellbeing, is a very progressive agreement of the countries. They really said that health is important for their development.

And the goal is healthy life and wellbeing, which will have a high degree for all the citizens.

So it was a landmark declaration by the counties. Human is just a conduit. It’s the countries that decided to do that.

And I’m also happy to see that mental health was explicitly included within SDG 3.

And it was an integral part of health. So yes, it was definitely a very progressive declaration and mental health attained a level of attention that perhaps was not there earlier.

I began my professional career as a psychiatrist, treating people who came to me one after another, 100 after another 100.

And that was very much in clinical practice where SDGs, which were not there at that time, were quite irrelevant. However, my profession transited to public mental health, where it was not about clinical practice. It was about population mental health.

And that’s where the principles of health for all, and also community participation, and prevention and promotion became more important than just the treatment.

That was a nexus stage where I started working for WHO. The SDG era, which started in 2015, is a further transition where mental health is not only a part of health, but it’s a part of development.

And that’s what my work involves now. To see to it that mental health is given enough attention within the health agenda, but it is also given importance in the sustainable development agenda.

I should just say that having done clinical practice for two decades actually helped me a lot in my further work as a policy person.

Because when I look at policies now, when I advise about mental health policies to countries, I have those people in mind who I treated. The policy is to actually help real people in real places, and not on an abstract. Policy is a document that is written on paper, but it’s supposed to help real people.

And that’s what is lost many times. And I consciously try to keep that in mind, to see what could be the impact of the policies on people who I saw in Delhi, or I saw in Nigeria, in Lagos, or anywhere else, including in New York, actually.

And the policies need to be such that they help the people who are most in need, at the maximum. And that is what is important. The principle of equity, the principle of policy, serving everybody, and policy serving the largest number of people, rather than, very well, a small number of people.

The understanding of mental health has improved a lot. The awareness about mental health problems within the citizens has also improved a lot. The very frequent references to mental health in the media, in the conventional as well as social media, has increased enormously.

Now, we cannot go through a day without reading something about mental health in the media that we read. So understanding has increased, research has increased, awareness has increased.

What has actually not increased is the amount of resources that we spend on mental health. I should also say that COVID pandemic, which obviously killed a lot of people and affected a very large proportion of population in the world, was actually a net gain for mental health because it increased the awareness.

Of course, mental health problems increased. Quite substantially, actually. But the awareness and attention also increased a lot.

However, there is still a lack of human as well as financial resources that are devoted to mental health. You might be surprised to learn that, on an average, countries spend less than 2% of their health budget on mental health, when the burden is something like 10%. So there is a large gap between what is needed, and what is available for mental health.

So that is the number one problem for mental health in the world today. We lack trained people who can provide care. We lack policies which are conducive to better mental health for the population. And we need the financial resources to make that happen.

Having said that, and also having said that mental institution has actually improved not as much as the day and the progress is far too slow.

Let’s take a couple of examples to illustrate. Suicide is one of the final and perhaps the most tragic outcome of mental health issues and conditions, not necessarily of mental disorders, but obviously of distress, which people face. And that is still a very large problem.

However, it is a public health problem. In the world currently, it’s nearly 800,000 people who die because of suicide every year. And every death is far too many.

So this is a big problem. Although I should say that the overall suicide rate in the world has actually come down just a little bit.

So there is some progress that is taking place. But in many countries, suicide rate is high and is increasing. Let’s take the example of two large countries. One is India, where the official rate, official number of people who die because of suicide is about 170,000 per year, which is anyway large. But a fairly substantial number of suicides are not reported because of the stigma and because of the legal issues and other issues. So the unofficial numbers are perhaps much larger than that.

And actually, it has been said that India has about one third of all completed suicides in the world, which is so large and is increasing.

What is even more troubling is that some of the most vulnerable groups in India have shown the largest increase in the suicide rate, which of course, includes the poor, but also suicides among women, and amongst young people are increasing a lot.

And that is something which is extremely tragic in a country like India, which is, which is developing, actually developing as opposed to many other countries who are not developing.

This is a very sad loss of human resources, who could actually assist the economy. And that brings me to SDGs. Because suicide is a phenomenon that is directly affected by the social and community environment where we live.

So, things like poverty, lack of education, lack of job opportunities, discriminations of all kinds, and deprivations of all kinds directly affect people who are prone to die because of suicide.

And we need policies that actually can provide the kind of environment where people live, which will be helpful to decrease the number of suicide. For example, suicide amongst young students have shown a marked increase because of the excessive competitiveness that is part of their life.

They have to struggle through the school education, they have to appear in the competitive examinations, then they have to struggle for a job. And many young people decide that dying is easier than struggling through for many years, which is very sad.

It reflects the society that we live in where a young person does not feel that life is worth living. It’s a sad reflection on the kind of environment that we’re providing to our young people. But that’s what is happening.

Take another example of USA, where again the suicide rate is larger than the global average. And in fact is increasing from about 10 per 100,000 per year in the year 2000. In 2022, the rate is 14.

So there is a substantial 40% increase in the rate of suicides. And it’s again increased in young people who find themselves jobless, or without any opportunities.

And there has been substantial amount of talk on what are the reasons for doing that, including lack of a direction in their life and lack of opportunities when they should be doing survey. Getting educated, getting a job raising a family. That’s where people decide to die.

So these are two countries which are very large, which have a higher rate of suicide than global average, and is an increasing rate. Which to me, directly connects it to the social and economic determinants of mental health, and of wellbeing. So these are issues that that are extremely important for global mental mental health currently.

Shekhar Saxena: 13:50

Mental health is the final outcome of many factors that are operating. There are of course biological factors.

It has to do something with the kind of brain that we have the kind of structure and function of our, of our higher brain functions, which is the, and to some extent, genetic predisposition. But those are relatively smaller.

Mental health is much more an outcome of the environment that we live in, and the kind of stresses that are operative on us, and the personality and the resilience that we gather over a period of time, and the maturity that we acquire over the years.

Mental health is important for all people at every stage of their life, so starting from their birth in fact, even before birth, there are factors that affect us.

And the factors that are affecting mental health are much more important during early childhood, compared to the later adult life. Because the formative years of life are the ones where some of these factors can have a very large impact later in life.

Many of these factors are social and economic. The kind of environment that we live in and the kind of family the kind of community, the kind of macroeconomic environment that we live in. And it has a direct relationship with sustainable development that have been decided by the United Nations as goals.

Shekhar Saxena: 15:40

Early childhood is a period where the privations of all kinds of, for example extreme poverty or lack of adequate nutrition, or lack of adequate social stimulation can have a direct impact on children’s development.

And that will lead to lesser mental health in the future, as well as certain mental health conditions. For example, depression, or anxiety, or sometimes the substance abuse problems that are there.

The second issue, which is again quite important is violence. Violence against children of all kinds, physical as well as sexual, and also against other vulnerable groups. Like girls who are especially prone to violence, as well as adolescents, who can be suffering from bullying, including cyberbullying, which is now quite a common occurrence, can have a lasting impact on your mental health.

And these factors can be definitely taken care of, by educate policies, but also by protective mechanisms, which are put by the family as well as community.

And that’s where the maximum cost effectiveness can be gained by the kind of policies and the kind of structures that we put in place. Unfortunately, there is inadequate realization of some of these very important factors.

And so we fail to protect our children and adolescents from suffering the harms of some of these factors. And in providing the kind of protection that is needed, especially for those children who are more vulnerable to that.

So for example, children coming from poor socioeconomic status, children who have difficulty in staying, joining and staying in school. The children at home who might be isolated, children who come from difficult families, and so on.

So these are the kinds of policies that can actually affect the mental health of the future generations in a much better way.

It is important to recall that 50% of all mental health conditions arise before the age of 15, and 75%, before the age of 24. So young people who have the vulnerability to have a mental health condition and sometimes, (not always, but sometimes), these conditions have an effect all throughout the life.

And so protection of mental health and prevention of mental disorders by socioeconomic policies and community-led initiatives is paramount for public mental health.

I know that we need treatment, but we need much more promotion, protection of mental health and prevention of many disorders, which are the hallmark of public mental health policies,

The problems because of mental health in societies around the world, are likely to continue to increase not only in terms of numbers of people who will be affected by mental ill health, but the overall status for mental health and wellbeing which are going down.

There are many reasons for that. That kind of prediction, a very unfortunate prediction. One is the demographic change because societies are getting older.

And we do know that older people have a higher chance of getting into mental health condition, including depression, as well as dementia, which directly affects affects the mental health of people.

But another reason is that large socioeconomic and other changes, including the recent recently-recognized climate change and environmental issues are also affecting a lot.

As if they were not enough problems we have one more to deal with.

Climate change is directly affecting the mental health of people. There has been various ways in which this is happening. One is that climate change is affecting the numbers of disasters and natural calamities that are coming up. And we do know that people who are affected by natural disasters, but also by conflicts and wars, are at a much higher risk of mental health problems compared to the other people. And so the proportion of people affected will continue to increase.

In the world today, with the number of conflicts and wars that are happening, as well as the increased frequency of natural disasters like floods and droughts and earthquakes and other disasters that are happening, including storms and hurricanes, much larger proportion of people are getting affected, and that’s likely to increase, which means a net increase in the mental health problems.

Global mental health has seen a number of policy initiatives in international area, as well as in many large countries, and these are all positive.

For example, as we discussed earlier, the United Nations included mental health andwell being in its Sustainable Development Goals in 2015. The WHO has a mental health action plan that was passed by the World Health Assembly in 2013, and has now been extended to 2030.

These are very progressive declarations by the countries to say that mental health is important, but also to actually clearly and explicitly state what they have agreed to do for mental health in the coming decade or more.

And these are very, very positive things. Another thing which has happened is that many countries have revised their mental health policies and laws, which are more in keeping with the research findings currently, as well as the human rights issues that are coming up much more in this area. So all of that is very positive.

Many countries have made new mental health policies which are very progressive and are rights-based, rather than the earlier policies which were much more charity-based. That mental health people require help, so let’s give that. But now it is that mental health is a right. So let people let’s honour people’s rights for their health, as well as mental health.

Another good policy, which has been accepted by the United Nations, but also by the WHO, is the policy of universal health coverage, which means everybody should have the access to health and health services, as per their needs.

And it is their right, without incurring the kind of catastrophic health expenses that are very common. And when we use the word health, we include mental health obviously.

So this is, again, very progressive, although I must say that many of these international policies and agreements are far from being implemented within countries.

And here, I mean, rich countries as well as poor. Many of the rich countries have actually not accepted the principle of universal health coverage, and are providing excellent health care for a few. But are ignoring the health needs of a large number of people who live in those countries.

And obviously, in low and middle income countries, this target is far from being achieved. However, it is good to have at least international policies that are progressive and hopefully gradually the countries will adopt and implement many of these policies. And good progress is being made in many countries.

Take the example of India, which has explicitly included mental health within their health policies. And in fact, at a local level, there are health facilities which are keeping mental health as one of the health services that need to be provided. Now that’s something which is good, but of course, the implementation requires much more effort, than is being done.

Take the example of a country like South Africa, where mental health has been integrated within overall health care, but also within maternal child healthcare, which has worked wonders for some of the people who need help. In spite of poor resources they are making making good progress.

Of course, there are rich countries which are making very good policies and implementing them. Take the example of Australia or Canada or some of the Nordic countries, which are doing very well. But many of the low and middle income countries are also making very good progress in their policies.

And when I mention policies, I mean, not only healthcare policies, but overall health and social economic policies, which as we discussed earlier, have a very large role on improvement and promotion of mental health rather than the treatment of mental disorders.

The United Nations Sustainable Development Goals was a promise as they agreed upon it. It was an inspiration. Are we, when we are midway on the SDGs, are we anywhere near achieving them?

I should say that in the area of health, much progress have taken place in some areas, but the progress in many other areas is is very much lacking. And it ism it’s very doubtful whether we will in the next, how many six years that are left, we’ll make enough progress to achieve those goals.

However, I should say in the area of mental health, the progress is really commendable. And we need to increase the resources that need to be available. We need to have better policies, better coverage of of mental disorders, for treatment and care and more human-rights based policies.

And if countries make more efforts, then we can certainly make much more progress on that. If you’re asking me a question, whether the SDG goal number three for health and wellbeing, way actually be achieved by the majority of countries, the answer is no.

But whether improvement is taking place and will take place towards this goals, the answer is yes. But I would also add that we need to speed up our progress if we are anywhere if we are to achieve the targets anywhere near the goals that we agreed upon.

Juliana Gil: 27:50

Thanks for listening to this series How to Save Humanity 17 Goals. Join us again next week when we look at Sustainable Development Goal number four: how to ensure quality education for all. See you then.

Sponsor message: 28:19

This Working Scientist podcast series is sponsored by the University of Queensland, where research is addressing some of the world’s most challenging and complex problems.

Take your research further at UQ. Visit uq.edu.au

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February 9, 2024
Why we need to rethink how we talk about cancer

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Download the Nature Podcast 9 February 2024

For over a century, cancer has been classified by areas of the body – lung cancer, breast cancer, skin cancer etc. And yet modern medical research is telling us that the molecular and genetic mechanisms behind cancers are not necessarily tied to parts of the body. Many drugs developed to treat metastatic cancers have the capacity to work across many different cancers, and that presents an opportunity for more tailored and efficient treatments. Oncologists are calling for a change in the way patients, clinicians and regulators think about naming cancers.In this podcast, senior comment editor Lucy Odling-Smee speaks with Fabrice André from Institute Gustave Roussy, to ask what he thinks needs to change.Comment: Forget lung, breast or prostate cancer: why tumour naming needs to change

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February 9, 2024
Premature and early menopause in India: what are the triggers?

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A study published in Scientific Reports explored the triggers of premature and early menopause in India based on the 2019–2021 National Family Health Survey. There were 96 million women over the age of 45 in India in 2011, a number that is expected to increase to more than 400 million by 2026.

Study: Exploring the triggers of premature and early menopause in India: a comprehensive analysis based on National Family Health Survey, 2019–2021. Image Credit: AJP/Shutterstock.com

Background

Biologists have hypothesized that the natural age for women to experience menopause, defined as ovarian failure, is between the ages of 45 and 50, during which individuals transition to a post-reproductive stage of their lives. Reaching menopause before the age of 40 is considered to be premature, while menopause before the age of 45 is considered early menopause.

Estimating the prevalence of premature and early menopause and identifying risk factors associated with them can enable public health professionals and policymakers to design appropriate policy interventions and ensure the preparedness of health systems to meet the needs of this population.

About the study

In addition to calculating prevalence, researchers in this study hypothesized that lifestyle behaviors, medical histories, and demographic and socioeconomic factors would modify the risk of premature and early menopause. The data used for the analysis came from the fifth round of the Indian National Family Health Survey (NFHS), which included 724,115 female respondents.

After excluding women who were pregnant or lactating during the survey, as well as those who had experienced surgical menopause, the final sample included 429,446 women who had experienced premature menopause and 79,643 women who had experienced early menopause. Women were categorized as menopausal if they had not had a menstrual cycle for a year or more.

Socioeconomic and demographic factors included education, case, religion, place of residence, household wealth index, working status, marital status, and geographical region. Lifestyle behaviors included consumption of tobacco and alcohol as well as unhealthy dietary patterns (specifically high intake of aerated drinks and fried foods). Anthropometric data was used to assess body mass index (BMI) and anemia status.

Hazard ratios were calculated from this data to assess how the risk of early or premature menopause changed for women in different demographic, socioeconomic, and other categories.

Findings

The prevalence analysis suggested that 2.23% of women between the ages of 15 and 39 experienced premature menopause, while 16.2% of women between the ages of 40 to 44 experienced early menopause. The majority of women experiencing early and premature menopause resided in rural areas (66%), and 15 to 40% of these women had received no education. Nearly 40% were poor, most were married, and more than 60% had delivered their first child when they were between 18 and 24 years old.

Time trends indicated that the prevalence of premature menopause showed gradual decreases over time; premature menopause peaked in 1998-1999 (3.4%) before declining or remaining stable in subsequent waves. Conversely, early menopause, which showed a prevalence of 21% in the 1990s, fluctuated over time.

Bivariate analyses showed that rural, employed women, those with low education, those with low household wealth, and those belonging to the ‘other backward classes’ (OBC) category were significantly more likely to experience premature menopause. Women in Northern and Western India were also at higher risk. Other risk factors included regular intake of fried food, alcohol use, and tobacco consumption. For early menopause, bivariate analysis identified similar risk factors.

Survival models suggested that higher educational levels were protective against premature menopause, as were unemployment and high wealth. Women who reported never getting married were less likely to have premature menopause, while those who had terminated a pregnancy faced a higher risk. Other risk factors included smoking and using unhygienic menstrual methods. Women whose age at menarche was 12 or less had an increased risk of premature menopause compared to those whose age at menarche was 15 or more.

Conclusions

To summarize, the study made use of a large-scale, nationally representative population survey to assess the prevalence and drivers of premature and early menopause. The authors surmised the existence of links related to nutrition and poverty. Specifically, educational, economic, and residential vulnerabilities could intersect and lead to compounded effects on the age at menopause.

Strengths of the study include its methodological robustness and use of a nationally representative survey, which collected detailed data to assess the relative importance of various factors in early and premature menopause. The comprehensive medical histories made it straightforward to exclude women who had hysterectomies or low estrogen levels. However, the self-reported nature of menstrual data could lead to recall bias, and the cross-sectional design does not allow for causal inference.

Further study on this topic, particularly through detailed micro-studies, will strengthen the public health system and allow public health initiatives to target health and nutrition interventions for underprivileged women to address menopause-related concerns such as osteoporosis.

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February 8, 2024
Study finds gut health key to combating skin diseases, eyes probiotics as potential treatment
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In a recent study published in the International Journal of Molecular Sciences, a team of Polish researchers conducted a review to understand the connection between the gut microbiome and dermatological diseases and examined the use of probiotics to correct gut microbiome dysbiosis as a treatment for various skin diseases.

Study: The Role of the Gut Microbiome and Microbial Dysbiosis in Common Skin Diseases. Image Credit: Kateryna Kon / Shutterstock

Background

While dermatological diseases are largely non-fatal, they still contribute substantially to the global public health burden, notwithstanding the impact of skin diseases on mental health and the quality of working and daily life due to discomfort and social stigma. Genetic and environmental factors often cause skin diseases. However, increasing research suggests that the gut microbiome, which plays a significant role in the progression of various types of diseases, also contributes to the development and progression of dermatological diseases.

Nucleic acid sequencing has been extensively used to explore bacterial genes, understand microbiome composition, abundance, and diversity, and understand the pivotal role the gut microbiome plays in human health and homeostasis. Gut microbiome dysbiosis has been found to significantly affect the development and progression of various chronic diseases. Determining the contribution of microbiome dysbiosis in the pathogenesis and progression of dermatological diseases could help find novel therapeutic avenues for skin diseases.

Gut microbiome function

In the present review, the researchers discussed the assembly and composition of the gut microbiome and its role in human health. The review reported that the gut microbiome consists of over 10¹⁴microorganisms, cumulatively weighing the same as the human liver. Furthermore, over three million of the bacterial genes from the gut microbiome are responsible for synthesizing numerous metabolites, some of which are essential for human health.

The studies examining the assembly and composition of the gut microbiome largely indicated that the gut microbiota is acquired as early as the prenatal developmental stages, and the microbiome profile is established by the age of five or six, which continues into adulthood. Bacteroidetes and Firmicutes are the two most dominant taxa of bacteria in the healthy human gut microbiome, with individual differences in the microflora proportions and compositions being present.

Antibiotic use, genetics, diet, and lifestyle factors such as smoking, stress, improper sleep, exercise, and body mass index are known to affect the gut microbiota profile. Diets composed mainly of fats, processed food, and sugars and low in fiber are known to push the gut microbiome towards an inflammatory profile.

Dermatological diseases and the gut microbiome

The review also included a detailed examination of the role of the gut microbiome in numerous dermatological diseases, including atopic dermatitis, psoriasis, acne, and alopecia areata. Studies have reported that the chronic nature of atopic dermatitis, especially the persistence of pruritis despite medication, has been known to lower the quality of life significantly and is linked to an increased risk of depression and anxiety. The review found that gut microbiome dysbiosis is strongly associated with atopic dermatitis.

Results from genome-wide association studies have shown that bacterial taxa such as Bifidobacteriaceae, Bifidobacteriales, Bifidobacterium, Christensenellaceae, Clostridia, Mollicutes, and Tenerticutes exhibit a negative correlation with the risk of atopic dermatitis, while Anaerotruncus, Bacteroides, and Bacteroidaceae exhibit a positive correlation.

Furthermore, in cases where atopic dermatitis developed in adulthood, the alpha diversity of the gut microbiome was lower. The species richness and proportion of taxa also differed between atopic dermatitis patients with and without gastrointestinal symptoms. Additionally, the lowering of alpha diversity was also associated with a higher risk of atopic dermatitis, severity, remission, and age of onset of the disease.

Genomic examinations of stool samples from psoriasis patients have found lower species diversity in their gut microbiome and significant dysbiosis as compared to healthy controls. Furthermore, while the microbiomes of psoriasis patients and healthy controls both comprised Actinobacteria, Proteobacteria, Firmicutes, and Bacteroidetes, the abundance of Proteobacteria and Bacteroidetes was substantially lower, and that of Actinobacteria and Firmicutes was significantly higher in the gut microbiome of psoriasis patients.

The review also discussed the findings from numerous studies on the link between the gut microbiome and the development, symptoms, severity, and progression of acne, and alopecia areata.

Conclusions

To summarize, the review examined numerous studies investigating the connection between the gut microbiome and dermatological diseases such as atopic dermatitis, psoriasis, acne, and alopecia areata. The findings indicate that gut microbiome dysbiosis at various stages in life is significantly associated with the development, severity, and progression of skin diseases.

Furthermore, while the research on the use of probiotics to alleviate the symptoms of various skin diseases is limited, the review found that some studies have found positive results, highlighting the need to further explore the potential use of probiotics as a therapeutic avenue for skin diseases.
Journal reference:

Ryguła, I., Pikiewicz, W., Grabarek, B. O., Wójcik, M., & Kaminiów, K. (2024). The Role of the Gut Microbiome and Microbial Dysbiosis in Common Skin Diseases. International Journal of Molecular Sciences, 25(4). DOI: 10.3390/ijms25041984, https://www.mdpi.com/1422-0067/25/4/1984
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February 8, 2024
Chewing tobacco linked to higher stroke and cancer risk, study finds
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In a recent study in the journal Nature Communications, researchers systematically reviewed and synthesized the literature on the health risks associated with chewing tobacco. Their results indicate that people who chew tobacco are significantly more likely to suffer from strokes and several cancers.

While chewing tobacco is not as prevalent as smoking cigarettes, estimates suggest that more than 270 million people use smokeless tobacco products, of whom the majority live in India and Bangladesh. Smoking has declined since the 1990s, while the popularity of chewing tobacco appears to have increased, including among women.

The health risks of chewing tobacco are less understood compared to the almost universal consensus on the harms caused by cigarettes and other forms of smoking. However, smokeless tobacco is thought to be a carcinogen.

Study: Health effects associated with chewing tobacco: a Burden of Proof study. Image Credit: bildfokus.se / Shutterstock

About the study

In this study, researchers conducted a systematic review and meta-analysis across three scientific databases (Global Index Medicus, Web of Science, and PubMed) to analyze relationships between chewing tobacco and stroke, ischemic heart disease, and five types of cancer of the neck and head.

The search included publications regardless of their language and papers published from 1970 onwards. They used meta-regressions and Bayesian methods to estimate a measure of pooled relative risk and then obtained an effect size for each health outcome. Of the literature obtained from the search, 4,480 were excluded, and 111 were included in the analysis.

Findings

Three studies conducted in Bangladesh and India included data on chewing tobacco and stroke; the meta-analysis suggested that conservatively, using smoking tobacco products increased the risk of stroke by 16%. This association is classified as a ‘weak’ relationship. However, these findings were robust to various validations; no publication or covariate bias was detected.

Eight studies examined associations between smokeless tobacco and ischemic heart disease, most of which were conducted in Bangladesh, India, and the United States. The meta-analysis found no evidence that chewing tobacco significantly changed ischemic heart disease risk; again, researchers found no evidence of publication bias or covariate bias.

For esophageal cancer, 22 studies were identified; analysis suggested that using chewing tobacco significantly increased the risk of cancer by 2% conservatively. However, a meta-analytic approach yielded a higher estimate of a 2.14-fold increase in esophageal cancer risk. Smoking status, sex, and age were adjusted for in the final analysis, and no publication bias was detected.

A total of 70 studies examined associations between smokeless tobacco products and cancers of the lip and oral cavity. The analysis incorporated numerous sources of uncertainty and found a relative risk factor of 3.64, and the association was characterized as weak; the risk of developing these forms of cancer increased when the sample was restricted to studies conducted in Asian countries.

The effect size for laryngeal cancer was estimated from 24 studies. Researchers found that evidence regarding this outcome was weak after accounting for sources of uncertainty, while the relative risk factor was 2.66. However, for a single study, the relationship between smokeless tobacco and laryngeal cancer was significantly higher.

17 studies were included for nasopharyngeal cancer, and weak evidence of a relationship with a relative risk measure of 2.50 was seen. Age and sex were included in the model after covariate selection, and no evidence of publication bias was found.

The outcome included in the meta-analysis was other cancers of the pharynx; data for this model was obtained from 31 studies. The relative risk factor was 2.33, and the association was characterized as weak. However, using a subset of the data, a higher risk measure of 4.38 was found, showing a stronger association.

Conclusions

The study had various strengths, including reducing the impact of geographical variation. Of the seven health outcomes included, six showed at least weak evidence of increased risk faced by smokeless tobacco users; the only outcome for which no evidence was found was ischemic heart disease. The highest risks were of stroke and esophageal cancer, with a conservative estimate suggesting an increase in incidence of 2-16%.

An important conclusion was that while chewing tobacco is considered a carcinogen, the literature predominantly examined its relationship with lip, oral cavity, and esophageal cancer, highlighting the need for more high-quality studies on associations with other cancers of the head and neck. Specifically, nasopharyngeal and laryngeal cancer should also merit careful observation in the future, as should stroke.

Limitations of the study included the variety of smokeless tobacco products, exposure definitions, and geographical settings. The approach followed in this study was also not able to estimate dose-response relationships. However, these findings can be used by public health workers to better counsel clients on harms associated with smoking tobacco products and advocate for more effective public health policies, while they may also be of interest to community awareness campaigns.
Journal reference:

Health effects associated with chewing tobacco: A Burden of Proof study. Gil, G.F., Anderson, J.A., Aravkin, A., Bhangdia, K., Carr, S., Dai, X., Flor, L.S., Hay, S.I., Matthew, M.J., McLaughlin, S.A., Mullany, E.C., Murray, C.J.L., O’Connell, E.M., Okereke, C., Sorensen, R.J.D., Whisnant, J., Zheng, P., Gakidou, E. Nature Communications (2024). 10.1038/s41467-024-45074-9, https://www.nature.com/articles/s41467-024-45074-9
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February 8, 2024
Why a cheap, effective treatment for diarrhoea is underused

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A salty-sweet solution is a cheap and effective way to prevent children’s death from diarrheal diseases. Yet doctors did not always recommend them.Credit: Jewel Samad/AFP/Getty

“The gap between knowing the right thing and doing the right thing is a persistent problem,” says David Levine, a health economist at the University of California, Berkeley. That gap is highlighted by a study published today in Science¹.

Every year, half a million children under five die of diarrhoea globally — but doctors and pharmacists often don’t prescribe a cheap lifesaving treatment for the condition. A large Indian study suggests that this happens because prescribers don’t think that their patients want the therapy.

Most private doctors and pharmacists in the study understand the benefits of an oral rehydration solution (ORS). The treatment, a pre-mixed sachet of salts and sugars that is mixed with water, has been around for more than half a century. It prevents dehydration and drastically reduces the risk of children dying from diarrhoea.

To better understand why more children aren’t given ORS, Zachary Wagner, a health economist at the RAND Corporation, a non-profit research and policy organization in Santa Monica, California, and his colleagues launched a large experimental intervention in two Indian states, Karnataka and Bihar.

They sent actors pretending to be the fathers of a sick two-year-old child to more than 2,000 randomly selected private doctors and pharmacists in mid-sized towns. Three-quarters of carers in India seek help for their sick children from private clinics and pharmacies.

The interactions were designed to assess whether low levels of ORS prescription were due to supply shortages, incentives to sell more expensive drugs, such as antibiotics, or sensitivity to patient desires.

Each actor arrived at a facility unannounced and explained that their child had been experiencing diarrhoea for two days. Some told the provider that they had previously used ORS to treat their child and asked whether they should use it again. Some instead mentioned antibiotics, and others brought up no earlier treatments. Some actors noted that they would not be purchasing any medications at the facility and just wanted advice. The researchers also sent a six-week supply of ORS to half of the facilities.

The researchers found that a patient’s treatment preference was much more important than the clinic or pharmacy’s financial incentives and accessible stock in explaining why ORS is under-prescribed.

Actors who expressed a preference for ORS were twice as likely to get it as those who mentioned no treatment. A survey of more than 1,000 carers across the two states and representatives from the clinics and pharmacies revealed that 48% of carers feel that ORS is the best treatment for diarrhoea, but only 16% express that preference when visiting clinics. In turn, only 18% of doctors and pharmacists think that their patients want ORS.

“It is a very elegant study,” says Levine.

Happy clients

The results “somewhat go against the belief among economists that financial incentives matter an awful lot”, says Karen Grépin, a health economist at the University of Hong Kong. Instead, informational barriers were more important.

But Ramanan Laxminarayan, an epidemiologist at Princeton University in New Jersey, says that financial incentives can be hard to disentangle from other motives. “We think of doctors as neutral decision-makers based on what is best for the patient, and that is often not the case,” says Laxminarayan. “Doctors make decisions based on what makes a patient happy,” he says, which has an underlying financial motive. “If a patient is not happy with you, they are not going to keep coming back.”

Overall, Grépin says the study is impressive, but there is still a lot more to unpack. For example, it is not clear why some patients don’t communicate their preference for ORS to their providers. The study also doesn’t offer a clear path forward on how to improve ORS uptake, she says. “It doesn’t really tell me what to do next.”

Wagner plans to design studies to test interventions for changing the perception of doctors and pharmacists, and how patients express their preferences. “Just telling people that ORS is a lifesaving medicine — we’ve hit the ceiling on what that can do.”

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February 8, 2024
Trust in doctors key to boosting vaccination rates

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“Trust me, I’m a doctor.”

While this expression has become an advertising slogan and meme, physicians and nurses continually rank among the most trusted professions in the U.S.

Now, a new study by researchers at the NYU School of Global Public Health shows that how Americans view the medical profession shapes whether they are likely to get vaccinated against COVID-19.

Among people who were hesitant or initially didn’t want a COVID-19 vaccine, those who trust the medical profession were more likely to ultimately get vaccinated. In addition,

people who were vaccinated and reported trusting their own doctor were more likely to get a booster.

In contrast, trust in public officials-;including national, state, and local leaders-;did not shift behaviors around vaccination.

“Our research suggests mobilizing the medical community is critical for addressing reluctance, uncertainty, and distrust of vaccines,” said Diana Silver, professor of public health policy and management at the NYU School of Global Public Health and the lead author of the study, published in the February issue of Preventive Medicine Reports.

Trust in government institutions, experts, and the medical community emerged as flashpoints in the polarized context of the COVID-19 pandemic. Medical professionals, including doctors and nurses, have long played a critical role in educating their patients about vaccination and administering vaccines, but the COVID-19 pandemic brought about new questions on the relationship among experts, trust, and attitudes toward vaccines.

The NYU researchers analyzed data collected by Social Science Research Solutions from 1,967 U.S. adults who were surveyed twice, once in April 2021 and again in June 2022. Participants were asked about their levels of trust in the medical profession, their own doctor, and national, state, and local officials. They also answered questions about their views on the COVID-19 vaccine and whether they were vaccinated (in 2021 and/or 2022) and boosted (in 2022).

A divide in public trust

Levels of trust varied considerably between those who were vaccinated or eager to be vaccinated and those who were hesitant or refused to be vaccinated. Among individuals who were vaccinated or eager to do so, 88% reported high levels of trust in their own doctors and 70% had high levels of trust in state and local officials. In contrast, vaccine-hesitant individuals were far less trusting of officials: 46% reported high levels of trust in their own doctors and about 25% had high levels of trust in state and local officials. This pattern was the same for trust in federal officials and the medical profession.

Among those hesitant to get vaccinated in 2021, trust in the medical profession was associated with ultimately deciding to get vaccinated by 2022. And for those who were vaccinated or eager to be in 2021, trust in one’s own doctor was linked to seeking a booster by 2022.

The research also revealed how COVID-19 vaccines have been politicized: holding trust in officials and other factors constant, Republicans and Independents were far less likely to ultimately choose to be vaccinated or seek booster shots than Democrats.

The researchers conclude that engaging the medical profession in communicating the benefits of vaccines will be needed in future pandemics.

The primary care workforce may, in particular, play an important role, given that many have long-standing relationships with their patients and have built trust.”

Diana Silver, professor of public health policy and management, NYU School of Global Public Health

Additional study authors include David Abramson of NYU School of Global Public Health and NYU alumnae Rachael Piltch-Loeb and Yeerae Kim. The authors were supported by a grant from the National Science Foundation (#2049886).

Source:

Journal reference:

Silver, D., et al. (2024). One year later: What role did trust in public officials and the medical profession play in decisions to get a booster and to overcome vaccine hesitancy? Preventive Medicine Reports. doi.org/10.1016/j.pmedr.2024.102626.

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February 7, 2024
Study reveals high insomnia rates in non-hospitalized COVID-19 survivors

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In a recent study published in Frontiers in Public Health, researchers investigated insomnia prevalence and its association with anxiety and depression in the non-hospitalized coronavirus disease 2019 (COVID-19)-recovered community.

Study: Sleep quality among non-hospitalized COVID-19 survivors: a national cross-sectional study. Image Credit: Stock-Asso/Shutterstock.com

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has afflicted millions globally since late 2019, with most cases resolved by mid-2023. Common symptoms include coughing, weariness, fever, dyspnea, musculoskeletal issues, gastrointestinal complaints, anosmia, dysgeusia, and vertigo. Post-infection and long-term physical and psychological difficulties are serious public health concerns.

Insomnia is a prevalent complaint, particularly among hospitalized COVID-19 patients. High-risk variables include being female, younger, and more educated, as well as having anxiety, depression, or post-traumatic stress disorder. Poor mental health is associated with insufficient sleep, and chronic disorders such as obstructive sleep apnea (OSA) can affect glycemic control, neurocognitive impairment, and aberrant functional pulmonary alterations.

About the study

In the current nationwide cross-sectional study, researchers investigated insomnia prevalence among COVID-19 survivors with no or moderate symptoms who did not require hospitalization throughout the recovery period (six months) and discovered relevant variables.

Between June and September 2022, the team conducted a web-based survey among 1,056 COVID-19-recovered individuals who recovered within six months of acute SARS-CoV-2 infection and did not need hospitalization. They used the Depression Anxiety and Stress Scale-14 (DASS-14) and the Insomnia Severity Index (ISI). They obtained data on demographics such as age, marital status, sex, educational attainment, occupation, employment status, and comorbidities.

The team asked the respondents to rate their SARS-CoV-2 infection severity and duration (days from the initial SARS-CoV-2-positive to the initial SARS-CoV-2-negative report). In addition, the respondents compared their sleep quality, sleep initiation, and total sleep duration in the previous two weeks with the time before confirming the SARS-CoV-2 infection.

The team used multivariate logistic regressions to determine odds ratios (OR) for the relationships between anxiety and depression scores and insomnia levels among the survey respondents. They included adult COVID-19 survivors (who recovered as confirmed using polymerase chain reaction (PCR) within six months and did not require COVID-19-associated hospitalization) in Vietnam’s general population. They excluded individuals diagnosed with insomnia or psychological disorders before the study.

Results

The study included 1,056 individuals, with the majority being married (64%), female (69%), and having attended university (69%). After the SARS-CoV-2 infection, almost a third of respondents reported shorter sleep duration, worsened sleep quality, and more difficulties falling asleep, and half of them reported more nocturnal awakenings. Insomnia prevalence was 76%, with 23% of patients reporting severe insomnia.

Individuals with anxiety (OR, 3.9) or depression (OR, 3.5) had a significantly increased risk of having insomnia. Other characteristics that increased the likelihood of sleeplessness included higher educational attainment and pre-existing medical conditions, but COVID-19 duration and symptoms had no significant relationship.

Individuals who were divorced or widowed, female, had postgraduate education, were not actively employed, or suffered from chronic medical conditions had higher mean ISI ratings than their peers. Concerning COVID-19, 92% of infected individuals experienced symptoms (mean, 11 weeks). Although these symptomatic individuals showed higher ISI scores (15.2), there was no significant difference compared to individuals without symptoms.

The mean scores for anxiety and depression were 7.6 and 6.4, respectively, with 439 (42%) and 291 (28%) individuals reporting relevant symptoms, respectively. Individuals with symptoms of anxiety (18.7) and depression (19.1) scored significantly higher on the ISI compared to those without (12.4 and 13.5, respectively). Participants experiencing insomnia scored higher on anxiety (9.2) and depression (7.8) than the overall group mean.

In univariate analysis, those who were wedded and had a university degree were significantly less likely to experience insomnia than single and formally-educated individuals. Students were significantly more likely to experience insomnia compared to healthcare workers. Individuals with a history of chronic medical conditions were significantly more likely to suffer from insomnia following COVID-19 compared to healthy individuals. After controlling for variables, healthcare professionals had a significantly increased likelihood of insomnia (OR, 1.6) than workers in other professions; however, there were no differences compared to those who did not work or were students.

Conclusion

Overall, the study findings highlighted insomnia prevalence among COVID-19 survivors, with more than 75% reporting it. This percentage is much higher than that of the general population (10% to 20%) and hospitalized survivors (12% to 47%). Individuals with chronic medical conditions are more likely to suffer from insomnia, which is underreported. Public health researchers should anticipate a greater frequency of insomnia and sleep disorders in this group, which can last for one-third of healed patients up to one year after infection.

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February 7, 2024
Eleven stroke researchers to be recognized during the 2024 International Stroke Conference
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Eleven scientists leading the way in stroke research will be recognized during the American Stroke Association’s International Stroke Conference 2024 for their exceptional professional achievements. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

The illustrious group of awardees includes four groundbreaking scientists who have devoted their careers to stroke research and six scientists will be recognized for their notable new research. The awards include the Ralph L. Sacco Outstanding Stroke Research Mentor Award, which honors Ralph L. Sacco, M.D., M.S., FAHA, a past president of the American Heart Association and American Stroke Association, who passed away in January 2023.

The 2024 honorees are:
- Bernadette Boden-Albala, M.P.H., Dr.P.H., University of California, Irvine, who will receive the Edgar J. Kenton III Lecture Award.
- Steven Warach, M.D., Ph.D., Dell Medical School at The University of Texas at Austin, who will receive the David G. Sherman Lecture Award.
- James F. Meschia, M.D., FAHA, Mayo Clinic in Jacksonville, Florida, who will be honored with the William M. Feinberg Award for Excellence in Clinical Stroke.
- Marc I. Chimowitz, M.B., Ch.B., Medical University of South Carolina, who will receive the Ralph L. Sacco Outstanding Stroke Research Mentor Award.
- Louise D. McCullough, M.D., P.H.D., McGovern Medical School at UTHealth Houston, who will be awarded the Thomas Willis Lecture Award.
- ·Takuma Maeda, M.D., Ph.D., Barrow Neurological Institute in Phoenix, who will receive the Mordecai Y.T. Globus New Investigator Award, for a research abstract.
- Raed Joundi, M.D., D.Phil., McMaster University in Hamilton, Ontario, Canada, who will receive the Vascular Cognitive Impairment Award for research being presented at the meeting.
- Oriana Sanchez, M.D., University of Texas, Houston, who will receive this year’s Robert G. Siekert New Investigator Award in Stroke for a research abstract.
- ·Mohammed Abdelsaid, R.P.H., Ph.D., Mercer University School of Medicine, Savannah, Georgia, who will receive the Stroke Basic Science Award for a research abstract.
- Shumei Man, M.D., Ph.D., FAHA, Cleveland Clinic in Ohio, who will receive the Stroke Care in Emergency Medicine Award for research being presented at the meeting.
- Susan Linder, P.T., D.P.T., Ph.D., Cleveland Clinic in Ohio, who will be awarded the Stroke Rehabilitation Award for a research abstract.
Bernadette Boden-Albala, M.P.H., Dr.P.H., the winner of the Edgar J. Kenton III Lecture Award, is the director and founding dean of the University of California, Irvine’s Program in Public Health and future School of Population and Public Health. With more than two decades of research experience, Boden-Albala is an internationally recognized expert in the social epidemiology of chronic disease whose research has focused on eliminating health disparities through defining and intervening on social support, structural and institutional barriers to optimal health. Her areas of expertise include community-based participatory research, health equity, stroke and cardiometabolic health disparities. She has led numerous large, multi-site studies utilizing community-based participatory research methods in urban and rural communities across the United States and globally, as well as large community health assessment, evaluation, capacity building and workforce training projects. The Edgar J. Kenton III Lecture Award recognizes lifetime contributions to the investigation, management, mentorship and community service in the field of racial and ethnic stroke disparities or related disciplines. Boden-Abala will present her Edgar J. Kenton III lecture, “A Roadmap for Health Equity: Understanding the Importance of Community-Engaged Research,” at 10:18 a.m. MT, Tuesday, Feb. 6.

Steven Warach, M.D., Ph.D., the recipient of the David G. Sherman Lecture Award, is a professor of neurology at Dell Medical School at The University of Texas at Austin, where he is executive director of the Seton Dell Medical School Stroke Institute and also serves as the regional stroke director for Ascension Texas. Warach is known for his seminal contributions in magnetic resonance imaging of stroke. He earned his Ph.D. in psychology-neuroscience from Michigan State University and M.D. from Harvard Medical School, where he completed his neurology residency. The Sherman Award honors David G. Sherman, M.D., a prominent stroke physician and an internationally recognized leader and researcher in stroke prevention and treatment. The award recognizes lifetime contributions to the investigation, management, mentorship and community service in the stroke field. Warach will present his lecture, “Improving Stroke Diagnosis and Treatment: A Journey Toward the End of Time,“ at 11:32 a.m. MT, Wednesday, Feb. 7.

James F. Meschia, M.D., FAHA, the awardee of the William M. Feinberg Award for Excellence in Clinical Stroke, is professor of neurology and chair emeritus of the department of neurology at Mayo Clinic in Jacksonville, Florida. Meschia is certified by the American Board of Psychiatry and Neurology (ABPN) in neurology and vascular neurology. Meschia is a pioneer in the study of inherited risk factors for ischemic stroke and has had a longstanding commitment to providing the latest evidence for carotid revascularization as a means for stroke prevention. He was the inaugural medical director of the first Joint Commission-certified stroke center within the Mayo Clinic Foundation, and he has authored or co-authored over four hundred peer-reviewed publications. The William M. Feinberg Award for Excellence in Clinical Stroke is named for the prominent stroke clinician-researcher and American Heart Association volunteer who contributed to a more comprehensive understanding of the causes of stroke. The award recognizes significant contributions to the investigation and management of clinical research in stroke. Meschia’s lecture, “Asymptomatic Carotid Stenosis: Current and Future Considerations,” will be presented at 11:03 a.m. MT, Thursday, Feb. 8.

Marc I. Chimowitz, M.B., Ch.B., the recipient of the Ralph L. Sacco Outstanding Stroke Research Mentor Award is professor emeritus of neurology at the Medical University of South Carolina in Charleston, South Carolina. His main career interests are in improving treatments for patients with intracranial arterial atherosclerosis and helping to mentor the next generation of clinical and translational scientists.The Ralph L. Sacco Outstanding Stroke Research Mentor Award recognizes outstanding achievements in mentoring future generations of stroke researchers in the field of cerebrovascular disease. Chimowitz will present his lecture, “Mentoring Clinical Stroke Researchers in Challenging Times,” at 11:34 a.m. MT, Thursday, Feb. 8.

Louise D. McCullough, M.D., P.H.D., FAHA, the winner of the Thomas Willis Lecture Award, is the Roy M. and Phyllis Gough Huffington Distinguished Chair of Neurology at McGovern Medical School; chief of neurology at Memorial Hermann Hospital-Texas Medical Center and co-director of UTHealth Neurosciences, all in Houston. McCullough is a physician-scientist and a practicing vascular neurologist with clinical expertise in sex/gender disparities, the microbiome, stroke and aging, and acute stroke treatments. A renowned investigator, she is well recognized for her work in cerebral vascular disease and is known for her research identifying sex differences in cell death pathways during stroke, which have now been shown to be a major factor in the response to ischemic insult. The Thomas Willis Award recognizes contributions to the investigation and management of stroke basic science. McCullough’s lecture, “Aging, Sex, and Stroke: The Three Amigos of Brain Misadventures,” will be presented at 11:03 a.m. MT, Friday, Feb. 9.

Takuma Maeda, M.D., Ph.D., the Mordecai Y.T. Globus New Investigator Award in Stroke awardee, is a postdoctoral fellow at Barrow Aneurysm & AVM Research Center (BARRC) at the Barrow Neurological Institute in Phoenix. This award recognizes Globus’ major contributions to research in cerebrovascular disease and his outstanding contributions to the elucidation of the role of neurotransmitters in ischemia and trauma; the interactions among multiple neurotransmitters; mechanisms of hypothermic neuroprotection; and the role of oxygen radical mechanisms and nitric oxide in brain injury. Maeda’s award-winning presentation, Abstract 15, “Pharmacological Activation of Efferocytosis Prevents Intracranial Aneurysm Rupture,” will be presented at 7:30 a.m. MT, Wednesday, Feb. 7.

Raed Joundi, M.D., D.Phil., is the Vascular Cognitive Impairment Award recipient. He is an assistant professor at McMaster University, an adjunct scientist at the Institute for Clinical Evaluative Sciences (ICES) and an investigator at the Population Health Research Institute, a joint institute of McMaster University and Hamilton Health Sciences, all in Hamilton, Ontario, Canada. The Vascular Cognitive Impairment Award encourages investigators to undertake or continue research or clinical work in the field of vascular cognitive impairment and submit an abstract to the International Stroke Conference. Joundi’ s award-winning presentation, Abstract 67, “Risk and Time-Course of Post-Stroke Dementia: A Population-Wide Cohort Study, 2002-2022,” will be presented at 7:30 a.m. MT, Thursday, Feb. 8.

Oriana Sanchez, M.D, the winner of the Robert G. Siekert New Investigator Award in Stroke, is currently completing a vascular neurology fellowship in the department of neurology at the University of Texas in Houston. The Siekert New Investigator Award in Stroke recognizes Robert G. Siekert, M.D., who was the founding chairman of the American Heart Association’s International Conference on Stroke and Cerebral Circulation, now known as the International Stroke Conference. The award encourages new investigators to undertake or continue stroke-related research. Sanchez’s award-winning presentation, Abstract 1, “Overcoming Clinical Trial Enrollment Challenges by Monitoring EMS Radio Transmissions: Pre-Hospital Screening of Acute Ischemic Stroke Patients,” will be presented at 7:30 a.m. MT, Wednesday, Feb. 7.

Mohammed Abdelsaid, R.P.H., Ph.D., the recipient of the Stroke Basic Science Award, is an assistant professor at Mercer University School of Medicine in Savannah, Georgia. The Stroke Basic Science Award recognizes outstanding basic or translational science that is laboratory-based. Abdelsaid’s winning presentation, Abstract 17, “SARS-CoV-2 Spike Protein Exacerbates Thromboembolic Cerebrovascular Complications in Humanized ACE2 Mouse Model,” will be presented at 7:54 a.m. MT, Wednesday, Feb. 7.

Shumei Man M.D., Ph.D., FAHA, the Stroke Care in Emergency Medicine Award awardee, is a neurologist at the Cleveland Clinic and stroke center director of Cleveland Clinic Fairview Hospital in Ohio. The Stroke Care in Emergency Medicine Award encourages investigators to undertake or continue research in the emergent phase of acute stroke treatment and submit an abstract to the International Stroke Conference. Man’s winning presentation, Abstract 43, “Race-Ethnic Specific Trends in Stroke Thrombolysis Care Metrics in Relation to U.S. Target: Stroke Nationwide Quality Improvement Program 2003-2021,” will be presented at 2:00 p.m. MT, Wednesday, Feb. 7.

Susan Linder P.T., D.P.T., Ph.D., the Stroke Rehabilitation Award recipient, is director of clinical research for the department of physical medicine and rehabilitation at the Cleveland Clinic in Ohio. The Stroke Rehabilitation Award encourages investigators to undertake or continue research and/or clinical work in the field of stroke rehabilitation. Linder’s winning presentation, Abstract TMP28, “Forced-Rate Aerobic Cycling Enhances Motor Recovery in Persons With Chronic Stroke: A Randomized Clinical Trial,” will be presented at 6:15 p.m. MT, Thursday, Feb. 8.

Source:

American Heart Association
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February 7, 2024