Tag: Research

Simple sore throat can lead to serious damage to the heart valves

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A simple sore throat from a bacterial streptococcal infection can lead to serious damage to the heart valves, a condition known as RHD. It mainly affects children and young adults with poor living conditions and limited access to health care. In Namibia, which was studied for the thesis, it is estimated that about 1% of the population lives with RHD.

In our research, we have reviewed health records from the Ministry of Health and Social Affairs and the Department of Cardiology for the years 2010 to 2020. We also interviewed patients with RHD at the cardiology clinic between 2019 and 2020 to understand how RHD affects them. Furthermore, we have reviewed international studies to assess the effectiveness of different prevention strategies that have been evaluated.”

Panduleni Penipawa Shimanda, dissertation author, Department of Epidemiology and Global Health

Main findings of the study suggest that there is poor documentation and detection of people with RHD in Namibia.

“From a survey of patients, we could see that treatment of RHD means that people can live a good life. Another observation is that there are few preventive interventions that have been evaluated worldwide. Our findings also suggest that school-based screening to detect early symptoms such as sore throat and RHD at an early stage is likely to be cost-effective”.

Overall, RHD was observed in children and young adults in Namibia’s northern regions, possibly due to living conditions and access to medical care.

To improve the situation in Namibia and other countries, ministries of health and health organizations need to work together for better data collection practices, raise awareness of RHD among families and health professionals, and ensure early detection and treatment. Incorporating RHD services into existing health care programs, such as for maternal and child health care, can save resources.

“This is important in countries like Namibia, where RHD prevention is limited. Prevention of RHD can save young lives, and for this we need to find efficient and effective strategies,” says Panduleni Penipawa Shimanda.

The dissertation will take place on 26 April 2024, 09.00. Thesis title: Rheumatic heart disease in Namibia: Evaluation of the burden and cost-effectiveness of a prevention strategy. Opponent Phillip Moons, KU Leuven, Belgium.

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April 23, 2024
Analysis finds significant variations in national COVID-19 treatment recommendations

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National clinical guidelines for the treatment of COVID-19 vary significantly around the world, with under-resourced countries the most likely to diverge from gold standard (World Health Organization; WHO) treatment recommendations, finds a comparative analysis published in the open access journal BMJ Global Health.

And nearly every national guideline recommends at least one treatment proven not to work, the analysis shows.

Significant variations in national COVID-19 treatment recommendations have been suspected since the advent of the pandemic, but these haven’t been formally quantified or studied in depth, note the researchers.

And despite the fact that COVID-19 is no longer taking the toll on lives and health that it once did, the virus is still evolving and active around the globe, they emphasize. The WHO only rescinded COVID-19’s status as a public health emergency in April 2023.

To assess how well national clinical practice followed the recommendations of the WHO (11th version; July 2022)—regarded as the gold standard—-for the treatment of COVID-19, the researchers analysed the content of all 194 WHO member states’ most recent national guidelines at the end of 2022.

Each set of guidelines was scored according to how closely they aligned with the WHO recommendations. Extra points were awarded for those that had been updated within the preceding 6 months; those that made recommendations in line with the strength of evidence; and those that included assessments of the effectiveness of treatments and their side effects.

The wealth and resources of each country were then compared using per capita World Bank gross domestic product (GDP) in US dollars for 2021, the Human Development Index 2021, and the Global Health Security Index 2021.

Of the 194 countries contacted, 72 didn’t respond. Of the remaining 122, 9 had no formal guidelines or couldn’t be accessed (1) and a further 4 didn’t recommend any treatments, so these were excluded, leaving a total of 109.

The countries for which guidelines weren’t obtained had, on average, smaller populations, lower GDP per head, and a lower Global Health Security Index, indicative of greater economic challenges and less ability to respond to health emergencies.

The 11th iteration of the WHO guidelines categorises disease severity, but most of the reviewed guidelines (84%; 92) didn’t define COVID-19 severity in the same way, and some didn’t define severity at all (6.5%; 7). Only 10 guidelines (9%) used disease severity definitions that were comparable with those of the WHO.

Most (77%; 84) guidelines didn’t include an assessment of the strength or certainty of the therapeutic recommendation. And the range of recommended drugs, irrespective of severity, varied from 1 to 22. The WHO guidelines recommend a total of 10.

In all, 105 guidelines included at least one treatment recommended by the WHO, but 4 didn’t recommend any. Countries in the African region had a significantly lower proportion of therapies recommended by the WHO, compared with countries in Europe and SouthEast Asia.

The most commonly recommended drugs were corticosteroids (92%;100), with 80% (88) of guidelines recommending them for the same disease severity as the WHO. But corticosteroids weren’t recommended in severe disease in nearly 1 in 10 guidelines despite overwhelming evidence of their benefit.

Remdesivir was recommended for severe or critical disease in half the guidelines (51%;72). But the WHO guidelines only indicate remdesivir conditionally for mild disease in patients at highest risk of hospital admission.

In late 2022, many guidelines continued to recommend treatments that the WHO had advised against, including chloroquine, lopinavir-ritonavir, azithromycin; vitamins and/or zinc.

One in three guidelines (36; 33%) recommended at least one neutralising monoclonal antibody directed against SARS-CoV-2, the virus responsible for COVID-19.These guidelines were issued by wealthier countries.

But 2 of these monoclonal antibodies—bamlanivimab plus or minus etesivamab and regdanivimab—appeared consistently in clinical guidelines, despite not being recommended by the WHO.

Doses of the most commonly recommended drugs also varied. And many guidelines hadn’t been updated for more than 6 months.

Guidelines from under-resourced countries diverged the most from the WHO recommendations, when stratified by annual GDP, the Human Development Index, and the Global Health Security Index.

The researchers acknowledge several limitations to their findings, including the scoring used to assess the guidelines, which hasn’t been validated by other studies, and the inability to assess all national guidelines.

But they nevertheless ask: “Why do [national guidelines] differ so much in their treatment guidance for such a widespread and potentially serious infection when all have access to the same information?

“Apart from the prohibitive cost of some medications for low-resource settings we do not have a satisfactory explanation.”

They offer some possible explanations, including variations in how the severity of, and therefore the most appropriate treatment for, COVID-19 is defined; the evolution of the evidence; and the research chaos and confusion of the early stages of the pandemic, leading to claims and counterclaims, compounded by intense political and media interest.

“In this ‘fog of war’ countries clearly felt the need to say something and do something, even if it was based on very little evidence,” explain the researchers. “But why many of these unproven remedies continued to be recommended as evidence of their ineffectiveness accrued is much less clear,” they add.

“There is clearly more variation in national guidelines for COVID-19 therapeutics than there should be to ensure optimum treatment,” which aren’t justified by significant differences between populations or geographic variation in SARS-CoV-2 antiviral susceptibility, they write.

Global health inequalities clearly have a part to play, leading to the recommendation of ineffective, unaffordable and unavailable therapies, they suggest.

“The formalisation of processes in the development of [national guidelines] for COVID-19 and other infectious diseases is essential for ensuring that these guidelines are grounded in the best available evidence,” they conclude.

“A systematic and structured approach would not only enhance the credibility of the guidelines but could also contribute to their effectiveness in guiding public health interventions, especially in a pandemic setting.”

Source:

Journal reference:

Cokljat, M., et al. (2024) Comparison of WHO versus national COVID-19 therapeutic guidelines across the world: not exactly a perfect match. BMJ Global Health. doi.org/10.1136/bmjgh-2023-014188.

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April 23, 2024
Cost becomes a significant factor in smoking cessation efforts

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Health concerns are still the primary motive for more than half of those who say they want to stop smoking in England, but cost is now a key factor for more than 1 in 4, finds an analysis of national survey responses, published in the open access journal BMJ Public Health.

Given this shift in thinking, making much more of the potential savings to be had might encourage more people to stub out for good, suggest the researchers.

Health concerns are generally the primary motive for people trying to stop smoking, with social and financial concerns, plus advice from a health professional, also commonly cited reasons, explain the researchers.

But since 2020, England has undergone a period of substantial societal instability, prompted primarily by the COVID-19 pandemic, which might have triggered changes in the reasons smokers give for wanting to ditch tobacco, they suggest.

To find out, the researchers looked at time trends in motives for trying to stop smoking between March 2018 and May 2023, exploring differences by age, sex, socioeconomic status, presence of children in the household and vaping status.

They drew on responses to the ongoing Smoking Toolkit Study, a monthly survey of a representative sample of around 1700 adults in England.

The responses were limited to those who were either current smokers or who had stopped smoking in the past year and had made at least one serious attempt to quit during that time.

Respondents were asked to name the reason(s) behind their most recent quit attempt from among: advice from a health professional; TV advert for a nicotine replacement product; government TV/radio/press advert; a new stop smoking treatment; cost; smoking restrictions; knowing someone else who was quitting; health warning on a cigarette packet; contact from a local NHS stop smoking service; current or future health problems; attending a local stop smoking activity or event; comments by family, friends, children; significant birthday; pregnancy; simple decision to quit; COVID-19 pandemic.

Out of the 101,919 survey respondents between 2018 and 2023, 17,812 reported smoking in the past year. Of these,17,031 (96%) provided data on quit attempts over the past 12 months, 5777 (34%) of whom reported having made at least one serious attempt to do so.

Health concerns were the most frequently cited motives, reported by more than half the sample (52%) across the entire period—especially concerns about future health, reported by more than 1 in 3 (35.5%) compared with 1 in 5 (19%) who were motivated by current health problems.

Cost was the next most frequently cited motive, reported by nearly 1 in 4 (23%), followed by social factors, reported by around 1 in 5 (19%) and advice from a health professional (12%).

Around 4% said they were motivated by health warnings on a cigarette packet, while smoking restrictions prompted 3.5% to try and stop; a simple decision to quit was cited by just over 3%. The other reasons attracted only around 1% each.

Up to the start of 2020, 1 in 2 quit attempts was motivated by health concerns; 1 in 5 by current health problems (20%), and 1 in 3 by concerns about future health (34%). One in 5 was motivated by social factors (20%) and cost (20%), and 1 in 6 by health professional advice (16.5%).

While there was little overall change in the proportion of quit attempts motivated by health concerns across the entire study period, the proportion of quit attempts motivated by cost increased significantly, rising from just over 19% in March 2018 to just under 25.5% in May 2023.

But the proportion of quit attempts motivated by health professional advice fell significantly over the entire study period, dropping from just over 14% in March 2018 to 8.5% in May 2023.

The COVID-19 pandemic, which began to affect England in March 2020, is likely to have influenced the proportion of respondents reporting health concerns, social factors, and cost as motives for trying to stop smoking, suggest the researchers.

The proportion of quit attempts motivated by future health concerns increased during 2020 and 2021.”It is likely the pandemic made health concerns (an already prevalent motive) even more salient, particularly during its first year when the virus was spreading rapidly and vaccinations were not yet available,” they write.

Once the immediate threat of the virus had subsided thanks to the vaccination programme, the proportion of health-related attempts to quit returned to pre-pandemic levels.

The pandemic probably influenced other motives, suggest the researchers, because it prompted loss of income and jobs for many people.

“These economic pressures probably contributed to the rise in cost-motivated attempts to quit around this time. But while the pandemic’s acute risks to health—and, as a result, attempts to quit motivated by concern for health or social factors—waned over time, its economic impacts have been compounded by a cost-of- living crisis,” they explain.

The pandemic’s impact on access to, and availability of, healthcare services may also have contributed to the decline in the proportion of respondents citing healthcare professional advice as a motivating factor, they add.

The researchers acknowledge various caveats to their findings, including that all the study data were self-reported and relied on personal recall, and may not apply to other countries with different attitudes to smoking, tobacco control policies, and provision of smoking cessation services.

But they conclude: “These findings have implications for smoking cessation interventions and clinical practice. ..They indicate that cost is an increasingly important factor motivating people to try to stop smoking.

“Communicating the potential savings people can make by stopping smoking (even if they switch to alternative nicotine products) could therefore be an effective means for motivating attempts to quit.”

Source:

Journal reference:

Jackson, S. E., et al. (2024). Trends in motives for trying to stop smoking: a population study in England, 2018–2023. BMJ Public Health. doi.org/10.1136/bmjph-2023-000420.

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April 23, 2024
Review finds link between active military service and women’s risk of having low birthweight babies

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Active military service may heighten a woman’s risk of having a low birthweight baby, suggests a review of the available scientific evidence published online in the journal BMJ Military Health.

The findings highlight the need for more research specifically focused on women in the armed forces, and their reproductive health in particular, conclude the study authors.

Worldwide, increasing numbers of women are on active service in their country’s armed forces. The UK Armed Forces, for example, has set a target of 30% female representation by 2030. And more and more countries are deploying women in combat units, and in other challenging environments, such as submarines, note the study authors.

Mounting evidence suggests that stress experienced during pregnancy is associated with birth complications, such as preterm delivery and low birthweight. And a military career and lifestyle expose service personnel to a wide range of physical, mental, and environmental stressors that could potentially influence pregnancy outcomes.

The study authors therefore wanted to explore the potential impact of active military service on the risks of preterm labour and birth, low birthweight, and stillbirth.

They scoured research databases for relevant studies, and included 21 that met all the eligibility criteria in their analysis. The studies, which involved 650,628 women serving in the US military, were all published between 1979 and 2023.

Ten of the studies included a comparison group—usually the wives of active service personnel. By way of a proxy for those that didn’t include a comparator, the study authors drew on national data from the US National Vital Statistics for any given year.

Analysis of the study results indicated no heightened risk of preterm birth among pregnant active service women. But there were significant methodological differences; most studies had a moderate to high risk of bias; and several included only small sample sizes, caution the study authors.

There was no observed association between branch of military service and increased risk of preterm birth, although again this should be interpreted cautiously as 5 studies included mixed service samples and the study design varied considerably, say the study authors.

There was no clear evidence for an increased risk of stillbirth among women on active military service, either.

But nearly two thirds (62.5%) of the studies concluded that women on active service may be at heightened risk of having a low birthweight baby, including one study with the lowest risk of bias. And 4 of the 5 studies that included a comparison group also indicated an increased risk of low birthweight.

Seven of the 8 studies reporting on low birthweight were carried out in single-service settings. Both of those from the US Air Force suggested a higher prevalence of low birthweight babies born to active duty military personnel.

But some 53% and 38% of the studies reporting on preterm birth and low birthweight, respectively, didn’t have a matched comparison group and relied on a proxy drawn from national statistical data.

This introduces a risk of systematic error as the baseline characteristics of the two groups are inherently different, caution the study authors.

Women on active military service will also be medically screened before any tours of duty and will have fewer co existing conditions, while national data will include high risk and multiple pregnancies, they explain.

Only observational studies were included in the review, and the data collection methods and/or adjustment for influential factors varied, acknowledge the study authors. Only 8 studies reported on smoking status despite a high prevalence of smoking in the military and the fact that smoking is associated with several health issues before and during pregnancy.

The data also focused exclusively on the US military, which although unsurprising given that it is one of the largest in the world, this does limit the generalisability of the findings to armed forces personnel elsewhere, highlight the study authors.

Nevertheless, they conclude: This review highlights a need for more female-specific research in armed forces, beyond the US military setting, to inform military maternity pathways and policies in ways that safeguard mothers and their babies while enhancing military readiness.”

Source:

Journal reference:

Morris, K. A. L., & McKee, M. (2024). Effect of active-duty military service on neonatal birth outcomes: a systematic review. BMJ Mil Health. doi.org/10.1136/military-2023-002634.

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April 23, 2024
U-M launches interprofessional digital wellness class for sixth graders

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Sixth grader Sera Bergman confesses she spends a significant amount of time watching reels—and enjoys it, like most kids her age. Once she starts scrolling through the short videos, stopping is challenging.

“When I am in the car, I think I will just watch a couple of YouTube shorts before I get somewhere,” said Bergman, who attends Scarlett Middle School in Ann Arbor. “But then when I get out of the car, I’ll be like, ‘Just one more.’ It is super addictive. When creating games and social media apps, designers find ways to make us addicted to them.”

Addiction, cyberbullying, eating disorders, anxiety and other mental health issues caused by problematic digital practices and an increase in screen time are some of the themes of a new and unique University of Michigan interprofessional Peer-to-Peer Digital Wellness class.

This semester, U-M students and scholars launched an interprofessional course in partnership with sixth graders from Ann Arbor Public Schools to provide classroom and real-world engagement about digital wellness.

Evidence suggests the COVID-19 pandemic has intensified mental health issues and shifted social engagement to digital platforms. With an increasing reliance on screens as primary tools of learning, entertainment and socialization, there is a critical need to educate students about digital wellness.

“Enhancing digital wellness, encompassing online engagement activities and emotional experiences, is crucial for students’ emotional, intellectual and social well-being.”

Liz Kolb, clinical professor at U-M’s Marsal Family School of Education

The current digital wellness program evolved from the digital citizenship curriculum designed by Kolb. The curriculum she launched at Scarlett Middle School began with a focus on bullying, privacy and online safety. As the concerns of parents, teachers and scholars around the country have mounted, the new digital wellness program has shifted toward a broader conversation with kids: “What impact are these devices having on me?”

The program is a collaboration between the Marsal Family School of Education, School of Information and School of Social Work. The U-M student mentors are undergraduate and graduate students from these schools taking a digital wellness course.

“Most education around digital device use for young people has focused on safety lectures and lists of ‘do’s and don’ts’ coming from adults and authority figures,” Kolb said. “These approaches do not often work at helping young people understand the impact of their device on their individual mental and physical health, and rarely cause young people to change habits.

“This course takes a different approach, giving young people—both college and middle school students—scientific information about what happens to our bodies when using screens, both the benefits and harms.”

This first class includes 52 sixth graders from Scarlett, Tappan and Clague middle schools and 11 U-M students.

Besides getting internship credit for the class and seeing digital wellness as an area of interest after graduation, master’s student Wanting Qian, majoring in education studies, decided to take this course for its interdisciplinarity.

“This course is interdisciplinary and co-taught by the schools of Social Work, Education and Information, and I want to understand how these three aspects work together,” she said. “I also needed hands-on experience to put theory into practice.”

Qian’s studies are concentrated on design and technologies for learning across cultures and contexts, and she has no doubt that this experience will benefit her future career.

“First, the understanding of trauma-informed practice,” she said. “This is a concept and theory every teacher should be aware of and integrate into their teaching, considering students’ prior experiences and personalities, and being culturally responsive.

“Second, technology is rapidly developing in today’s world. In addition to investing in new technology, we must critically examine how it impacts our lives and what we should do when facing negative influences, especially for the younger generation.”

Muneer Khalid of the U-M Center for Research on Learning and Teaching has been working closely with Kolb and her colleagues Kristin Fontichiaro, clinical professor of information, and Beth Sherman, clinical associate professor of social work, to develop and support the new class.

According to the researchers, it has been surprising to see what the sixth graders and college students have in common regarding their device use and mental health struggles. They hope many schools throughout Michigan and the United States can replicate this digital wellness program.

“Students of all ages have been able to share stories, engage in conversation and debate solutions to their challenges,” Kolb said. “This near-peer approach seems to be leading to more long-term change of habit or, at the very least, an understanding of how individual feelings and emotions are impacted through screen time.

“This project has had a lot of joy, which feels different from the shame often associated with school-related talks/lectures on digital safety and citizenship. Engaging with digital devices in a healthy way should feel good.”

For sixth grader Oliver Thomas, who attends Scarlett Middle School, balance has been one of the program’s big takeaways.

“I learned that technology isn’t a really bad thing,” he said. “It can be bad in some cases, so you just have to monitor it. We learned that social media, for example, can lead to higher anxiety and depression rates. So, I have to be smarter about how much I use social media, if at all. We should try to put it off for as long as we can. But if we decide to use it, we should be smart and put a time limit on it.”

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April 23, 2024
Undernourished household contacts three times more likely to develop TB

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Mycobacterium tuberculosis, the bacteria that causes tuberculosis (TB), is distinct from most germs in its capacity to silently infect individuals for months and even years before waking up and causing active disease that can lead to severe illness and death. The immune system plays an important role in controlling the germ and keeping it dormant.

Decades of epidemiological data have linked undernutrition to TB. While undernourished individuals have blunted immune systems, a phenomenon which has been dubbed nutritionally acquired immune deficiency (N-AIDS), it is not clear why undernourished individuals are at increased risk of TB disease.

In a new study that followed household contacts (family members/people who share the same dwelling) of persons with TB, researchers have found that undernourished household contacts were three times more likely to progress to TB disease. The study did not find that undernourished contacts were at increased risk of testing positive for TB infection as compared to well-nourished individuals.

Are they more likely to become infected with the TB germ? Or are their immune systems unable to contain the germ resulting in severe disease? This fundamental question is important to answer as it can guide how we can best protect undernourished individuals who form a key and vulnerable population in the fight against TB.”

Pranay Sinha, MD, corresponding author, assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine

The researchers, which included investigators from both U.S. and Indian institutions (which are part of the Regional Prospective Observational Research for Tuberculosis (RePORT) India consortium), identified nearly 900 household contacts of persons who were newly diagnosed with TB, screening them to make sure they did not have TB disease at enrollment. They then followed these contacts to see if they developed TB disease for up to four years. Those who had a negative TB infection test at enrollment were retested to see if it had turned positive. The researchers then compared the rate of TB disease and TB infection between undernourished household contacts and well-nourished household contacts.

According to the researchers, these findings have clinical implications. “We now have greater insight into the mechanism by which undernutrition leads to greater TB risk. It is not by increasing infection, instead, it is by failing to contain the infection when it happens. Fortunately, undernutrition is a modifiable risk factor. Our findings should prompt TB programs to promptly provide adequate rations for the entire household to prevent TB disease among household contacts in addition to TB preventive therapy,” adds Sinha.

These findings appear online in the journal Clinical Infectious Diseases.

Source:

Boston University School of Medicine

Journal reference:

Sinha, P., et al. (2024) Undernourished Household Contacts Are at Increased Risk of Tuberculosis (TB) Disease, but not TB Infection— a Multicenter Prospective Cohort Analysis. Clinical Infectious Diseases. doi.org/10.1093/cid/ciae149.

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April 23, 2024
Researchers aim to use AI for early screening and prognosis of Dry Eye Disease

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Dry Eye Disease (DED) is one of the more common eye diseases, affecting up to 30% of the world’s population. This disease can affect many different types of people and can wind up being a great hindrance to their overall quality of life. Early screening and prognosis is vital to the patient’s progression with the disease. However, this can be difficult. In this study, researchers aim to use artificial intelligence (AI) to aid in early screening and prognosis of DED. Not only can the use of AI make screening more accessible for individuals, but it can also aid patients in personalized therapeutic intervention.

Researchers published their results in Big Data Mining and Analytics on April 22.

DED can affect a wide array of people, including those who wear contact lenses, makeup, stay up late, look at screens for a long time and are over 30 years old. Symptoms of this disease are dry eyes, irritation and burning, tears, eye fatigue and pain. One can easily see how this disease has the potential to drastically impact a large portion of the modern world’s population. Here is where the combined efforts of ophthalmic disease detection and the world of computer scientists and engineers can help.

By addressing challenges, imparting insights, and delineating future research pathways, it contributes substantially to the advancement of ophthalmic disease detection through sophisticated technological modalities.”

Mini Han Wang, author and researcher

There are seven facets to this AI-based disease detection. Timely intervention via the AI screening process and correct prognosis is the first part. The use of exhaustive surveys for DED through AI is another, and this is a supporting principle to ensure a level of thoroughness and trustworthiness throughout the process. A systematic approach follows, as well as the marriage of computer science and engineering with ophthalmology. Then, the standards for DED detection must be devised and upheld for future researchers and practitioners, which will naturally lead to the advancement of the field. Finally, all the research, methodologies and tools must be compiled so researchers, scholars and practitioners can have all of the information currently out there available to them.

While the ophthalmologists set the guidelines regarding the framework of the disease and flags for diagnosis, the AI does a lot of the heavy lifting. Ideally, this AI would use images and videos taken from a user’s cell phone to help reach users across the world. The AI can then utilize these images, as well as risk factors in the patient’s life, to make a smart and well-informed prognosis. Further, AI continuously learns and can help propel research forward by contributing to predictive models for DED.

The use of AI detection for DED holds a lot of promise, especially considering the risk factors are often normal activities in many people’s everyday lives. To make the detection methods accessible enough and accurate enough, further research needs to be done.

“However, there are still challenges for engineers to select the diagnostic standards and combinations of different types of datasets. By using trustworthy algorithms, images and videos captured from phones for accessibility purposes, a holistic approach to healthcare for early screening is possible,” said Wang.

With continued testing and collaboration between engineers and ophthalmologists, there is great potential for this method of testing to be useful in contributing to early screening of DED and subsequent therapeutic actions taken for the patient to reduce a worsening condition or to recover some quality of life.

Mini Han Wang and Xiangrong Yu of the Zhuhai People’s Hospital with Mini Han Wang also of the Department of Ophthalmology and Visual Sciences at the Chinese University of Hong Kong, The Faculty of Data Sciences at City University of Macau and the Department of big data at the Zhuhai Institute of Advanced Technology at the Chinese Academy of Sciences, Lumin Xing of the First Affiliated Hospital of Shandong First Medical University, Yi Pan of the Shenzhen Institute of Advanced Technology Chinese Academy of Sciences, Feng Gu of the College of Staten Island at the City University of New York, Junbin Fang at the Department of Optoelectronic Engineering at Jinan University, Chi Pui Pang, Kelvin KL Chong, Carol Yim-Lui Cheung and Xulin Liao of the Department of Ophthalmology and Visual Sciences at The Chinese University of Hong Kong, Xiaoxiao Fang with the Zhuhai Aier Eye Hospital, Jie Yang of the College of Artificial Intelligence at Chongqing Industry and Trade Polytechnic, Ruoyu Zhou and Wenjian Liu with the Faculty of Data Science at City University of Macao, Xiaoshu Zhou with the Centre for Science and Technology Exchange and Cooperation between China and Portuguese-Speaking Countries, and Fengling Wang with the School of Artificial Intelligence at Hezhou Univeristy contributed to this research.

The National Natural Science Foundation of China Natural, the Shenzhen Key Laboratory of Intelligent Bioinformatics, the Shenzhen Science and Technology Program, the Guangdong Basic and Applied Basic Research Foundation, the Zhuhai Technology and Research Foundation, the Project of Humanities and Social Science of MOE, the Science and Technology Research Program of Chongqing Municipal Education Commission and the Natural Science Foundation of Chongqing China made this research possible.

Source:

Tsinghua University Press

Journal reference:

Wang, M. H., et al. (2024) AI-Based Advanced Approaches and Dry Eye Disease Detection Based on Multi-Source Evidence: Cases, Applications, Issues, and Future Directions. Big Data Mining and Analytics. doi.org/10.26599/BDMA.2023.9020024.

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April 23, 2024
Immune dysfunction mechanism discovered in stroke and heart attack patients

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Every year, between 250,000 and 300,000 people in Germany suffer from a stroke or heart attack. These patients suffer immune disturbances and are very frequently susceptible to life-threatening bacterial infections. Until now, little was known about the underlying mechanisms of this immune dysfunction. Research teams from the Faculty of Medicine at the University Hospital of the UDE and the Leibniz Institute for Analytical Sciences in Dortmund have now uncovered a previously unknown cause – and a therapeutic approach. These findings are published in the May 2024 issue of the Journal Nature Cardiovascular Research.

The study was led by Prof. Matthias Gunzer, Director of the Institute of Experimental Immunology and Imaging (IEIB) at the UDE and Head of the Biospectroscopy Department at the Leibniz Institute for Analytical Sciences (ISAS), and Dr. Vikramjeet Singh, Head of the Stroke Immunology Unit at the IEIB. They found that in patients one to three days after a stroke or heart attack, the amount of IgA antibodies in the blood decreases drastically – these are essential for defense against infections. Antibodies come in several subtypes, collectively known as immunoglobulins (Ig), which are produced by specialized plasma cells.

To track down the mechanism behind the loss of antibodies – and to improve the treatment of patients with these findings – the researchers used disease mouse models. Mice also experienced a loss of IgA in their blood and stool after a stroke or heart attack. The researchers discovered that specialized DNA fibers released in blood are a factor in the loss of immune defense. These DNA fibers, known as neutrophil extracellular traps (NETs), originate from the nuclei of another type of immune cell, neutrophils. NETs are released into the blood in large quantities by highly activated neutrophils after a stroke or heart attack and can directly kill plasma cells in the intestine. Probably an even more important effect of NETs is the formation of hundreds of small clots in the blood vessels that supply energy to plasma cells in the intestine. This results in a lack of nutrient and oxygen supply and the Ig-forming cells die off in large numbers.

The immunologists and their teams not only succeeded in proving a causal link between stroke, heart attack and immunodeficiency, but they were also able to demonstrate a new treatment approach: If the NETs were destroyed with the enzyme DNase or their release was prevented by a substance with a novel mode of action, the immune defense remained intact. The researchers were able to demonstrate this both in the mouse model and – in the case of DNase – in later clinical studies.

Until now, no therapeutic approaches could be developed because the cause of the immune deficiency was unclear. A treatment that breaks down the NETs or even prevents them from forming in the first place could be a promising new approach to maintaining the immune defense in patients after a stroke or heart attack. It may be possible to prevent serious secondary infectious diseases or even death.”

Prof. Matthias Gunzer, Director of the Institute of Experimental Immunology and Imaging (IEIB) at the UDE and Head of the Biospectroscopy Department at the Leibniz Institute for Analytical Sciences (ISAS)

Source:

Universität Duisburg-Essen

Journal reference:

Tuz, A. A., et al. (2024). Stroke and myocardial infarction induce neutrophil extracellular trap release disrupting lymphoid organ structure and immunoglobulin secretion. Nature Cardiovascular Research. doi.org/10.1038/s44161-024-00462-8.

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April 23, 2024
PCORI funds more than $150 million to support new patient-centered clinical effectiveness research

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The Patient-Centered Outcomes Research Institute (PCORI) today announced the approval of funding awards totaling more than $150 million to support new patient-centered comparative clinical effectiveness research (CER) studies, research to strengthen the rigor and quality of patient-centered CER and a project to implement the findings of PCORI-funded research into practice.

Among the nine awards for patient-centered CER, two include support for large, two-phased trials comparing approaches to treatments for heart failure and asthma. Two other large studies will compare health system strategies to improve hypertension control, and another will evaluate the effectiveness of medications used for migraine prevention.

As a leading funder of patient-centered comparative clinical effectiveness research, PCORI recognizes the evidence generated from PCORI-funded research helps patients and those who care for them make informed decisions about which health care options will work best for them. These latest awards present significant opportunities to fill important evidence gaps across a broad range of health conditions facing millions of people living in the United States every day.”

Nakela L. Cook, M.D., MPH, PCORI Executive Director

This latest round of PCORI funding awards also includes CER studies exploring questions about the value of screening for financial hardship to improve patient-centered outcomes for individuals with advanced cancer, training to increase shared decision making to improve patient experiences during labor, screening approaches for post-traumatic stress disorder in obstetrics clinics, and strategies to care for patients experiencing intimate partner violence.

Several studies will contribute data and strategies on how to optimize use of care delivery approaches to achieve greater equity in and access to care as well as better outcomes among historically underserved populations.

As generating evidence is not the end of the process to improve health outcomes, PCORI also supports efforts to promote the uptake of PCORI-funded CER findings in clinical practice. One of the new awards funds a project to implement a telepsychiatry model of care to serve primary care patients with more complex psychiatric disorders.

In addition, PCORI approved more than $6 million to fund six studies to improve methods for conducting CER and nearly $7 million for four studies that will strengthen the evidence base to inform researchers on how to optimize engagement of patients and other health care decision makers throughout the design and conduct of patient-centered CER.

“PCORI invests in studies focused on methodology and the science of engagement because it takes rigorously designed and conducted comparative clinical effectiveness research – using evidence-based approaches – to generate reliable results,” said Harv Feldman, M.D., MSCE, PCORI’s deputy executive director for patient-centered research programs. “PCORI also funds projects to encourage uptake of results from PCORI-funded comparative clinical effectiveness research to promote trustworthy findings reaching those whom they can help the most.”

Details of these newly funded studies and projects are available on PCORI’s website. All award funding has been approved pending final PCORI contractual considerations. Since 2010, PCORI has invested more than $4.5 billion to fund patient-centered CER and research-related projects.

Source:

Patient-Centered Outcomes Research Institute

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April 23, 2024
Social media messages may sway young people’s beliefs about mental illness

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Even subtle differences in the wording of social media messages may be enough to sway young people’s beliefs about depression and anxiety and their treatment.

In a new study, researchers found that college students were more optimistic about the possibility of successfully treating mental health problems after they read social media messages conveying what is called a “growth mindset.”

But social media posts written with a “fixed mindset” led young people to feel that depression and anxiety were more stable and innate, and not so easy to treat.

Growth mindset is the belief that a feature, such as mental health, can be improved with effort. A fixed mindset is the belief that a feature can’t change, no matter how hard you try.

The results are important because young people spend a lot of time on social media and those with depression and anxiety may be encountering a lot of messages about their condition, said Whitney Whitted, lead author of the study and a doctoral student in psychology at The Ohio State University.

“These relatively subtle messages may be influencing whether they believe they have any possibility of working through their depression and anxiety and getting better,” Whitted said.

The study, published recently in the Journal of Clinical Psychology, involved 322 undergraduate students.

Participants viewed a series of messages (tweets) from the social media site X, formerly Twitter. They were randomly assigned to view tweets about mental health with a growth mindset or a fixed mindset, or a control condition in which the tweets did not involve mental health at all.

In the fixed mindset condition, the tweets portrayed mental health as a fixed condition that does not change. (For example, one tweet said, “I can’t wait for my seasonal depression to be over so that I can get back to my regular depression.”)

Participants in the growth mindset condition read tweets that emphasized the fluid nature of mental health and the ability to recover from and take control of mental illness. (In one tweet, the user captioned “I got this” to a meme that read “telling those anxious thoughts who’s really in control.”)

After reading the tweets, participants completed a survey assessing their beliefs about how long depression and anxiety normally last and whether they ever go away; the effectiveness of treatment for depression and anxiety; and beliefs about how much control people have in recovering from mental illness.

Results showed that participants who read the growth mindset tweets were more likely than others to say depression and anxiety don’t have to be permanent conditions and that people can take steps to alleviate the symptoms.

In contrast, those who read the fixed mindset tweets had less optimistic views about the permanence of mental illness and the ability of people to treat it.

It is notable that this short intervention had an impact, said study co-author Jennifer Cheavens, professor of psychology at The Ohio State University.

“It was just a few minutes of people reading these tweets with small variations in how the messages about mental illness were framed,” Cheavens said. “But it made a difference in what these participants reported they believed.”

Of course, it is not known how long the changes connected to reading the social media messages will last. But the results could be encouraging for several reasons.

For one, it suggests that growth mindset social media messages may help persuade people with depression or anxiety that it is worthwhile to seek help, the researchers said.

It can also help with people who are already in therapy.

We want our clients to put in the hard work necessary to overcome their problems – but they have to believe it is possible.

This study suggests there may be ways to give them a boost, to help persuade them that working hard in therapy can pay off in the end.”

Jennifer Cheavens, professor of psychology, The Ohio State University

Whitted said the findings are especially important now, given how much time young people spend on social media. Participants in this study reported using social media one to three hours a day.

“What we found is that what young adult college students view on social media has the potential to impact what they believe about mental illness,” Whitted said.

“It is important that the messages they receive accurately reflect what we know about mental illness, especially the fact that it is treatable.”

Other co-authors were Matthew Southward of the University of Kentucky; Kristen Howard of the Milwaukee VA Medical Center/Medical College of Wisconsin; Samantha Wick of Miami University; and Daniel Strunk of Ohio State.

Source:

Journal reference:

Whitted, W. M., et al. (2024). Seeing is believing: The effect of subtle communication in social media on viewers’ beliefs about depression and anxiety symptom trajectories. Journal of Clinical Psychology. doi.org/10.1002/jclp.23647.

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April 23, 2024