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Belief in conspiracy theories about the coronavirus pandemic is not only persistent but also is associated with reluctance to accept a COVID-19 vaccine when one becomes available and to engage in behaviors such as mask-wearing that can prevent its spread, according to researchers at the Annenberg Public Policy Center.

In a new study, based on a two-wave national panel survey conducted in late March and mid-July, the researchers find that belief in conspiracy theories about the source and seriousness of the pandemic persisted across the four-month period. These beliefs in March were associated with increasing reluctance to adopt preventive behaviors in July, including actions such as mask-wearing and accepting a vaccine when one is available.

“Belief in pandemic conspiracy theories appears to be an obstacle to minimizing the spread of COVID-19,” said Dan Romer, research director of the Annenberg Public Policy Center (APPC) of the University of Pennsylvania, who co-authored the study with APPC director Kathleen Hall Jamieson. “To control the pandemic we need high rates of mask-wearing, physical distancing, and hand-washing now – and of vaccination when a safe and effective vaccine is available.”

The study was published today in the journal Social Science & Medicine.

Widespread belief in conspiracy theories

Researchers assessed belief in three COVID-19 conspiracy theories in March and July among 840 U.S. adults on a survey panel and found that high proportions believed in them at both times:

More than 1 in 4 people (28%) in March reported believing that the Chinese government created the coronavirus as a bioweapon, a proportion that increased to 37% in July;
Nearly 1 in 4 (24%) believed in March that some in the U.S. Centers for Disease Control and Prevention, or CDC, are exaggerating the danger posed by the virus in order to damage Donald Trump’s presidency, which increased to 32% in July;
Nearly 1 in 7 (15%) believed that the pharma industry created the virus to increase sales of drugs and vaccines, which edged up to 17% in July.

Heavy use of conservative media or social media was associated with a greater likelihood that people would report believing in these theories. This study extends prior APPC studies which found that people who rely on social media were more likely to be misinformed about vaccines and that people who used conservative or social media at the outset of the COVID-19 pandemic were more likely to believe conspiracy theories about it and to be misinformed about how to prevent the virus.

“Conspiracy theories are difficult to displace because they provide explanations for events that are not fully understood, such as the current pandemic, play on people’s distrust of government and other powerful actors, and involve accusations that cannot be easily fact-checked,” Jamieson said.

In the study, the authors argue that counteracting the effects of conspiracy beliefs will require “continued messaging by public health authorities on mainstream media and in particular on politically conservative outlets that have supported COVID-related conspiracy theories.”

Conspiracy theories and vaccination intentions

The researchers found that belief in conspiracy theories was inversely related to the perceived threat of the pandemic; taking of preventive actions, including wearing a face mask; and the intention to be vaccinated when there is a COVID-19 vaccine.

Assessing people’s COVID-19 vaccination plans, researchers found a widening gap over time between people who most strongly believed the COVID-19 conspiracies and those who did not believe them.

In March, those who did not believe the conspiracies were 2.2 times more likely to intend to be vaccinated than those who most strongly believed in the conspiracies – a ratio that had widened to 3.5 times in July:

In March, 37% of people who most strongly believed in these three conspiracy theories reported that they intended to be vaccinated, compared with 81% of the people who did not believe in them.
By July, the vaccination intention rates were 22% for those who most strongly believed in these conspiracies and 76% for those who did not believe in them.

Believers in the coronavirus conspiracies were also more likely to have doubts about the safety of the measles, mumps, and rubella vaccine (MMR), a concern that appeared to play a role in their heightened hesitancy to accept a vaccine for COVID-19.

Conspiracy theories and mask-wearing

The first wave of the survey was conducted before the CDC advised people in early April to wear nonsurgical masks as a preventive measure when they go out in public.

In July, among those who were most likely to believe in the COVID-19 conspiracies, 62% reported wearing a mask every day that they went outside of the home and had exposure to others – compared with 95% of those who did not believe in the conspiracies.

In other words, those who did not believe in the conspiracies were 1.5 times more likely to wear a mask every day outside of the home when they were in contact with others than the people who most strongly believed in the conspiracies.

Group differences and conspiracy beliefs

Members of historically disadvantaged racial and ethnic groups were more likely to believe the conspiracies, a finding which is rendered even more troubling because communities of color are disproportionately suffering the effects of COVID-19. However, older adults were less likely to believe the conspiracies, which is good news because they are more likely to suffer from the disease.

One positive note was that political ideology was not related to changes in vaccination intentions from March to July. This was in contrast to mask-wearing; the July survey found that liberals were more likely than conservatives to adopt mask-wearing.

The survey

The research is based on a national probability survey of l,050 U.S. adults conducted between March 17-27, 2020, and a follow-up with 840 of the same individuals between July 10-21, 2020. The analysis was based on 840 individuals who took part in both waves.

Both waves of the survey were conducted before one conspiracy theory – that CDC scientists are seeking to undermine the president – was voiced in September by Michael R. Caputo, the top communications official at the U.S. Department of Health and Human Services. He made a Facebook Live video in which he accused government scientists of “sedition” and the CDC of harboring a “resistance unit” against the president. He subsequently apologized.

“Conspiracy theories as barriers to controlling the spread of COVID-19 in the U.S.” was published online in Social Science & Medicine on September 21, 2020: https://doi.org/10.1016/j.socscimed.2020.113356

Journal

Social Science & Medicine

DOI

10.1016/j.socscimed.2020.113356

RICHMOND, Va. (Sept. 21, 2020) -- In a paper published Friday by the Journal of the American Medical Association, Virginia Commonwealth University researchers released data showing an alarming surge in opioid-related overdoses during the COVID-19 pandemic.

Nonfatal opioid overdose visits to the VCU Medical Center emergency department in Richmond increased from 102 between March and June 2019 to 227 between March and June 2020. That's an increase of 123%.

The overdose increase occurred during a time when the emergency room was experiencing a lower-than-average number of visits overall. March through June visits in 2020 were down 29% from the same time last year.

The study's lead author, Taylor Ochalek, Ph.D., a postdoctoral research fellow at the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research, analyzed the 2019 and 2020 data from VCU Medical Center's emergency department.

"Social isolation, job loss, the inaccessibility of community resources -- these could all contribute to the overdoses we're observing," said Ochalek, who works in the Department of Pharmacology and Toxicology at the VCU School of Medicine.

Ochalek also examined demographic information for the opioid overdose patients. For both years, the patients mostly were male (70% in 2019 and 73% in 2020), and nearly half were uninsured (40% in 2019 and 44% in 2020). But the percentage of Black patients increased: from 63% in 2019 to 80% in 2020.

"Health disparities have been magnified during the pandemic," Ochalek said. "I hope this study provides a baseline of data for future research into reasons for the increase, mitigation efforts, longitudinal outcomes for patients and further overdose data."

"This data is from the Richmond area, but it confirms what we're hearing anecdotally from across the U.S.," said F. Gerard Moeller, M.D., director of the Wright Center and director of the VCU Institute for Drug and Alcohol Studies. "The pandemic is more than a crisis of one disease. Its ripple effects will be felt for some time in the form of secondary health impacts like addiction."

Collaborators on Ochalek's study are Kirk Cumpston, D.O., a professor in the Department of Emergency Medicine; Brandon Wills, D.O., an associate professor in the Department of Emergency Medicine; Tamas Gal, Ph.D., director of research informatics at the Wright Center; and Moeller.

"The numbers in this study are alarming, and it's important that health providers and community partners know what we're facing," said Peter Buckley, M.D., interim CEO of VCU Health System, interim senior vice president of VCU Health Sciences and dean of the School of Medicine. "Studies like these will guide us in providing the best possible care to the Richmond community."

A new Johns Hopkins Medicine study adds to evidence that the earlier parents, educators and health care workers have age-appropriate and frank discussions about safe sex, the better will be their -- and their partners' -- long-term sexual health and development. Specifically, the research concludes, these early interventions can lead to fewer unintended pregnancies.

The findings, published online in the Aug. 13, 2020, issue of the journal Culture, Health & Sexuality, are based on the analysis of self-reported sexual experiences of Black male teens and young adults.

"Our findings add to our understanding of the context and consequences of having sex early in life (before age 13), suggesting ways to better support the healthy sexual development of Black male adolescents," says Johns Hopkins Children's Center physician Arik Marcell, M.D., associate professor of pediatrics and public health at the Johns Hopkins University School of Medicine, and a member of the research team.

Prior research, Marcell says, indicates that up to 30% of U.S. urban Black male adolescents report their first sex experience before age 13, compared with 10% among white peers. These studies also suggest that regardless of race or gender, young people whose first sexual encounter occurs before age 13 are more likely to experience negative sexual and reproductive health behaviors, such as multiple sexual partners, sex under the influence of substance use, unintended or unwanted pregnancy, and sexually transmitted infections.

But past studies, including this Guttmacher institute publication, have mostly looked at the socioeconomic contributors of early sexual experiences of girls, particularly from non-Black races and ethnicities. Few studies have examined the impact of early sexual experiences for boys, which this current research explored.

In the new study, based on data gathered with young men after their clinic visits using a computer survey, the researchers sought a correlation between the ages at which young Black males said they first had sex and the contexts of these first sex experiences.

Specifically, they analyzed information gathered between August 2014 and September 2017 from 493 Black males, ages 15-24 and living in Baltimore, Maryland. All were asked to complete a computer survey at the end of a clinical visit at five clinics across the city that serve young men.

As part of the study, survey participants were asked about their demographic and sexual and reproductive health histories, and for specific information about their relationships with their parents and sexual partners at the timing of their first sex experience. Participants were also asked at what age they first engaged in vaginal, oral and anal sex; what they considered to be their race, ethnicity and sexual orientation; how many sexual partners they had within the previous three months; whether their primary care or clinic visit was for a routine physical exam, a sexually transmitted infection or other reason; whether or not they used condoms; what, if any, personal history they had with pregnancies, miscarriages or abortions; and whether or not they had biological children.

Additionally, participants were asked about their knowledge of sex prior to their first sex experience, if they felt their masculinity was tied to having sex, whether they had sex to impress their peers, and if they felt it was acceptable for an unmarried couple to have sex if they have affection for one another.

The researchers also assessed partner relationships by asking about the type of sexual relationship in which they were involved (such as long-term, casual or just meeting the person with whom they had sex); the age of their partner relative to theirs; and if the decision to engage in sex was mutual or under pressure from their partner. Finally, participants were asked about their parent/guardian guidance, including if they had the freedom to do whatever they wanted, as well as what they thought their parents felt about them having sex.

The survey was part of an existing program related to the current program in which youth-serving professionals provided sex education and information about sexual and reproductive health care to promote healthy sexual development.

Sixty-one percent of the survey participants were ages 20-24, 90% were non-Hispanic Black, 83% had a mother with a high school diploma and 75% identified as heterosexual. Additionally, 75% reported female-only partners, 32% had three or more partners in the past three months, 47% reported their partner had gotten pregnant, 10% had two or more children, and 38% had a history of a sexually transmitted infection.

Like findings from past national school-based studies, first sex at age 13 years or younger was reported by more than 28% of young Black males in this study. Compared with those males who had their first sexual experience at age 14 or older, the younger "first sex" group also reported being involved in at least one pregnancy, having a "much older" first partner, and being dissatisfied in their relationships with their parents at the time of their first sex.

Some 60% of participants reported they had first sex with older partners compared with a partner of the same age or younger. When reporting relationship dissatisfaction with their parents or guardians, 16% stated they had difficulties with their mother or female guardian, and 12% said their father or male guardian caused greater problems.

The researchers caution that their results may not apply widely because of the small study size, and the fact that participants were limited to clinic-attending young urban males in Baltimore. But the authors note that there have been similar findings among school-based samples of young men in other urban settings.

"The results suggest that earlier sex education and information -- well before a first sexual encounter -- would help ensure the sexual health of young urban Black men and their partners," says Marcell. Prevention strategies, he adds, could include programs designed to delay first experiences with sex for this population. Study findings also indicate the importance of sexual behavior assessments in routine clinical care.

A team of scientists led by Paul Dent, Ph.D., at Virginia Commonwealth University Massey Cancer Center has discovered that an experimental cancer drug called AR-12 inhibits the SARS-CoV-2 virus, the cause of the COVID-19 pandemic, from infecting cells and replicating. Their findings were published online today in the journal Biochemical Pharmacology, and steps are now being taken to develop a clinical trial testing the novel oral treatment at VCU Health.

AR-12 has been studied extensively in Dent's laboratory as both an anti-cancer and anti-viral drug, with prior peer-reviewed publications from Dent and others showing it to be effective against viruses including Zika, mumps, measles, rubella, chikungunya, RSV, CMV, drug resistant HIV and influenza. Recently, collaboration with Jonathan O. Rayner, Ph.D., at the University of South Alabama and Laurence Booth, Ph.D., from Dent's lab, has demonstrated that AR-12 is highly effective against SARS-CoV-2.

"AR-12 works in a unique way. Unlike any other anti-viral drug, it inhibits cellular chaperones, which are proteins that are required to maintain the right 3D shape of viral proteins. The shape of the virus is critical to its ability to infect and replicate," said Dent, who is a professor in the VCU Department of Biochemistry and Molecular Biology and the Universal Corporation Chair in Cancer Cell Signaling and a member of the Cancer Cell Signaling research program at Massey.

One of the cellular chaperones inhibited by AR-12 is GRP78, which is essential for the reproduction of all viruses. GRP78 acts as a sort of cellular stress sensor and is required for the life cycle of all mammalian viruses.

Andrew Poklepovic, M.D., medical oncologist, member of the Developmental Therapeutics research program and medical director of the Clinical Trials Office at Massey, is leading efforts to translate these exciting findings into a clinical trial.

"AR-12 is an oral therapy that has been well tolerated in a prior clinical trial, so we know that it is safe and tolerable," says Poklepovic. "Most COVID-19 drugs are given intravenously, so this would be a unique therapeutic option and potentially suitable for outpatient therapy, similar to the way one would take an antibiotic."

Poklepovic hopes to begin enrolling patients in early 2021, but several milestones remain. The team must develop the clinical trial protocol, receive approval from the FDA to test AR-12 on COVID-19 patients and manufacture enough of the drug for the trial.

"For help reaching these significant milestones and moving forward with this research at the accelerated pace that we know is needed, we turned to our colleague at Massey, Said Sebti, who has extensive experience in drug development," says Poklepovic.

Sebti, Ph.D., associate director for basic research and member of the Developmental Therapeutics program at VCU Massey Cancer Center, and professor of pharmacology and toxicology at the VCU School of Medicine, attracted knowledgeable entrepreneurs to form C19 Therapeutics, which recently licensed AR-12 from VCU in order to raise funds in support of drug synthesis and clinical trial sponsorship.

"We are working to submit the required information for FDA approvals, and we are also in discussions with a local pharmaceutical company to manufacture the drug for the trial," says Sebti. "We are hopeful that AR-12 will emerge as a treatment option for patients suffering from COVID-19, ultimately saving lives and contributing to the global pandemic solution."

Another observation made in Dent's research may also shed light into why African Americans have been more affected by severe illness during the COVID-19 pandemic. People of non-European descent, particularly those with African ancestry, make a protein called ATG16L1 T300, while those with primarily European ancestry make a different variant, ATG16L1 A300.

"We compared matched colon cancer cells, with one set making A300 and the other T300, and found that cells making the T300 form made more GRP78 and more of the virus receptor ACE2," said Dent. "This, of course, does not prove that those with the T300 form are more susceptible to COVID-19, but it provides a biomarker that could be evaluated to help explain why some people get more severe illness than others."

While scientists race to develop and test a vaccine effective against SARS-CoV-2, the virus that causes COVID-19, recent studies have indicated that countries with widespread BCG vaccination appear to be weathering the pandemic better than their counterparts. This has led many researchers to suspect that BCG vaccine, which immunizes against tuberculosis, might offer protection against COVID-19.

Controlled trials with the vaccine are in progress, but in the meantime Clément de Chaisemartin, an assistant professor of economics at UC Santa Barbara, and his coauthor -- and cousin -- Luc de Chaisemartin, an immunologist at Paris-Saclay University, decided to see what they could learn from existing public health data.

Using information from the Swedish public health agency, the pair determined that BCG vaccination during infancy actually does not protect against the virus. Their results, which appear in the journal Clinical Infectious Diseases, suggest that other, related factors likely underlie the disparities between countries.

"Having a study like ours, which builds upon a natural experiment, is useful," Clément de Chaisemartin explained, "because even though it does not look at exactly the same research question as the controlled trials -- which will measure the effect of a recent BCG vaccination -- our results are available much more quickly."

The inspiration for the study was rather idiosyncratic. Clément de Chaisemartin is the oldest of five siblings. He received the BCG vaccine and its boosters as a child, but he recalled that his 18-year-old youngest brother had not. His native France did away with mandatory BCG vaccination in the early 2000s. In fact, many developed countries gradually went this way as tuberculosis became ever rarer.

The economist remembered this fact when studies began reporting that countries that had mandatory BCG vaccinations were faring better in the pandemic than those that didn't.

"So then I just went onto Wikipedia and tried to find a country were the BCG interruption was less recent, so that the people affected would be older and at higher risk of COVID-19," he recalled.

Sweden, he discovered, had discontinued the practice in April 1975. That fit his needs perfectly, so he reached out to the country's public health agency, which agreed to share data with him.

Usually, non-randomized studies can provide evidence only of correlations, not actual causation. But the type of analysis that the Chaisemartins applied is different. "The regression discontinuity method we used is considered almost as reliable as a randomized controlled trial in terms of teasing out correlation from causation," said Clément de Chaisemartin.

The researchers took advantage of the fact that the Swedish policy essentially created a randomized controlled trial. People born in March and April 1975 are extremely similar in terms of their susceptibility to COVID-19. Meanwhile, those born in March got the BCG vaccine, while those born in April did not. It's almost as if the individuals were randomly placed in the two different groups.

The researchers compared the COVID-19 outcomes between the two groups and found that cases per capita, hospitalizations per capita, and deaths per capita were very similar for people born just before and just after the April 1st cutoff.

The results were enlightening. The correlation between mandatory BCG vaccination and COVID-19 outcomes is very strong, and shows up even when controlling for a number of relevant factors, such as per-capita income. But the similar COVID-19 outcomes between those who received the vaccine in childhood and those who didn't indicate that immunization can't be the cause.

"Our study shows that this correlation is probably not due to the BCG vaccination, but rather to some omitted variable," explained Clément de Chaisemartin. "This raises the question as to what this omitted variable is, because if it is something that policymakers can act upon, then maybe we would have something actionable against COVID-19."

He hypothesized that mandatory child BCG vaccination may reflect the overall strength of a country's public health agency. "Countries that have many mandatory vaccinations may be countries where public health agencies are more powerful," he said. "So maybe those public health agencies are also able to implement effective policies against COVID-19."

Another hypothesis is that the mandatory vaccination relates to risk aversion. "Maybe countries where many mandatory vaccinations are in place are countries where people tend to be more risk averse," he continued. In that case, the public may adhere to more cautious guidelines during the pandemic.

Clément de Chaisemartin is quick to point out that these conjectures are preliminary, and would require more research to corroborate. Also, despite having found no connection between vaccination in infancy and protection from COVID-19, current experiments may still find that a recent BCG vaccination can provide some benefit.

One thing is abundantly clear, though, said Luc de Chaisemartin, "Without sound evidence that BCG protects against COVID-19, it is important to wait for the results of the ongoing trials, rather than deplete stocks of a vaccine already difficult to get for those who really need it, namely children in countries with a high prevalence of tuberculosis."

A global survey of health professionals, led by Queen Mary University of London, has shown that during the COVID-19 pandemic, patients with Parkinson's disease in large parts of Asia, Africa, and Latin and South America experienced difficulty in accessing their medication, which is likely to have led to deterioration of symptom control.

The email survey of the Movement Disorders Society, conducted in June 2020 at the height of the pandemic, received 346 responses from members in 76 countries. Responses indicated that 88.9% of those in low-income countries considered access to Parkinson's disease medication to have been affected by COVID-19, compared with 22.8% of those in high income countries. All of the surveyed health professionals in low income countries indicated that this would result in increased disability. Resource-poor countries appear to be disproportionately affected compared with more affluent countries.

Corresponding author, Dr Alastair Noyce from the Preventive Neurology Unit at Queen Mary's Wolfson Institute, said: "This study showed that patients from high income countries in East Asia, Europe and North America were less affected, but patients in middle and low income countries had difficulty obtaining medication, which in turn has resulted in a worsening of morbidity. The results provide further evidence of inequity in routine Parkinson's disease care by region and wealth, which has been worsened by COVID-19."

Boston - A new study led by Boston Medical Center researchers indicates a well-known biomarker that serves as a marker for earlier diagnosis of neurodegenerative diseases is now detectable in the eye. Neurofilament light chain, a protein previously detected in cerebrospinal fluid and blood that is being explored as a biomarker to detect neurodegeneration, has now been identified in the vitreous humor, or fluid within the eye. Published in Alzheimer's Research & Therapy, these results set a foundation for future studies to investigate the potential of this biomarker to accelerate the diagnosis of Alzheimer's disease, Parkinson's disease, and other neurodegenerative diseases.

Diseases such as Alzheimer's Disease and Parkinson's Disease are the result of nerve cells in the brain or peripheral nervous system losing function over time, eventually leading to cell death. While there are treatments available to address the physical and mental symptoms associated with these progressive diseases, there are no known cures, and early treatment can help delay the progression of these diseases once they start.

"One of the biggest priorities in Alzheimer's disease research is to develop ways to diagnose the disease before the onset of symptoms, which would allow for early treatment that could help halt the progression of this fatal disease," said Manju Subramanian, MD, an ophthalmologic surgeon at Boston Medical Center and the study's first and corresponding author. Neurodegenerative diseases are currently diagnosed based on clinical presentation and diagnostic testing - once symptoms appear it means that the disease is already progressing.

Biomarkers are a major focus of neurodegenerative disease research given their promise as a way to detect the presence of a disease in earlier stages based on clues found in other parts of the body. Previous studies have established that amyloid- β and tau proteins are biomarkers for Alzheimer's disease, and they have been detected in cerebrospinal fluid, blood, and in fluid around the eye.

For this study, the researchers collected eye fluid samples from 77 patients who were undergoing previously scheduled eye surgery at Boston Medical Center. Sixty three percent of the subjects were male, and the average age was just over 56 years old. The results showed that all 77 patients had Neurofilament light chain in their vitreous humor, and higher levels of this biomarker were associated with higher levels of other biomarkers known to be associated with Alzheimer's disease, including amyloid-B and tau proteins. Neurofilament light chain levels were not significantly associated with eye disease, which means that those levels appear not to be influenced by the clinical eye conditions affecting the patients.

As the number of people living longer has increased over the previous decades, particularly in the Western world, the prevalence of neurodegenerative diseases has also increased. According to the National Institutes of Health, Alzheimer's disease and Parkinson's disease are the two most common neurodegenerative diseases, affecting approximately 5.5 million and one million Americans, respectively.

"As an extension of the brain, the eye can provide important insight about what's happening pathologically in the brain," added Subramanian, also an associate professor of ophthalmology at Boston University School of Medicine. "We hope that these results will add another way to use information about what's happening in different parts of the body to detect the presence of disease before neurodegeneration takes hold, causing irreversible damage. The earlier we can diagnose and treat these diseases, the better off our patients will be."

Irvine, CA - September 21, 2020 - In a new University of California, Irvine-led study, researchers have discovered how regulatory T cells (Treg) are instrumental in limiting the damage caused to the spinal cord in diseases like multiple sclerosis (MS).

Published in the Proceedings of the National Academy of Sciences, the results of the study help explain how Treg cells prevent autoimmunity and dampen immune responses, specifically the negative effects of type 17 helper T cells (Th17) which are known to drive the progression of several autoimmune diseases.

This new study, which builds on recent research that identified pathogenic Th17 cells and their role in the progression of several autoimmune diseases, showed how the inhibition of Th17 cells by Treg cells enabled partial recovery from paralysis. This finding demonstrates how autoimmune diseases may be effectively targeted using Treg-based cellular therapies.

"We discovered a unique 'repetitive scanning motility' by which Treg cells (the good guys) dampen calcium signaling in pathogenic Th17 cells (the bad guys), and help to resolve neuroinflammation and limit reactivation of Th17 cells in the spinal cord," explained Shivashankar Othy, PhD, lead author of the study with Amit Jairaman, PhD, both project scientists in the Cahalan Lab at UCI.

Senior author, Michael D. Cahalan, PhD, distinguished professor and chair of the Department of Physiology & Biophysics at the UCI School of Medicine, added, "Building on our years of expertise in immunoimaging and calcium signaling, this study highlights Th17 and Treg cell interactions, their motility characteristics, and intracellular signaling, thus providing new insights into the pathophysiology of MS. Our results illustrate how a regulatory T cell-based immunotherapy may be instrumental in limiting demyelination in MS."

Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units. She noticed diabetes is rarely referred to as a primary cause of death in itself, yet the disease is a leading contributor to deaths involving heart disease, stroke and cancer.

"In addition to being a contributor to cardiovascular-related deaths, diabetes can lead to a variety of negative health outcomes, such as kidney failure, arthritis, nerve issues, eye problems and leg ulcers that can become infected," said Despins, now an assistant professor and researcher in the MU Sinclair School of Nursing. "Therefore, creating a plan to keep blood glucose levels from getting too high or too low will help those with diabetes better manage the disease and avoid those negative health complications down the road."

To help adults with diabetes better manage their blood sugar levels, Despins interviewed individuals diagnosed with type 2 diabetes about their understanding of the disease and their approach toward self-management. She found those who had previous life experiences watching a relative or neighbor manage diabetes influenced how they viewed diabetes management themselves.

"For example, one subject grew up watching his grandma inject insulin needles into her thigh all the time like it was no big deal, so naturally that person did not look at diabetes as something to be overly concerned about," Despins said. "On the other hand, another subject saw his neighbor with diabetic leg ulcers and swore that he never wanted that to happen to him, so he was very attentive to monitoring his blood sugar levels."

Because there is no one-size-fits-all approach to diabetes management, Despins says healthcare providers need to better understand the life circumstances of their diabetic patients, including their financial resources.

"People on a fixed income might not be able to routinely buy fresh produce instead of pasta, which can impact their blood glucose levels," Despins said. "Given the tough circumstances some people with diabetes live in, health care providers need to do an assessment of what resources patients with diabetes have available so they optimize what they can do."

To better serve patients with diabetes, Despins recommends that when health care providers collect initial quantitative data from patients such as weight, height and age, they should also ask additional qualitative questions to get a better understanding of the patients' knowledge of the disease.

"Asking questions like 'What do you currently know about diabetes?', 'Do you know someone with diabetes?' and 'How do you think they did at self-managing it, and does this influence the way you view your self-management plan?' will help the health care provider better understand the patient's life experiences," Despins said. "My overall goal is to help people with diabetes better optimize their self-management, which will improve their health outcomes by avoiding negative complications in the long run."

The suspension of fertility treatments due to the COVID-19 pandemic has had a variety of psychological impacts on women whose treatments were cancelled, but there are several protective factors that can be fostered to help in the future, according to a new study by Jennifer Gordon and Ashley Balsom of University of Regina, Canada, published 18 September in the open-access journal PLOS ONE.

One in six reproductive-aged couples experiences infertility, and many turn to treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF), which require many in-person appointments to complete. On March 17, 2020, the American Society of Reproductive Medicine and the Canadian Fertility and Andrology Society announced their recommendations to immediately and indefinitely suspend all in-person fertility treatments in the United States and Canada due to COVID-19.

In the new study, researchers used online social media advertising to recruit 92 women from Canada and the U.S. who reported having their fertility treatments suspended to participate in an online survey. The women, who were aged between 20 and 45, had been trying to conceive for between 5 and 180 months. More than half had had an IVF cycle cancelled and approximately one-third had been in the middle of IUI when treatments were suspended.

Overall, 86% of respondents reported that treatment suspensions had a negative impact on their mental health and 52% reported clinically significant depression symptoms. Neither age, education, income or number of children were correlated with the effect of treatment suspension on mental health or quality of life. However, other factors were found to positively influence these outcomes: lower levels of defensive pessimism (r=-0.25, p

The authors add: "This study highlights how enormously challenging the COVID-19 pandemic has been for women whose fertility treatments have been suspended. At the same time, it points to certain factors that may help women cope during this difficult time, such as having good social support."

New research suggests that Black women experience longer waits for treatment initiation than white women after a breast cancer diagnosis, and their duration of treatment is prolonged. The findings are published early online in Cancer, a peer-reviewed journal of the American Cancer Society (ACS).

Previous research has shown that Black women face a higher risk of dying from breast cancer than white women despite similar rates of breast cancer occurrence, and this disparity is especially high among younger women. A team led by Melissa A. Troester, PhD, of the University of North Carolina at Chapel Hill (UNC) and UNC Lineberger Comprehensive Cancer Center evaluated whether two aspects of care--time to treatment and duration of treatment--may be contributing factors.

The investigators' analysis included 2,841 participants (roughly equal numbers of Black and white women) with stage I-III breast cancer in the Carolina Breast Cancer Study, a population-based study of women with invasive breast cancer.

The overall median time to treatment initiation was 34 days. More Black women experienced a delayed time to treatment (13.4 percent versus 7.9 percent) and a prolonged duration of treatment (29.9 percent versus 21.1 percent) compared with white women.

Thirty-two percent of young Black women were in the highest quartile of treatment duration, compared with 22.3 percent of younger white women; similarly, 27.9 percent of older Black women experienced prolonged treatment duration compared with 19.9 percent of older white women.

Also, among women with high socioeconomic status, 11.7 percent of Black women experienced delays in initiating treatment compared with 6.7 percent of white women.

"Even among women with low socioeconomic status, we still saw fewer delays among white women, underscoring the disparate experience of Black women, who appear to experience unique barriers," said lead author Marc Emerson, PhD.

"It is important to recognize that the causes of delay are complex and reflect both individual barriers and system level factors," Dr. Troester added. The study identified a number of specific barriers, including financial and transportation issues.

New research presented at this year's annual meeting of the European Association for the Study of Diabetes (EASD), held online this year (21-25 September), shows that having type 1 diabetes (T1D) is associated with a 33% increase in the risk of falls compared with the general population, while having type 2 diabetes (T2D) is associated with a 19% increased risk of falls. The study is by Nicklas Rasmussen, Steno Diabetes Center and North Jutland Aalborg University Hospital, Aalborg, Denmark, and colleagues.

People with diabetes can be at increased risk of falls as they tend to have more complications (for example high and low blood sugar), and use of medication compared with the general population without diabetes. This study aimed to estimate the risk of falls and to identify risk factors associated with increased falls in people with diabetes compared with the general population. The second aim was to estimate fall-related injuries including fractures and where in the body these fractures are occurring compared with the general population.

From the Nationwide Danish National Patient Register the authors identified 12,975 people with T1D and 407,099 people with T2D and a sex- and age-matched control group (1:1) from the general population. All episodes of people hospitalised with a first fall from 1996 to 2017 were analysed using computer modelling. Risk factors such as age, sex, diabetic complications, a history of alcohol abuse and a history of medication were included in an adjusted analysis. The incidence rates, incidence rate differences and incidence rate ratios of falls and the location in the body of fall-related injuries and fractures were calculated.

In the adjusted analysis T1D was associated with 33% increased risk of a first fall, and T2D a 19% increased risk. The cumulative incidence, of falls requiring hospital treatment was 13% in T1D, and 12% in T2D.

For patients with T2D, other risk factors for falls were: being female (60% increased risk), being aged over 65 years (32%), use of selective serotonin receptor inhibitors (SSRIs) (used to treat depression) (32%), use of opioids (9%), SSRIs and opioids combined (60%), and a history of alcohol abuse (a near doubling of risk).

For patients with T1D, other risk factors identified for falls were: being female (20 % increased risk) aged over 65 years (30%), use of SSRIs (35%), use of opioids (15%) and a history of alcohol abuse (77%).

Increased incidence of fractures was also identified in people with T2D. Compared with the general population, there was increased risk of fractures of the hip and femur (2%), humerus (the long arm bone) (24%), radius (forearm bone) (39%) and skull/face (15%). People with T1D also had an increased risk of fractures, but only at the hip and femoral region (11%).

The authors say: "While of course we cannot do anything about getting older or our gender, diabetes - especially type 2 diabetes - use of medications and alcohol abuse could be potentially modifiable risk factors for falls. Gaining further information on risk factors for falls could guide the management of diabetes treatment such as the choice of medication, which enables us to improve treatment particularly in people with a high risk of falls and fractures associated with high mortality."

A new study presented at this year's annual meeting of the European Association for the Study of Diabetes (EASD), held online this year, shows that rheumatoid arthritis (RA) is associated with a 23% increased risk of type 2 diabetes (T2D), and may indicate that both diseases are linked to the body's inflammatory response. The research was conducted by Zixing Tian and Dr Adrian Heald, University of Manchester, UK, and colleagues.

Inflammation has emerged as a key factor in the onset and progression of T2D, and RA is an autoimmune and inflammatory disease. The team suggest that the systemic inflammation associated with RA might therefore contribute to the risk of an individual developing diabetes in the future.

The team conducted a comprehensive search of a range of medical and scientific databases up to 10 March 2020, for cohort studies comparing the incidence of T2D among people with RA to the diabetes risk within the general population. Statistical analyses were performed to calculate the relative risks, as well as to test for possible publication bias (in which the outcome of research influences the decision whether to publish it or not). The eligible studies identified comprised a total of 1,629,854 participants. Most of the studies were population-based and one was hospital-based, while no evidence was found for publication bias in any of them.

The authors found that having RA was associated with a 23% higher chance of developing T2D, compared to the diabetes risk within the general population. They conclude that: "This finding supports the notion that inflammatory pathways are involved in the pathogenesis of diabetes."

The researchers also state: "We suggest that more intensive screening and management of diabetes risk factors should be considered in people with rheumatoid arthritis. Agents that reduce systemic inflammatory marker levels may have a role in preventing type 2 diabetes. This may involve focussing on more than one pathway at a time."

New research being presented at this year's Annual Meeting of the European Association for the Study of Diabetes (EASD), held online this year, shows that when one half of a couple shows high levels of certain behaviours that prevent type 2 diabetes, such as good diet or exercise, that behaviour also tends to be high in the other half of the couple. The study is by Omar Silverman-Retana, Department of Public Health, Aarhus University, Aarhus, Denmark, and Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark, and colleagues.

In study, the authors compared the degree of spousal concordance in a set of detailed pathophysiological mechanisms and risk factors for type 2 diabetes to understand where in the causal cascade spousal similarities are most relevant. They used data from the Maastricht Study, a large ongoing study focusing on the etiology of type 2 diabetes, its classic complications, and its emerging comorbidities.

They carried out a cross-sectional analysis of 172 couples in this study to assess the similarity of couples in pathophysiological mechanisms of type 2 diabetes, including beta cell function and insulin sensitivity. Risk factors included body mass index, waist circumference, percentage body fat, time spent in light and high intensity physical activity, sedentary time and diet indicators. They additionally assessed glucose metabolism status using fasting and 2-hour plasma glucose testing, and also glycated haemoglobin (HbA1c).

The analysis of 172 couples showed the strongest spousal concordance for the Dutch Healthy Diet Index (DHDI) for men, meaning that a one-unit increase in wives' DHDI was associated with a 0.53 unit increase in the men's DHDI.

For women the strongest concordance was for the time spent in high intensity physical activity (HPA); thus, a one-unit increase in husbands' time spent in HPA was associated with a 0.36 unit increase in women's time spent in HPA. The weakest spousal concordance was observed in beta cell function measurements.

The authors conclude: "Our results show with a high level of detail that spousal concordance was strongest in behavioural risk factors such as diet and physical activity, and that concordance weakened when moving downstream towards pathophysiological factors in the causal cascade leading to type 2 diabetes. From a practical point of view, public health prevention strategies to mitigate diabetes risk may benefit from spousal similarities in health-related behaviours and diabetes risk factors to design innovative and potentially more effective couple-based interventions."

Results from the PROfound phase III study, funded by AstraZeneca and Merck Sharp & Dohme, open up a much-needed new treatment avenue for the more precise and effective treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) whose disease has progressed with hormonal therapy.

The PROfound trial investigators show significantly longer overall survival of mCRPC patients with at least one alteration in BRCA1, BRCA2, or ATM genes, who received treatment with PARP inhibitor olaparib versus enzalutamide or abiraterone plus prednisone.

Ringing in a new era of precision medicine to more effectively combat this lethal disease, it is the first time that a PARPi has shown an increased survival rate in a prospective clinical trial. PROfound also demonstrates the importance of incorporating genomic sequencing for the optimal stratification of mCRPC patients.

Barcelona, 20 September 2020- In the quest to establish more potent treatment strategies that target vulnerabilities in BRCA1/2-associated cancers+, PARP inhibitor (PARPi) olaparib continues to drive more precise and personalized therapeutic approaches. By extending survival and reducing risk of disease progression, this anti-cancer therapy has been approved for the treatment of both BRCA1/2 mutated advanced breast and ovarian cancers, and is also licensed as maintenance therapy after response to platinum-based chemotherapy for the latter.

Revealed today during the second Presidential Session of the European Society for Medical Oncology's (ESMO) Virtual Congress 2020 (19-21 September), findings from the PROfound open-label, randomised phase III study evidence the efficacy of olaparib for the targeted treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) with at least one alteration in BRCA1, BRCA2, or ATM genes. Presented by second author Joaquin Mateo, Principal Investigator of the Vall d'Hebron Institute of Oncology's (VHIO) Prostate Cancer Translational Research Group, this practice-changing data has published simultaneously as an Original Article in the New England Journal of Medicine.

Building on previous findings first-authored by Joaquin Mateo*, showing that olaparib leads to tumor responses in mCRPC patients with DNA-damage repair (DDR) alterations who had previously received chemotherapy and were no longer responding to standard treatments, the PROfound investigators now show significantly longer overall survival in this patient population who were treated with olaparib versus standard therapy with enzlutamide or abiraterone plus prednisone.

This present research, spearhead by Maha Hussain, the Robert H. Lurie Comprehensive Cancer Center (Chicago, USA), and Johann de Bono, the Institute of Cancer Research and Royal Marsden (London, UK), has led to the approval of olapirib by the U.S. Food and Drug Administration (FDA) for the treatment of this disease. In addition, clinical guidelines have been elaborated by ESMO, the National Comprehensive Cancer Network (NCCN), and American Urological Association (AUA), among others, that now recommend genomic sequencing of patients with advanced prostate cancer to identify which patients would most likely benefit from this novel and personalized treatment approach.

Commenting for VHIO's Global Communications second author of the study, Joaquin Mateo, who is also a Medical Oncologist at the Vall d'Hebron University Hospital (Vall d'Hebron Barcelona Hospital Campus) said, "The relevance of our results is reflected by the fact that the FDA has already authorized olaparib for the treatment of metastatic castration-resistant prostate cancer. Based on these data, this week the European Medicines Agency recommended the approval of olaparib for prostate cancer patients with BRCA1 or BRCA2 mutations, irrespective of somatic or germline. We expect to have the treatment available for patients in the clinic soon.”

The PROfound Trial consisted of two cohorts: A included 245 patients with at least one alteration in BRCA1, BRCA2 or ATM, the most common and well-known mutations in this subtype of prostate tumors, and B with 142 patients who had a least one alteration in any of the other 12 prespecified genes. Alterations in these genes, whose function is related to BRCA1 or BRCA2, are found in between 10-15% of these cancers. "Cohort B was more exploratory given that there is little data on these genes individually. We sought to establish whether any of the twelve might be as relevant as those in cohort A in identifying patients who may benefit from olaparib. More information on these less frequent subgroups is required because some may well be important," noted Joaquin.

The ratio of patients treated with olaparib to patients treated with standard drugs was 2 to 1, with 256 patients treated with olaparib and 131 with hormonal therapy (enzalutamide or abiraterone plus prednisone). All patients had previously received hormonal therapy.

The results showed that the median survival increased, particularly in cohort A, in which the survival rate increased from 14.7 months with standard treatment to 19.1 months in the olaparib arm of the study, which indicates a reduced risk of death of 31%. In cohort B, the survival rate increased from 11.5 months to 14.1 months.

"While our results show that olaparib is effective in patients with DNA repair gene mutations, even within this group we identified differences depending on the specific gene of each patient. Mutations in BRCA1 and BRCA2 are those clearly associated with the greatest benefit. For genes whose mutations are not very prevalent, more studies are warranted," added Joaquin.

By showing that certain genomic profiles benefit from treatment with olaparib, this study represents a paradigm shift in the treatment of this subpopulation of patients. Specifically, it supports the implementation of genomic stratification of patients with mCRPC, who do not respond to treatment with hormonal therapy in clinical practice based on tumor sequencing.

He concluded, "This gene-targeted approach could help more precisely guide treatment decisions as well as match more effective therapies to the molecular make up of individual patients' tumors. The challenge that lies ahead will be implementing genomic testing in clinical practice, especially because, unlike breast or ovarian cancer, these BRCA1 or BRCA2 mutations are not necessarily hereditary. It is therefore imperative to sequence tumor biopsies, beyond just normal tissues or blood from patients."