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BOSTON - A new study by research, quality improvement and health equity experts at Massachusetts General Hospital (MGH) in The American Journal of Managed Care lays out the challenges of achieving equity for diverse patients in communication at hospital discharge. A survey of 224 recently discharged patients was conducted in five languages just before the COVID-19 pandemic and highlighted challenges, including limited understanding of medications; lack of available professional medical interpreters and translated patient instructions at discharge; and worries about support for at home after hospitalization.

Major findings include:

Overall, one in four patients were alone at discharge, without a family member or friend to accompany them, a factor that may contribute to miscommunication.

More than half of patients with limited English proficiency reported lack of access to medical interpreters and translated materials at the time of discharge

Significant differences were reported in technology access to smartphones, laptop or tablet computers, and to the electronic health record patient portal by patients who are Hispanic, Latino, Black or African American, and experience limited English proficiency. Only 25% of Hispanic or Latino patients and 57% of Black patients reported having laptop or tablet computers, and fewer than 10% of Hispanic or Latino patients had used the patient portal.

Patients of Asian or Pacific Islander descent were more likely to express worries about understanding medications and about getting home health services.

Esteban Barreto, PhD, lead author of the paper, says the researchers conducted the study to gather a more rich and nuanced view of patient perspectives than can be found in standard quality improvement surveys. "We employed a team approach to survey development and translation, embedding in the team bilingual interviewers and clinicians from diverse backgrounds to capture the experience of this patient population," he says. "This was a work of love for the team."

Many of these issues became more urgent during the pandemic--the data from this survey helped to put new innovations in place to support patients with better information, technology access and communication support during hospitalization and discharge. MGH has taken several steps to address issues revealed in survey results and improve patient care. Joseph R. Betancourt, MD, MPH, Senior Vice President, Equity and Community Health, notes: "MGH has been working on improving quality, addressing disparities, and achieving equity for over 20 years, and has made a lot of progress. In some of these areas, like interpreter services, we have been industry leading. That being said, we are firm believers that you can't manage what you don't measure, and we have had the courage to be deliberate and look everywhere for opportunities to improve the care we provide to diverse populations. We will expand and improve what we do well, and create strategies to address the new challenges we identify."

Funded by the Edward P. Lawrence Center for Quality and Safety at MGH, the study involved researchers and operational leaders from multiple areas including Equity and Community Health, General Internal Medicine, Interpreter Services, and the Disparities Solution Center, with research leadership provided from the Mongan Institute.

Karen Donelan, ScD, EdM, director of the Survey Research Unit at MGH, says: "For more than a decade, our team has worked to identify barriers to care faced by diverse populations and use those data to build solutions. Language barriers, especially in the use of medications and technology, need to be overcome to achieve equity in care through improved communication at care transitions."

During the height of the pandemic, some hospitals were overwhelmed with patients seeking treatment for COVID-19. This situation could happen again during future outbreaks, especially with SARS-CoV-2 variants of concern on the rise. Now, researchers reporting in ACS' Analytical Chemistry have developed a blood test to predict which people infected with COVID-19 are most likely to experience serious symptoms, which could help health care workers prioritize patients for hospitalization and intensive care.

Although many people who contract COVID-19 have either no symptoms or mild ones, some require intensive care for pneumonia with acute respiratory distress syndrome. Risk factors for severe disease include older age, heart disease, cancer and diabetes, but these characteristics alone are not sufficient to predict which patients will become the sickest. Measuring levels of certain proteins or metabolites in the blood could help, but these tests are often slow, complicated or expensive. For more effective triage of COVID-19 patients at hospitals, Michelle Hill, Sanjeeva Srivastava and colleagues aimed to develop an easy-to-use method that could quickly and cost-effectively predict COVID-19 severity.

To measure changes in blood biochemistry that occur with severe COVID-19, the researchers chose a technique called attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), which has been tested previously as a COVID-19 diagnostic tool. Two regions of FTIR spectra from 128 patient plasma samples showed small but observable differences between those with severe and non-severe COVID-19. Using these data together with clinical information about patients, the researchers developed a statistical model to predict COVID-19 severity. They found that the best predictor was whether the patient had diabetes, followed by the two regions in the FTIR spectra. Adding the FTIR data to the model improved the sensitivity for detecting severe disease in a different set of 30 patients from 41.2% to 94.1%, but reduced the specificity from 84.6% to 69.2%, compared with the clinical factors alone. This means that the new test was more likely to identify severe cases, but it also had a higher rate of false positives, than the clinical data alone. Although the strategy needs to be tested in larger numbers of patients, it shows promise as a rapid, simple and economic triaging test for hospitals, the researchers say.

Since antiretroviral therapy (ART) for HIV was introduced in 1996, AIDS-related morbidity and mortality has declined significantly. People living with HIV are now expected to live nearly as long as people without HIV. Despite these advances, those living with HIV often report poor well-being and health-related quality of life.

To guide stakeholders in improving health system responses to achieve the best possible long-term health outcomes for people living with HIV, a global multidisciplinary group of HIV experts led by CUNY SPH Senior Scholar Jeffrey Lazarus and including Distinguished Professor Denis Nash and Associate Professor Diana Romero developed a consensus statement identifying the key issues health systems must address in order to move beyond the longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for people living with HIV throughout their lives.

Following a rigorous, multi-stage Delphi process, the research team established a diverse panel of experts with expertise in the long-term health needs of people living with HIV. The panel reviewed the literature on multimorbidity and stigma and discrimination in order to identify priority issues to incorporate in the Delphi process to develop a consensus statement.

"An important strength of this consensus statement is that it was generated through this rigorous process, incorporating quantitative and qualitative data from experts from over 20 countries," says Dr. Romero.

The panel found that multimorbidity, health-related quality of life, and stigma and discrimination continue to be major issues for people living with HIV, including those who have achieved viral suppression and in particular those from marginalized populations.

"These factors can lead to depression, social isolation and barriers in accessing health and support services," says Dr. Lazarus, who is also associate professor at the Barcelona Institute for Global Health. "Many of these issues are not currently addressed in HIV monitoring, strategies or guideline."

'There is ample evidence that addressing things like mental health, stigma reduction, quality of life, and in many settings, housing and food security, will also improve HIV outcomes like adherence to antiretroviral medications and viral suppression," Dr. Nash says. "The field of HIV implementation science can play a key role in assessing the impact of strategies integrated into HIV service delivery to mitigate these issues."

The World Health Organization (WHO) and UNAIDS should create new HIV monitoring processes and guidelines, and Member States should commit to report on the indicators and implement policies to enhance health system performance and ensure the long-term well-being of the millions of people around the world living with HIV, the authors note.

Drugs must be safe not just for the patients; in the case of pregnant patients, drugs must also be safe for the unborn children still in the womb. Therefore, at an early stage in the development of new medicines, candidate substances are tested in the Petri dish on embryonic stem cells from mouse cell lines. This is to avoid that an embryo-damaging effect would only be noticed at a later stage during tests with pregnant mice.

However, these cell culture tests are a highly simplified version of what takes place in the uterus. Researchers just add the test material to a culture of embryonic stem cells in a Petri dish, and can identify substances that have a direct adverse effect on embryonic cells. By contrast, in the body of a pregnant woman, active pharmaceutical ingredients may be modified by the mother's metabolism and enter the embryo's bloodstream via the placenta. Moreover, standard cell culture tests can't detect substances that have indirect effects on the embryo, for example, in that they interfere with the functioning of the placenta or generate stress responses.

A chip with different cell types

Researchers in the Department of Biosystems Science and Engineering at ETH Zurich in Basel have now devised a laboratory test that incorporates the role of the placenta into embryotoxicity assessments. To do so, Julia Boos, a doctoral student in the group of ETH Professor Andreas Hierlemann, and her colleagues developed a new chip. This chip contains several compartments, all interconnected by miniature channels. On this chip, the scientists combined human placental cells taken from cell lines with microtissue spheroids derived from mouse embryonic stem cell lines, known as "embryoid bodies", which reflect the early development of the embryo. Test substances first encounter a layer of placental cells, which they have to pass before reaching the embryonic cells, thereby reproducing the situation in utero.

Incidentally, these experiments do not produce viable embryos. The embryonic cells from cell lines only undergo the very first steps of embryonal development over a period of ten days.

Test detects indirect damage

To demonstrate the functioning of the new test, the researchers used microparticles that did not harm the embryoid bodies if they came into direct contact. With the new test, which also includes placental cells, however, the scientists observed a potential indirect adverse effect. Although the placental cells managed to hold the microparticles back, meaning the particles did not get through to the embryonic cells, the placental cells showed a detectable stress response.

Now the researchers would like to further develop their system with regard to more suitable plastic materials. It is also conceivable to use human stem cell lines, instead of mouse cells, to form embryoid bodies in the future. "There are significant differences between lab animals and humans, particularly in terms of embryonic development and the processes taking place in the placenta," Boos says, continuing: "Of all the organs, the placenta is where differences between the species are most pronounced."

The group aims at creating a new test that is also easy to use for the pharmaceutical industry. Being able to detect - and eliminate - substances that are harmful to the embryo at an early stage of drug development means that fewer substances will subsequently be tested on animals in in-vivo studies.

COLUMBUS, Ohio - The oral targeted therapy drug ibrutinib is an effective treatment option for high-risk hairy cell leukemia, according to a new study conducted by researchers at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James).

Hairy cell leukemia is a rare form of B-cell blood cancer that is diagnosed in 600 to 800 people annually in the United States. Researchers note that while the disease generally has a good prognosis for the majority of people affected, a small group of patients with variants of the disease do not respond well to existing U.S. Food and Drug Administration (FDA) approved therapies or cannot tolerate the side effects of established therapies.

"There is a critical unmet need for therapy options in this subset of patients to achieve long-term cancer control," said Dr. Kerry Rogers, principal investigator of the clinical trial and a hematologist/scientist at the OSUCCC - James. "Our study shows that ibrutinib (pronounced eye-broo-ti-nib) is a safe, effective and well-tolerated option for patients with relapsed or variant forms of hairy cell leukemia. It is a very important discovery for patients facing this diagnosis."

For this phase 2 clinical trial, a multi-institutional team led by the OSUCCC - James recruited 44 patients with high-risk hairy cell leukemia to test the effectiveness of the drug ibrutinib, 15 of whom were treated in Columbus, Ohio, at the OSUCCC - James.

All study participants had either classic hairy cell leukemia and had received other treatments previously or the variant form of the disease where it is not likely that the standard therapies--the chemotherapy drugs cladribine (pronounced KLAD-rih-been) and pentostatin (pronounced PEN-toh-STA-tin)--would be effective.

Researchers reported their findings in the June 24 issue of Blood.

Ibrutinib is an oral therapy in a class of drugs known as Bruton's tyrosine kinase (BTK) inhibitors. These drugs block specific chemical reactions in the body that are involved in cellular processes. Use of the drug for this study was considered experimental; however, ibrutinib is FDA approved for the treatment of certain cancers, including mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma and others.

"The underlying cellular biology of these diseases is similar, so we wanted to determine if this FDA-approved drug that is used to treat other forms of blood cancer could also serve as an effective treatment for this small segment of hairy cell leukemia patients who did not respond to traditional therapies," said Rogers, who is an assistant professor in Ohio State's College of Medicine.

"Even though hairy cell leukemia is a disease with a generally good prognosis, there is a small group of patients for whom current therapies are inadequate for cancer control," Rogers added. "This is an effective, well-tolerated new treatment option for patients impacted by the highest-risk forms of hairy cell leukemia. It's a very exciting development that could transform survivorship for this subset of patients from months and years, to years and decades."

Older people appear to have fewer antibodies against the novel coronavirus, a new laboratory study from Oregon Health & Science University suggests.

Antibodies are blood proteins that are made by the immune system to protect against infection. They are known to be key players in protection against SARS-CoV-2 infection.

The study published today in the Journal of the American Medical Association.

"Our older populations are potentially more susceptible to the variants even if they are vaccinated," said senior author Fikadu Tafesse, Ph.D., assistant professor of molecular microbiology and immunology in the OHSU School of Medicine.

Tafesse and colleagues emphasized that even though they measured diminished antibody response in older people, the vaccine still appeared to be effective enough to prevent infection and severe illness in most people of all ages.

"The good news is that our vaccines are really strong," Tafesse said.

However, with vaccine uptake slowing in Oregon and across United States, researchers say their findings underscore the importance of promoting vaccinations in local communities.

Vaccinations reduce the spread of the virus and new and potentially more transmissible variants, especially for older people who appear to be more susceptible to breakthrough infections.

"The more people get vaccinated, the less the virus circulates," Tafesse said. "Older people aren't entirely safe just because they're vaccinated; the people around them really need to be vaccinated as well. At the end of the day, this study really means that everybody needs to be vaccinated to protect the community."

Researchers measured the immune response in the blood of 50 people two weeks after their second dose of the Pfizer vaccine against COVID-19. They grouped participants into age groups and then exposed their blood serum in test tubes to the original "wild-type" SARS-CoV-2 virus and the P.1 variant (also known as gamma) that originated in Brazil.

The youngest group - all in their 20s - had a nearly seven-fold increase in antibody response compared with the oldest group of people between 70 and 82 years of age. In fact, the laboratory results reflected a clear linear progression from youngest to oldest: The younger a participant, the more robust the antibody response.

"Older people might be more susceptible to variants than younger individuals," Tafesse said.

The findings highlight the importance of vaccinating older people as well as others who may be more vulnerable to COVID-19, said co-author Marcel Curlin, M.D., associate professor of medicine (infectious diseases) in the OHSU School of Medicine.

"The vaccine still produces strong immune responses compared with natural infection in most older individuals, even if they are lower than their younger counterparts," Curlin said. "Vaccination in this group may make the difference between serious and mild disease, and likely reduces the chances of transmitting SARS-CoV-2 to another person."

The average American spends 5 days each year in line by some estimates. Many of these lines are for things like a cup of coffee, movie theater tickets or a ride on the newest roller coaster, but for some the wait is for something far more pressing -- a new kidney.

In South Carolina, the average time spent on a waitlist for a kidney transplant is 42 months, but according to a recent paper in JAMA Surgery, changes to the U.S. kidney allocation system could result in reduced access to kidney transplants and longer times spent in line.

"At face value, the changes in the allocation system seem quite appropriate," said Derek DuBay, M.D., director of transplant at MUSC Health and principal investigator on the study. "Everyone waits in line for the same amount of time. It's hard to argue with that." And yet he still disagrees.

There are three main components to transplant volume: organ allocation, a particular transplant center's aggressiveness for accepting organs, and a patient's geographical access to a transplant center. The Organ Procurement and Transportation Network (OPTN) addressed allocation inequalities by ensuring that all patients wait at least the same amount of time for a kidney rather than the previous geography-based model.

As the only transplant center in South Carolina, MUSC Health performs more kidney transplants per year than any other organ transplant in its program, which gave researchers an opportunity to predict the results of these allocation changes.

Kidney transplants are an important treatment option for patients. As the gold standard for chronic renal failure treatment, a kidney transplant can add 5 years to a patient's life expectancy, on average, compared to dialysis. DuBay says there are few things in medicine that confer a survival advantage of that magnitude as well as a great improvement in quality of life. His team looked at patients with end-stage kidney disease (ESKD) for this study, since kidney transplant is the best treatment option for these patients.

DuBay and his research team have the same goal as the OPTN: ensuring equitable access to organ donations. Recent results for ESKD patients, however, point to longer wait times for those in rural parts of the country than the times seen before the policy changes. DuBay points to the complexity of fair organ allocation to explain this effect. With more Medicaid expansion programs in urban areas, higher rates of insurance and closer proximity to transplant centers, patients in densely populated areas have more access to donated organs even if their wait times are longer.

While ESKD patients in South Carolina wait 3.5 years on average for a kidney, patients in New York City can wait upwards of 8 years. And while that appears to be unfair at first glance, DuBay says it's more complex than that. With a higher population density and high access to organ donation, patients in New York City are 3 times more likely to receive an organ despite the longer list than those in South Carolina.

DuBay likens the organ allocation equation to lines at a theme park. While it may appear that those in rural areas have a fast pass, he suggests the OPTN consider which patients to put on the list rather than the wait times of those already on the list.

"I think the important metric to consider is who gets into the theme park," said DuBay. "If waiting times are equal length, equal proportions of people with renal failure from South Carolina and New York City should be admitted to the park. Alternatively, if we let three times more people from New York into the theme park, for instance, then maybe they should wait a little bit longer."

Allocation can look like the right aspect to address, but DuBay points to access to transplant instead. "In South Carolina, we've been hit with a double whammy," he said. "You have patients with renal failure and ESKD whose chances of getting on the waitlist are already low. And now with the new allocation system, if they do get on the waitlist, they have an even lower probability of getting a transplant than before."

These policy changes are also predicted to result in a 40% decline in kidney transplant volumes for the state -- not due to a shorter waitlist, but due to reduced access to transplant.

This research reflects the importance of this access when looking at transplant volumes. "Organ allocation algorithms can't fix all of the inequities of organ transplantation," said DuBay. "And in fact, they can unintentionally worsen it." His goal is to bring public awareness and help his patients get the care they need.

"The average person in Sumter, South Carolina, should have the same opportunity and probability for a kidney transplant as those with renal failure in Chicago," he said. "It shouldn't be different because you have a different health care infrastructure or a different allocation system. The playing field needs to be leveled."

Two recently published studies available on the National Institutes of Health (NIH) website indicate Epstein-Barr virus (EBV) reactivation may play a role both in the development of long COVID symptoms, as well as severe COVID-19 cases.

The first evidence linking EBV reactivation to long COVID symptoms was discovered by Gold et al. (2021) and published in Pathogens. This study can be viewed on the NIH website here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233978/

"We ran Epstein-Barr virus serological tests on COVID-19 patients at least 90 days after testing positive for SARS-CoV-2 infection, comparing EBV reactivation rates of those with long COVID symptoms to those who never experienced long COVID symptoms," said lead study author Jeffrey E. Gold of World Organization. "We found over 73% of COVID-19 patients who were experiencing long Covid symptoms were also positive for EBV reactivation."

Another group of researchers, Chen et al. (2021), found EBV reactivation may also be associated with COVID-19 severity. Their report published in Scientific Reports by Nature is available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149409/

According to Gold, more than 95% of health adults will test positive for latent EBV infection, identified by testing for the presence of EBV VCA IgG and/or EBV nuclear antigen 1 (EBNA-1) IgG. EBV reactivation, on the other hand, is identified by further testing for the presence of EBV EA-D IgG, EBV VCA IgM, and/or circulating EBV DNA.

David J. Hurley, PhD, a professor and molecular microbiologist at the University of Georgia and coauthor of the Pathogens study said, "We found similar rates of EBV reactivation in those who had long COVID symptoms for months, as in those with long COVID symptoms that began just weeks after testing positive for COVID-19. This indicated to us that EBV reactivation likely occurs simultaneously or soon after COVID-19 infection."

According to Gold, other diseases and stressors can also trigger EBV reactivation, this is not exclusive to COVID-19. The inflammation response from SARS-CoV-2 infection, however, appears more successful than many other stressors at triggering EBV reactivation. While EBV reactivation may not be responsible for all cases of recurring fatigue or brain fog after recovering from COVID-19, evidence indicates that it likely plays a role in many or even most cases.

The Pathogens study found that nearly one-third of 185 people surveyed who had tested positive for COVID-19 ended up with long haul symptoms, even some who were initially asymptomatic. This percentage of long term sequelae after COVID-19 infection was similar to the percentage found in a separate study Sequelae in Adults at 6 Months After COVID-19 Infection published in JAMA Network Open.

The relationship between SARS-CoV-2 and EBV reactivation described in these studies open up new possibilities for the diagnosis and treatment of initial COVID-19 infection as well as long COVID. The researchers of the study in Pathogens indicated that it may be prudent to test patients newly positive for COVID-19 for evidence of EBV reactivation indicated by positive EBV EA-D IgG, EBV VCA IgM, or serum EBV DNA tests. If patients show signs of EBV reactivation, they can be treated early to reduce the intensity and duration of EBV replication, which may help inhibit the development of long COVID.

While there is no available vaccine to prevent EBV infection, on July 26, 2021 a phase 1, open-label study to evaluate the safety and immunogenicity of an EBV vaccine sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) at NIH is expected to begin.

"As evidence mounts supporting a role for EBV reactivation in the clinical manifestation of acute COVID-19, this study further implicates EBV in the development of long COVID," said Lawrence S. Young, PhD, a virologist at the University of Warwick speaking about the Pathogens study. "If a direct role for EBV reactivation in long COVID is supported by further studies, this would provide opportunities to improve the rational diagnosis of this condition and to consider the therapeutic value of anti-herpesvirus agents such as ganciclovir."

The Covid-19 pandemic has improved perceptions of facial attractiveness and healthiness of people wearing face masks in Japan.

Wearing sanitary facemasks was not uncommon in Japan prior to the Covid-19 pandemic. Public health initiatives during the pandemic have led to a drastic increase in the use of facemasks as they reduce the transmission of the SARS-CoV-2 virus. The sanitary-mask effect is a model that predicted how facemasks affected perceptions of facial attractiveness. However, as mindsets might have changed due to the pandemic, it is likely that the sanitary-mask effect has been altered.

A team of four scientists, including Professor Jun I. Kawahara from Hokkaido University's Faculty of Letters, has revealed that there has been a shift in how the use of facemasks affects the perception of facial attractiveness among the Japanese population. Their findings were published in the journal i-Perception.

Facial attractiveness is affected by many features including facial symmetry, facial contours, the smoothness or roughness of the skin, and skin color. According to the sanitary-mask effect, reported in 2016 by members of the team, wearing a facemask affects perceptions of facial attractiveness due to two factors: the mask covers up the lower half of the face and hides features used to judge facial attractiveness (occlusion); and, the very act of wearing a face mask carries connotations of illness or susceptibility to infection (priming). Due to occlusion, they found faces appear less attractive when wearing a mask; as a result of priming, wearing facemasks reduces facial attractiveness perception across the board.

As wearing a sanitary facemask has become more common after the onset of SARS-CoV-2 pandemic, the research team speculated that beliefs regarding mask-wearers and perceptions of mask-worn faces have been changed.

In the current study, a survey of 286 adults showed that a larger proportion of respondents believed that wearing a facemask either increased or had a neutral effect on assumptions of healthiness. Prior to the pandemic, the opposite was true. A survey of 59 individuals showed that the perception of mask-worn faces has changed after the onset of the pandemic. In particular, the effect of priming was reduced, so the perceptions of attractiveness were primarily dependent on occlusion; mask color had no effect on these perceptions. Finally, a survey of 44 individuals demonstrated that the perceived unhealthiness of mask-worn faces was lower after the onset of the COVID-19 pandemic compared with before the epidemic. All the observed changes are likely due to the changes in the perception of and messaging surrounding mask use.

The current study has validated the sanitary-mask model by confirming one of the predictions made when the model was first proposed: removing the perception of unhealthiness associated with mask-wearing would reduce the negative impact on attractiveness ratings. This study also revealed the impact of the COVID-19 epidemic, on perceptions of attractiveness of masked faces. The scientists suggest that the sanitary mask effect could reflect the progress of the pandemic, but the surveys need to be conducted on much larger scales to verify this possibility.

DALLAS, July 21, 2021 -- Babies who were breastfed, even for a few days, had lower blood pressure as toddlers and these differences in blood pressure may translate into improved heart and vascular health as adults, according to new research published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

Research has found that cardiovascular disease risk factors, including high blood pressure, can start in childhood. Studies have also confirmed breastfeeding is associated with lower cardiovascular disease risk in adulthood. However, the amount and length of time breastfeeding that is needed to achieve cardiovascular benefit has not been clear.

"This is the first study to evaluate the association of breastfeeding in the first days of life and blood pressure in early childhood," said lead study author Kozeta Miliku, M.D., Ph.D., clinical science officer of the CHILD Cohort Study and post-doctoral fellow in medicine at McMaster University in Hamilton, Ontario, Canada. "Infants who received even a relatively small amount of their mother's early breast milk, also known as colostrum, had lower blood pressure at 3 years of age, regardless of of how long they were breastfed or when they received other complementary foods."

Colostrum is known to be especially rich in growth factors, immunologic components and stem cells that are extremely beneficial to newborns and only found in human breastmilk.

Researchers used data from the ongoing Canadian CHILD Cohort Study - a study of over 3,000 children who were born between 2009-2012 and have been followed ever since to understand how early life experiences shape health and development. They analyzed infant feeding information collected from hospital records and caregiver questionnaires for nearly 2,400 children.

Among those children, 98% were breastfed to some extent, including 4% who received "early limited breastfeeding" defined as a few breastfeedings during the hospital stay. Only 2% of children in the study were not breastfed at all.

Among breastfed children, 78% were breastfed for six months or more and 62% were exclusively breastfed for at least three months. Exclusive breastfeeding meant breast milk only, without any formula, solid foods or other fluids since birth. On average, mothers who never breastfed were younger, more likely to smoke during pregnancy and less likely to have a post-secondary degree, compared to the mothers who breastfed briefly or beyond their hospital stay.

Researchers found:

At 3 years of age, the children who were never breastfed had higher blood pressure measures (average 103/60 mm Hg), compared to those who were breastfed for any duration (average of 99/58 mm Hg).

Among the infants who received only limited early breastfeeding while in the hospital as newborns, blood pressure measures were also lower (average of 99/57 mm Hg) compared to those who were never breastfed (average of 103/60 mm Hg).

Blood pressure among the toddlers who had been breastfed was lower regardless of their body mass index at age 3 or their mothers' social, health or lifestyle factors.

Blood pressure was also lower among toddlers who had been breastfed, regardless of how long they were breastfed or if they received other complementary nutrition and foods.

"The benefits of sustained and exclusive breastfeeding are well documented for numerous health conditions, including respiratory infections and diarrheal disease during infancy, and chronic conditions including asthma and obesity later in life," said senior study author Meghan B. Azad, Ph.D., deputy director of the CHILD Cohort Study, associate professor of pediatrics and child health at the University of Manitoba, and research scientist at the Children's Hospital Research Institute of Manitoba in Winnipeg, Canada. "Our study suggests that for cardiovascular outcomes such as blood pressure, even a brief period of breastfeeding is beneficial. This points to colostrum as a key factor in shaping developmental processes during the newborn period. For many reasons, sustained breastfeeding should be strongly supported, and it is also important to understand that 'every drop counts,' especially in those critical first few days of life."

"Doctors and public health policymakers should consider the importance of educating new mothers about breastfeeding and offering immediate postpartum lactation support," said Azad, who co-directs the Manitoba Interdisciplinary Lactation Centre. "Our study's results suggest the short-term savings from not providing in-hospital breastfeeding support and discharging moms too quickly could be greatly outweighed by the long-term costs from reduced cardiovascular health later in life."

Researchers noted further investigation is warranted to examine the bioactive components of colostrum, understand how they influence cardiovascular development and determine their long-term associations with cardiovascular health. The study has some limitations including its observational design, meaning it does not allow researchers to confirm a cause-and-effect relationship between breastfeeding and blood pressure in early life. In addition, researchers collected only a single blood pressure measurement, rather than taking the average of at least two measurements, and there were few infants who had never been breastfed, which limited comparisons.

"This important study provides ongoing support for the premise that care during infancy can influence heart health. While further investigation is needed to understand the mechanisms responsible for the positive impact of early breastfeeding on blood pressure in young children, the authors should be commended for their identification of a modifiable factor that has the potential to improve child health," said Shelley Miyamoto, M.D., FAHA, chair of the American Heart Association's Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts) and Jack Cooper Millisor Chair in Pediatric Heart Disease and director of the Cardiomyopathy Program at Children's Hospital Colorado in Aurora.

DALLAS, July 21, 2021 -- People who made even small increases in their daily physical activity levels after receiving an implantable cardioverter defibrillator (ICD) experienced fewer incidences of hospitalization and had a decreased risk of death, according to new research published today in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Implantable cardioverter defibrillators, also known as ICDs, are battery-powered devices placed under the skin that can detect abnormal heart rhythms and deliver an electric shock to restore a normal heartbeat. According to American Heart Association's Heart Disease and Stroke Statistics--2021 Update, there were 60,000 ICD procedures annually in 2014, the most recent data available. ICDs help reduce the risk of sudden cardiac death and can be recommended for life-threatening rhythm irregularities due to heart attack, cardiac arrest or a congenital heart disease.

"Cardiac rehabilitation programs offer patients a safe environment to increase physical activity after ICD implantation. Evidence has also shown cardiac rehab lessens the risk of additional hospitalization and death, but cardiac rehabilitation programs are underutilized, especially among women, the elderly, people from diverse racial and ethnic groups and those living in rural areas," said study author Brett D. Atwater, M.D., director of electrophysiology and electrophysiology research at Inova Heart and Vascular Institute in Fairfax, Virginia. "The causes of underutilization are a combination of providers failing to prescribe and patients being unwilling to participate because of the time requirements for participation, the travel to and from the rehab facility and out of pocket costs associated with that.

"Our study examined whether physical activity outside of a formal cardiac rehabilitation program could yield similar benefits, and we found it did," he said. "This suggests that additional options like home-based cardiac rehabilitation might help more patients realize the health benefits of increased physical activity."

While previous studies have shown that heart attack patients were 53% less likely to die if they participated in cardiac rehabilitation, only about one-third of heart attack patients participate in formal programs after they are discharged from the hospital. "Cardiac rehabilitation participation is lower among patients with heart failure, with recent studies reporting only 2.7% of eligible Medicare beneficiaries with heart failure participated in cardiac rehabilitation," Atwater explained.

Researchers reviewed health and physical activity information for nearly 42,000 Medicare beneficiaries who had ICDs implanted between January 1, 2014, and December 31, 2016, assessed through the Centers for Medicare and Medicaid Services (CMS) Virtual Research Data Center. The patients were average age 75; 72% male; and about 90% of participants were white. Sensors in the ICDs measured the participant's motion and heart rate in order to detect physical activity. For physical activity to be logged by the ICD, sensors needed to note both physical movement and heart rate values higher than the patient's individualized values at rest.

"In this study, any physical activity counted towards daily totals, as long as the patient was moving and the heart rate increased at the same time," Atwater said. "Prior work shows that simple activities of daily living such as walking around the house or doing the dishes, count toward these totals and can improve health compared to sitting still."

They found:

Only 3% of the patients who received ICDs during the study period participated in a cardiac rehabilitation program.

Participants who had cardiac rehabilitation increased physical activity by nearly 10 minutes daily during their cardiac rehabilitation sessions, compared to a decrease of one minute a day among those not enrolled in a cardiac rehabilitation program.

Those who participated in a cardiac rehabilitation program were 24% less likely to die during the one to three years after ICD implantation compared to those who did not have cardiac rehabilitation.

Every 10 minutes of increased daily physical activity was associated with a 1.1% reduction in death from all causes among all patients in this analysis.

After adjusting for the increased physical activity observed during cardiac rehabilitation, reductions in death rates were the same between those who did and did not participate in cardiac rehabilitation if they increased physical activity.

"This finding helps confirm prior research showing that cardiac rehabilitation is underutilized, and the benefits of increased physical activity obtained in cardiac rehabilitation programs also may be achievable at home, potentially offering another opportunity to improve outcomes in patients with ICDs," Atwater said.

The current American College of Cardiology/American Heart Association guidelines recommend comprehensive cardiac rehabilitation for patients with heart failure because it improves the heart's functional capacity and the patient's quality of life, while also reducing the risk of hospital readmission for patients with heart failure with reduced heart pumping ability. Cardiac rehabilitation is also recommended for heart attack survivors and patients who have recently had percutaneous coronary intervention or bypass surgery. The American Heart Association supports congressional legislation to increase access to cardiac and pulmonary rehabilitation programs.

A limitation of the study is its retrospective design, using prior health information. Additional prospective research that follows patients through ICD implantation and monitors their physical activity in the years after the procedure is needed to confirm if increasing physical activity at home can safely reduce the risks of death or hospitalizations.

Chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world. New research published in the Journal of Leukocyte Biology reveals that certain protein markers may indicate which patients have stable forms of CLL and which have more aggressive types.

Identifying these proteins may not only help determine patients' prognoses but also point to potential therapeutic targets for investigators who are searching for new CLL treatments.

"The results offer a meaningful biological approach into the protein composition of CLL cells at an early stage of the disease, when the clinical characteristics of patients are similar and the course of the disease is difficult to predict. Our results showed that the protein profile can however predict how the disease will further evolve," said lead author Cristina Bagacean, PhD, of CHU de Brest, in France. "This approach could identify putative therapeutic targets in order to prevent CLL progression."

The frequency of misattributed paternity, where the assumed father is not the biological father, is low and decreasing in Sweden, according to an analysis of 1.95 million family units with children born mainly between 1950 and 1990.

In the Journal of Internal Medicine analysis, the overall rate of misattributed paternity was 1.7%, with rates closer to 1% in more recent decades.

The authors note that beyond its general scientific and societal relevance, the frequency of misattributed paternity has implications for studies on hereditary conditions. The study's findings indicate that misattributed paternity is unlikely to have large effects on such studies.

"Using simple but elegant methods, together with large-scale register data, we present population-based estimates of a peculiar question. These findings should once and for all put an end to the common misconception of overinflated occurrences of misattributed paternity in the general population," said lead author Torsten Dahlén, of the Karolinska Institutet, in Sweden.

Experts say these unexpected healthcare costs may discourage people from seeking recommended preventive care.

Despite a sharp reduction in out-of-pocket (OOP) costs for preventive care since the Affordable Care Act was enacted in 2010, patients are still receiving unexpected bills for preventive services that should be free, according to a new study co-authored by a Boston University School of Public Health (BUSPH) researcher.

Published in the journal Preventive Medicine, study found that total out-of-pocket costs billed for preventive services to Americans with employer-sponsored insurance (ESI) in 2018 ranged from $75.6 million to $219 million, with 1 in 4 patients who used preventive care incurring these charges.

"The ACA enabled great strides in making preventive care free to patients, but the job is not done," says Dr. Paul Shafer, senior author of the study and an assistant professor of health law, policy & management at BUSPH. "As with any benefit that has to be implemented by thousands of different health insurance plans that are subject to the ACA, it won't always be perfect. We found that a majority of patients are receiving preventive care for free and those who were charged only paid about $20 or less. This is great news in light of the next legal attack on the ACA with Kelly v. Becerra, but too many people are still footing the bill for care that most likely should be covered by their insurance plan."

Shafer and study lead author Alexander Hoagland, PhD student in economics at Boston University College of Arts & Sciences, calculated these estimates by analyzing national health insurance claims data from 2018 for adults and children covered by ESI. To accommodate for variations in the way insurance plans cover preventive care, the researchers categorized preventive care ranging from "least restrictive" (including all preventive services) to "most restrictive" (including cheapest in-network claim for each type of preventive service during the year).

The researchers found that the likelihood of a patient being charged an OOP cost for any covered preventive service that they used ranged from 19.2 percent for the most restrictive measure, to 32.1 percent for the least restrictive, with a median cost of $20-$23 per person each year.

They also found that OOP charges varied widely depending on the type of preventive service patients received, as well as the patients' geographic location. Annual wellness visits accounted for a majority of the costs, at more than 35 percent. Unexpected charges were also common for routine screenings for cancer, diabetes, cholesterol, depression, obesity, and sexually transmitted infections as well as pregnancy-related services, with OOP costs for these services ranging from $3.63 to $293.28 per person.

The findings also revealed that patients in the South and rural areas were more likely to be billed for preventive services. On average, less than 10 percent of patients in Massachusetts and Colorado were charged for OOP costs, compared to more than 20 percent of patients in Mississippi and Alabama. Covered preventive care may also be more difficult to access in rural areas with fewer in-network providers.

This wide range of OOP costs may be driven by inadvertent errors and inconsistencies in coding by providers or practices, the researchers say. There are no federal standards for what combinations of diagnosis and procedure codes--these are filed in insurance claims by doctors for reimbursement--related to preventive services should be free so insurers set up their own guidelines, which creates unnecessary complexity.

These OOP charges for preventive care can cause direct and indirect effects that ultimately discourage patients from receiving recommended care, says Hoagland.

"The direct effect arises from patients who unexpectedly had to pay for a preventive service, and who are now less likely to return for repeated screenings," Hoagland says. "Indirectly, other potential patients who hear about these negative experiences may be less likely to seek out any screenings for fear of getting stuck with a bill."

Standardizing and simplifying how preventive care is delivered would solve a lot of problems, Shafer says.

"Instead of having insurer-specific coding criteria for wellness visits or to determine whether a particular screening is preventive or no, what if the first office visit or cancer screening was fully covered each year?" says Shafer. "That would be take a lot of the guesswork and frustration out of the equation for patients. If that is a step too far, we could at least standardize the coding criteria across insurers so that patients aren't left footing the bill when the practice gets it wrong."

In the early days of the pandemic, scientists at Virginia Tech created a COVID-19 testing laboratory and novel test for the virus from scratch.

They not only developed a test in-house that avoided the reagent supply shortages that hampered testing efforts nationwide, but also used 3D-engineered supplies and stable storage media, enabling samples to be transported to rural sites in Virginia without the need for constant refrigeration.

This novel protocol for transforming a research laboratory into a testing operation capable of processing more than 130,000 tests for the Commonwealth of Virginia and Virginia Tech communities since April 2020, has been described in a new article published July 20 in Nature Communications.

Carla Finkielstein, associate professor at the Fralin Biomedical Research Institute at VTC and scientific director of the Virginia Tech Molecular Diagnostics Laboratory at the Fralin Biomedical Research Institute, is the paper's corresponding author.

Since testing began, the Molecular Diagnostics Lab has analyzed samples from eight health districts across Southwest Virginia and more than 650 businesses, nursing homes, medical and dental offices, construction sites, and schools.

"This publication in Nature Communications provides an overview of the enormous dedication of the people, including Dr. Finkielstein and her colleagues, and the successful enterprise they have implemented in service of not only Virginia Tech, but also the entire community," said Michael Friedlander, executive director of the Fralin Biomedical Research Institute, Virginia Tech's vice president of health sciences and technology, and an author of the paper. "The partnership by Virginia Tech faculty, staff, students, and university leadership working closely with our health department leaders to meet the scientific, regulatory, legal, financial, and infrastructural needs to implement this program represents the Virginia Tech spirit of Ut Prosim at its finest."

At Virginia Tech, Finkielstein, who is also an associate professor of biological sciences in the College of Science, helped lead scientists across the university to develop a new test. An award-winning cancer researcher, Finkielstein shifted her attention from her laboratory and enlisted "a small army of volunteers" at the Fralin Biomedical Research Institute to work around the clock to develop a reliable RT-qPCR-based assay that could be validated and submitted to the Food and Drug Administration (FDA) for Emergency Use Authorization consideration, while avoiding the flawed tests kits and potential reagent supply chain challenges on the horizon for the nation, Friedlander said.

The Virginia Tech COVID-19 Lab launched on April 20, 2020, after submitting its application for an FDA-issued Emergency Use Authorization and receiving permission to begin testing. The initiative has helped expand public health lab testing capacity in Southwest Virginia -- a critical step to monitor the spread of the virus in the commonwealth and slow the pandemic.

The Virginia Tech Board of Visitors has since bestowed Finkielstein with its highest honor for faculty -- the Ut Prosim Scholar Award - for her service to humanity and her work to improve COVID-19 testing efficiency and effectiveness in support of Virginia Tech and the Virginia Department of Health.

"Dozens of dedicated, caring people contributed -- it is always more than just one individual effort," said Finkielstein, who is also affiliated with the Fralin Life Sciences Institute. "I am grateful to work with people who cared and stepped forward when they were needed. It is an honor to see the teamwork making contributions to people's lives."

Virginia Tech sits at the edge of Southwest Virginia, a rural section of the state that includes some counties with economic challenges. The region's population is older and lags the rest of Virginia in income and access to health care, according to U.S. Census data, making it especially vulnerable to COVID-19.

Paige Bordwine, Southwest Virginia's regional epidemiologist in the Virginia Department of Health's Office of Epidemiology, and Noelle Bissell, director of the New River Health District, who worked closely with the Virginia Tech team in validating and implementing the testing, are co-authors of the paper.

The Virginia Tech team developed a testing assay that in many cases is more sensitive and specific to SARS-CoV-2 than other available molecular tests. While most other tests target one or two regions of the same gene to identify the virus, the Virginia Tech test targets three, making it more accurate and bolstering its ability to detect virus variants. The test can analyze a variety of clinical sample types, including nasopharyngeal, nasal and throat swabs, and saliva.

To guard against errors, the Molecular Diagnostics Laboratory, located in the Fralin Biomedical Research Institute's new research building in Roanoke, was designed with physically segregated processing stations, controls to flag sources of contamination, monitors for human error, and strict criteria for reporting a sample as positive.

Because the test was developed in-house, scientists can rapidly adapt it to detect new mutations in the virus' genome and variants of the virus and implement it within hours, which enables a quicker assessment and public health response to virus mutations. The laboratory has the capacity to process 7,500 tests per week.

Deborah Birx, former White House coronavirus response coordinator, praised Virginia Tech's work to develop its own coronavirus testing site and open its campuses amid the global pandemic. In September, she told university officials that only a handful of universities nationwide are doing their own COVID-19 testing.

On Nov. 10, 2020, state officials announced Virginia Tech's COVID-19 lab was selected as one of three exclusive OneLab Network Tier 2 laboratories to expand virus testing capacity across Virginia. The lab is called upon to receive samples from any health district in the state, depending on the greatest need.

The paper's first authors are Alessandro Ceci, an analyst in the Molecular Diagnostics Lab at the Fralin Biomedical Research Institute; and Carmen Muñoz-Ballester, postdoctoral associate in the lab of Stefanie Robel, assistant professor at the Fralin Biomedical Research Institute.

Other authors include Friedlander; Allison Tegge, research assistant professor of statistics in Virginia Tech's College of Science; F. Marc Michel, associate professor of geosciences in Virginia Tech's College of Science; Harald Sontheimer, a former professor at the Fralin Biomedical Research Institute; Robyn Umans, a former postdoctoral associate in Sontheimer's lab at the Fralin Biomedical Research Institute; Dipankumar Patel, a former research scientist at the Fralin Biomedical Research Institute; Tewari, a former research assistant professor at the Fralin Biomedical Research Institute; Oscar Alcoreza, a former graduate research assistant in Sontheimer's lab at the Fralin Biomedical Research Institute; and Thomas Maynard, a research associate professor in the lab of Anthony-Samuel LaMantia, professor at the Fralin Biomedical Research Institute; and Daniel Martinez-Martinez, postdoctoral research scientist at the MRC London Institute of Medical Sciences.

The paper serves as a blueprint that could help research institutions act swiftly to ramp up viral testing protocols, navigate regulatory requirements, and support testing in rural communities - in the event of another global pandemic.

"By openly sharing our experience in developing and implementing a diagnostic test born from the necessity of our community, we hope to inspire other academic laboratories to overcome obstacles and provide assistance to their communities if challenges from infectious diseases arise in the future," Finkielstein said.