Body

(APRIL 1, 2021) -The pandemic has exacerbated risk factors for gender-based violence, such as unemployment and financial strain, substance use, isolation, depression anxiety, and general stress, according to the American Psychological Association. That's inspired The University of Texas at San Antonio criminology and criminal justice professor Kellie Lynch, along with professor TK Logan from the University of Kentucky, to work with the National Coalition Against Domestic Violence on a national survey to investigate the impact of the COVID-19 pandemic on the dynamics of gender-based violence and the experiences of those serving victims of gender-based violence.

"The consequences of the COVID-19 pandemic are far-reaching and we still have much to learn about how this pandemic has impacted and will continue to impact gender-based violence," said Lynch. "Gender-based violence, such as intimate partner violence, child abuse, sexual assault and human trafficking, are crimes that thrive on survivor isolation. The isolation resulting from this pandemic, coupled with financial strain and a myriad of mental health issues experienced by many, creates a perfect storm to enhance the occurrence of gender-based violence."

Many victim and criminal justice services have been operating in a limited capacity, if at all, during the pandemic. "The pandemic has forced agencies to quickly adapt their policies and/or manage with limited resources in these unprecedented times. One critical step in helping victim service agencies become better equipped to serve survivors is to document the challenges that agencies face so they can prioritize their needs for future service" said Lynch.

Professionals who serve survivors of gender-based violence across the United States were recruited to complete the online survey between September and December 2020. It consisted of questions across a variety of areas, including the impact of the pandemic on forms of gender-based violence, risks and challenges for survivors, challenges for agencies, interactions with law enforcement, innovations for agencies in going forward and survey respondent information.

In the open-ended responses section of the survey, respondents highlighted a numerous list of barriers to serving survivors, such as maintaining staff and victim health/safety, statewide mandates restricting access to services, limited resources, shelter capacity and reduced criminal justice system operations.

The survey findings indicated that most respondents believed Intimate Partner Violence (IPV), child abuse and sexual assault have increased during the pandemic.

"The results revealed strong concerns about financial insecurity for survivors and their families. In particular, the ability to access safe housing is a major concern as many shelters are operating at limited capacity and homelessness continues to rise in the U.S. The impact of continued isolation on mental health and child wellness are also key issues that we must grapple with as we continue to move toward some version of normal," Lynch added.

The study also found that survivors face immense barriers to seeking help during the pandemic, such as concerns for their health and safety, being closely monitored at home by an abuser, and a lack of knowledge of if and how agencies are providing services during these times.

Additionally, nearly 40% of respondents reported that gun sales have increased in their community since the start of the pandemic and about 50% of respondents reported that abusers threatening to shoot survivors has become a bigger problem since the start of the pandemic.

"The potential risk posed by increased access to firearms in volatile situations cannot be overlooked as an abusive partner's access to a firearm dramatically increases the risk of domestic fatality. Further, there are broader implications for public safety as a recent analysis by Bloomberg found that 60% of U.S. mass shootings in the last six years were committed by men with a history of domestic violence or began as domestic-related attacks."

Findings are coupled with the fact that about two-thirds of respondents reported that abusers have interfered with survivors' work/employment as a control tactic during the pandemic.

The survey also demonstrates that survivor populations are at greater risk during the pandemic. For example, in the case of children, respondents assessed, "They are at an increased risk during the pandemic as many of them live with their abusers or are continuously exposed due to having to function in all aspects from home. There is also a decrease in the access to needs/resources that were being provided from schools."

Among the responses, 25% reported that law enforcement's response to meeting the needs of survivors worsened during the pandemic.

The researcher's concluded the efforts to gather this information is to highlight areas of high concern and innovations to improve services going forward and identify the challenges that victim service agencies face during a global pandemic and perceptions of the impact the pandemic has had on the dynamics of gender-based violence.

"This study was an initial step in documenting the resiliency of victim service agencies and highlights the creativity, determination, and passion of agency staff to navigate this pandemic" Lynch concluded. "These results can be used to inform strategies and allow coordinated plans for providing services to survivors as this pandemic continues and in future emergencies, such as natural disasters and also highlight important areas of need for agencies so that they may seek funding to support their services during these difficult times."

PHILADELPHIA - A Penn Medicine patient with a genetic form of childhood blindness gained vision, which lasted more than a year, after receiving a single injection of an experimental RNA therapy into the eye. The clinical trial was conducted by researchers at the Scheie Eye Institute in the Perelman School of Medicine at the University of Pennsylvania. Results of the case, detailed in a paper published today in Nature Medicine, show that the treatment led to marked changes at the fovea, the most important locus of human central vision.

The treatment was designed for patients diagnosed with Leber congenital amaurosis (LCA) -- an eye disorder that primarily affects the retina -- who have a CEP290 mutation, which is one of the more commonly implicated genes in patients with the disease. Patients with this form of LCA suffer from severe visual impairment, typically beginning in infancy.

"Our results set a new standard of what biological improvements are possible with antisense oligonucleotide therapy in LCA caused by CEP290 mutations," said co-lead author Artur V. Cideciyan, PhD, a research professor of Ophthalmology. "Importantly, we established a comparator for currently-ongoing gene editing therapies for the same disease, which will allow comparison of the relative merits of two different interventions."

In an international clinical trial led at Penn Medicine by Cideciyan and Samuel G. Jacobson, MD, PhD, a professor of Ophthalmology, participants received an intraocular injection of an antisense oligonucleotide called sepofarsen. This short RNA molecule works by increasing normal CEP290 protein levels in the eye's photoreceptors and improving retinal function under day vision conditions.

In a 2019 study published in Nature Medicine, Cideciyan, Jacobson, and collaborators found that injections of sepofarsen repeated every three months resulted in continued vision gains in 10 patients. The eleventh patient, whose treatment was detailed in the latest Nature Medicine paper, received only one injection and was examined over a 15-month period. Prior to treatment, the patient had reduced visual acuity, small visual fields, and no night vision. After the initial dose, the patient decided to forgo the quarterly maintenance doses, because the regular dosing could lead to cataracts.

After a single injection of sepofarsen, more than a dozen measurements of visual function and retinal structure showed large improvements supporting a biological effect from the treatment. A key finding from the case was that this biological effect was relatively slow in uptake. The researchers saw vision improvement after one month, but the patient's vision reached a peak effect after month two. Most striking, the improvements remained when tested over 15 months after the first and only injection.

According to the researchers, the extended durability of vision improvement was unexpected and provides implications for treating other ciliopathies -- the name of the large category of diseases associated with genetic mutations encoding defective proteins, which results in the abnormal function of cilia, a protruding sensory organelle found on cells.

"This work represents a really exciting direction for RNA antisense therapy. It's been 30 years since there were new drugs using RNA antisense oligonucleotides, even though everybody realized that there was great promise for these treatments," said Jacobson. "The unexpected stability of the ciliary transition zone noted in the patient prompts reconsideration of dosing schedules for sepofarsen, as well as other cilium-targeted therapies."

One reason why antisense oligonucleotide has proven successful in treating this rare disease, according to the researchers, is that these tiny RNA molecules are small enough to get into the cell nucleus, but are not cleared very quickly, so they remain long enough to do their work.

"There are now, at least in the eye field, a series of clinical trials using antisense oligonucleotides for different genetic defects spawned by the success of the work in CEP290-associated LCA from Drs. Cideciyan and Jacobson," said Joan O'Brien, MD, chair of Ophthalmology in the Perelman School of Medicine and director of the Scheie Eye Institute

For future studies, the Penn authors are planning gene-specific therapies for other currently incurable blinding inherited retinal disorders.

A possible explanation for why many cancer drugs that kill tumor cells in mouse models won't work in human trials has been found by researchers with The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics and McGovern Medical School.

The research was published today in Nature Communications.

In the study, investigators reported the extensive presence of mouse viruses in patient-derived xenografts (PDX). PDX models are developed by implanting human tumor tissues in immune-deficient mice, and are commonly used to help test and develop cancer drugs.

"What we found is that when you put a human tumor in a mouse, that tumor is not the same as the tumor that was in the cancer patient," said W. Jim Zheng, PhD, professor at the School of Biomedical Informatics and senior author on the study. "The majority of tumors we tested were compromised by mouse viruses."

Using a data-driven approach, researchers analyzed 184 data sets generated from sequencing PDX samples. Of the 184 samples, 170 showed the presence of mouse viruses.

The infection is associated with significant changes in tumors, and Zheng says that could affect PDX as a drug testing model for humans.

"When scientists are looking for a way to kill a tumor using the PDX model, they assume the tumor in the mouse is the same as cancer patients, but they are not. It makes the results of a cancer drug look promising when you think the medication kills the tumor - but in reality, it will not work in human trial, as the medication kills the virus-compromised tumor in mouse," Zheng said.

He hopes his findings will change researchers' approach to find a way to kill tumor cells.

"We all share the common goal of hoping to find a cure for cancer. There are 210 ongoing NIH-funded projects relevant to PDX models, with a combined annual fiscal year budget of over $116 million. We need to tighten up quality control and use models that are not compromised so that the treatments we give to future patients are effective," Zheng said.

This work is a collaboration between the Texas Therapeutics Institute, Institute of Molecular Medicine (IMM) at McGovern Medical School, and the Data Science and Informatics Core for Cancer Research at the School of Biomedical Informatics.

"As a team, we synergized the strengths of McGovern Medical School's virology research and School of Biomedical Informatics' data analysis expertise, and it has led to the success of this project," said Zhiqiang An, PhD, co-senior author of the study, professor and Robert A. Welch Distinguished University Chair in Chemistry at McGovern Medical School.

Exposure to antibiotics in utero and infancy can lead to an irreversible loss of regulatory T-cells in the colon-a valuable component of the immune system's response toward allergens in later life - after only six months, a Rutgers researcher found.

The study was published in the journal mBio.

It is already known that the use of antibiotics early in life disrupts the intestinal microbiota - the trillions of beneficial microorganisms that live in and on our bodies - that play a crucial role in the healthy maturation of the immune system and the prevention of diseases, such as obesity and inflammatory bowel disease. However, less is known about how disruption of the microbiota, which produce short chain fatty acids that regulate T-cells, effects T-cells in the colon.

The study, based on a mouse model, looked at fetal and newborn exposure to antibiotics through the mother in the weeks immediately preceding and after birth, the time when microbial communities assemble and are prone to disruptions, to investigate how this reduction in beneficial bacteria affects neonatal immune system development. These effects were specific to the colon and not observed in the lungs, upper gastrointestinal tract or spleen.

"By studying the exposure to newborns through lactating mothers, we see how the offspring acquire their mothers' antibiotic-impacted microbiota, which compromises their ability to generate a pool of CD41 T cells in the colon, resulting in long-term damage," said co-author Martin Blaser, director of the Center for Advanced Biotechnology and Medicine at Rutgers. "The consequences persist into adulthood, compromising the body's ability to turn off allergic responses."

Video games offer students obvious respite from the stresses of studies and, now, a study from a University of Ottawa medical student has found they could benefit surgical skills training.

Arnav Gupta carries a heavy course load as a third-year student in the Faculty of Medicine, so winding down with a game of Legend of Zelda always provides relief from the rigorous of study. But Zelda may be helping improve his surgical education, too, as Gupta and a team of researchers from the University of Toronto found in a paper they recently published in the medical journal Surgery.

"Given the limited availability of simulators and the high accessibility of video games, medical students interested in surgical specialties should know that video games may be a valuable adjunct training for enhancing their medical education, especially in surgical specialties where it can be critical," says Gupta, whose findings were deciphered from a systematic review of 16 studies involving 575 participants.

"Particularly, in robotic surgery, being a video gamer was associated with improvements in time to completion, economy of motion, and overall performance. In laparoscopic surgery, video games-based training was associated with improvement in duration on certain tasks, economy of motion, accuracy, and overall performance," explains Gupta, who has been a gamer since age 8.

This study builds on past reviews and is the first to focus on a specific medical student population where this style of training could be feasibly implemented. Their timely study found some of the most beneficial games for students of robotic surgery and laparoscopy were: Super Monkey Ball, Half Life, Rocket League and Underground. Underground is purposely designed to assist medical students with their robotic surgery training via a video game console.

"While video games can never replace the value of first-hand experience, they do have merit as an adjunctive tool, especially when attempting to replicate important movements to surgery. For example, first-person shooting games require you to translate three dimensional motions onto a two-dimensional screen, which is like the concept of laparoscopic surgery," says Gupta, whose studies are focused on surgery in ophthalmology, which makes games like Resident Evil 4 or Trauma Center: New Blood fitted for his own ambitions.

"I'm not joking when I say that games such as Fortnite have the potential to enhance those necessary movements, providing stronger motivational components and in a low stakes environment."

Reports suggest 55 percent of university students are gamers and enjoy proficiency with video consoles. Yet, many medical students don't admit to owning and using a gaming console.

"I think there definitely is some ambivalence towards video games in medicine," says Gupta, who is also a fan of Witcher 3. "Given how accessible games have become and how video game technology is advancing, video games definitely are an easy go-to for the students who do love them in some capacity. The hope is that maybe this study can inspire someone to take advantage of video games' unique capabilities, reduce the general ambivalence towards it, and develop some fun ways to let students engage with surgical education."

As the COVID-19 pandemic lingers, researchers have found associations between certain lifestyle factors and a person's risk of getting infected. While it has already been established that those with Type II diabetes and a high body mass index (BMI) are at greater risk of experiencing hospitalizations and other severe complications related to COVID-19, they are also at greater risk of getting symptomatic infection in the first place. That is the finding of a recent study conducted by researchers at the University of Maryland School of Medicine that was published today in the journal PLoS ONE.

Using data from the UK Biobank of 500,000 British volunteers over age 40, the researchers examined health factors in those who tested positive for COVID-19 and compared them to those who tested negative. They found that those who had positive COVID-19 test results were more likely to be obese or have Type II diabetes. Those who tested negative were more likely to have high levels of "good" HDL cholesterol and be at a healthy weight with a normal body mass index (BMI).

"Certain baseline cardiometabolic factors appear to either protect a person from COVID-19 infection while others make a person more vulnerable to infection," said study author Charles Hong, MD, PhD, professor of medicine and director of cardiology research at the University of Medicine School of Medicine. "But this study wasn't designed to determine what factors actually cause COVID-19 infections. These are statistical associations that point to the importance of a healthy functioning immune system for protecting against COVID-19 infection."

He and his colleagues controlled for potential confounding factors like socioeconomic status, age, gender and ethnicity.

"Our findings point to some healthy measures people can take to help potentially lower their risk of COVID-19 infection," Dr. Hong said. "Controlling body weight is very important during this time, and measures to increase HDL levels like regular exercise and a diet rich in monounsaturated fats like extra virgin olive oil and avocados might be helpful too."

Washington, DC, April 1, 2021 - A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that middle schoolers from a predominantly Latinx community, with elevated levels of mental health problems, showed a reduction in symptoms during the early stages of the pandemic.

"While the negative impact of the COVID pandemic on mental health is widespread, our study found that COVID-19 stay-at-home measures may have offered some protective effects for youth mental health early in the pandemic," said study coordinator Francesca Penner, MA, University of Mississippi Medical Center, Mississippi, MA, USA. "These may be related to increased time with family, fewer social and academic pressures, more flexible routines, factors related to Latinx culture and the socio-emotional learning program that students were engaged in throughout the study period."

The findings are based on the Identity Development in Typical Adolescents Study, a US-based ongoing longitudinal project tracking identity development in adolescence, that began in January 2020, prior to the onset of the pandemic.

A sample of 322 young adolescents (Mage = 11.99, 55% female), with a racial/ethnic composition of 72.7% Hispanic/Latinx; 9.3% Black or African American; 5.9% Multiple Races; 5.0% Asian; 1.6% White; and 1.2% American Indian, completed a mental health screening measure prior to the COVID-19 pandemic and at three bi-weekly time points starting one month into stay-at-home orders (mid-April, early May, late May, 2020). A subsample also completed a survey about their experience at home during COVID-19.

For youth who had elevated levels of mental health problems pre-pandemic, symptoms were significantly reduced across domains during the pandemic. Reductions in internalizing, externalizing and overall problems were clinically significant. For youth without notable pre-pandemic mental health problems, there were statistically significant reductions in internalizing and overall problems, and no change in attention or externalizing problems. Further analyses revealed that better family functioning was consistently related to lower mental health symptoms in youth during the bi-weekly follow-ups.

"These results have important clinical implications," said senior author Carla Sharp, PhD, who led the study, and is a professor in the Department of Psychology, University of Houston, Texas. "First, promoting family functioning during COVID-19 may have helped protect or improve youth mental health during the pandemic. Further, it is important to consider cultural factors, such as familism and collectivism in Latinx communities that may buffer the early effects of disasters on mental health to COVID-19 stress.

"It also points to the need to determine specific features of stay-at-home measures that may be protective for youth mental health: for example ongoing socio-emotional learning programs in schools that can pivot to support mental health during crises, increased family time, changes in school structure, addressing middle school peer stress, more sleep, and more flexible routines."

It is of course possible that the negative impact of stay-at-home orders began to take effect after the study period ended in May 2020. Assessments were completed while the academic year was still in session and the COVID-19 outbreak worsened in the school's region after that time. Mental health may have declined later as the spread increased in the area or as stay-at-home measures continued.

The window when this study was conducted may present a unique "natural experiment" with the combination of increased time at home while stress related to COVID-19 in this region was not yet at its peak. Related, families who were financially impacted by COVID-19 may have had worsening stress that had not yet manifested during follow-up points. Further analysis indicated that in families where job loss occurred due to the pandemic, children did not experience the same level of reduction in total mental health problems at the first follow-up, compared to children in families where no job loss occurred.

"Our findings underline the importance of the family environment and Latinx collectivist values of community connection for promoting child resilience and brings into stark focus the possibility that school environments may exacerbate mental health difficulties," said co-author, Jessica Hernandez Ortiz, a graduate student working with Dr. Sharp, who is currently leading the follow-up of the sample to assess more long-term effects of COVID-19 on adolescent mental health outcomes. "Removal from that context into a less pressured environment immediately and positively impacts mental health."

LOS ANGELES (April 1, 2021) -- A single dose of the Pfizer-BioNTech vaccine for individuals who previously had COVID-19 generates an immunologic response similar to that of individuals receiving the two-dose recommended sequence, according to a Cedars-Sinai study published today by the journal Nature Medicine.

"Our findings extend those from smaller studies reported elsewhere and support a potential strategy of providing a single dose of vaccine to persons with a confirmed prior history of coronavirus infection, along with two doses for people not previously infected," said Susan Cheng, MD, MPH, MMSc, associate professor of Cardiology and director of Public Health Research at the Smidt Heart Institute at Cedars-Sinai. "This approach could maximize the reach of a limited vaccine supply, allowing potentially millions more people to be vaccinated in the U.S. alone."

The vaccine that was studied, produced by Pfizer Inc. and BioNTech SE, normally is administered in two doses, 21 days apart, to provide nearly full protection against the novel coronavirus, known as SARS-CoV-2.

The Cedars-Sinai research strongly suggests the second dose may not be needed for individuals who have successfully recovered from a prior coronavirus infection.

"Overall, individuals who had recovered from COVID-19 developed an antibody response after a single vaccine dose that was comparable to that seen after a two-dose vaccination course administered to individuals without prior infections," said Kimia Sobhani, PhD, medical director of the clinical core laboratories and associate professor of Pathology and Laboratory Medicine at Cedars-Sinai. "It appears that a single booster dose given to previously infected individuals offers the same benefit as two doses given to people without prior infection." Sobhani and Cheng, along with Jonathan Braun, MD, PhD, professor of Medicine at the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute at Cedars-Sinai, co-senior-authored this study.

For their research, the investigators administered surveys to 1,090 healthcare workers in the Cedars-Sinai Health System who had received the Pfizer-BioNTech vaccine. The surveys asked the workers about prior coronavirus infections and any symptoms they might have experienced after being vaccinated.

The healthcare workers also took antibody tests to gauge the response of their immune systems to the vaccinations. Antibody levels were measured at three points in time: before or up to three days after the first dose, within seven to 21 days after the first dose, and within seven to 21 days after the second dose.

Based on the surveys, the research team identified 35 individuals with prior coronavirus infections who had received a single vaccine dose and 228 individuals without prior infection who had received both vaccine doses. Based on the antibody tests, the team found that levels and responses of coronavirus-specific antibodies were similar in both of these groups.

Post-vaccine symptoms were more prominent for those with prior infection after the first dose, but symptomatology was similar between the two groups after the second dose.

The investigators said their study had limitations and that more research will be needed to confidently guide vaccine policy.

They noted that they measured antibody levels only up to 21 days following each vaccine dose and that longer-term follow-up likely would provide additionally informative data, especially regarding the duration of the immunity acquired from receiving a single versus double dose of the vaccine.

They also noted that even larger cohort samples will be needed to examine differences across demographic and clinical subgroups that are known to exhibit variation in antibody response following vaccination. More studies also are needed to determine if the results seen after a single dose of the Pfizer-BioNTech vaccine might also apply to other SARS-CoV-2 vaccines, they added.

Taking progestogens - steroid hormones - during pregnancy could reduce the risk of preterm birth in high-risk single baby pregnancies, research has shown.

Although these compounds have been in use for some time, results of individual clinical trials investigating their effectiveness in preventing preterm birth have been conflicting, and so further evaluation of the research evidence was needed.

University of York researchers led the Evaluating Progestogens for Prevention of Preterm Birth International Collaborative (EPPPIC) project, a systematic review which brought together and re-analysed datasets from 31 clinical trials of progestogens, including more than 11,000 women and 16,000 babies worldwide.

Professor Lesley Stewart, the project principal investigator and Director of the University of York's Centre for Reviews and Dissemination, said: "Babies born preterm are at greater risk, of health problems during infancy and of death during their first year. It is therefore essential to have reliable information about how well these interventions work, and for this we need systematic and rigorous evaluation of large amounts of data.

"We hope that our findings will help inform shared decision-making between clinicians and expectant mothers who are considered at high-risk of preterm birth."

Data was obtained from trials of vaginal progesterone given as a gel or pessary, and from trials of 17-OHPC, given as an injection. The project looked separately at trial data from twin and triplet pregnancies. It is the first meta-analysis using raw data from individual pregnancies of 17-OHPC in single baby pregnancies and the first to examine both compounds together.

Both vaginal progesterone and 17-OHPC reduced the risk of preterm birth before 34 weeks for high-risk single baby pregnancies - mostly for women who had experienced a previous preterm birth or had a short cervix in their current pregnancy.

There was a consistent benefit for other outcomes including fetal and baby deaths and serious neonatal complications, including infection and lung and eye problems.

In contrast, analysis showed no evidence that either vaginal progesterone or 17-OHPC was useful for twin or triplet pregnancies with no other risk factors.

Professor Zarko Alfirevic, Coordinating Editor of Cochrane Pregnancy and Childbirth and member of the EPPPIC Secretariat, said: "Consistency of the results across so many different trials is quite remarkable and should be very reassuring to clinicians, but even more importantly to pregnant women and their families."

ST segment-elevation myocardial infarction (STEMI) is a particularly severe type of heart attack associated with a high risk of mortality or long-term disability. Clinicians can reduce a patient's chances of unfavorable outcomes by performing a procedure known as percutaneous coronary intervention (PCI), which combines coronary angioplasty--in which a balloon is inserted into a blocked artery of the heart to clear it--with stenting--inserting a tiny tube into a blocked artery to keep the line open. But studies in China have found that many patients with STEMI choose not to undergo PCI and that women with STEMI, in particular, have a reduced likelihood of undergoing guideline-based management and acute reperfusion therapy.

The phenomenon of patients with STEMI refusing PCI attracted the interest of a research team at China's Shandong University. As lead researcher of the team, Dr. Yu-Guo Chen explains, "Understanding the factors that influence patients' decisions to reject medical advice may facilitate efforts to improve treatment compliance, quality of care, and prognoses." Dr. Chen and team conducted analyses of treatment data to identify the predictors of PCI refusal for patients with STEMI. Their results appear in a paper published in a recent edition of the Chinese Medical Journal.

For their analyses, the researchers used data that had been prospectively collected through a cohort study involving patients with STEMI who presented to any of six Chinese emergency departments between August 2015 and September 2017. After excluding patients who never had the opportunity to decide whether to undergo PCI, as well as patients transferred to other hospitals and those discharged against the treating clinicians' advice, the researchers had a dataset of 957 patients, including 260 women and 697 men. On this dataset, they used multivariable logistic regression analyses to identify the predictors of PCI refusal.

In total, 98 of the patients in the dataset (10.2%) chose not to undergo PCI. One factor that had a major influence on their decisions was age, with patients older than 65 years being more likely than their younger counterparts to refuse PCI. Some important predictors of PCI refusal were having a history of myocardial infarction, experiencing cardiac shock while in the emergency department, a more than 12-hour delay in reaching the hospital after STEMI onset, and having a faster heart rate.

Some other factors included being married, receiving treatment at a tertiary hospital, and having a higher body mass index value.

Interestingly, comparisons between male and female patients showed that female patients were older, were less likely to be married, had lower body mass index values on average, and were less likely to receive treatment at tertiary hospitals. Given that these factors were all predictors of PCI refusal in the regression model, these differences may help to explain why women with STEMI are more likely to refuse PCI than their male counterparts are.

In conclusion, the researchers at Shandong University have identified a host of factors that may help to predict whether a patient with STEMI will give or withhold consent to PCI. When asked about the long-term medical and societal importance of these findings, Dr. Chen notes that knowledge of these predictors may aid healthcare providers in their efforts to persuade more patients with STEMI to consent to PCI. He predicts that increasing the number of patients who undergo PCI "will lead to reductions in mortality and improvements in long-term clinical outcomes." Given the sex disparities in PCI refusal rates, such improvements may be of particular value to Chinese women.

Percutaneous coronary intervention is the recommended procedure after ST-elevation myocardial infarction, but some patients refuse to undergo it. Researchers from Shandong University, China, have identified some demographic and clinical features associated with such treatment refusal.

As with any complex machine, sometimes a simple crossed wire or short circuit can cause problems with how it functions. The same goes for our brains, and even when the short circuit is uncovered, sometimes experts don't have a quick fix.

A new study reveals that an evidence-based treatment may "fix" this human short circuit and, with the help of brain imaging, might predict treatment outcomes for adolescents with anxiety disorders. University of Cincinnati researchers say this could determine medication effectiveness more quickly to help patients.

Study results showed that brain imaging was able to predict -- after just two weeks of treatment with almost 80% accuracy -- how much a patient would improve.

"We also see [through imaging] that the medication in this study increases the strength of the connection between a brain area that generates anxiety and an area that serves as a 'brain brake' for the fear center," says Jeffrey Strawn, MD, associate professor and anxiety expert in the Department of Psychiatry and Behavioral Neuroscience at UC, who is the senior author on this study. "In essence, the medication allows the brain to dampen the overactivity of fear areas, and we see this dampening very early in the course of treatment using imaging."

In this National Institutes of Health-sponsored study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, researchers used brain imaging (MRI) to see how 41 adolescents, ages 12-17, with anxiety disorders responded to a medication called escitalopram, versus a placebo, over eight weeks. Escitalopram is a medication known as a selective serotonin reuptake inhibitor (SSRI) that is approved by the Food and Drug Administration for depression in adolescents and for both depression and anxiety in adults.

Strawn, who is also a physician at Cincinnati Children's Hospital Medical Center and UC Health, says SSRIs work by boosting the activity of serotonin in the brain. Serotonin is one of the chemical messengers that nerve cells use to communicate with one another and one that is involved in anxiety disorders. These medications block the recycling of serotonin into nerve cells, making more serotonin available to improve transmission of messages between neurons.

"These medications are an effective treatment for many adolescents with anxiety disorders. However, how much a specific patient will benefit is difficult to predict," he continues.

He says clinicians typically need six to eight weeks of the patient being on the medication in order to evaluate whether or not the treatment is going to work. "But with the brain imaging in this study, doctors could determine -- after just two weeks -- if they would need an alternative treatment. Knowing this early in treatment could greatly improve outcomes for patients," he adds. "This study helps clinicians understand how the medication -- even early in treatment -- changes brain circuits that are involved in anxiety and can help to get patients back to their normal lives more quickly."

Larger studies are needed to further test this, but the results are promising and, as Strawn notes, are really important for better treating adolescents with anxiety disorders.

"Anxiety disorders are the most common mental illnesses in the U.S., with approximately 4.4 million children and adolescents affected," he says. "These disorders are not only common in children and teens, but, if untreated, result in considerable personal and economic cost over the lifetime.

"This study uncovers a way to predict how effectively a medication will treat anxiety in kids and reveals that brain changes occur within two weeks of starting the medication. Additionally, the changes that occur in the brain can predict treatment response and improvement over time which is incredibly beneficial for physicians and can help us determine promising biomarkers for drug development. While not necessarily a quick fix, this could be a quicker fix that could help patients tremendously and improve their quality of life."

Review of 40 published studies from 17 countries offers first global assessment of the collateral impact of the COVID-19 pandemic on pregnancy outcomes.

Findings reveal overall increase in the chances of stillbirth and maternal death during the pandemic, but chances of pre-term birth decreased in high-income countries.

Women requiring surgery for ectopic pregnancies increased almost six-fold during the pandemic across all studies, after accounting for the size of included studies (surgery rate for ectopic pregnancies during pandemic 27/37 vs pre-pandemic 73/272), and symptoms of maternal depression were also increased.

Study reveals disproportionate impact on low- and middle-income countries and highlights health disparities worldwide.

Pregnancy outcomes for mothers and babies have worsened during the COVID-19 pandemic, a review of data from 40 studies representing 17 countries published today in The Lancet Global Health journal has revealed.

Findings varied by country but analysis of pooled data showed stillbirth and maternal mortality rates increased by approximately one-third during the pandemic compared to life before COVID-19 took hold (stillbirth rates: during pandemic 1099/168,295 pregnancies vs before pandemic 1325/198,993 pregnancies; maternal mortality rates: during pandemic 530/1,237,018 pregnancies vs pre-pandemic 698/2,224,859 pregnancies).

Mental health outcomes also worsened during the pandemic. Of the 10 studies included in the analysis that reported on maternal mental health, six reported an increase in postnatal depression, maternal anxiety, or both.

Overall, outcomes were worse in low- and middle-income countries as compared to high-income countries and the researchers say immediate action is required to preserve safe maternity care worldwide, especially during the global emergency.

Although the study did not analyse the impact of COVID-19 infection during pregnancy, it provides the first global assessment of the collateral impact of the pandemic on antenatal, birth, and postnatal outcomes.

Professor Asma Khalil, lead author of the study, of St George's University of London, said: "The COVID-19 pandemic has had a profound impact on health care systems around the world. Disruption to services, nationwide lockdowns, and fear of attending health care facilities mean that the adverse effects of COVID-19 are expected to have health consequences that extend beyond the deaths and disease caused by the virus itself. It is clear from our study and others that the disruption caused by the pandemic has led to the avoidable deaths of both mothers and babies, especially in low- and middle-income countries. We urge policymakers and health care leaders to prioritise safe, accessible, and equitable maternity care within the strategic response to the pandemic and aftermath, to reduce adverse pregnancy outcomes worldwide." [1]

Studies from individual countries have suggested that the pandemic has affected rates of stillbirth and pre-term birth, potentially as a result in a reduction of healthcare-seeking behaviour for fear of infection, as well as reduced provision of maternity services.

In this latest study, researchers reviewed data from 40 studies that were published between 1 January 2020 and 8 January 2021, representing 17 countries and with data from more than 6 million pregnancies. All of the studies compared pregnancy outcomes during and before the pandemic, but studies that focused solely on SARS-CoV-2 infected women were excluded.

Of the studies included in the review, 12 reported on the incidence of stillbirth. Analysis of the pooled data found the chances of having a stillbirth were increased by more than a quarter compared with pre-pandemic instances (odds of stillbirth increased 28%; stillbirth rate during pandemic: 1,099/168,295 pregnancies, stillbirth rate before pandemic: 1,325/198,993 pregnancies).

The review included two studies that investigated the impact of the pandemic on maternal death rates, both from middle-income countries (one from India and one from Mexico). Pooled analysis of data from both studies found that the risk of mothers dying during pregnancy or childbirth was increased by more than a third compared with before the pandemic (maternal death rate: during pandemic, 530/1,237,018 pregnancies vs pre-pandemic: 698/2,224,859 pregnancies). This finding was dominated by the study from Mexico, which represented the majority of pregnancies included in the analysis (Mexico study 3,452,141/ 3,468,086 pregnancies [99.7%], India study 9,736 / 3,468,086 pregnancies [0.3%]).

The review did not find any difference in overall rates of pre-term birth before and during the pandemic. However, pooled data from studies from high-income countries suggests that, in this setting, the odds of preterm birth were reduced by almost 10% during the pandemic. The authors say the reduction appears to be driven by a drop in spontaneous pre-term birth, rather than those requiring medically indicated early induction of labour or cesarean section, which may be increased. They say this means it is more likely that changes in health care delivery and population behaviours are contributing factors, which may bring valuable lessons for understanding the mechanisms underlying preterm birth. The odds of having a pre-term birth in low- and middle-income countries were unchanged.

From the three studies that reported on the use of surgery for treatment of ectopic pregnancies, analysis of pooled data revealed that surgery rates were almost six times higher during the pandemic compared with before, after accounting for the size of the included studies (surgery rate for ectopic pregnancies across all studies during pandemic 27/37, pre-pandemic 73/272). If discovered early, ectopic pregnancies can typically be treated with medication, meaning this increase in surgeries may be an indication that more women delayed seeking care.

The variation in outcomes reported between different studies may be partially explained by inefficiencies in health care systems in the countries studied, the researchers found. Differences in pandemic mitigation responses between countries did not seem to affect the findings, however. The researchers say this suggests the increase in adverse pregnancy outcomes may be driven by pressures on health care systems caused by COVID-19 itself, rather than measures aimed at limiting the spread of the virus, such as lockdowns.

The review did not identify any changes in reporting of other pregnancy complications during the pandemic, including gestational diabetes or pregnancy disorders linked to high blood pressure. There were no observed changes in delivery outcomes during the pandemic either, such as cesarean section or spontaneous vaginal delivery or the rate of pregnancies requiring induction of labour. Despite these numbers remaining steady, the researchers none the less say their findings provide clear indication that women and babies have experienced worse health outcomes during the pandemic. They highlight the need to prioritise safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises.

Dr Erkan Kalafat, a co-author of the study from Koc University, Turkey, said: "We have an unprecedented opportunity to learn from the experiences of the COVID-19 pandemic to plan for a future of inclusive and equitable maternity care worldwide. One such learning opportunity will be to investigate the mechanisms underlying the apparent reduction in pre-term births observed in high-income settings during the pandemic, with a view to identifying new preventative interventions that could potentially benefit all women worldwide." [1]

The authors note several limitations to their findings. Notably, the studies included in their analysis varied in the way pregnancy outcomes were defined and measured, which makes it difficult to compare results between studies. There were fewer studies from low- and middle-income settings, and this is concerning as the analysis shows substantial variation in outcomes between high- and low-income settings. The authors also note that they cannot exclude the risk of publication bias against studies reporting negative findings, although they did not find any evidence of bias when they tested for this.

Writing in a linked Comment article, Dr Jogender Kumar, of the Postgraduate Institute of Medical Education and Research, India, who was not involved in the study, said: "There was significant heterogeneity in outcomes between HICs and LMICs, and the rates of the adverse outcomes were much higher in LMICs. These findings highlight disparities in health care within and across countries."

He added: "In resource-poor countries, even under normal circumstances, it is a challenge to provide adequate coverage for antenatal checkups, obstetric emergencies, universal institutional deliveries, and respectful maternity care. The COVID-19 pandemic has widened this gap and exposed several lacunae of health-care systems worldwide, but more so in LMICs."

(Denver, Colo., -- March 31, 2021)- A new Molecular Database Project initiated by the International Association for the Study of Lung (IASLC) will accelerate the understanding of lung cancer biology, clinical care and care delivery on a global scale and will improve the prognosis and optimal treatment of lung cancer across time and space, according to an editorial in the Journal of Thoracic Oncology, an official journal of the IASLC. The editorial can be viewed here: https://www.jto.org/article/S1556-0864(21)01781-0/fulltext.

In the editorial, the IASLC Staging and Prognostic Factors Committee's Molecular Sub-Committee, and committee members, emphasized that there is great opportunity, with the emergence of molecular biomarkers of disease behavior, to improve treatment and survival.

"Biomarker testing, the portal to personalized treatment of lung cancer, has splintered a once seemingly monolithic disease into fragments of genomic and proteomic disease subsets with widely different, but generally improving, treatment and survival expectations," the committee wrote in the editorial.

Staging serves three main purposes: communication, prognostication and direction of treatment. The Tumor (T), Node (N), and Metastasis (M) system is a strictly anatomy-based communication of the extent of cancer and, by inference, its likely effects on quality of life and death (prognosis), which then informs the choice of treatment modalities. Since its introduction between 1966 and 1968, the TNM staging system has facilitated communication about lung cancer across time and space, bridging geographic, linguistic, healthcare infrastructural, socioeconomic and cultural differences. The system has gone through seven revisions, each designed to improve its utility in identifying anatomic clusters of patients with similar prognoses, and, indirectly, improve its practical utility in guiding treatment.

As of December 2020, nine genomic/protein markers could be used to select US Food and Drug Administration (FDA)-approved treatment for stage IV lung cancer (EGFR, ALK, BRAFV600E, ROS1, NTRK, MET exon 14 skipping, and RET mutations; PD-L1 Tumor Proportion Score of > 50%; and microsatellite instability high or mismatch repair deficient tumors). Drugs targeting two other biomarkers, mutations of ERBB2 and KRASG12C, received FDA breakthrough therapy designation for fast-tracked clinical development.

"This trend will only increase with time along with the list of prognostic and predictive markers," the editorial states.

Objectives of the molecular database project include:

Provide a global platform for a deeper, broader understanding of the value of molecular testing,
and targeted therapy for prognostication, prediction and treatment selection across the full
spectrum of TNM stage.

Evaluate novel single or multiple prognostic markers that could add biological information.
regarding the outcome of patients in the different TNM stages. These novel prognostic factors
would add to the current clinical gold-standard criteria and would be formally considered using
criteria developed by the Prognostic Factors Subcommittee, and the Minimal Standards
Working Group.

Create evidence in a set of highly characterized lung cancers with complete clinical, pathologic
and staging information to support the role of biomarkers in lung cancer diagnosis, prognosis
and treatment selection, across the stage spectrum.

Create evidence to support advocacy for routine genomic testing where appropriate.

Define important research questions that might be the focus of observational studies, pragmatic
trials and clinical trials of existing and emerging biomarkers and therapeutics.

Invite applications for projects to analyze the molecular database.

DETROIT (March 31, 2021) - In a study that looked at racial differences in outcomes of COVID-19 patients admitted to the intensive care unit, researchers at Henry Ford Hospital in Detroit found that patients of color had a lower 28-day mortality than white patients.

Race, however, was not a factor in overall hospital mortality, length of stay in the ICU or in the rate of patients placed on mechanical ventilation, researchers said.

The findings, published in Critical Care Medicine, are believed to be one of the first in the United States to study racial differences and outcomes specific to patients hospitalized in the ICU with COVID-19.

Since the start of the pandemic, data have shown that Black and Hispanic populations have higher rates of COVID-19 infections, hospitalizations and mortality. The Henry Ford study found just the opposite.

"What we wanted to look at was once patients are in the ICU, does that same racial disproportion occur. And the answer is no," said Michael Lazar, M.D., a Henry Ford pulmonology and critical care medicine physician and the study's lead author. "The care we deliver is essentially the same and race makes no difference."

Researchers theorized that the 28-day mortality in patients of color could be easily explained: The deaths among patients of color were delayed. Seven of the nine patients who died in the hospital after 28 days were patients of color.

Still, they said their findings reflect more about the level of care provided in the ICU than racial differences.

"What we do in the intensive care is driven by protocol and everyone is approached similarly," said Jeffrey Jennings, M.D., a Henry Ford pulmonology and critical care medicine physician and the study's senior author.

Detroit was one of the cities hardest hit in the first surge of the pandemic. Henry Ford Hospital is the largest of the five acute-care hospitals in the Henry Ford Health System. To date, the health system has treated more than 44,000 patients with COVID-19 and more than 11,000 patients with COVID-19 have been hospitalized.

For the retrospective study, researchers evaluated the electronic medical records of 365 COVID-19 patients 18 and older who were admitted to the ICU between March 13, 2020 and July 31, 2020. The patients were divided into two groups: White and people of color, which included Black, Asian, Hispanic/Latino and Arab populations. Of the 365 patients, 219 were Black, 129 were White, eight were Hispanic/Latino, seven were Arab and two were Asian.

In other demographics, 205 patients were men and 160 women. The people of color group were slightly younger, 62.8 years, compared to the White group, 67.1 years. Co-morbidities ranged from COPD and asthma to hypertension, diabetes and coronary artery disease.

Other key highlights in the study:

Overall mortality in the two groups was 50%

Nearly 75% required mechanical ventilation

While most patients were treated with steroids early in their hospitalization, it was not a significant predictor of mortality

In looking at the broader impact of the COVID-19 pandemic on health and wellbeing, public health experts are examining screening rates for cancer. A new study looking at U.S. mammography screening rates during the first five months of the pandemic found both a strong rebound in breast cancer screening rates and a concerning cumulative deficit in mammograms due to missed appointments, as well as uncovering disparities when looking at screening according to race.

The study was released this week in the Journal of the National Cancer Institute.

Conducted by investigators from the Breast Cancer Surveillance Coalition (BCSC), a federally-funded, national network of breast imaging registries, the study sought to quantify the impact of the COVID-19 pandemic on both breast cancer screening and diagnostic mammography services in the U.S. Results suggest that, despite huge declines in the early months of the pandemic, mammography volumes rebounded strongly in summer 2020, as healthcare facilities adapted new protocols to ensure staff and patient safety.

In April 2020, screening mammography utilization was only 1% of expected volume based on comparative historical data. However, by July 2020, rates had rebounded to approximately 90% of pre-pandemic volume. Similar results were observed for diagnostic breast imaging, as opposed to screening imaging, with volumes rebounding to 100% by July 2020. However, researchers note that a substantial cumulative deficit in mammography screening remains, due to missed exam appointments from March through May 2020, and in an effort to reduce that deficit, screening rates will need to be above pre-pandemic levels.

The researchers found that trends in mammography screening were similar by age and risk factors, but identified disparities by race, with the rebound in mammography volume being lower among Hispanic and Asian women.

Reductions in screening and diagnostic imaging rates could lead to delays in diagnosis that cause increased morbidity and mortality due to breast cancer. The BCSC emphasizes that increased attention is needed to better understand specific barriers to healthcare utilization during the pandemic and to develop interventions to overcome these barriers.

Lead author and UVM Cancer Center researcher Brian Sprague, PhD, associate professor of surgery at the University of Vermont Larner College of Medicine, notes that further BCSC research is ongoing to understand the impact of reduced mammography utilization during the pandemic on breast cancer detection and outcomes. "This national snapshot is important to help us focus research, outreach and intervention to close gaps that were perhaps created or made worse by the pandemic," said Sprague.