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DENVER (Feb. 2, 2021) - Jongeun You, a researcher at the University of Colorado Denver, recently released a study looking at how a more global approach would have far-reaching societal benefits in tackling the COVID-19 pandemic. You discovered that while many governments had a restrictive and nationalistic response to the pandemic, they also focused on international cooperation to provide new insights to the rest of the world.

COVID-19 challenged governments to rely on their own resources and pandemic policies as the world turned away from a globalist approach to fight the virus. Since the beginning, national governments have implemented border restrictions and blocked exports of medical supplies. The large number of bilateral COVID-19 vaccine deals between high-income countries and vaccine producers hindered the ability of low-income countries to access COVID-19 vaccines.

However, You argues that a more open approach and international collaboration is needed to tackle COVID-19 and future pandemics. Restrictive measures impede necessary aid and technical support against the virus and disrupt international economic activities.

You's research into South Korea's response showed that while the country focused on its own population, it shared knowledge with the international community, supplied medical resources to the rest of the world, and helped to strengthen public health systems in developing countries. South Korea held hundreds of webinars and conference calls with other nations on pandemic policy. For instance, Special webinars on COVID-19 for policy and technology sharing, also called "K-bangyeok" webinars, reached over 3,780 people from 118 countries.

South Korea was also able to continue exporting medical supplies to countries in need while avoiding business losses. Between January and September 2020, South Korea saw a 48% increase in medical exports from the previous year. With the surge in COVID-19-related exports of test kits and face masks, the country saw growth in the medical industry. In addition, South Korea was committed to assisting developing countries build up their pandemic response capacity.

"Advancing international cooperation is also critical to avoid a future pandemic crisis," said You. "Since pandemics can spread rapidly from one country to another, when one country struggles to tackle a pandemic, a wave of infection is likely to occur in any and all countries."

According to a worldwide survey by the United Nations, 95% of respondents agreed that countries need to work together to address global issues like the current pandemic.

"The COVID-19 pandemic shows how interconnected we all are," said You. "The international community must move forward by preparing in the face of complexity rather than by building walls."

MINNEAPOLIS- February 2, 2021 - In Minnesota, there are currently about 60 diseases that all newborns are screened for at birth using a heel prick and a few drops of blood. Of all the screenable disorders combined, newborn infection with cytomegalovirus (CMV) is most common, and it is ranked as the most prevalent infectious disease in the U.S. and Europe that causes birth defects, long-term disabilities and deafness in babies.

Yet, current routine screening practices do not include monitoring for CMV. The lack of blood spot screening may be due to past studies not showing a good enough detection rate for CMV, using the blood spot test, that would be sufficiently sensitive to justify universal screening.

Mark Schleiss, MD, pediatric infectious disease physician with the University of Minnesota Medical School and M Health Fairview, led a study that used improved techniques to show that the dried blood spot taken at birth can, in fact, find CMV infection in the newborn with almost 90% accuracy. The study was recently published in JAMA Pediatrics.

"This is a major new development in the field and means that automated testing for CMV could be done for this infection using the standard dried blood spot tests that are already obtained on all newborns, using existing infrastructure and requiring no new tests on the baby," said Schleiss, who is the principal investigator of the study. "Identifying CMV at birth, in turn, allows for earlier intervention that can improve the outcome for these children."

Earlier intervention could improve hearing, speech, language and intellectual/neurodevelopmental outcomes for newborns with CMV.

Schleiss will continue his work with the Minnesota Department of Health to encourage that the results are translated into action, by considering adding the CMV screening to all newborn dried blood spot tests currently done in Minnesota newborns. Ultimately, he would like to see it become standard practice nationally.

New Haven, Conn. --A new study by Yale researchers found a significant association between the availability of hospital resources -- particularly ICU beds -- and patient mortality during the early weeks of the COVID-19 pandemic.

This was especially true at hospitals in the northeastern U.S. which were hardest hit by the first surge of patient cases, according to the study published in the Journal of Hospital Medicine.

"There is a general narrative among people in healthcare that the more resources there are, the better we can take care of patients," said lead author Dr. Alexander Janke, a Yale Emergency Scholar in the fourth year of a five-year combined residency and health services research fellowship. "This study begs the question -- are case fatality rates driven by changes in resources?"

According to their findings, the answer is "yes." In an analysis of 306 hospital referring regions (HRRs) in the U.S. from March 1 to July 26, 2020, researchers found that geographic regions with fewer resources per COVID-19 patient -- including ICU beds, intensivists or critical care physicians, emergency physicians, nurses, and general hospital beds -- were statistically associated with more deaths in April, 2020. The study looked at 4,453 hospitals overall.

The strongest association was related to ICU bed availability. According to the findings, for every additional ICU bed per COVID-19 case, there was an associated one-fifth decrease in incidence rate of death during the month.

According to their estimates, 15,571 COVID-19 patients died at these hospitals due to lack of ICU beds during the month of April. Most of the hospitals with greatest numbers of excess deaths were located in the Northeast, specifically HRRs in New York City, Boston, Philadelphia, Hartford, and Camden, N.J.

The findings provide important insights as, nearly a year later, the country continues to see high rates of COVID-19.

"As the country enters one of the darkest periods of the COVID-19 pandemic, with cases and hospitalizations anticipated to continue unabated in the coming months, the lessons of this work is clear -- our hospital resources are finite, and a failure to implement the policies to prevent hospital overload is certain to result in deaths that could have been avoided," said Dr. Arjun Venkatesh, associate professor of emergency medicine at Yale School of Medicine, a co-author of the study.

"Our paper is a worst-case scenario for what resource limitations might mean for mortality," said Janke.

"This is a phenomenon that's close to the hearts of everyone in emergency medicine," he added. "Sometimes patients have to wait hours or days to get a bed. Emergency medicine is really good at managing a patient's first few hours of care, but that transition [to an ICU bed from the emergency department] needs to happen."

Although Janke noted that it may not be worthwhile for hospitals to have excess resources ready in case of a pandemic, he said that there are opportunities for hospitals to engage flexible transitions to accommodate mass illness events in the near term. The paper found that after April 2020, the relationship between hospital resources and patient deaths was more muted, suggesting that hospitals were able to implement innovations to better manage rising caseloads over time.

Yale New Haven Hospital provided one such example, he said.

"Yale was especially successful at mobilizing space," he said. "In the [hospital pavilion] where the medical ICU is, whole floors had to be converted to ICU beds. That required additional staffing, both ICU doctors and nurses, as well as overcoming the logistical challenge of clearing floors and creating new negative pressure [isolation] rooms."

Such examples, he said, can provide important models for other hospital systems as COVID-19 cases again surge across the country.

Amazon's search algorithm gives preferential treatment to books that promote false claims about vaccines, according to research by UW Information School Ph.D. student Prerna Juneja and Assistant Professor Tanu Mitra.

Meanwhile, books that debunk health misinformation appear lower in Amazon's search results, where they are less likely to be seen, the researchers wrote in a paper that was recently accepted to CHI, the top annual conference on human-computer interaction.

In their paper, Juneja and Mitra noted that Amazon has faced criticism for not regulating health-related products on its platform. They conducted audits to determine how much health misinformation is present in Amazon's recommendations and how the personalization of its search results affects the amount of misinformation users receive.

The researchers tested a list of 48 search terms on vaccine-related topics, such as "immunization" and "MMR vaccine and autism" over a 22-day period and found that products promoting misinformation consistently outperformed those that debunk false claims. Misinformative products performed especially well when results were sorted by certain filters -- "average customer reviews" and "price low to high."

Juneja and Mitra used bots to build user histories and test whether Amazon pushes shoppers toward misinformation after they've shown an interest. They found that after users click on misinformative products or place them in their carts, they are more likely to see similar items on their Amazon home pages, creating a misinformation feedback loop.

To combat misinformation on its platform, the researchers recommended several actions Amazon could take. Those include displaying informative links alongside the product listings, introducing bias indicators, and, in the long term, modifying its algorithms and policies to stop promoting misinformative books.

ATLANTA - FEBRUARY 2, 2021 - A new study finds that long-term aspirin use before a diagnosis of colorectal cancer (CRC) may be associated with lower CRC-specific mortality. The report that appears in JNCI: The Journal of the National Cancer Institute, suggests that the findings for pre-diagnosis aspirin use might help reduce CRC mortality in the overall population by limiting metastatic spread of colorectal tumors before diagnosis. Preventing distant metastases leads to fewer deaths from colorectal cancer.

The study, led by Peter T. Campbell, PhD, of the American Cancer Society, used data from men and women enrolled in the American Cancer Society's Cancer Prevention Study-II (CPS-II) Nutrition Cohort who were cancer-free at the baseline (year 1992/1993) and diagnosed with CRC during follow-up through 2015. Mortality outcomes were complete through to the end of 2016.

"These findings are important because colorectal cancer patients seek guidance on lifestyle factors to improve their prognosis," said Dr. Campbell.

The study also examined the associations of pre- and post- diagnosis use of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) with CRC-specific mortality among CRC survivors.

"While more evidence is needed, preferably from randomized, controlled trials, findings from this study are an important resource to inform clinicians and CRC survivors about the potential benefits and harms of aspirin and non-aspirin NSAIDs use," said Dr. Campbell.

DALLAS, Feb. 2, 2021 — Young, Black adults are more than twice as likely to die in the first year after a heart transplant when compared to same-age, non-Black heart transplant recipients, according to new research published today in Circulation: Heart Failure, an American Heart Association journal.

Research has consistently shown that Black heart transplant recipients have a higher risk of death following heart transplantation compared to non-Black recipients. Black patients have higher prevalence of cardiovascular disease at younger ages, and therefore, they may need heart transplants at younger ages. Researchers hypothesized that studies focused on disparities among Black heart transplant recipients may be missing an even greater disparity – younger Black patients. 

“Generally, older patients are at a higher risk of having worse outcomes following a major procedure,” said Errol L. Bush, M.D., senior author of the study, associate professor of surgery and surgical director of the Advanced Lung Disease and Lung Transplant Program at Johns Hopkins University in Baltimore, Maryland. “Organ transplantation, however, is a complex operation that requires lifelong, specialized medical and surgical care. Continued access to the health care system and financial resources such as insurance may be unfairly limited in younger patients, potentially leading to worse outcomes.”

Researchers analyzed the outcomes of almost 23,000 adults (median age 56, 25% female) who had a heart transplant between Jan. 1, 2005 and Jan. 31, 2017. Patient information was obtained from the Scientific Registry of Transplant Recipients, a registry that includes data on all transplant donors, wait-listed patients and recipients in the United States. Risks of mortality were compared between Black and non-Black transplant recipients in four different age groups (18-30 years, 31-40 years, 41-60 years and 61-80 years).

The researchers found that when compared to other heart transplant recipients:

Across all age groups, Black heart transplant recipients had approximately a 30% higher risk of death.
However, when examined by age groups, the risk of death among Black heart transplant recipients was 2 times higher among recipients aged 18-30 years and 1.5 times higher among recipients aged 31-40 years.
Among Black heart transplant recipients aged 18-30, the risk of death was primarily during the first year after transplant, with Black recipients having 2.3 times higher risk of death in this time period.

“Our study is the first to highlight young, Black recipients as a subgroup at a higher risk of death during the first year after a heart transplant,” said Hasina Maredia, M.D., first author of the study whose interest in health disparities inspired her to initiate and lead the project as a medical student at Johns Hopkins. “Our findings indicate clinical research moving forward should focus attention on young, Black recipients during this high-risk period so that longstanding racial disparities seen in heart transplant survival can be improved.”

In the study, young, Black heart transplant recipients differed from young, non-Black recipients in several ways, including being more likely to have diabetes and/or high blood pressure; have a weakened heart muscle (cardiomyopathy); and be insured by Medicaid rather than a private insurer. More serious illness and additional medical problems prior to surgery might increase the risk of death from surgical complications, and financial constraints might make it more difficult for younger recipients with limited insurance to access specialized care and take the medications needed to prevent organ rejection, according to the researchers’ discussion of possible mechanisms for the disparity.

“The high risk associated with Black race is not specifically due to race itself; it is a marker of systemic racism and inequities that have resulted in significant health care disparities,” said Bush and Maredia.

The American Heart Association recently published a presidential advisory that addresses structural racism as a cause of poor health and premature death from heart disease and stroke. The advisory, titled “Call to Action: Structural Racism as a Fundamental Driver of Health Disparities,” reviews the historical context, current state and potential solutions to address structural racism in the U.S. and outlines steps the Association is taking to address and mitigate the root causes of health care disparities.

A new Veterans Affairs study finds that delays in undergoing colonoscopy following an abnormal stool test increase the risk of a colorectal cancer diagnosis and cancer-related death.

The results appeared online in the journal Gastroenterology in January 2021.

In a retrospective study of more than 200,000 Veterans, the researchers found that patients who received colonoscopy more than 13 months after an abnormal stool blood test were up to 1.3 times more likely to have colorectal cancer, compared with those who had colonoscopy up to three months after the stool test. Odds of an advanced stage of cancer at diagnosis were up to 1.7 times higher when colonoscopy was delayed beyond 16 months.

The findings also showed the risk of colorectal cancer-related death increased by up to 1.5 times when colonoscopy was delayed more than 19 months.

The cohort included Veterans who had an abnormal fecal immunochemical test (FIT) or fecal occult blood test (FOBT). Both are common stool blood screening tests that, when abnormal, require a follow-up colonoscopy to evaluate for precancerous and cancerous colorectal growths known as polyps.

Dr. Folasade May, a gastroenterologist at the VA Greater Los Angeles Healthcare System, led the study. In light of the results, she and her team emphasize that improved colorectal cancer outcomes call for colonoscopy within one year of an abnormal stool test, which is when blood is detected after a sample is sent to a lab.

"These findings extend current knowledge about the clinical implications of time to follow-up after abnormal FIT-FOBT," the researchers write. "Further work should include [efforts] that address barriers to [undergoing] colonoscopy after abnormal non-colonoscopic screening results and policies to encourage the routine monitoring of follow-up rates."

This is the first study in the United States, the researchers note, to examine the risk of death linked to delays in undergoing a colonoscopy following an abnormal stool blood test.

Excluding skin cancers, colorectal cancer is the third-most common cancer diagnosed in men and women in the U.S. It's also one of the most preventable forms of cancer. Incidence and death related to colon cancer can be significantly reduced by the detection and removal of pre-cancerous polyps and the cancer itself.

"Currently, there is no national policy or standard for the clinically acceptable time interval between an abnormal FIT-FOBT result and diagnostic colonoscopy," May and her colleagues write. "Time to colonoscopic follow-up varies widely in practice and across health care settings. A recommended interval that is too long can contribute to polyp progression and stage migration of colorectal cancer, risking the need for more aggressive and morbid treatment, as well as less favorable outcomes."

The investigators accessed electronic health record data of Veterans who had an abnormal stool test between 1999 and 2010, who had no history of colorectal cancer or inflammatory bowel disease, and who were between 50 and 75 years of age. The cohort, which was mostly male, averaged 61 years of age.

Many health care experts believe that stool tests, such as FIT, are as reliable as colonoscopy in screening for colorectal cancer. "If your doctor tells you a colonoscopy is better, that's not accurate," Dr. Alex Krist, chairman of the U.S. Preventive Services Task Force, an independent panel that reviews evidence and issues recommendations, told The New York Times. "The data show the tests are equally effective at saving lives."

The use of stool tests has increased during the COVID-19 pandemic because of the convenience and safety of home testing and because patients may be reluctant to go to a health care facility for colonoscopy.

Dr. Samir Gupta, chief of gastroenterology at the VA San Diego Healthcare System, co-authored the study. Many patients and some primary care providers do not understand the importance of having colonoscopy after an abnormal stool test, he says.

"Some patients and providers even explain these results incorrectly, attributing abnormal results to hemorrhoids, something that was eaten, or other problems," Gupta says. "They don't believe the results. The results of this study should raise awareness that delaying colonoscopy after an abnormal stool test can have major consequences, including increased risk for cancer diagnosis, late-stage cancer at diagnosis, and death from colorectal cancer. These findings can also help motivate patients and providers to make sure colonoscopies are completed after an abnormal test."

The study findings will have even greater implications as more non-invasive tests for colorectal cancer screening come on the market, Gupta adds.

"With stool tests, such as FIT and FIT-DNA, already covered by most insurance companies and with promising new blood-based screening tests for colorectal cancer under study in large trials," he says, "the challenge of ensuring complete screening, including initial completion and follow through to colonoscopy after an abnormal test, is likely to grow substantially."

Sedative medications used in intensive care are associated with increased delirium, which is in turn connected with higher medical costs and greater risk of death and ICU-related dementia.

A study published today in the New England Journal of Medicine provides the most definitive evidence to date that, of the two drugs recommended for light sedation of patients receiving mechanical ventilation in the ICU, one is as effective and safe as the other.

Mechanical ventilation is a life-saving intervention often involving a breathing tube inserted in the patient's windpipe, typically entailing light sedation to quell the attendant discomfort, anxiety and psychological stress. Several studies have sought evidence of which sedative is best for this purpose. Two sedatives are currently recommended, dexmedetomidine or propofol.

The new study, a double-blinded, randomized-controlled trial led by researchers at Vanderbilt University Medical Center, enrolled 422 mechanically ventilated adults at 13 U.S. medical centers. As patients were placed on ventilators, roughly half were lightly sedated with dexmedetomidine, the other half with propofol. The patients all had sepsis, an extreme and dangerous bodily reaction to infection.

"We found very similar patient outcomes with the two drugs for brain function, ventilator times and death. From a critical care outcomes perspective, our results show that these two sedatives are equally effective when performing up-to-date ICU care," said Christopher Hughes, MD, professor of Anesthesiology, who led the study with Pratik Pandharipande, MD, MSCI, professor of Anesthesiology.

During the 14 days from the start of mechanical ventilation, the median total days alive without delirium or coma was 10.7 in the dexmedetomidine group, 10.8 in the propofol group.

During the 28 days from the start of ventilation, the median ventilator-free days was 23.7 in the dexmedetomidine group, 24.0 in the propofol group.

Death came within 90 days for 38% of those who had received dexmedetomidine, and 39% of those who had received propofol.

The median cognitive status score at six months was 40.9 in the dexmedetomidine group, 41.4 in the propofol group. (In both drug groups, at six months following their illness, approximately one in four patients appeared to exhibit clinically important cognitive dysfunction, with cognitive scores two standard deviations below population norms.)

"For this critical care application, statistically speaking, there's nothing in our results to distinguish the safety and patient outcome profiles of these two drugs," Pandharipande said.

Dexmedetomidine, which is a newer sedative drug, might have been expected to support better patient outcomes, because, in comparison to certain other sedatives used in critically ill patients, it's known to provide advantages such as better sleep and better anti-inflammatory properties. The new results, however, bear out less rigorous trials that found no major outcome benefits with the newer drug.

"Our findings [...] strongly reinforce current guidelines recommending either dexmedetomidine or propofol use for light sedation when continuous sedation is needed for adults requiring mechanical ventilation, with or without sepsis," the authors write.

"This multi-center, randomized clinical trial answers an important clinical question in critical care," said Lora Reineck, MD, MS, program director of the acute lung injury and critical care program at the National Heart, Lung, and Blood Institute. "We now know that the choice of dexmedetomidine versus propofol does not alter outcomes for patients with sepsis on ventilators in a critical care setting."

Pandharipande and Hughes were joined in the study by 24 other researchers from VUMC and 38 researchers from other institutions. The study was supported by a grant from the National Institutes of Health (HL111111).

As the U.S. confronts a bitter election season, political unrest and violence, a shaky economy, and a soaring death toll due to COVID-19, 84% of U.S. adults say the country has serious societal issues that we need to address, according to a new poll.

At the same time, 9 in 10 adults say they hope that the country moves toward unity, according to Stress in AmericaTM: January 2021 Stress Snapshot, conducted by The Harris Poll on behalf of the American Psychological Association.

The survey found that the average reported stress level during the prior month was 5.6, (on a scale from 1 to 10 where 1 means "little to no stress" and 10 means "a great deal of stress"). This is higher than stress levels reported in 2020 Stress in AmericaTM surveys since April. It is therefore no surprise that 84% of adults reported feeling at least one emotion associated with prolonged stress in the prior two weeks. The most common were feelings of anxiety (47%), sadness (44%) and anger (39%). Additionally, 2 in 3 adults (67%) said the number of issues America is facing is overwhelming to them.

"Nearly a year into the pandemic, prolonged stress persists at elevated levels for many Americans. As we work to address stressors as a nation, from unemployment to education, we can't ignore the mental health consequences of this global shared experience," said Arthur C. Evans Jr., PhD, APA's chief executive officer. "Without addressing stress as part of a national recovery plan, we will be dealing with the mental health fallout from this pandemic for years to come."

The majority of adults reported the future of our nation (81%), the coronavirus pandemic (80%) and political unrest around the country (74%) as significant sources of stress in their lives. And despite more than three weeks having passed since the breach of the U.S. Capitol on Jan. 6, 66% of adults said this event was a significant source of stress. The events on Jan. 6 also impacted adults disproportionately: Almost three-quarters of Black adults (74%) said that the Capitol breach was a significant source of stress, compared with 65% of white adults and 60% of Hispanic adults.

Regardless of political affiliation, the majority of Americans reported emotions associated with stress (85% of Democrats, 83% of Republicans and 83% of independents). They also shared similar concerns about the country: When looking at the future of our nation, slightly more than 8 in 10 Democrats (82%), Republicans (82%) and independents (81%) said it was a significant source of stress.

APA offered the following evidence-based advice to help people manage their stress:

Give yourself permission to take a break from the news, social media or even certain friends. Constantly exposing ourselves to negative information, images and rhetoric maintains our stress at unhealthy levels.

Practice the rule of "three good things" and ask friends and family to do the same. The rule states that at the end of each day, reflect on three good things that happened -- large or small. This helps decrease anxiety, counter depression and build emotional resiliency.

Practice self-care in 15- or 30-minute increments throughout the day. This can include taking a short walk, calling a friend or watching a funny show. Parents should encourage or help their children to do the same.

Stay connected with friends and family. This helps build emotional resiliency so you can support one another.

Keep things in perspective. Try to reframe your thinking to reduce negative interpretations of day-to-day experiences and events.

ARLINGTON HEIGHTS, IL (Feb. 2, 2021) - As the number of states increase where medical and recreational cannabis use is legal, so does the importance that physicians discuss with patients the effects of cannabis on those with asthma. A new survey in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology, shows that of those who used cannabis, about half smoked it while a third vaped - both "inhalation routes" likely to affect one's lungs.

"It surprised me that over half of the cannabis users in this study who have asthma were smoking it," said Joanna Zeiger, PhD, principal investigator for the study. "And further, of those with uncontrolled asthma, half reported smoking cannabis. We also found that people with asthma are not routinely being asked or advised by their physician about cannabis and how they are consuming it."

Eighty-eight (18%) of the 489 adults with allergy/asthma who completed the survey reported current cannabis use. The majority of those responding were younger than 50 years, female, and White. Among non-cannabis users, 2.5% reported an allergy to cannabis. Two-thirds of current cannabis users did so for medical or medical/recreational purposes. The anonymous survey, conducted in collaboration with Allergy & Asthma Network, was of those 18 years and older and looked at cannabis knowledge, attitudes, and patterns of use.

"Strikingly, among current cannabis users, only about 40% report having their physicians inquire about cannabis use, and about the same number of patients want to discuss cannabis with their physicians," says allergist William Silvers, MD, study co-author, ACAAI member and expert on cannabis allergy. "In order to more completely manage their allergy/asthma patients, allergists should increase their knowledge about cannabis and inquire about cannabis use including types of cannabinoid, route of use, reasons for use, and adverse effects," says Dr. Silvers. "As with cigarette smoking, efforts should be made to reduce smoking of cannabis, and recommend other potentially safer routes such as edibles and sublingual tinctures."

Positive effects of cannabis use (e.g., reduced pain, calm, improved sleep) were reported significantly more frequently than adverse effects (e.g., cough, increased appetite, anxiety). Of concern, about 20% of survey respondents reported coughing from cannabis, which was significantly related to smoking the cannabis. Almost 60% of the cannabis users in the survey reported current asthma, of whom 40% were uncontrolled by the Asthma Control Test.

Says Dr. Zeiger, "We look forward to future studies of larger, more diverse cohorts to better explore more deeply the effect of cannabis use on asthma and other allergic disorders."

A surgical procedure meant to counter ulcerative colitis, an immune disease affecting the colon, may trigger a second immune system attack, a new study shows.

The study results revolve around the immune system, the cells and proteins that destroy invading bacteria and viruses. Activating it brings about inflammation, responses like swelling and pain that result from cells homing in on the site of infection or injury. Autoimmune diseases like ulcerative colitis occur when this system mistakenly damages the body's own tissues.

Colon tissue damaged by the disease is routinely addressed with a "J-pouch" procedure wherein a pouch is surgically constructed from nearby, healthy small intestine tissue to replace the damaged section of the colon. The procedure is designed to restrain the inflammatory attack on the colon, but more than half of these patients, unfortunately, go on to develop inflammation in the J-pouch (pouchitis).

Led by researchers at NYU Grossman School of Medicine, the new investigation showed that some immune cells attacking the colon in ulcerative colitis are the same types attacking the J-pouch. Several varieties of immune cells were found swarming both organs in numbers as high as five times those seen in healthy tissue.

"Our findings suggest that since ulcerative colitis and pouchitis are biologically similar, they may be treated by the same drugs, even though the diseases originate in different parts of the gut," says study co-lead author Jordan Axelrad, MD, MPH. Axelrad is an assistant professor in the Department of Medicine at NYU Langone Health.

He says starting with the most promising drugs can give medical providers a head start at combating pouchitis and avoiding complications from delayed treatment.

"With our newfound understanding of pouchitis, we can also begin to uncover why some people develop it in the first place and how to prevent it," adds study co-lead author Joseph Devlin, MS, a doctoral candidate at NYU.

Devlin notes that overall, inflammatory bowel diseases, which occur throughout the lining of the digestive tract, progress over time and often resist treatment. By removing a colon damaged by ulcerative colitis, surgeons hope to give the body a chance to start over with fresh tissue unaffected by the disease. As a result, experts were unclear why the new J-pouch would develop an immune reaction.

For their investigation, published in the journal Gastroenterology online last month, the research team collected tissue samples from 15 men and women who had undergone J-pouch surgery, of whom 10 developed pouchitis. They compared the gene activity in pouch tissue from these patients with colon tissue samples from 11 patients with ulcerative colitis who did not undergo J-pouch surgery.

Investigators also analyzed the gene activity of 56,000 individual cells using an experimental method called RNA sequencing. They say it is the most detailed analysis of the pouchitis cellular immune response to date, and enabled them to track step-by-step genetic activity in a single cell in any given moment.

"Since using this RNA-sequencing technique has improved our understanding of treatment options for one kind of inflammatory bowel disease, we can likely use it to assess how effective treatments are for related issues like Crohn's disease," says study co-senior author Ken Cadwell, PhD.

Cadwell, an associate professor in the Skirball Institute of Biomolecular Medicine at NYU Langone, cautions that since the investigation focused only on immune cells, it remains unclear how other cells within the J-pouch, such as those that make up the organ's lining, may behave during pouchitis.

He adds that the research team plans to evaluate the same patients before and after J-pouch surgery to see how the immune cell landscape changes over time as inflammation develops. Cadwell is also an associate professor in the Departments of Microbiology and Medicine at NYU Langone.

COLUMBUS, Ohio - People who start adulthood with a body mass index (BMI) in the normal range and move later in life to being overweight - but never obese - tend to live the longest, a new study suggests.

Adults in this category lived longer than even those whose BMI stayed in the normal range throughout their life. Those who started adulthood as obese and continued to add weight had the highest mortality rate.

"The impact of weight gain on mortality is complex. It depends on both the timing and the magnitude of weight gain and where BMI started," said Hui Zheng, lead author of the study and associate professor of sociology at The Ohio State University.

"The main message is that for those who start at a normal weight in early adulthood, gaining a modest amount of weight throughout life and entering the overweight category in later adulthood can actually increase the probability of survival."

Similar results were found in two generations of mostly white participants in the Framingham Heart Study, which followed the medical histories of residents of one city in Massachusetts and their children for decades.

But the study showed worrying trends for the younger generation, who are becoming overweight and obese sooner in their lives than their parents did and are more likely to have deaths linked to increasing obesity.

The study was published recently online in the journal Annals of Epidemiology.

The researchers used data on 4,576 people in the original cohort of the Framingham Heart Study, and 3,753 of their children. The heart study started in 1948 and followed participants through 2010. Their children were followed from 1971 to 2014.

The members of the original cohort had almost all died by the end of the study, so the results can uncover how BMI evolves over all of adulthood and provide a more accurate estimate than previous studies of how obesity is linked to mortality, Zheng said.

In both generations, the researchers looked at data from those aged 31 to 80. The main measure was BMI, which is based on a person's height and weight and is used as a rule of thumb to categorize a person as underweight, normal weight, overweight or obese.

After analyzing data on how the participants' BMI changed over the years, the researchers found that the older generation generally followed one of seven BMI trajectories throughout their lives.

The younger generation had six trajectories - there were not enough people who lost weight through their lives to have a downward weight trajectory as was present in their parents' generation.

After controlling for a variety of factors that have been found to influence mortality, including smoking, gender, education, marital status and disease, the researchers calculated how each BMI trajectory was related to mortality rates.

In both generations, those who started at normal weight and moved to being overweight later in life - but never obese - were the most likely to survive.

Those who stayed at normal weight throughout life were the next most likely to survive, followed by those who were overweight but stayed stable and then those who were at the lower level of normal weight. In the older generation, those who were overweight and lost weight came next.

The least likely to survive were two trajectories involving those who started as obese and continued to gain weight.

While both generations showed the same basic results, the researchers discovered some worrying trends in the younger cohort.

"The higher BMI trajectories in the younger generation tend to shift upward at earlier ages relative to their parents," Zheng said.

Moreover, the proportion of the sample in higher BMI trajectories systematically increased from the parental generation to their children.

Medical advances mean that people are more likely to survive with obesity now than in the past, Zheng said. But there's a problem for the younger generation in the study.

"Even though the mortality risks associated with obesity trajectories have decreased across the generations, their contributions to population deaths increased from 5.4% in the original cohort to 6.4% in the offspring cohort," Zheng said.

"That's because more people are in the obesity trajectories in the offspring cohort."

This study supports and extends findings from a 2013 study, published in the American Journal of Epidemiology, by Zheng and colleagues that found people who were slightly overweight in their 50s but kept their weight relatively stable were the most likely to survive over the next 19 years.

"Now, with this study, we know more about weight trends earlier in life and how they are related to mortality," Zheng said.

FOLSOM, Calif., February 2, 2021 - Researchers, from the Harvard T.H. Chan School of Public Health in collaboration with investigators from Rovira i Virgili University and the University of Navarra, Spain, used machine learning models, a subset of artificial intelligence, to identify more precisely the components in walnuts that may be responsible for potentially reducing the risk of type 2 diabetes and cardiovascular diseases - two of the leading causes of death in the U.S.

This study, supported by the California Walnut Commission and published in the Journal of Nutrition, used a novel machine learning model to identify 19 metabolites that were associated with walnut consumption. The body forms specific metabolites based on what food is consumed. The walnut metabolite profile was associated with a 17% lower risk of type 2 diabetes and 29% lower risk of cardiovascular disease. This is the first study to examine the association between walnut metabolites and the risk of cardiometabolic diseases, contributing to the three decades of existing research on walnuts and heart health.

"With data-driven technologies, we are able to enhance our understanding of the relationship between diet and disease and take a personalized approach to nutrition which will lead to better prevention and management of various health conditions," says Dr. Marta Guasch-Ferré, a Research Scientist at the Department of Nutrition at Harvard T.H. Chan School of Public Health, Instructor in Medicine at Harvard Medical School and Brigham and Women's Hospital, and lead investigator of this research.

"In this study, we revealed the unique metabolomic signature of walnuts, which brings us one step closer to understanding "how" walnuts are good for our health. These cutting-edge technologies are shaping the future of nutrition recommendations," says Guasch-Ferré.

Researchers examined data from 1,833 participants of the PREvención con DIeta MEDiterránea (PREDIMED) study, a large-scale, multi-year study that took place in Spain and looked at the effects of a Mediterranean diet in the prevention of cardiovascular disease among people at high risk for heart disease. Participants were aged 55-80 and followed one of three diets: 1) Mediterranean diet supplemented with mixed nuts (50% walnuts, 25% almonds, and 25% hazelnuts); 2) Mediterranean diet supplemented with extra-virgin olive oil; or 3) low-fat diet. The metabolites in walnuts form the walnut metabolite profile associated with a reduction in type 2 diabetes and cardiovascular disease.

These findings further emphasize the connection between walnut consumption as part of a healthy diet and cardiometabolic health. New tools as used in this epidemiological study will help identify links between diet and disease. However, the results do not prove cause and effect. More research is needed in other populations since this study was focused on older Spanish adults only. In addition, given the field of metabolomics is rapidly evolving, future studies will be needed to identify additional biomarkers of walnut intake that were not pursued in this study as well as to understand individual metabolic responses after consuming walnuts.

Increases in life expectancy in the UK and elsewhere had slowed even before 2016 - and COVID-19 is expected to further eliminate any gains, Newcastle University studies show.

After 2011, over the post-financial crisis period the authors find that the UK performed poorly, in almost all measures, compared to the 28 countries of the European Union (EU28).

Life expectancy at birth, and age 65, in the UK were increasing rapidly in 2008 but slowed around 2011 and Germany, Portugal and France showed evidence of a similar slowing.

Furthermore, years of good health, called Healthy Life Years, at birth in the UK decreased, whereas it increased in most EU28 countries. The UK experienced a period of absolute expansion of unhealthy life in both older men and women.

The authors, led by Dr Claire Welsh at Newcastle University, suggest the reasons for the decline may include cuts to public spending on health and social care under austerity, increasing mortality rates from seasonal influenza combined with more frequent extremes of temperature, a larger proportion of the population in the 'susceptible' group of older, frail people, and a higher mortality rate amongst the working age population.

Dr Welsh explains: "Given that other countries in the EU have already achieved higher life expectancy than the UK, it seems unlikely that the deceleration in the UK is due to being close to any natural maximum lifespan of human beings. This suggests that our health and social care system was under strain even before the effects of COVID-19."

Slowing life expectancy in UK

In 2008, life expectancy at birth was highest for French women (84.8 years) and Swedish men (79.2 years). The countries with the lowest life expectancy at birth were Lithuania and Bulgaria (for men, 65.9 years and women, 77.0 years, respectively).

By 2016, the highest life expectancy for men was recorded in Italy (81.0 years) and for women, in Spain (86.3 years) and the lowest in Lithuania and Bulgaria (for men 69.1 years, and women 78.5 years, respectively).

Life expectancy at birth in the UK in 2008 was the seventeenth highest in women (81.8 years) and tenth highest in men (77.7 years) and the UK remained tenth and seventeenth highest for life expectancy at birth in 2016 in men (79.4 years) and women (83.0 years), respectively. However, modelling suggested that life expectancy growth slowed significantly around 2011 for both UK men and women.

Modelling also suggested that the increase in UK men's life expectancy at age 65 slowed significantly around 2011. In 2008 the UK had the eighth highest life expectancy at age 65 for men (17.6 years), and the sixteenth highest for women (20.2 years), but by 2016 both had dropped down one place (women, seventeenth with 21.1 years, men to ninth with 18.8 years).

Another recently published study from Newcastle University using the Cognitive Function and Ageing Studies I and II found that inequalities in disability-free life expectancy between the most and least advantaged older people increased between 1991 and 2011. For the most advantaged men and women all the gains in life expectancy at age 65 between 1991 and 2011 were years free of disability. In contrast, the least advantaged women experienced little increase in life expectancy or disability-free life expectancy. COVID-19 is only expected to increase these gaps.

The human body strives to keep itself in homeostasis, or balance. When blood clots are created, the body’s innate response is to break the clots down to prevent significant health problems from arising.

Research has found that patients with COVID-19 are prone to serious blood clotting. This is why many patients receive high dose anticoagulants as part of their treatment.

But a new study in Scientific Reports, led by senior author Daniel Lawrence, Ph.D., a Professor of Basic Research in Cardiovascular Medicine at Michigan Medicine, found that aside from this heightened clotting risk, some COVID-19 patients have an unbalanced ability to break down clots as well, which is linked to a potential clinical biomarker seen in later stages of the disease.

This abnormal process of breaking down clots can contribute to a high bleeding risk, raising concerns about the current practice of giving COVID-19 patients high dose anticoagulants throughout the duration of their disease course.

This finding may be consistent with the NIH’s recent decision to pause enrollment of critically ill COVID-19 patients in the Antithrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC) trial, because “a potential for harm in this sub-group could not be excluded.”

“Pathological blood clotting in COVID-19 patients has been studied extensively, but recognizing and addressing the high bleeding risk in a subgroup of patients is equally important,” says first author Yu (Ray) Zuo, M.D., M.S.C.S., a rheumatologist at Michigan Medicine.

Zuo, Lawrence and their colleagues sought to understand the balance between COVID-19 coagulation and the breakdown of clots to help inform approaches to treatment.

The study included 118 COVID-19 patients and 30 healthy controls. In the COVID-19 patients, the team expected to see high levels of plasminogen activator-inhibitor-1, a molecule associated with stabilizing blood clots. However, they didn’t expect high levels of tissue-type plasminogen activator, the molecule responsible for removing the clots.

According to the researchers, almost half of the study’s patients were supported by a ventilator and a quarter breathed just room air. Compared with the patients breathing room air, patients that required supplemental oxygen had significantly higher levels of plasminogen activator-inhibitor-1, but not of tissue-type plasminogen activator.

High levels of both tissue-type plasminogen activator (tPA) and plasminogen activator-inhibitor-1 (PAI-1) were associated with worse lung function, but high tPA independently correlated with mortality. The levels of either molecule can increase independently of the other, but the research also found a change in one can have consequences on the other.

The team asked whether COVID-19 plasma with the highest tPA levels might correlate with an enhanced, spontaneous breaking down of clots, as compared with low tPA COVID-19 plasma or control plasma.

Journal

Scientific Reports

DOI

10.1038/s41598-020-80010-z