Body

Among women with breast cancer, colorectal cancer, or melanoma, those who were taking cholesterol-lowering medications, were less likely to die from cancer, according to an analysis published in the British Journal of Clinical Pharmacology.

The analysis included 20,046,11,719 and 6,430 women in Australia who were diagnosed with breast cancer, colorectal cancer, and melanoma, respectively, from 2003 to 2013. The women had been prescribed cholesterol-lowering medications such as statins before their diagnosis.

The more consistently women took these medications in the year after being diagnosed with cancer, the lower their likelihood of dying from the disease, suggesting that the drugs may have anti-tumor effects.

"If this inverse adherence-response relationship is confirmed, cholesterol-lowering medications--primarily statins--could be repurposed as adjuvant therapy to improve cancer prognosis," said co-author Jia-Li Feng, BMed, MMed, PhD, of QIMR Berghofer Medical Research Institute.

WILMINGTON, Del. (October 21, 2020) - Critically ill newborns who receive blood transfusions prior to surgery had about a 50% increased rate of complications or death than those who did not receive transfusions, according to a new study published today in Pediatrics by Nemours Children's Health System researchers. The findings demonstrate the potential danger that blood transfusions may have on the surgical outcomes of neonatal patients.

"In some cases, blood transfusions may be doing more harm than good when used before surgery in our most critically ill infants," said Loren Berman, MD, pediatric surgeon at Nemours Children's Health System in Delaware. "Giving a transfusion in anticipation of blood loss may seem prudent, but our findings suggest that a "wait and see" approach to giving infants blood during surgery may reduce surgical complications and the risk of death."

Neonatal patients, especially pre-term infants, often undergo blood transfusions to treat anemia to increase oxygen delivery, especially in preparation for surgery. However, this treatment can have adverse effects, including stimulating an inflammatory response. Since there are currently no established guidelines defining red blood count thresholds for transfusion in neonatal surgical patients, there is significant variability in how and when transfusion is used before surgery.

Berman and her colleagues conducted a retrospective database analysis of 12,184 infants who underwent surgery between 2012 and 2015 using the American College of Surgeons National Surgical Quality Improvement Project Pediatric database. From there, a total 1,209 were identified who received a blood transfusion within 48 hours prior to surgery. The team compared the complications and deaths that occurred in this group within 30 days after surgery to those who did not receive a pre-operative transfusion. Because the group that received transfusions was found to be sicker prior to surgery, the team also conducted propensity score matching, a statistical analysis to make a more equal comparison.

Using both analytic approaches, pre-operative transfusions were independently associated with an approximately 50% increased rate of post-operative complications or death in the 30 days post-surgery. Given the findings, researchers concluded that blood transfusion may adversely affect surgical outcomes. They caution that prospective studies are needed to define transfusion thresholds to maximize the benefit of transfusion for anemia, while minimizing the risk for surgical patients.

"It is clear that research is desperately needed to inform decision-making and improve surgical outcomes in these vulnerable infants," said Berman.

Having subtler symptoms, a form of epilepsy that affects only one part of the brain often goes undiagnosed long enough to cause unexpected seizures that contribute to car crashes, a new study finds.

The study, publishing online Oct. 20 in the journal Epilepsia, addressed focal epilepsy, the most common form of this brain disorder. Researchers say the study is among the first to outline failure to recognize symptoms of subtle seizures as a main reason for the delay in diagnosis.

Led by researchers at NYU School of Medicine, the study shows that it can take on average two years for physicians to recognize the early signs of focal epilepsy, particularly in a subset of patients with seizures that do not involve uncontrolled movements of their arms and legs. Symptoms of these "non-motor seizures" instead may include a recurring brief hallucination, a strong sense of déjà vu, or sensations of a dreamlike state while awake.

Subtler cases are often not diagnosed until they have progressed to disruptive "motor" seizures, say the study authors, which can cause the unrestrained, whole-body spasms often portrayed in popular culture.

"Our study highlights how common the early and subtle signs of focal epilepsy are," says study senior investigator Jaqueline A. French, MD, a professor of neurology and director of translational research and clinical trials for epilepsy at NYU Langone Health. "We must do a much better job of recognizing them before people go undiagnosed, untreated, and with the potential to cause harm."

The World Health Organization estimates that at least 50 million people worldwide have epilepsy, including the most common focal epilepsy, affecting one in 26 American adults. French says medication is highly effective in controlling most symptoms once a diagnosis is made, but because subtle signs often go undetected, the actual numbers are likely higher than estimated.

For the current study, funded by NYU Langone Health, researchers analyzed data collected from 447 epilepsy patients between the ages of 12 and 60 who were being monitored over time at 34 epilepsy treatment centers around the world. Researchers found that 246 patients were diagnosed as long as six years after experiencing some history of initial signs of non-motor seizures, while 201 patients were diagnosed, on average, within two months of having motor seizures.

Researchers believe the impact of earlier diagnosis in focal epilepsy patients goes beyond more timely treatment of patients. Among the study's other findings, 23 patients reported having one or multiple car accidents before their diagnosis. Nineteen of these undiagnosed patients had non-motor seizures, while four patients had motor seizures. The researchers estimate that for every 13 early diagnoses, one car accident could be prevented, or an estimated 1,816 preventable accidents annually worldwide.

"To improve diagnoses, it is critical that physicians not overlook the possibility of a seizure, particularly during emergency room visits and after any kind of car accident," says study lead investigator Jacob Pellinen, MD, a recent postdoctoral fellow in the Department of Neurology's Division of Epilepsy at NYU Langone. "Patients need to partner with their physicians and be honest about any recurring abnormal or unusual symptoms they experience," he adds.

All of the patients studied were enrolled in a detailed patient registry, the Human Epilepsy Project, between 2012 and 2017. The participants, mostly from the U.S. and Canada, but also from Australia and Europe, were able to report the frequency and type of their seizures prior to the study. For the analysis, the self-reported symptoms were combined with medical records, which included evaluations by a neurologist and information about previous seizure-related injuries and car accidents.

The research team next plans to study patients who go to the emergency room (ER) after a car accident with early signs of epilepsy to see whether they are asked about their seizure history,or subsequently evaluated by a neurologist. Because an ER visit can be the first time undiagnosed epilepsy patients are seeing a doctor, it offers a critical opportunity to fix the problem and prevent subsequent harm, the researchers say.

ANN ARBOR, Mich. - Chronically ill children with kidney disease may spend more time in the hospital, incur larger health care costs and have a higher risk of death compared to pediatric patients hospitalized for other chronic conditions, a new study suggests.

And one of the biggest drivers of these outcomes, researchers found, was the level of medical complexity the young patients faced. Many children with chronic kidney disease also have multiple other chronic health conditions that adversely impact outcomes, including cardiovascular disease, hypertension, diabetes and difficulties in growth.

"Chronic kidney disease is a lifelong health issue that has an outsized burden on children's lives," says lead author Zubin Modi, M.D., pediatric nephrologist at Michigan Medicine C.S. Mott Children's Hospital and researcher with at the Susan B. Meister Child Health Evaluation and Research Center (CHEAR.)

"We wanted to improve our knowledge of this high risk population in order to better support the needs of chronically ill children with kidney disease. Our findings suggest that these patients have very complex health needs, and we need to determine more effective ways to provide them with the care they need before, during and after hospitalization."

Chronic kidney disease includes long term abnormalities of kidney structure or function that may progress to end-stage kidney disease requiring dialysis or a transplant. Children with the condition are also at risk for acute deteriorations in health secondary to infection, dehydration, and side effects associated with medications.

Researchers analyzed national data during 2006, 2009, 2012, and 2016. Of the 6.5 million national pediatric hospital discharges, nearly 4 % involved children with chronic kidney disease, according to the findings published in the .American Journal of Kidney Diseases.

Children with chronic kidney disease spent about 30% longer in the hospital (an average of 2.8 days compared to 1.8 days for those without a chronic kidney disease) with nearly 60% more in hospital expenses ($8,755 per hospitalization compared to $5,016.)

Children with chronic kidney disease were also 50% more likely to die during hospitalization.

"Data on in-hospital mortality for children with chronic illnesses is lacking, but we know that hospitalizations with a chronic kidney disease diagnosis have a higher mortality than those with other chronic condition diagnoses with the exception of heart failure," Modi says.

"The fact that these children are potentially at higher risk of death while hospitalized should prompt providers to closely evaluate management strategies."

That may mean bringing nephrologists in earlier if they are not already involved in patients' care, making sure to avoid medications that could make kidney function worse as well as other steps that will improve care for these patients, Modi notes.

The high health care expenses for hospitalized pediatric patients with end-stage kidney disease, including dialysis, transplantation, and associated complications may be comparable to hospitalized heart failure patients, authors say.

Kidney disease may be associated with more medical complexities, authors say. The causes of chronic kidney disease in children include genetic disorders, congenital anomalies that may be part of a multi-organ system syndrome, and systemic inflammatory disorders. A recent study from the UK reported that adult kidney disease patients also have a greater degree of medical complexity than patients seen by any other specialty.

"Chronic kidney disease can be a devastating illness with many long-term consequences," Modi says. "Some features of chronic kidney disease that start during childhood will have a significant impact on patients' lives through adulthood.

"We need further studies to better understand the health care needs and delivery of care to hospitalized children with chronic kidney disease in order to optimize health outcomes."

What The Study Did: 

In this survey study of U.S. adults, vaccine-related attributes and political characteristics were associated with self-reported preferences for choosing a hypothetical COVID-19 vaccine and self- reported willingness to receive vaccination. These results may help inform public health campaigns to address vaccine hesitancy when a COVID-19 vaccine becomes available.

Authors: 

Douglas L. Kriner, Ph.D., of Cornell University in Ithaca, New York, is the corresponding author.

To access the embargoed study:

Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2020.25594)

Editor's Note:

The article includes funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

PULLMAN, Wash. -- Washington State University scientists have developed a method to detect the biomarkers for Alzheimer's disease that is 10 times more sensitive than current blood testing technology.

While still in the initial stages of development, the research could lead to earlier detection of the neurodegenerative brain disease that affects 5.8 million people in the U.S. That number is predicted to rise to 14 million Americans by 2050.

Led by Research Professor Dan (Annie) Du in WSU's School of Mechanical and Materials Engineering, the researchers report on their work to use an artificial enzyme to detect the Alzheimer's biomarkers in the Science partner journal, Research. WSU Ph.D. students Zhaoyuan Lyu and Shichao Ding are the co-first authors of the paper.

For Alzheimer's disease, doctors most often diagnose patients based on their symptoms. By that time, the patients often already have severe brain damage. Imaging technology such as magnetic resonance imaging and CT scans can also be used to help confirm the disease, but they are not suitable for early stage diagnosis.

Occasionally, doctors may test spinal fluid to look for beta-amyloid proteins, markers of the disease, but the process is more invasive than a simple blood test would be.

One common way of testing blood is the ELISA, or enzyme-linked immunosorbent assay, which is used to test for a variety of diseases such as HIV, which causes AIDS, and Lyme Disease. The ELISA uses a natural enzyme found in the roots of horseradish that can change color to indicate the presence of disease biomarkers. But, using the technique to detect the beta-amyloid proteins of Alzheimer's is difficult because their levels in the blood are too small.

Last year, the WSU researchers created an artificial enzyme using a single-atom architecture that was able to work as efficiently as natural enzymes. Their artificial enzyme, called a nanozyme, is made of single iron atoms embedded in nitrogen-doped carbon nanotubes.

For this work, the researchers were able to use their single-atom nanozyme to mimic the active site of a natural enzyme and to detect the Alzheimer's Disease proteins at levels 10 times lower than commercially available ELISA tests.

"The nanozyme based on a single-atom catalyst that we created has a similar structure as a natural enzyme with remarkable enzyme-like activity and paved the way for detecting the Alzheimer's Disease biomarker," Du said.

The nanozyme was also more robust than natural enzymes, which can degrade in acidic environments or in high temperatures. It is also less expensive and could be stored for long periods of time, Du added.

Lyu said she has family members who have been touched by Alzheimer's Disease that has such a huge impact on the daily lives of patients and their families. She hopes that she can make a difference in detecting the disease earlier.

"This shows great potential for the early-stage diagnosis of Alzheimer's Disease," she said.

The next step of the research will involve testing their method with real blood samples.

In addition to the WSU team, scientists from Singapore helped to model the nanozyme's structure, and Oregon State University and University of California researchers helped to characterize the single-atom catalysts.

What The Study Did: Whether treatment with tocilizumab in the first two days after being admitted to an intensive care unit was associated with a reduced risk of death among critically ill patients with COVID-19 was investigated in this study.

Authors: David E. Leaf, M.D., M.M.Sc., of Brigham and Women's Hospital in Boston, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamainternmed.2020.6252)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

What The Study Did: This randomized clinical trial assessed whether tocilizumab improves outcomes of patients hospitalized with moderate-to-severe COVID-19 pneumonia compared to usual care.

Authors: Olivier Hermine, M.D., Ph.D., of the Université de Paris, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamainternmed.2020.6820)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

Patients with psoriasis who are taking drugs that affect their immune system have high rates of survival from COVID-19. According to the first findings from a global registry of psoriasis and COVID-19 patients, led by Guy's and St Thomas' clinicians, over 90% survive.

The researchers found that the risk factors of severe COVID-19 outcomes in patients reported to the registry were similar to the general population.

The findings come from the first analysis of the web-based PsoProtect registry, established to understand how psoriasis and the medications that are used to treat it might influence the severity of COVID-19. Collaboration has been crucial to the registry, founded by dermatologists and researchers at the St John's Institute of Dermatology at Guy's and St Thomas', King's College London and University of Manchester, and supported by psoriasis patient organisations throughout the world, including the Psoriasis Association in the UK.

Psoriasis is a skin condition that causes red, flaky, crusty plaques of skin covered with silvery scales and affects around 2% of people in the UK. It is thought to be related to a problem in the immune system, so dermatologists have been working to understand how COVID-19 and the condition may interact.

Patients with moderate to severe disease are treated with drugs that affect the immune system including biologics that target specific immune proteins, or traditional tablet immunosuppressants, and many of these patients were asked to shield during the pandemic.

Dr Satveer Mahil, a consultant dermatologist at the St John's Institute of Dermatology at Guy's and St Thomas', co-leads the registry. She said: "Our analysis is important for informing our conversations with patients as the pandemic continues. We can reassure our patients that the survival for people with psoriasis is high, and the risk factors for psoriasis patients are similar to those of the general population.

"These findings wouldn't be possible without all the clinicians who have reported cases to PsoProtect and the invaluable support of our partner professional and patient organisations."

Helen McAteer, Chief Executive of the Psoriasis Association said: "From the beginning of the pandemic we understood the importance of being proactive in order to address the many concerns expressed by people who are living with psoriasis. The PsoProtect registry is vital in helping us understand more about the interactions between psoriasis, its treatments and COVID-19 infection so as patients can make the most informed choices about their care and treatment at this challenging time."

The initial findings from the PsoProtect registry were published in the Journal of Allergy and Clinical Immunology. The paper is an analysis of 374 clinician-reported cases where patients with psoriasis had COVID-19. The cases came from 25 countries, and were submitted between March and July 2020. Most of the patients (334, 89%) were taking biologics for their psoriasis (267, 71%) or traditional immunosuppressants (67, 18%).

Most of the cases - 348 (93%) fully recovered from COVID-19, 77 (21%) were hospitalized and nine (2%) died. The study found that, similarly to the general population, patients who were older, male, of non-white ethnicity and with other health conditions such as chronic lung disease were more likely to require hospital admission for their COVID-19 infection.

More than half of young adults at risk for alcohol-related harm report symptoms of insomnia. Cognitive behavioral therapy (CBT) is one of the first-line treatments for insomnia, but it's never been tested on young adults who are actively drinking. Researchers from the University of Missouri School of Medicine conducted a pilot study to evaluate CBT's effect on young adult binge drinkers with insomnia to determine if this treatment can improve their sleep and potentially affect alcohol use outcomes.

"The potential for insomnia treatment to influence alcohol-related consequences has significant implications for the prevention and treatment of alcohol use among young adults," said Mary Beth Miller, PhD, assistant professor of clinical psychiatry at the MU School of Medicine. "Given the stigma associated with mental health issues and addiction, it's crucial to identify other forms of treatment that either influence alcohol outcomes or open the door to alcohol-related treatment."

Miller tested CBT in a pilot study of 56 people between 18 and 30 years old who reported at least one binge-drinking episode in the past month. Binge drinking was defined as four or more drinks in one occasion. Participants were randomly assigned to either five weekly sessions of CBT -- a behavioral therapy program that focuses on changing patterns of thinking and behavior -- or a single session on sleep hygiene, which focuses on creating optimal sleeping conditions and establishing a bedtime routine. The CBT session topics included sleep hygiene, sleep restriction, relaxation techniques, behavioral experiments, insomnia prevention discussions and sleep diary use. All participants wore wrist devices to objectively measure sleep and completed subjective daily sleep and drinking surveys.

Results showed CBT participants reported a 56% reduction in insomnia severity, compared to a 32% reduction in symptoms for those who completed only the sleep hygiene session. The CBT participants also showed moderate improvement in objectively assessed sleep efficiency after treatment compared to the sleep hygiene participants. Both groups reduced their drinks per week and alcohol-related consequences after treatment. However, CBT participants reported greater improvements in insomnia, which in turn were associated with reductions in alcohol-related problems.

"The results of this study indicate that insomnia treatment may improve alcohol-related problems, and therefore, may be an ideal first step toward treatment among binge-drinking young adults with insomnia," Miller said.

Miller believes the data collected in this study warrants a larger sample size study looking at alcohol-related problems as a primary outcome. She plans to determine if insomnia treatment improves executive function and the ability to regulate emotions, which in turn might decrease risk for alcohol-related problems.

For the past two years, a different national allocation policy has been in effect in order to more fairly distribute hearts to those who require a life-saving transplant. People who need temporary mechanical pumps to support their hearts, like ECMO (extracorporeal membrane oxygenation) or a temporary LVAD (left ventricular assist device), are now given high preference.

These mechanical pumps are meant to be markers of illness severity, and thus, identify the sickest patients who would benefit most from a heart transplant.

However, a new research letter published by scientists at the Michigan Medicine Frankel Cardiovascular Center finds clinicians gave more patients these mechanical pumps once the new policy was in place than they had previously. That in turn moves more patients up the list for a transplant.

"Following the policy change, use of certain types of mechanical pumps increased up to five times," says lead author Jessica Golbus, M.D., an advanced heart failure and heart transplant cardiology fellow at the Frankel CVC. "There was notably greater use of these pumps among men following the policy change, potentially giving them priority on the heart transplant list. This may reflect gaming of the system and has the potential to worsen outcomes such as gender disparities in heart transplantation."

Co-author Monica Colvin, M.D., a heart failure and transplant cardiologist at the Frankel CVC, says transplant allocation policy changes are frequently accompanied by changes in listing practices in an effort to optimize listing strategies for individual patients.

"It remains to be seen whether this is a better strategy for transplant patients or whether this will create the same problems faced by the prior policy," says Colvin, also a professor of internal medicine. "These types of analyses are essential in helping the community understand the challenges of policy development and its effect on patients and transplant centers, and will help to inform future policy."

Mammography, which is an x-ray picture of the breast, is efficient also for women over the age of 70. For women invited to regular mammography screening over the age of 70, the reduction in mortality rate was significant. This according to a vast new study from Sweden.

"The results confirm that the Swedish assessment of setting the upper age limit for mammography screening to 74 was justified," says Håkan Jonsson, docent at the Department of Epidemiology and Global Health at Umeå University.

This new Swedish study builds upon twenty years of follow ups and over 2,000 breast cancer deaths. It turned out that the breast cancer mortality rate was 20 per cent lower for women invited to partake in mammography between the ages of 70 and 74 compared to those who were only invited up until the age of 69. For those who actually took part in screening, the mortality rate reduction was a full 27 per cent.

Mammography screening was introduced in the late 1980s after positive results from a number of randomised controlled trials of which several were conducted in Sweden. However, there have previously been uncertainties regarding what age groups should be included. As a result, countries have made different assessments and the recommendations have varied.

Currently, most countries offer screening for women up until the age of 69, but some countries - Sweden included - have chosen to set the upper age limit to 74. In Sweden, the screening programmes are decentralised which has meant that the upper age limit of 74 has been introduced at different points in the various parts of the country. This not least as the early recommendations from the Swedish National Board of Health and Welfare allowed regional exceptions of an upper age limit of 69.

In the current study, the breast cancer mortality rate in women in the areas of Sweden that used an upper age limit of 74 were compared to those regions that used an age limit of 69 between the years 1986 and 2012. The Cancer Register was used to identify women diagnosed with breast cancer aged 70-74 and the National Cause of Death Register was used to gain data on cause of death for those who died from breast cancer aged 70-89. Cause of death may be difficult to decide - particularly for older women. Consequently, the excess mortality in breast cancer cases was measured in conjunction with the underlying cause of death.

"Given that we live longer and remain active in old age, it is also valuable to screen for cancer in order to start treatment in time," says Håkan Jonsson.

Most randomised controlled trials were conducted about 40 years ago. Only one of those trials included women aged 70 to 74. Nevertheless, this group was too small to provide any clear evidence. Observational studies are rare in this age group as few countries have invited these women to screening. This also means that the evidence of the importance of mammography in women aged 70 to 74 has been scarce until now.

Syracuse, N.Y. - A recent study by Syracuse University sociology professor Shannon Monnat shows that mortality rates are higher for U.S. working-age residents who live in rural areas instead of metro areas, and the gap is getting wider.

The study "Trends in U.S. Working-Age non-Hispanic White Mortality: Rural-Urban and Within-Rural Differences" was published recently by Population Research and Policy Review. Monnat, an associate professor of sociology at Syracuse University's Maxwell School of Citizenship and Public Affairs, said no single cause of death is to blame for the growing disparity.

"Smaller nonmetro declines in cancers and ischemic/circulatory system diseases and larger increases in suicide, alcohol-induced cause, mental/behavioral disorders, cardiometabolic diseases, infectious diseases, and respiratory diseases are major culprits," Monnat said. "Mortality rate trends have been particularly problematic for females."

Monnat is director of the Lerner Center for Public Health Promotion and co-director of the Policy, Place and Population Lab in the Aging Studies Institute at Syracuse University. Here are the key findings from the study:

The U.S. rural mortality penalty is wide and growing. This is the case for the rural population overall (all racial/ethnic groups combined) and for non-Hispanic whites, non-Hispanic blacks, and Hispanics individually.

Smaller rural declines in mortality from cancers and cardiovascular disease (throughout the 1990s and 2000s) and larger increases in metabolic and respiratory diseases, suicide, alcohol-related, and mental/behavioral disorders (throughout the 2010s) collectively drove the growth in the rural disadvantage. Trends for females are particularly concerning. That the rural disadvantage is not limited to one or two specific causes of death but is pervasive across multiple disease and injury categories suggests that more than one underlying structural cause is to blame.

However, the rural United States is not monolithic, and some rural places have experienced much larger mortality rate increases than others over the past 30 years. There are large divisional disparities, with particularly poor trends in New England, South Atlantic, East South Central, West South Central, and Appalachia and more favorable trends in the Mid-Atlantic, Mountain, and Pacific. Mining-dependent counties have very high mortality rates and have diverged from other economies since the mid-2000s due to multiple causes of death, whereas farming counties have comparatively lower mortality rates.

High and rising mortality rates across a variety of causes and rural places, some of which have been occurring since the 1990s and others that emerged more recently, suggest that there is not one underlying explanation. Instead, systemic failures across a variety of institutions and policies have contributed to rural America's troubling mortality trends generally and within-rural disparities more specifically.

Despite these findings, Monnat said "not all of rural America is in dire straits."

"While there is much to be concerned about in Appalachia, the South, and increasingly New England, some groups have seen improvement in the Mid-Atlantic, East North Central, and Mountain divisions," Monnat said. "My analysis of specific causes of death begins to offer insight into what's driving these disparities, but research is needed that identifies the specific upstream causal explanations for these trends, particularly those that are amenable to policy change."

In terms of policy recommendations, Monnat said, "Behavioral interventions targeting smoking, diet, and exercise have been widely advocated and have been attempted for decades, but they appear to have had little impact on reducing rural-urban or within-rural disparities. Far too often, the public health approach has been to apply health care and behavioral intervention to places with the worst health profiles.

"This approach has been costly and ineffective because it treats problems after they arise rather than preventing their onset," she continued. "Instead, the more cost-effective and humane approach would be to apply upstream interventions that target the structural (economic, social, environmental), corporate, and policy determinants of health to prevent future generations from exacerbating these already problematic mortality trends."

A research team from the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), the Barcelona Institute for Global Health (ISGlobal), the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine (LSHTM), and Georgetown University Law School announced today that Nature Medicine has published their research revealing potential global hesitancy to accept a COVID-19 vaccine. Based on data collected with the previously validated COVID-SCORE survey of a sample of over 13,400 individuals from 19 countries that have been hard-hit by the virus, the investigators found that 72 % of participants would likely take the vaccine. Of the remaining 28 %, 14% would refuse, while 14% would hesitate, which translates into tens of millions of potential vaccine avoiders.

To date, more than 90 COVID-19 vaccines are in development, half of which are in human trials. In addition to addressing the formidable challenges of developing a safe and effective vaccine, producing it on a large scale, and distributing it equitably, health authorities worldwide must now consider the added obstacle of vaccine hesitancy.

"We found that the problem of vaccine hesitancy is strongly related with a lack of trust in government. Vaccine confidence was invariably higher in countries where trust was higher", said Jeffrey V. Lazarus, ISGlobal researcher and study coordinator.

"We need to increase vaccine confidence, and we need to improve the public's understanding of how they can help control the spread of COVID-19 in their families and their communities," adds Ayman El-Mohandes, Dean of CUNY SPH, and co-coordinator of the study.

The country with the highest score of positive responses to "taking a proven, safe and effective vaccine" was China (87%), which also had the lowest percentage of negative responses (0.7%). On the other end, Poland had the highest number of negative responses (27 %), while the Russian respondents gave the lowest number of positive responses (55%). In the U.S., 76% of respondents answered positively, 11 % were negative, and 13% had no opinion.

When asked if "you would accept a vaccine if it were recommended by your employer and was approved safe and effective by the government," 32% of respondents completely agreed, while 18% somewhat or completely disagreed. Again, a great variation between countries was observed - China again had the highest percentage of positive responses (84%) and the lowest percentage of negative responses (4%). Russia had the highest percentage of negative responses (41%) and the lowest percentage of respondents (27%) who were likely to accept their employer's recommendation. In the U.S., 52% had confidence in an employer's recommendation, and 25% did not.

Vaccine acceptance also varied with age (with higher acceptance among older people as compared to those aged under 22), income (higher among people earning more than 32 dollars per day, as compared to those earning under two dollars per day), or education level. Curiously, people who had fallen sick with COVID-19, or whose relatives had fallen sick, were not more likely to respond positively.

"It will be tragic if we develop safe and effective vaccines and people refuse to take them. We need to develop a robust and sustained effort to address vaccine hesitancy and rebuild public confidence in the personal, family and community benefits of immunizations," warns Scott C. Ratzan, study co-author and Distinguished Lecturer at CUNY SPH. "Our findings are consistent with recent surveys in the US, which show diminished public trust in a COVID-19 vaccine," he concludes.

Heidi J. Larson, study co-author and Professor and Director of the Vaccine Confidence Project at LSHTM says, "These findings should be a call to action for the international health community. If we do not start building vaccine literacy and restoring public trust in science today, we cannot hope to contain this pandemic."

The authors also point out that people's decisions about vaccination depend on many factors and can change with time. In fact, since this survey was conducted in late June 2020, vaccine-related issues have become increasingly politicized and the antivaccine movement has become more aggressive, which suggests that vaccine hesitancy may be a greater threat today.

(TORONTO, ON) Oct. 20, 2020 -- The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery. This month, a team of scientists and clinicians led by the University of Toronto's Faculty of Dentistry say they've found the reason why -- and it's related to the body's own hyperactive immune response. The findings were published in October in the Journal of Dental Research.

HYPERACTIVE STATE

Science has already established that state of your oral health is an important indicator of overall health. "There are statistically significant correlations between periodontitis (oral inflammatory disease) and systemic diseases ranging from diabetes to cardiovascular diseases," says Howard Tenenbaum, professor at the University of Toronto's Faculty of Dentistry, and chief dentist at Sinai Health Systems in Toronto, who is one of the authors of the study.

To find what links those conditions, the researchers focused on the behaviours of cells primarily activated by gum disease -- neutrophils, which are cells of the innate immune system. Through in vivo models, the researchers found that the immune system releases an abundance of these neutrophils to tackle the bacterial infections responsible for periodontitis, more commonly known as gum disease.

Activated to fight an oral infection, a systemic effect was noted: once periodontal inflammation was present, an overabundance of neutrophils circulated, 'primed' for attack. The hyper-vigilant immune system then responds with an excess of force to any secondary infection.

"It's almost as if these white blood cells are in second gear when should be in first," says Michael Glogauer, professor at the University of Toronto's Faculty of Dentistry and the study's senior author.

That's when the body becomes susceptible to damage from secondary inflammatory conditions. With the immune system already primed by the neutrophils for attack, a secondary event causes those immune cells to destroy affected tissues and organs.

"The [neutrophils] are much more likely to release cytokines much more quickly, leading to negative outcomes," adds Glogauer, who is also dentist-in-chief at the University Health Network and head of dental oncology at Toronto's Princess Margaret Cancer Centre.

Produced initially in in vivo models, the findings were confirmed through a controlled clinical experiment.

ORAL HEALTH KEY TO OVERALL HEALTH

The study's findings underscore the importance of oral health as a vital indicator of potential complications for other inflammatory conditions, as well as disease model outcomes.

"We believe this is the mechanism by which oral hygiene can impact vulnerability to unrelated secondary health challenges," says lead author Noah Fine, a postdoctoral fellow at the University of Toronto's Faculty of Dentistry. "Neutrophil (immune) priming throughout the body can connect these seemingly distinct conditions," he says.

The study also may have important ramifications for an inflammatory disease at the top of everyone's mind these days: COVID-19.

"There is evidence out there that patients with periodontal disease may be much more likely to have negative outcomes with COVID-19," explains Glogauer. The current study could provide some clues as to why: "Neutrophils are the cells that are at prime risk of causing cytokine storms. That's the exact cell we show is primed with people with periodontal disease," he explains.

Research into the relationship between neutrophils and inflammation is ongoing.