Culture

People exposed to higher levels of air pollution are more likely to experience depression or die by suicide, finds a new analysis led by UCL.

The first systematic review and meta-analysis of evidence connecting air pollution and a range of mental health problems, published in Environmental Health Perspectives, reviewed study data from 16 countries.

The researchers found that, if the relationship with depression reported in some of these studies is causal, then reducing global average exposure to fine particulate matter (PM2.5) air pollution from 44 micrograms per metre cubed (μg/m3) to 25μg/m3 could result in a 15% reduction in depression risk worldwide.

The World Health Organization guidelines recommend that fine particulate matter pollution - small airborne particles that can include dust and soot - should be kept under 10μg/m3.

"We already know that air pollution is bad for people's health, with numerous physical health risks ranging from heart and lung disease to stroke and a higher risk of dementia," said the study's lead author, Dr Isobel Braithwaite (UCL Psychiatry and UCL Institute of Health Informatics).

"Here, we're showing that air pollution could be causing substantial harm to our mental health as well, making the case for cleaning up the air we breathe even more urgent."

The research team searched for studies that had investigated the association between particulate matter pollution and five different adverse mental health outcomes in adults. They identified 25 studies that fitted their criteria, nine of which were included in the primary analyses.

Five studies looking at long-term particulate matter exposure and depression were included in one meta-analysis. By pooling the results, they found that a 10μg/m3 (microgram per metre cubed) increase in the average level of fine particulate matter (PM2.5) air pollution people were exposed to over long periods was associated with an approximately 10% increase in their odds of depression.

"We found quite consistent results across the studies we reviewed that analysed the relationship between long-term air pollution exposure and depression, even after adjustment for many other factors which could explain the association. The association seems to be similar in magnitude to those that have been found for some physical health impacts of particulate matter, such as all-cause mortality," Dr Braithwaite said.

Global city PM2.5 levels range from 114 and 97 in Delhi and Dhaka, to 6 in Ottawa and Wellington.

In UK cities, the average particulate matter level that people are exposed to is 12.8μg/m3. The researchers estimate that lowering average air pollution levels to the WHO recommended limit of 10μg/m3 could reduce urban UK residents' depression risk by roughly 2.5%.

The researchers also found evidence of a connection between short-term changes in coarse particulate air pollution (PM10)* exposure and the number of suicides, from pooling the results of four different studies in a meta-analysis. The risk of suicide appears to be measurably higher on days when PM10 levels have been high over a three-day period than after less polluted periods.

The studies into short-term changes in suicide risk accounted for confounding factors such as weather changes, and day of the week. The relationship is not affected by other neighbourhood or socioeconomic factors given that the comparisons being made are among the same individuals on days with different pollution levels.

The researchers say the evidence was particularly strong for the suicide risk link, but the effect was smaller than for depression (an increase in suicide risk of 2% for each 10μg/m3 increase in the average coarse particulate pollution level over a three-day period).

The researchers say they cannot yet confirm whether air pollution directly causes mental ill health, but say there is evidence to suggest possible causal mechanisms.

"We know that the finest particulates from dirty air can reach the brain via both the bloodstream and the nose, and air pollution has been implicated in increased neuroinflammation, damage to nerve cells and to changes in stress hormone production, which have been linked to poor mental health," Dr Braithwaite said.

The study's senior author, Dr Joseph Hayes (UCL Psychiatry and Camden and Islington NHS Foundation Trust), said: "Our findings correspond with other studies that have come out this year, with further evidence in young people and in other mental health conditions. While we cannot yet say that this relationship is causal, the evidence is highly suggestive that air pollution itself increases the risk of adverse mental health outcomes."

"A lot of what we can do to reduce air pollution can also benefit our mental health in other ways, such as enabling people to cycle or walk rather than drive, and enhancing access to parks, so this adds support to the promotion of active travel and urban green spaces," he added.

Recent colorectal cancer screening rates more than doubled among people ages 45 to 49 in the months after the release of updated American Cancer Society guidelines recommending screening in that age group, according to a new study. The increase in was unique to the 45 to 49 year-old age group according to the study, which is published in the journal CANCER.

In May 2018, the American Cancer Society (ACS) updated its colorectal cancer (CRC) screening guidelines, lowering the age to begin average-risk screening from 50 to 45 years, based on increasing incidence of early onset colorectal cancer and a favorable benefit-to-harm ratio. Whether this change has influenced screening among people in their mid-to-late 40's is unknown.

To find out, investigators led by the ACS's Stacey Fedewa, PhD examined recent CRC screening patterns among adults ages 45 to 49 compared to those ages 50 to 59 in the United States. They reviewed responses from about 5,800 people ages 45 to 59 participating in the 2018 National Health Interview Survey (NHIS), an in-person household survey.

Among people ages 45 to 49, past-year CRC screening rates rose from 4.8% in the first quarter (Q1) of 2018 to 6.6% in Q2, 8.8% in Q3, and 11.7% in Q4. Compared to Q1, screening rates were 4.1% and 7.0% percentage-points higher in Q3 and Q4, respectively. The estimated number of people ages 45 to 49 screened rose from 226,656 in Q1 of 2018 to 592,351 in Q4, a rise of 365,695. Past-year CRC screening did not increase among people in their 50's.

The authors say the 2018 ACS guidelines and accompanying scientific and lay media attention may have raised provider and patient awareness of asymptomatic and symptomatic testing for CRC, noting that similar abrupt changes in screening following release of updated guidelines have been reported for prostate and breast cancer, as have short-term gains in CRC screening following media campaigns.

"It is unknown whether the recent accelerating CRC screening rates among people 45-49 years will be sustained," said Dr. Fedewa. "Commercial health insurers are only required to cover average-risk screening beginning at age 50, following recommendations from the US Preventive Services Task Force. Also, it's possible those who quickly adopted updated guidelines may have been those at increased risk."

A study published in the journal Vaccine provides the first rigorous look at how our attitudes towards vaccines (here: the flu vaccine) are shaped by online forces. University of Konstanz psychologists from both DFG Clusters of Excellence--"Centre for the Advanced Study of Collective Behaviour" and "The Politics of Inequality"--led the research, which also included scientists from the Max Planck Institute for Human Development and the University of Erfurt.

In a departure from similar studies that rely on observational data, the current study used experimental manipulation to directly measure polarization in the transmission of vaccination risk information in online communication chains. Their findings show that, contrary to expectations, existing vaccination beliefs are very resilient to radicalization, even to the point of being immune to any influence at all. The results have important implications for public health, suggesting that successful health communication should particularly target those who have not yet made up their mind.

ARLINGTON, Va.--December 18, 2019 -- Total U.S. investment in medical and health research and development (R&D) grew by 6.4% from 2017 to 2018, reaching $194.2 billion. For the third straight year, the growth-rate of medical and health R&D investment outpaced the growth-rate of overall health spending. However, R&D spending still represents only about 5 cents of every health dollar spent. This is one of the key findings of the just-released 2019 U.S. Investments in Medical and Health Research and Development, a new report from Research!America.

The Investment Report shows growth in investment across every sector over the last six years, with industry growth leading at $36.5 billion, followed by the federal government at $9.1 billion.

"This growth in R&D investment is positive and welcome, certainly," said Research!America's Chair, the Honorable Michael N. Castle. "However, our nation's total investment is not tracking with disease burden. Increased investment in medical and health R&D is essential to ending diseases that are taking time and quality of life from Americans and people across the globe."

Every year, almost 130,000 people in the United States die by the age of 45 due to health threats that a larger investment in R&D can help us better understand and ultimately prevent. Further, major chronic diseases cost our nation more than $1.1 trillion in 2018, which is almost six times the amount all sectors spend on R&D.

In 2018, total U.S. medical and health R&D investment was $194.2 billion. Of that:

Industry invested $129.5 billion in medical and health R&D (66.7%).

Federal agencies invested a total of $43 billion (22.2%).

Academic and research institutions including colleges and universities, independent research institutes, and independent hospital medical research centers invested $15.7 billion of their own funds (8.1%).

Foundations invested $2.3 billion (1.2%).

State and local governments invested $2.1 billion (1.1%).

Voluntary health associations and professional societies invested $1.5 billion (0.8%).

"Increased investment across all sectors contributing to R&D is the right path for our nation, but relative to unmet medical needs, we are walking, rather than running down that path," said Mary Woolley, president and CEO, Research!America. "Federal funding and policies need to be aligned behind the objective of empowering both public sector and private sector-driven research, because research saves lives."

The full report breaks down research investments sector by sector.

The data for U.S. medical and health R&D investment were developed by TEConomy Partners, LLC (http://www.teconomypartners.com) under contract to Research!America. View the full report here.

LONDON, ON - Researchers from Lawson Health Research Institute and Brescia University College found that teenage pregnant women are more likely to live in poverty, have poorer mental health and have higher rates of substance use.

There are limited Canadian studies on teenage pregnancies, in particular looking at risk factors and birth outcomes compared to women who became pregnant during adulthood. London researchers were able to take advantage of a large sample of pregnant women from Southwestern Ontario by accessing data from patients at London Health Sciences Centre. Of the 25,363 pregnant women making up the total sample of the retrospective cohort study, 4.3 per cent (1080) were 19 years old or younger.

Teenage pregnant women were much more likely than older pregnant women to live in poor, disadvantaged neighbourhoods across Southwestern Ontario. They were also more likely to have a history of depression and had higher rates of depression during pregnancy, with 10 per cent on medication while pregnant. Looking at substance use, 41 per cent of teenage women smoked cigarettes, 13 per cent used cannabis and 7 per cent drank alcohol during pregnancy, which was significantly higher than rates for older pregnant women.

Once adjusted for other medical, behavioural and economic factors, teenage pregnancy was not associated with a higher risk for preterm birth or low birth weight compared to pregnancy for women ages 20-34 years. However, the infants had a higher risk of low Apgar scores.

An Apgar score, a test given to newborns soon after birth, indicates how well the baby is doing outside of the womb. Babies with very low Apgar scores are more likely to need assistance with breathing. However, Apgar scores have little correlation with the long-term health of the baby.

"Although teenage pregnancy has been declining in Canada over the past few decades, this does not mean that we have solved this social issue. The majority, 70 per cent, of teenage pregnancies in this country are unintended," says Dr. Seabrook, Scientist at Children's Health Research Institute, a program of Lawson, and Associate Professor at Brescia University College. "Unfortunately, declining rates of teenage pregnancy means that the issue has received minimal attention in recent years with respect to social policy."

Contrary to findings in the United States, where teenage pregnancy is associated with a higher risk for preterm birth and low birth weight, these recent results suggest that geographical context, differences in social inequality and type of health care system are important. It's possible that Canada's universal health care system provides a stronger safety net.

"There are so many factors associated with poor birth outcomes, and the advantage of our sample size and statistical modelling was that we were able to include key medical and behavioural factors which play a larger role than age," says Dr. Jasna Twynstra, Associate Professor at Brescia University College.

"Although our study adds to the limited research on teenage pregnancy and birth outcomes, the findings are only from Southwestern Ontario," adds Dr. Seabrook. "We are currently working on a systematic review and meta-analysis of all studies conducted in Canada on the relationship between teenage pregnancies and adverse birth outcomes to determine whether our findings here are consistent with what's happening across the country."

He hopes the study reopens discussion on this important issue so that work can be done to improve the overall health of teenage pregnant women and their children. "We need to target teenage mental illness, as well as their high substance use during pregnancy, to minimize the impact on their overall health and wellbeing."

San Juan Capistrano, Calif. - A landmark two-year follow-up study on the Ellipsys® Vascular Access System was highlighted at the annual Controversies in Dialysis Access (CiDA) meeting, one of the premier dialysis access medical conferences in the world.

The Ellipsys System from Avenu Medical is a non-surgical alternative to creating vascular access for end-stage renal disease (ESRD) patients who require hemodialysis. It creates an endovascular arteriovenous fistula (endoAVF) using just a small needle puncture and catheter.

The multi-center study was included as part of a presentation during CiDA's "EndoAVF in Clinical Practice" session, as well during the "Ellipsys for EndoAVF®" industry symposium. It marks the first published two-year data for any endoAVF procedure.

Researchers found that nearly 92 percent of the Ellipsys fistulas were still functional after two years. In addition, patients reported high levels of satisfaction with the minimally invasive procedure. The study was recently published in the Journal of Vascular Access.

"These results confirm the Ellipsys system provides good vascular access while reducing the pain and discomfort associated with traditional fistula surgery," said Thomas Fogarty, MD, a world-renowned vascular surgeon and medical device inventor. "I've been creating surgical fistulas for over 50 years, and there has been very little innovation during that time. This groundbreaking technology represents a true paradigm shift in dialysis patient care."

An AVF provides vascular access for hemodialysis by establishing a permanent connection between an artery and a vein in the arm. Until recently, the only way to create an AVF was an open surgical procedure that subjects patients to discomfort, longer recovery times and delayed dialysis.

Dr. Fogarty was among the faculty who spoke at the "Ellipsys for EndoAVF: Creation to Cannulation" symposium. The multi-disciplinary panel lead by Monnie Wasse, MD, consisted of vascular surgeons, interventional radiologists, interventional nephrologists, a registered vascular technologist and an expert nurse cannulator. The program gave participants a comprehensive overview of the continuum of care required for successful dialysis treatment of ESRD patients, including patient selection, vessel mapping, endoAVF creation, maturation and cannulation.

"A really unique and important aspect of the program was having all vascular access disciplines represented. Each access center will have variations in specialty and specific procedure expertise, yet all must closely interact with one another to give patients the very best outcomes," said William Jennings, MD, a prominent vascular access surgeon from Tulsa, OK. "A team approach to dialysis access creation is the key element needed for a higher level of patient care and increases the likelihood of getting the patient on dialysis sooner using that newly created fistula with fewer procedures, complications and interventions."

During the CiDA annual meeting, the Centers for Medicaid and Medicare Services (CMS) published its final rules for 2020, which include increased reimbursement for the code associated with the Ellipsys procedure, effective January 1, 2020.

"This is tremendous news for people with end-stage renal disease in the U.S., which is a traditionally underserved patient population," said Mark Ritchart, President and CEO of Avenu Medical. "This reimbursement update will make it easier for physicians to perform the Ellipsys procedure at ambulatory surgery centers and hospitals, thereby increasing the number of people who have access to this faster, more efficient and less invasive option for AV fistula creation. This will be a significant quality of life improvement for these patients and their loved ones."

Approved by the FDA in 2018 for patients with ESRD, the Ellipsys endoAVF technology transforms a complex surgery into a minimally invasive procedure that can be performed in a hospital outpatient setting or ambulatory surgery center. A faster recovery enables patients can start dialysis sooner, and the lack of scars or disfigurement typically associated with surgical fistulas leads to better cosmetic outcomes. Over 1,200 patients worldwide have had the Ellipsys procedure since 2015.

The Controversies in Dialysis Access conference was held Oct. 31-Nov. 1 in San Diego. The meeting is the leading educational forum for surgeons, radiologists, nephrologists and medical staff who care for dialysis access patients.

People who live in areas of higher than average deprivation are more likely to be admitted to hospital and to spend longer in hospital, according to new research from the University of Cambridge. The difference was particularly pronounced among manual workers and those with lower education level.

Despite increases in overall life expectancy there is still an inequality, with lower life expectancy observed more often in disadvantaged groups. It is well known that those in higher social classes have a typical life expectancy several years longer than those with the lowest. Similarly, life expectancy and levels of good health vary between UK cities and regions, with large variations in expected years of life in good health.

In research published in BMJ Open, a team led by researchers at the Cambridge Institute of Public Health examined whether there was a link between living in an area of deprivation and subsequent hospital use. To do so, they examined data from almost 25,000 individuals (11,000 men and 14,000 women) from the EPIC-Norfolk cohort across almost two decades, between 1999 and 2018.

The researchers used the Townsend Index to measure the deprivation of individuals' residential areas, stratifying people into five levels. The Index looks at levels of unemployment, number of households without a car, the percentage of households not owner-occupied, and the percentage of households with more than one person per room.

Participants completed a lifestyle questionnaire that included questions about their own and their partner's current and past employment and a list of qualifications. The researchers used the employment information to assign each participant to either non-manual or manual social classes. Non-manual social class included those individuals who worked in professional, managerial, technical and non-manual skilled occupations; manual social class included those who worked in skilled, partly skilled and unskilled manual occupations. The qualifications marked were used to assign participants to lower or higher educational attainment categories.

The researchers found that people who lived in areas of highest deprivation spent the most time in hospital, but the risk of a long hospital stay is seen disproportionately in people who also had low educational attainment or were in manual social class. While the average amount of time spent in hospital over the two decade period was around 28 days for people with high educational attainment, for those with low educational attainment, the average was around 37 days, rising steeply to 43 days in the group living in areas of highest deprivation.

The picture relating to social class was similar, though the differences between social classes was not as pronounced as those between educational attainments. Those individuals in non-manual social classes spent between 29 and 31.5 days in hospital; in manual social classes, people in areas of less deprivation spent around 32 days in hospital, rising to 39.5 days in areas of highest deprivation.

"Regardless of your age and gender, or even lifestyle factors such as smoking and obesity, living in an area of high deprivation is a significant risk factor for spending time in hospital," said Dr Robert Luben from the Department of Public Health and Primary Care at the University of Cambridge, the study's first author. "People living in areas at or below the national average for deprivation were more likely to spend more than 20 days in hospital or be admitted to hospital on more than seven occasions during the two decades that we examined."

Senior author Professor Kay-Tee Khaw, also from the Department of Public Health and Primary Care, said: "People working in a manual occupation or with lower education level and living in more deprived areas had the greatest risk of hospitalisation. This suggests that hospitalisation is greatest when poorer individual socioeconomic factors are combined with residential deprivation.

"It isn't clear why this should be the case, though we can speculate that it could in part be down to better education improving an individual's ability to live a healthier life."

Previous research from the group has examined the link between lifestyle factors, education and hospitalisation. This is the first to look at the link between deprivation at an area level and hospitalisation.

"It clearly is not enough just to focus on educating people and improving lifestyle factors at an individual level," added Dr Luben. "A poor environment affects those least able to cope. Effective NHS and government policy also needs to address deprivation infrastructural levels - improving housing, transport, access to recreation and green space, for example."

Whether or not a patient receives pain treatment when seeking emergency medical services may depend, in part, on their race or ethnicity, according to a new study by Portland State researchers. The study was published in the journal Medical Care and was led by PSU Sociology PhD student Jamie Kennel and Associate Professor of Sociology Hyeyoung Woo.

"We found evidence that the odds of receiving a lower quality of care from EMS providers are higher among racial minorities in Oregon, when compared to white patients in Oregon, after experiencing traumatic and painful injuries," said Kennel. PhD students Elizabeth Withers and Nate Parson also contributed to this study.

The researchers analyzed 25,732 health records from patients seeking emergency help for traumatic injuries in Oregon between 2015 and 2017. The records came from dozens of emergency medical service (EMS) agencies, including most of the ambulance and fire organizations in the state.

The researchers found that the odds that EMS responders provided pain assessments were 21% and 31% lower for Hispanic patients and Asian patients, respectively. Furthermore, the odds of receiving pain medication for traumatic injuries were significantly lower among black, Hispanic and Asian patients (32, 21 and 24%, respectively) than they were for white patients. This was despite the fact that black and Hispanic patients reported higher average pain scores than white patients.

"Like most healthcare providers, EMS providers don't desire to provide inequitable healthcare but often have never been exposed to evidence suggesting these disparities are taking place," Kennel said. "We hope that, when exposed to this new evidence, individual EMS providers will work with their agencies to better understand, and take steps to mitigate, this phenomenon in their community."

This study was unable to look at the factors that cause inequities in pain treatment, but the researchers speculated about a few possibilities, including difficulties in providing care for people with limited English proficiency.

While previous studies have found racial and ethnic disparities in medical care, this was the first to look at both pain assessment and pain medication in a large statewide database. This study was also unique in that it took into account several potential confounding variables, including insurance status, which can be used as a proxy for socioeconomic status.

"Race, unfortunately, still has a complex relationship with socioeconomic status, which--if not accounted for--can confound the results of a study like this without the steps we took to separate the influence of these factors," said Kennel.

Kennel said he was surprised by the size of the disparities in pain assessment and treatment. "This is very large, concerning and should be motivating for change," he said.

He noted that he and the other researchers hope these findings will positively impact patient care and how EMS agencies do their work.

In particular, he hopes that EMS agencies will recognize that the quality of care that they provide patients is being influenced by race and that the government regulators charged with creating local policy and overseeing EMS and Fire contracts will require evidence that EMS treatment is being provided to all patients equitably.

A distant galaxy more massive than our Milky Way - with more than a trillion stars - has revealed that the 'cores' of massive galaxies in the Universe had formed already 1.5 billion years after the Big Bang, about 1 billion years earlier than previous measurements revealed.

Researchers published their analysis on November 6, 2019 in The Astrophysical Journal Letters, a journal of the American Astronomical Society.

"If we point a telescope to the sky and take a deep image, we can see so many galaxies out there," said Masayuki Tanaka, paper author and associate professor of astronomical science in the Graduate University for Advanced Studies and the National Astronomical Observatory of Japan. "But our understanding of how these galaxies form and grow is still quite limited -- especially when it comes to massive galaxies."

Galaxies are broadly categorized as dead or alive: dead galaxies are no longer forming stars, while living galaxies are still bright with star formation activity. A 'quenching' galaxy is a galaxy in the process of dying -- meaning its star formation is significantly suppressed. Quenching galaxies are not as bright as fully alive galaxies, but they're not as dark as dead galaxies. Researchers use this spectrum of brightness as the first line of identification when observing the Universe.

The researchers used the telescopes at the W.M. Keck Observatory in Hawaii to observe a quenching galaxy in what is called the Subaru/XMM-Newton Deep Field. This region of the sky has been closely observed by several telescopes, producing a wealth of data for scientists to study. Tanaka and his team used an instrument called MOSFIRE on the Keck I telescope to obtain measurements of the galaxy. They obtained a two-micron measurement in the near-infrared spectrum, which the human eye cannot see, but it confirmed that the light from the galaxy was emitted just 1.5 billion years after the Big Bang. The team also confirmed that the galaxy's star formation was suppressed.

"The suppressed star formation tells you that a galaxy is dying, sadly, but that is exactly the kind of galaxy we want to study in detail to understand why quenching occurs," said Francesco Valentino, a co-author of the paper and an assistant professor at the Cosmic Dawn Center in Copenhagen.

According to Valentino, astronomers believe that massive galaxies are the first to die in the history of the Universe and that they hold the key to understanding why quenching occurs in the first place.

"We also found that the 'cores' of massive galaxies today seem to be fully formed in the early Universe," Tanaka said. How stars move within a galaxy depends on how much mass that object contains. Tanaka and his team found that the stars in the distant galaxy seem to move just as quickly as those closer to home. "The previous measurement of this kind was made when the Universe was 2.5 billion years old. We pushed the record up to 1.5 billion years and found, to our surprise, that the core was already pretty mature."

The researchers are continuing to investigate how massive galaxies form and how they die in the early Universe, and they are searching for more massive quenching galaxies in the far distant Universe that may shed light on earlier phases of the process.

"When did the first dead galaxy appear in the Universe?" Tanaka asked. "This is a very interesting question for us to address. To do so, we will continue to observe the deep sky with the largest telescopes and expand our search as more advanced facilities become available."

WHAT:

Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases. The observational study included neuropsychological evaluations of 611 children in sub-Saharan Africa. It was conducted by the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT), supported by the National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute of Mental Health, all components of the National Institutes of Health.

Researchers at the Michigan State University College of Osteopathic Medicine and other collaborating institutions recruited 246 5- to 11-year-olds with HIV who had begun antiretroviral therapy (ART) before age 3 during a previous IMPAACT study. The study participants were given a suite of neuropsychological tests at enrollment, at 48 weeks and at 96 weeks. Two comparator groups of HIV-negative peers who had been exposed to HIV in utero or during birth or breastfeeding, and peers never exposed to HIV, also received the same testing. All children with HIV were on ART during the study and about three-quarters were virally suppressed.

After controlling for age, sex and certain socioeconomic and family factors, the researchers found that participants with HIV had poorer performance on cognitive ability, motor function and attention tests compared to participants without HIV in the two comparator groups, at all three time points. Notably, participants with HIV had significantly less improvement in planning and reasoning abilities than their HIV-negative peers over time. On each test, researchers observed no significant differences between HIV-negative children exposed to HIV and those never exposed to HIV.

The landmark Children with HIV Early Antiretroviral Therapy (CHER) study found in 2008 that immediately initiating ART improved overall health outcomes among infants and children with HIV. However, these new findings suggest that some children may experience neuropsychological difficulties over time, even when HIV is well controlled. Together, these data highlight the need to investigate the underlying mechanism of these neuropsychological challenges, and to develop additional interventions to support children who acquire HIV early in life.

Bottom Line: Marijuana vaping reported by U.S. adolescents increased from 2018 to 2019. This observational study used annual Monitoring the Future surveys from a nationally representative group of eighth, 10th and 12th graders to examine changes in marijuana vaping among adolescents. In 2019, past 30-day marijuana vaping was reported by 14% of 12th graders, an absolute increase of 6.5% from 2018. Additionally, 3.9% of 8th graders reported past 30-day use, an absolute increase of 1.3% from 2018 to 2019, and 12.6% of 10th graders reported such use in 2019, an absolute increase of 5.6% over 2018. One-year increases from 2018 to 2019 were larger than the increases from 2017 to 2018 for 10th and 12th graders for past 30-day use. Limitations of the study include potential errors in self-reported use and an absence of high-school dropouts. The growth in marijuana vaping suggests new prevention and intervention efforts aimed specifically at adolescents are needed.

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

Authors: Richard A. Miech, Ph.D., University of Michigan, Ann Arbor, and coauthors.

(doi:10.1001/jama.2019.20185)

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

It's not just oranges that grow in Florida. Carambola, or star fruit as most in the United States call it, is gaining popularity. One researcher from Florida International University is researching how cover crops can help the sustainability of star fruit farms.

"Tropical fruit production has become a prominent practice in Miami-Dade County," says Ariel Freidenreich. "For this reason, it is vital that sustainable farming practices are applied to these systems to ensure healthy soils and economically viable fruit production."

"Star fruit are a great snack while working in the sun because they are juicy and sweet," says Freidenreich. "The Arkin variety is the most popular and widely planted in south Florida. Some growers are now expanding to sweeter and juicier varieties from Hawaii and other areas. They go great with salads and are used for juicing. There is even a winery that makes a delicious star fruit wine (tangy and not too sweet). While these fruits are not very popular in American culture, they are popular in Asian and Hispanic cultures, which are very prominent in south Florida."

Besides being tasty, there's another reason for finding a variety of crops that grow well in Florida.

"Increasing the diversity of crops that are grown in various areas is important for several reasons," says Freidenreich. "First, crops like oranges are under pressure from a disease called citrus greening. It's a blight disease that causes trees go into decline and die within three years. The disease destroys the production, appearance, and economic value of citrus trees and their fruit, and there is no cure. Similarly, laurel wilt has been greatly impacting the avocado industry in south Florida. Different crops are being planted to replace avocado groves."

Establishing crops like star fruit will help diversify the biological system of a farm. It also diversifies the income stream for growers. Just like a well-balanced retirement portfolio, balancing the mix of crops on a farm can reduce overall risk. This is good for the environment and the sustainability of our food sources.

Freidenreich's research with carambola includes cover crops. Cover crops are grown, not to be harvested, but to assist with soil health. Two cover crops the team studied are sunn hemp and velvet bean. Both are in the legume family and can take nitrogen from the air and metabolize it into a plant nutrient.

"We established cover crops within this young carambola stand to enhance overall soil quality," says Freidenreich. "We grew sunn hemp and velvet bean between trees. We cut them and incorporated them into the soil as green manure for two summer growing seasons. This helps ensure healthy tree development without the addition of synthetic inputs."

The research is taking place on a certified organic farm, and these practices are being developed to help farmers transitioning to organic production or those interested in sustainable practices.

Cover cropping should improve the soil organic matter. "The soil [at the research site] is rock-plowed limestone with little natural organic matter content," says Freidenreich. "These soils have a basic pH, so improving organic matter content is necessary to help lower pH. This, in turn, should inspire healthy crop growth."

Improving soil organic matter "should have positive effects on soil nutrient availability," says Freidenreich. "It should also improve soil structure and microbial interaction. We expect fruit yield improvement over time. South Florida has a subtropical climate, so hot and humid weather inspires quick turn over for organic matter degradation. Continually adding these treatments should have positive benefits season to season. The cover crops can be great for weed suppression in the growing season and after termination."

Future research means Freidenreich might get to snack on more star fruit while in the field. "Star fruit are very wind sensitive. They can defoliate with strong gusts. Sunn hemp has the potential to act as a windbreak for starfruit trees. Additionally, star fruit is truly tropical and can be sensitive to cool temperatures in the winter months in subtropical south Florida. Cover crop mulches might insulate the roots of carambola trees."

Gun homicide rates in the US are associated with several social determinants of health, including income inequality, government welfare spending, trust in institutions, and social mobility, according to a new study published December 17 in the open-access journal PLOS Medicine by Daniel Kim from Northeastern University in Boston, Massachussetts.

Gun violence is a major contributor to the life expectancy of Americans, and better knowledge about its root causes is crucial for prevention. Yet no previous studies have comprehensively investigated and compared major area-level social determinants of health as possible drivers of firearm homicides and mass shootings. To address this knowledge gap, Kim used the latest location-linked gun homicide incident data from the US in 2015 to explore and compare the independent associations of key state-, county-, and neighborhood-level social determinants of health with neighborhood gun homicides and mass shootings in the United States. State firearm laws and other state, county, and neighborhood (census tract [CT]) characteristics were also taken into account. The study population consisted of all 74,134 CTs as defined for the 2010 Census in the 48 states of the contiguous US. The analyses were based on 13,060 firearm-related deaths reported in 2015.

Higher levels of trust in institutions (including the government, media, and corporations) by citizens at the county level were linked to a 19% reduction in the gun homicide rate and a 17% decrease in the total number of gun homicide incidents at the neighborhood level. County levels of social mobility, the ability to climb the socioeconomic ladder, were related to a 25% reduction in the gun homicide rate and a 24% decrease in the total number of gun homicide incidents. Increases in the neighborhood percentages of residents in poverty and males living alone were associated with 26-27% and 12% higher neighborhood gun homicide rates, respectively. One limitation of the study was the lack of disaggregation of gun homicide data by factors such as race and gender.

Taken together, this study shows that the rich-poor gap, levels of citizens' trust in institutions, social mobility, and welfare spending may be related to neighborhood firearm homicide rates in the US. According to Kim, further establishing the cause-and-effect nature of these associations and modifying these social determinants may help to address the growing gun violence epidemic and reverse recent downward trends in life expectancy among Americans.

Boston, MA -- An unhealthy diet is one of the leading risk factors for poor health, accounting for up to 45 percent of all deaths from cardiometabolic diseases (CMD), such as heart disease, stroke and type 2 diabetes. But the national economic burden of unhealthy diet habits remains unknown. A new study by investigators from Brigham and Women's Hospital, in collaboration with investigators at the Friedman School of Nutrition Science and Policy at Tufts University, analyzed the impact of 10 dietary factors -- including consumption of fruits and vegetables, nuts and seeds, processed meats and more -- and estimated the annual CMD costs of suboptimal diet habits. The team concludes that suboptimal diet costs approximately $300 per person, or $50 billion nationally, accounting for 18 percent of all heart disease, stroke and type 2 diabetes costs in the country. The team's findings are published in PLOS Medicine.

"There is a lot to be gained in terms of reducing risk and cost associated with heart disease, stroke and diabetes by making relatively simple changes to one's diet," said corresponding author Thomas Gaziano, MD, MSc, of the Division of Cardiovascular Medicine at the Brigham. "Our study indicates that the foods we purchase at the grocery store can have a big impact. I was surprised to see a reduction of as much as 20 percent of the costs associated with these cardiometabolic diseases."

To conduct their study, Gaziano and colleagues, including co-senior author Renata Micha, PhD, an associate research professor at Tufts, focused on the impact of 10 food groups -- fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages, polyunsaturated fats, seafood omega-3 fats and sodium). Using data from the National Health and Nutrition Examination Survey (NHANES), the team created a representative U.S. population sample of individuals aged 35-85 years. Using a model they developed and termed the CVD PREDICT model, the team analyzed individual risk of cardiometabolic disease and associated costs for the sample population based on respondents' current dietary patterns. They then re-calculated costs for CMD if everyone's diet was optimized to the healthiest amounts of the 10 foods and nutrients.

The team found that suboptimal diets account for $301 per person in terms of CMD-related costs. This translates to more than $50 billion nationally, 84 percent of which is due to acute care. Costs were highest for those with Medicare ($481/person) and those who were eligible for both Medicare and Medicaid ($536/person).

"We have accumulating evidence from the Food-PRICE collaborative research work to support policy changes focused on improving health at a population level. One driver for those changes is identifying the exorbitant economic burden associated with chronic disease caused by our poor diets. This study provides additional evidence that those costs are unacceptable. While individuals can and do make changes, we need innovative new solutions - incorporating policy makers, the agricultural and food industry, healthcare organizations, and advocacy/non-profit organizations - to implement changes to improve the health of all Americans," said co-senior author Renata Micha of the Friedman School of Nutrition Science and Policy at Tufts.

Three dietary factors contributed most to these costs: consumption of processed meats, low consumption of nuts/seeds, and low consumption of seafoods containing omega-3 fats.

The team notes that the current study may underestimate the cost of unhealthy diet habits as dietary factors may contribute to risk of diseases beyond heart disease, stroke and diabetes, such as cancer. While the study focuses on 10 dietary factors for which there were robust data, others may influence risk and cost as well. In addition, the study relied on dietary intake data collected from food questionnaires that asked respondents to recall what foods they had consumed in the past 24 hours. Respondents may have underreported unhealthy food choices or inaccurately recalled what they had consumed.

"Our work illustrates the need for interventions or policies that incentivize healthier dietary behavior as these changes have the potential to have a big impact and reduce the health and financial burden of cardiometabolic disease," said Gaziano.

Columbia researchers, analyzing national data on opioid overdose deaths, have found that only 4% of opioid-related overdose deaths are due to suicide--far below recent estimates of 20-30%.

The findings were published today in JAMA.

"Our findings suggest that the current emphasis on the contribution of suicide to opioid-related deaths may be overstated and that for most individuals who overdose on opioids, the primary clinical focus should be on substance use," says the study's leader Mark Olfson, MD, MPH, the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law at Columbia University Vagelos College of Physicians and Surgeons.

The study is the first to use national data on opioid overdose deaths between 2000 and 2017 to find out what share of these deaths in individuals age 15 and older were unintentional, due to suicide, or of undetermined intent.

Over the 17-year study period, the percentage of opioid-related overdoses attributed to suicide decreased from 9% to 4%.

However, the rate of opioid-related suicide deaths more than doubled, from 0.27 to 0.58 per 100,000 people, and the rate of unintentional deaths increased over six-fold, from 2.20 to 13.21 per 100,000 people. (Although the percentage of overall opioid-related deaths that were undetermined in intent decreased from approximately 17% to 5%, their rate increased from 0.51 to .79 per 100,000.)

"It's likely that the increasing use of illicit fentanyl, which is approximately fifty times more potent than heroin, has contributed to the rapid increase in unintentional opioid overdose deaths," says Olfson.

Though the researchers did not find a close link between opioid overdose deaths and suicide deaths--two ongoing public health crises--they note that the increase in suicide deaths in the U.S. may still be driven, at least in part, by the rise in opioid overdose deaths because of the absolute increase in opioid-related suicide deaths.

Additional research is needed to understand the role of suicidal intent in opioid overdoses, say the authors. "Considering the high risk of suicide after nonfatal opioid overdose, this information could be especially valuable in suicide prevention efforts," Olfson says.

"This type of rigorous research accessing large sets of data is essential to understanding and alleviating the social and clinical factors adversely affecting the health of our population," adds Jeffrey A. Lieberman, Chair of the Department of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons.