Monthly Archives: May 2024

Patient-centered cardiovascular care is essential for enhancing equity and outcomes

A new Scientific Statement from the American Heart Association, published in Circulation, emphasizes the significant benefits of adopting a patient-centred approach to adult cardiovascular care. This approach, as detailed by Michael J. Goldfarb, M.D., M.Sc., the chair of the statement writing committee and an associate professor of cardiology at Jewish General Hospital and McGill University, revolves around treating patients as individuals, respecting their beliefs, preferences, and values. It advocates for a harmonious blend of the healthcare professional’s expertise with the patient’s health priorities, fostering an environment where informed decisions are made through the empowerment of patients. This entails not just providing information but cultivating an active partnership among patients, their families, and the healthcare team. However, it is made clear that this does not grant patients carte blanche to make any healthcare decisions indiscriminately.

Goldfarb highlights the current gap in guidance and practical tools for healthcare professionals managing adults with heart disease in terms of integrating person-centred care into everyday clinical practice. The statement outlines essential elements of patient-centred care, such as shared decision-making, effective medication management, and the prioritization of patient-oriented outcomes. Shared decision-making is underscored as a process grounded in trust, mutual respect, and open communication, encouraging patients to express their values and preferences openly.

Despite the known benefits of medication in preventing and treating heart disease, adherence remains a challenge, with more than half of patients not consistently taking their medication as prescribed. The statement suggests that patient-centred discussions could enhance medication adherence and reduce costs and side effects. Importantly, any decision regarding starting, adjusting, or cessation of cardiovascular medications must consider the patient’s preferences and goals.

The comprehensive care model also includes the evaluation of patient-reported outcomes like physical functioning, symptom burden, and quality of life, offering a more holistic view of a patient’s condition and treatment impact. Goldfarb stresses the importance of aligning healthcare outcomes with what matters most to the patient, acknowledging that traditional metrics such as hospital stay length might not capture a patient’s primary concerns regarding their quality of life post-treatment.

The statement addresses the need to overcome barriers to patient-centered care, especially for populations disproportionately burdened by cardiovascular disease. It calls for culturally and linguistically competent care teams to assess and address social determinants of health alongside considerations for special groups such as older adults, women, individuals with behavioural and mental health disorders, adults with congenital heart disease, and those with physical disabilities.

However, the path to implementing patient-centred care is fraught with challenges from patient, clinician, and health system barriers, including distrust, limited health literacy, time pressures on clinicians, and fragmented health systems. Despite these obstacles, Goldfarb remains optimistic about the feasibility and existing instances of patient-centred care within current delivery systems. He advocates for the further development and inclusion of patient-centred outcomes measures to optimize care for patients, their families, and caregivers, highlighting the pivotal role of patient-centred care in improving medical outcomes and patient experiences in cardiovascular health.

More information: Michael J. Goldfarb et al, Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association, Circulation. DOI: 10.1161/CIR.0000000000001233

Journal information: Circulation Provided by American Heart Association

Women caregivers are stressed: improvements in transportation infrastructure could help

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Travel related to caregiving, such as escorting a child to school or accompanying a parent to medical appointments, is often linked with increased stress and reduced happiness among women, but not men, reveals a study from the University of Michigan. This disparity highlights the societal tendency to prioritise travel for employment over “mobility of care.”

Published in the journal Transportation Research Part D: Transport and Environment, the study provides evidence that public transportation planning has historically overlooked caregiving travel’s unique needs, predominantly affecting women. This research is pioneering in its quantitative analysis of the impact of caregiving travel on well-being. It expands upon earlier findings that women are more likely to undertake domestic caregiving tasks than men.

The researchers utilised data from the 2021 American Time Use Survey by the U.S. Department of Labor to examine the correlation between daily activities and personal well-being, encompassing happiness, stress, and sense of meaning. They discovered that women, regardless of their or their male partner’s employment status, were about 60% more likely to engage in caregiving travel during a typical weekday—23% for women compared to 14% for men. During these journeys, women exclusively reported heightened stress and diminished happiness and meaning, unlike during leisure activities, where such feelings were not reported.

The study suggests that time constraints imposed by balancing work and family duties might contribute to this stress. It shows that men in full-time employment who also perform caregiving duties tend to spend less time on caregiving and household tasks such as shopping and maintenance than their female counterparts, allowing them more time for work-related activities.

Atiyya Shaw, U-M Assistant Professor of Civil and Environmental Engineering and the study’s senior author, notes that employment does not influence women’s likelihood of undertaking caregiving travel as it does for men. Interestingly, men with employed female partners are more likely to engage in caregiving travel than those without partners, a trend not seen among women.

The researchers also pointed out limitations in their study, such as the inability to differentiate between same-sex and different-sex partners and the broader spectrum of gender identities and family structures, which could influence the relationship between caregiving travel and well-being.

The study critically evaluates how transportation planning contributes to these disparities and suggests improvements that could mitigate them. Amy Fong, a doctoral student in civil and environmental engineering at U-M and the study’s first author emphasised the growing awareness among transportation engineers of how cultural and societal norms have shaped the design of transport systems and, by extension, people’s daily lives.

Historically, U.S. transportation systems have been designed to focus on commuting patterns, thus prioritising work-related travel over unpaid caregiving tasks. Shaw and Fong argue that this focus reflects a broader societal undervaluation of domestic labour.

To address these issues, Shaw and Fong recommend several strategies.
Local governments should enhance the safety and accessibility of alternative walking, biking, and public transit options for those who usually require assistance to travel. The federal government could streamline funding across different agencies to improve transportation services for people with disabilities, older adults, and low-income people. State transportation departments might focus on projects facilitating independent travel for the elderly and disabled. Local governments and school districts could collaborate with initiatives like Safe Routes to School to promote children’s independent mobility.
Future travel surveys should differentiate between types of trips to better understand the specific impacts of caregiving-related mobility on quality of life.

These recommendations underscore the need for a more inclusive approach to transportation planning that acknowledges the essential nature of caregiving travel and its significant impact on caregivers’ quality of life.

More information: Amy Z. Fong et al, Well-being implications of mobility of care: Gender differences among U.S. adults, Transportation Research Part D Transport and Environment. DOI: 10.1016/j.trd.2024.104109

Journal information: Transportation Research Part D Transport and Environment Provided by University of Michigan

Encouraging hair regeneration in aging follicular stem cells

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Just as the ageing process can lead to reduced mobility due to less flexible joints, the stem cells within hair follicles also experience decreased flexibility, hindering their ability to foster hair growth. Northwestern Medicine’s recent study brought this crucial insight to light. However, the research also unveiled a potential solution: increasing these stem cells’ suppleness could significantly enhance their hair-producing capabilities, a finding of immense importance in hair growth and stem cell research.

The team at Northwestern embarked on an innovative path, discovering a method to increase the flexibility of these stem cells, thereby rejuvenating their hair-producing function. In their groundbreaking research, published in the prestigious journal PNAS, they revealed that enhancing the production of a specific tiny RNA molecule, miR-205, can decrease the rigidity of these cells. By genetically altering the stem cells to amplify miR-205 production, they were able to encourage hair growth in both young and aged mice, a testament to the potential of cutting-edge research in this field.

Rui Yi, the study’s leading author and the Paul E. Steiner Research Professor of Pathology and Dermatology at Northwestern University Feinberg School of Medicine, remarked, “Within 10 days, they began to grow hair.” Yi elaborated, “We are not creating new stem cells. Instead, we’re invigorating existing stem cells to produce hair. Often, the stem cells are present but fail to generate hair.”

The findings of this study showcase the potential of stimulating hair growth through regulating cellular mechanics. With the feasibility of delivering microRNA directly to the skin via nanoparticles, the team plans to investigate whether applying miR-205 topically can encourage hair growth in mice. Pending the success of these experiments, they aim to explore the possibility of using this microRNA to stimulate hair growth in humans.

This pioneering research was conducted using genetically modified mouse models. It employed sophisticated microscopy techniques, such as atomic force microscopy, to assess cell stiffness and two-photon microscopy to observe cell behaviour in living subjects.

More information: Jingjing Wang et al, MicroRNA-205 promotes hair regeneration by modulating mechanical properties of hair follicle stem cells, Proceedings of the National Academy of Sciences. DOI: 10.1073/pnas.2220635120

Journal information: Proceedings of the National Academy of Sciences Provided by Northwestern University

Identifying foodborne illness early

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Produce, including lettuce and spinach, routinely undergoes testing for pathogenic bacteria such as Salmonella, Listeria monocytogenes, and pathogenic strains of E. coli, aiming to shield consumers from illness.

Although rapid testing of foods is possible, there remains to be a delay in identifying the source of contamination and the affected individuals. When a multi-state recall is initiated as a remedy, it is often too late for many consumers who have already consumed the contaminated produce. This approach predominantly serves as damage control.

Researchers at the University of Delaware are working on a proactive solution. As described in a publication in the Journal of Food Safety, a collaboration between UD faculty and a Delaware-based startup, Biospection, aims to accelerate the detection process drastically. Harsh Bais, a professor of plant biology, and Kali Kniel, a microbiologist specialising in food safety, along with graduate student Nick Johnson, have teamed up with Andy Ragone of Biospection to detect foodborne pathogens within three to six hours.

Kniel, with expertise in pathogens like Salmonella that can transfer between hosts, stresses the importance of innovative tools for the produce industry to minimise microbial contamination risks. The collaboration between academia and biotechnology firms, such as their own, is poised to enhance technologies that significantly impact food safety and public health.

Pathogens often infiltrate plants, which serve as unwitting hosts, unable to disclose the presence of these microbial invaders. Like humans, plants employ defence mechanisms against diseases. However, specific pathogens have adapted to bypass these defences by settling comfortably within stomata—tiny openings in the plant surfaces.

Bais highlighted that these pathogens are not typical plant pathogens; thus, visual signs of plant stress are not apparent. Biospection technology promises rapid indication of these opportunistic pathogens within plants.

The association between Ragone, a chemical physicist based in Wilmington, and the UD researchers developed through shared scientific resources and community engagements in Delaware. Their collaborative efforts, supported by a research grant from the Delaware Biotechnology Institute Center for Advanced Technology (CAT), have led to the creation of a multispectral imaging platform designed to observe plant responses to pathogens.

This innovative technique, yet to be commercially available, allows for the non-invasive scanning of plants directly on conveyors before they even reach supermarket shelves. By employing multispectral imaging and deep ultraviolet sensing, the technology can detect subtle changes in plants when exposed to harmful pathogens—changes that would be invisible to the naked eye.

For instance, a significant reduction in chlorophyll pigments within a few hours of exposure to Listeria indicates that the plant reacts to an attack, marking a significant shift towards more effective and rapid detection methods.

With funding from a National Science Foundation Small Business Innovation Research grant in 2022, Biospection is developing this technology into a real-time imaging sensor for commercial use, capable of inspecting plants for diseases and other stresses. Ragone envisions a portable, automated device that delivers quick results, revolutionising how we monitor and ensure plant health.

This technology also holds promise for vertical farming, which could greatly benefit from enhanced disease detection methods. Vertical farms use less water and space and are susceptible to diseases such as E. coli, potentially devastating entire harvests. Biospection is actively engaging with agricultural companies to integrate these sensors into vertical farming systems and, potentially, drones for outdoor farming applications.

Looking ahead, Bais is interested in refining the technology to distinguish between different microbes based on the plant’s sentinel response. This breakthrough could redefine microbial identification and plant health monitoring.

In summary, this pioneering approach not only aims to prevent the consumption of contaminated produce but also represents a significant advancement in integrating biotechnology with agricultural practices, ultimately contributing to safer food supply chains and enhanced public health.

More information: Nick Johnson et al, Deep ultraviolet fluorescence sensing with multispectral imaging to detect and monitor food-borne pathogens on the leafy green phyllosphere, Journal of Food Safety. DOI: 10.1111/jfs.13056

Journal information: Journal of Food Safety Provided by University of Delaware

Predominantly cited scientists remain men, yet the gender disparity is narrowing

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An examination of 5.8 million authors across the entire spectrum of scientific disciplines reveals a promising trend of a narrowing gender gap, indicating that significant strides have been made. The recent study led by John Ioannidis from the Meta-Research Innovation Center at Stanford (METRICs) at Stanford University, US, along with his team, was released on November 21st in the open-access journal PLOS Biology, offering a beacon of hope for a more equitable scientific community.

Science continues to exhibit a pronounced gender divide, evident in numerous facets. Among these, the differential visibility of male and female scientists in their work’s prominence in scientific publications stands out significantly.

The research scrutinized the comprehensive Scopus database, encompassing articles from all areas of science. This database accounted for 5.8 million authors whose gender could be determined with high confidence. Among these, men constituted 3.8 million and women 2.0 million.

The findings indicated a male predominance, with men outnumbering women by a factor of 3.93 among authors who began their publishing careers before 1992. Still, this ratio dropped to 1.36 for those who commenced after 2011. Nevertheless, focusing on authors with the most significant impact (those within the top 2% in their field based on citation metrics), men still outnumbered women by 3.21 times among the most-cited authors. This disparity decreased from 6.41 times among the more senior groups to 2.28 times among the newest cohort, who started publishing post-2011. In this youngest group, 32 out of 174 scientific fields (18%) featured an equal number of women and men, or more women, among the top-cited authors.

The gap in gender representation among authors has markedly narrowed over time in affluent countries like the USA. However, the latter showed minimal progress concerning top-cited authors’ gender imbalances. An in-depth review of random samples of 100 women and 100 men from the newest group revealed that advancement to full professorship was exceedingly rare. At the same time, most were engaged in academia as of 2023. The researchers contend that improvements are needed in addressing gender disparities and the slow progression routes for highly talented scientists, irrespective of gender.

Ioannidis highlighted, “Our research captures a significant reduction over time in the gender-based inequalities among the upper tiers of scientific citation impact. However, considerable scope remains for further advancements in the majority of scientific domains.”

More information: John P. A. Ioannidis et al, Gender imbalances among top-cited scientists across scientific disciplines over time through the analysis of nearly 5.8 million authors, PLoS Biology. DOI: 10.1371/journal.pbio.3002385

Journal information: PLoS Biology Provided by PLOS

The presence of particular lipids signals tissue ageing, which can be mitigated through regular exercise

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A collaborative team from Amsterdam UMC and Maastricht UMC+ has made a groundbreaking discovery: a specific type of fat accumulates as tissues age, but exercise can reverse this process. This research, a testament to the power of collective effort, involved analysing tissue samples from mice and humans before and after exercise. The team’s findings have been published in today’s edition of Nature Aging.

Professor Riekelt Houtkooper from Amsterdam UMC’s Genetic Metabolic Diseases laboratory expressed his excitement about the potential implications of these findings. “The notion of reversing aging has traditionally been relegated to the realm of science fiction. However, these discoveries provide us with significant insights into the aging process,” he stated. Houtkooper’s colleague, Georges Janssens, who is the first author of the study and an assistant professor at Amsterdam UMC, added, “Often, we accept aging as an inevitable part of life, but this research shows that this doesn’t necessarily have to be the case. With a deeper understanding of how aging works, we can explore new methods of intervention that could potentially revolutionise aging research.”

Recent laboratory studies have indicated that it might be possible to combat age-related diseases by targeting the fundamental mechanisms that drive ageing. While scientific understanding of how metabolism alters with age has progressed, many aspects still need to be better understood. “Our goal was to broaden the existing knowledge base. Lipids, a crucial component of our diet and essential for cell function, form the cellular membranes that maintain the separation between the interior and exterior of cells,” explained Houtkooper.

To expand on this knowledge, the researchers examined how fat composition changes in various tissues of mice, such as muscles, kidneys, liver, and heart. They observed that in all these tissues from older mice, levels of a particular lipid known as bis(monoacylglycero)phosphates (BMPs) were increased, indicating that these lipids accumulate with age. The team then explored whether a similar pattern could be observed in humans. Although they could not sample as many tissue types, the accumulation of BMPs was also noticeable in muscle biopsies from older individuals. Further studies involving additional muscle biopsies from participants before and after engaging in daily hour-long exercise sessions showed decreased BMP levels among the active subjects.

“These findings mark a significant advancement in our understanding of aging,” Houtkooper remarked. “However, they do not represent the definitive answer. We are planning further studies to explore how BMPs contribute to the aging process, the effects of BMP accumulation, and whether factors other than exercise can also influence BMP levels.”

This research challenges the inevitability of ageing and opens the door to potential new strategies for extending health span and combating age-related diseases through molecular and lifestyle interventions.

More information: Georges E. Janssens et al, A conserved complex lipid signature marks human muscle aging and responds to short-term exercise, Nature Aging. DOI: 10.1038/s43587-024-00595-2

Journal information: Nature Aging Provided by Amsterdam University Medical Center