Monthly Archives: June 2024

Night-time Heat Heightens Stroke Risk

A recent investigation by researchers from Helmholtz Munich and Augsburg University Hospital has revealed a significant link between nocturnal heat and increased stroke risk. The study, which drew upon extensive data and was led by Dr Alexandra Schneider, underscores the pressing need for preventive measures as climate change leads to more frequent and intense hot nights.

The study, which spanned 15 years and included approximately 11,000 stroke cases treated at Augsburg University Hospital, revealed a notable seven per cent rise in stroke risk following periods of extreme nocturnal heat. Dr Cheng He, the study’s lead author, highlighted that elderly individuals and women face heightened susceptibility, with clinics predominantly diagnosing strokes with mild symptoms post hot nights.

Moreover, the research team noted a concerning trend: from 2013 to 2020, the risk of stroke associated with elevated nocturnal temperatures saw a marked increase compared to the preceding period (2006-2012). Prof. Michael Ertl, overseeing the Stroke Unit at Augsburg University Hospital, noted a rise from two additional annual stroke cases in the earlier period to 33 extra cases annually in recent years.

The implications extend beyond epidemiology, prompting recommendations for adaptive strategies in urban planning. The researchers advocate for mitigating urban heat islands and enhancing healthcare preparedness. These initiatives are crucial for safeguarding public health against escalating nocturnal heat impacts.

Furthermore, the study’s findings are pivotal for hospitals, enabling better anticipation and allocation of resources in response to weather forecasts predicting hot nights. Prof. Markus Naumann, Director of the Neurological University Hospital in Augsburg, stressed the importance of proactive staffing to manage potential influxes of stroke patients during such periods.

The term “tropical nights,” defined by the Hot Night Excess Index (HNE), quantifies nocturnal temperature anomalies. It measures deviations above a threshold (14.6 °C in this study), which signifies temperatures surpassed during only the warmest five per cent of nights within the study period. The HNE index provides a metric to gauge the intensity of nocturnal heatwaves, aiding in understanding their impact on health outcomes.

Looking ahead, the research aims to translate these findings into practical applications, informing public health strategies and urban policies aimed at mitigating the adverse effects of nocturnal heat. Dr. Schneider underscored the importance of early implementation of preventive measures, stressing their potential to mitigate future health risks associated with climate change-induced nocturnal temperature rises.

The study by Helmholtz Munich and Augsburg University Hospital not only illuminates a critical nexus between nocturnal heat and stroke risk but also underscores the need for proactive measures in urban planning and healthcare. These measures are crucial in countering the health impacts of climate change-driven temperature shifts.

More information: Cheng He et al, Nocturnal heat exposure and stroke risk, European Journal of Nutrition. DOI: 10.1093/eurheartj/ehae277

Journal information: European Journal of Nutrition Provided by Helmholtz Munich

Comprehending Cardiac Dysfunction: A Deeper Look into Heart Issues

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Recent research has unveiled a significant discovery in the field of heart health. It has been found that heart failure induces lasting physiological stress, potentially contributing to recurrent health issues. This is not just a temporary effect, but a ‘stress memory’ phenomenon that persists in hematopoietic stem cells, the cells responsible for blood and immune cell production, particularly macrophages crucial for heart health. During heart failure, the DNA modifications of these stem cells are altered, affecting the transformative growth factor beta (TGF-β) pathway. Suppressed TGF-β levels hinder macrophage production, exacerbating heart failure and associated complications. The implications of this ‘stress memory’ are profound, offering a promising strategy for mitigating recurrent heart failure, with potential applications in the early detection of stress accumulation.

Global efforts towards sustainable development goals, including improved health and well-being, yield positive outcomes, with life expectancy projected to rise by approximately 4.5 years by 2050. Public health initiatives have significantly reduced disease incidence and mortality rates, particularly for cardiovascular diseases. Despite these advances, heart disease remains the world’s leading cause of death, affecting an estimated 26 million people through conditions like heart failure.

Researchers in Japan have focused on understanding the mechanisms underlying heart failure recurrence and associated organ deterioration. Their investigations suggest that stress accumulated during heart failure, specifically in hematopoietic stem cells, may play a pivotal role. Project Professor Katsuhito Fujiu from the University of Tokyo’s Graduate School of Medicine highlights the role of these stem cells in the bone marrow and responsible for immune cell production. Studies in mice with heart failure reveal epigenetic changes in DNA, including suppression of the TGF-β pathway in hematopoietic stem cells, leading to dysfunctional immune cell production.

This stress-induced ‘memory’ persists over time, as demonstrated by experiments in which bone marrow transplanted from mice with heart failure perpetuated dysfunctional immune cell production and increased susceptibility to heart failure and organ damage in recipient mice. Fujiu describes this phenomenon as ‘stress memory’, wherein the effects of heart failure stress continue to influence the body long after the initial episode, potentially exacerbating future health challenges.

Excitingly, the identification of these epigenetic changes in the TGF-β pathway has opened new avenues for therapeutic interventions. Project Professor Katsuhito Fujiu from the University of Tokyo’s Graduate School of Medicine suggests innovative treatments that could potentially revolutionize the management of heart failure. These treatments aim to prevent stress memory accumulation during heart failure hospitalization, such as supplementing active TGF-β to restore normal signalling and correcting the epigenome of hematopoietic stem cells. These strategies hold the promise of not only preventing recurrent heart failure but also intercepting its development before significant symptoms arise, offering a beacon of hope for the future of heart health.

The research team aims to develop diagnostic tools capable of detecting and mitigating stress memory in human patients. Their ultimate goal is to enhance early intervention strategies, transforming the management of heart failure by addressing underlying physiological stressors before they manifest clinically.

More information: Yukiteru Nakayama et al, Heart failure promotes multimorbidity through innate immune memory, Science Immunology. DOI: 10.1126/sciimmunol.ade3814

Journal information: Science Immunology Provided by The University of Tokyo

UC Irvine Study Reveals Heat Waves’ Harmful Effects on Vital Organs

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Researchers from the University of California, Irvine, have uncovered the molecular origins of heat stress’s detrimental impact on the gut, liver, and brain in elderly individuals. These findings highlight the prospect of developing targeted prognostic and therapeutic strategies. The interconnectedness of these organs forms a complex communication network that spans from the gastrointestinal system to the nervous system. Understanding this gut-liver-brain axis is critical for safeguarding human health, as it influences various physiological processes such as appetite regulation and mental health.

Published in Scientific Reports, a Nature Portfolio journal, their study on mouse models represents a pioneering effort to elucidate the molecular mechanisms underlying heat stress’s effects on this vital biological dialogue. Saurabh Chatterjee, corresponding author and professor of environmental and occupational health at UC Irvine’s Program in Public Health, underscores the impact of inflammation on cognitive decline and age-related diseases. He explains, “Investigating how heat stress disrupts gut-liver-brain communication enables us to better protect our increasingly vulnerable aging population.”

Employing RNA analysis and bioinformatics, Chatterjee and his team identified heat stress-induced changes in gene expression in the brain and liver of elderly mice. Notably, they observed a significant increase in ORM2 production—a liver-derived protein—in heat-stressed mice compared to unstressed controls. This finding suggests organ dysfunction induced by heat stress. The researchers hypothesize that elevated ORM2 secretion may be a compensatory response linked to gut inflammation and dysfunction.

Moreover, the potential impact of ORM2 on brain function through a compromised blood-brain barrier underscores the intricate interplay between multiple organs. This finding not only deepens our understanding of the molecular mechanisms of heat-related health challenges but also opens up new avenues for future research and therapeutic developments. The study also highlights ORM2’s potential as a biomarker for targeted interventions, offering a glimmer of hope in mitigating liver disease exacerbated by heat exposure.

Chatterjee underscores the urgency of their findings, stating, “Our discoveries are not just academic, they have immediate practical implications. With climate change contributing to escalating temperatures and recurrent heat waves, our aging population faces increasing risks of acute and chronic heat stress, threatening their health. The time to act is now.” In conclusion, the UC Irvine study not only sheds light on the molecular underpinnings of heat stress’s impact on vital organs but also offers a foundation for innovative approaches to mitigate its adverse effects on health, particularly in older adults.

More information: Subhajit Roy et al, Periodic heat waves-induced neuronal etiology in the elderly is mediated by gut-liver-brain axis: a transcriptome profiling approach, Scientific Reports. DOI: 10.1038/s41598-024-60664-9

Journal information: Scientific Reports Provided by University of California, Irvine

Unlock the Secret to Better Kimchi with Ancient Techniques

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Fermented foods like kimchi have been integral to Korean cuisine for thousands of years. Since ancient times, Korean chefs have used onggi — traditional handmade clay jars — to ferment kimchi. Today, most kimchi is made through mass fermentation in glass, steel, or plastic containers, but it has long been claimed that the highest quality kimchi is fermented in onggi. Kimchi purists now have scientific validation, thanks to recent research from David Hu, professor in the George W. Woodruff School of Mechanical Engineering at Georgia Tech, and Soohwan Kim, a second-year PhD student in Hu’s lab.

In a combined experimental and theoretical study, Hu and Kim measured carbon dioxide levels in onggi during kimchi fermentation. They developed a mathematical model to show how the gas was generated and moved through the onggi’s porous walls. By bringing the study of fluid mechanics to bear on an ancient technology, their research highlights the work of artisans. It provides the missing link for how traditional earthenware allows for high-quality kimchi. Their study was published in the Journal of the Royal Society Interface. “We wanted to find the ‘secret sauce’ for how onggi makes kimchi taste so good,” Hu said. “So, we measured how the gases evolved while kimchi fermented inside the onggi — something no one had done before.”

The porous structure of these earthenware vessels mimics the loose soil where lactic acid bacteria — known for their healthy probiotic nature — are found. While previous studies have shown that kimchi fermented in onggi has more lactic acid bacteria, no one knows exactly how the phenomenon is connected to the unique material properties of the container. First, Kim obtained a traditional, handmade onggi jar from an artisan in his hometown of Jeju, South Korea, a region famous for onggi. Back at Georgia Tech, Hu and Kim first tested the permeability of the onggi by observing how water evaporated through the container over time.

Next, they installed carbon dioxide and pressure sensors into the onggi and a typical, hermetically sealed glass jar. They prepared their own salted cabbage and placed it in both containers. They then used the sensors to measure and compare the change in carbon dioxide — a signature of fermentation. Hu and Kim also developed a mathematical model based on the porosity of the onggi. The model allowed them to infer the generation rate of carbon dioxide since the onggi lets carbon dioxide out gradually. They concluded that the onggi’s porous walls permitted the carbon dioxide to escape the container, accelerating the fermentation speed.

The onggi’s porosity also functioned as a “safety valve,” resulting in a slower increase in carbon dioxide levels than the glass jar while blocking the entry of external particles. Their data revealed that the carbon dioxide level in onggi was less than half of that in glass containers. They also found that the beneficial bacteria in the onggi-made kimchi increased 26% more than in the glass counterpart. In the glass jar, the lactic acid bacteria became suffocated by their carbon dioxide in the closed glass container. It turns out that because the onggi releases carbon dioxide at a small rate, the lactic acid bacteria are happier and reproduce more.

“Onggi were designed without modern knowledge of chemistry, microbiology, or fluid mechanics, but they work remarkably well,” Kim said. “It’s very interesting to get these new insights into ancient technology through the lens of fluid dynamics.” Onggi’s semi-porous nature is unique compared to other forms of earthenware. A clay container that leaks, but only slightly, is not easy to make. Terra cotta containers, for example, quickly leak water. “It’s amazing that, for thousands of years, people have been building these special containers out of dirt, but in many ways, they are very high-tech,” Hu said. “We discovered that the right amount of porosity enables kimchi to ferment faster, and these onggi provide that.”

While the use of onggi by artisans is dwindling, the research by Hu and Kim serves as a reminder of the value of these traditional methods. The study’s findings not only validate the artisan work but also inspire the development of energy-efficient methods for fermenting and storing foods. Moreover, the aesthetic appeal of onggi adds to their allure, making them a unique and beautiful addition to any kitchen.

More information: Soohwan Kim et al, Onggi’s permeability to carbon dioxide accelerates kimchi fermentation, Journal of The Royal Society Interface. DOI: 10.1098/rsif.2023.0034

Journal information: Journal of The Royal Society Interface Provided by Georgia Institute of Technology

Impact of Extreme Temperatures on Stroke Mortality in Low-Income Countries

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A study led by Harvard T.H. Chan School of Public Health has identified a significant association between extreme temperatures and increased risks of death from both ischemic and hemorrhagic stroke. Scheduled for publication on May 22, 2024, in Stroke, the research underscores that this relationship is particularly pronounced in low-income countries compared to their high-income counterparts.

Lead author Barrak Alahmad, a research fellow in the Department of Environmental Health, highlighted the study’s implications for understanding climate change’s impact on stroke mortality. He emphasised that as temperatures become more extreme, fatal strokes are anticipated to rise, potentially exacerbating the disparity in stroke mortality between high- and low-income countries, with the latter likely bearing a disproportionate burden of climate-related health impacts.

Prior investigations into the correlation between extreme temperatures and stroke mortality have yielded inconsistent findings. Many studies have been confined to single cities or countries, predominantly in high-income regions, and few have differentiated between ischemic and hemorrhagic stroke subtypes. To address these gaps, the researchers leveraged the Multi-Country Multi-City Network, a global consortium in environmental health, to compile a comprehensive database spanning 522 cities across 25 countries. This dataset encompassed over 3.4 million ischemic stroke deaths and 2.4 million hemorrhagic stroke deaths reported between 1979 and 2019.

The study reveals that extreme cold and hot days contributed significantly to stroke mortality. Specifically, for every 1,000 deaths from ischemic or hemorrhagic stroke, approximately 11 were attributable to extreme temperatures. The coldest and hottest 2.5% of days were associated with 9.1 and 2.2 excess deaths from ischemic stroke, respectively, and 11.2 and 0.7 excess deaths from hemorrhagic stroke, respectively. Notably, low-income countries experienced a higher burden of heat-related hemorrhagic stroke mortality compared to high-income countries. However, evidence linking cold temperatures to hemorrhagic stroke mortality in low-income countries was suggestive rather than conclusive. Interestingly, the study did not find a clear relationship between a country’s GDP and the risk of temperature-related ischemic stroke mortality.

The researchers hypothesised that factors such as better indoor temperature regulation and lower rates of outdoor work in high-income countries, coupled with poorer-quality healthcare infrastructure in low-income countries, may contribute to these disparities. They stressed the need for further investigation to elucidate the underlying drivers behind the heightened vulnerability of low-income countries to temperature-related hemorrhagic stroke mortality and to identify effective interventions.

The study’s limitations include its geographical focus, with rural areas and regions in South Asia, Africa, and the Middle East being underrepresented. Additionally, the study did not collect or analyse individual-level demographic data. Furthermore, the focus solely on stroke deaths underscores the necessity for additional research into the incidence of non-fatal strokes to comprehensively assess the overall burden of temperature-related stroke impacts.

Alahmad urged professional stroke societies to invest more in such research, particularly as climate change escalates, and to spotlight emerging environmental risk factors that could exacerbate strokes, already a significant contributor to global mortality rates. He emphasised the importance of expanding this research to inform better public health policies to mitigate the adverse health effects of climate change.

This study by Harvard T.H. Chan School of Public Health underscores the critical link between extreme temperatures and stroke mortality, highlighting the urgent need for targeted interventions, especially in low-income countries most vulnerable to climate change’s health impacts. As global temperatures continue to rise, understanding and addressing these risks will be essential in mitigating the future burden of stroke morbidity and mortality worldwide.

More information: Barrak Alahmad et al, Extreme Temperatures and Stroke Mortality: Evidence From a Multi-Country Analysis, Stroke. DOI: 10.1161/STROKEAHA.123.045751

Journal information: Stroke Provided by Harvard T.H. Chan School of Public Health

Higher Costs of Nature’s Decline Revealed

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Researchers advocate for governments to adopt a novel approach to calculating the benefits of conserving biodiversity and nature for future generations. This method, proposed in the journal Science, aims to integrate the monetary value of ecosystem services, such as air and water filtration, crop pollination, and recreational value, into cost-benefit analyses for public infrastructure projects. The objective is to enhance the visibility of biodiversity loss and the benefits of nature conservation in political decision-making processes.

Current methodologies for valuing ecosystem services are criticised for their limitations in capturing how these values evolve. In contrast, the new approach considers the projected increase in monetary value as human incomes rise and the expected decline in biodiversity, treating nature as a progressively scarce resource. This economic principle acknowledges that people are willing to invest more in conserving nature as incomes grow. Additionally, it recognises that as ecosystem services become scarcer, their monetary value increases, a phenomenon fundamental to economics.

Professor Moritz Drupp, leading the study on sustainability economics at the University of Hamburg, emphasises that their formula provides governments with a tool to estimate future values of essential ecosystem services crucial for decision-making. The research underscores two critical factors influencing these adjustments: the annual rise in global income adjusted for inflation and the diminishing availability of biodiversity resources. These considerations argue for setting significantly higher present values of ecosystem services in contemporary cost-benefit analyses, potentially exceeding 130 per cent when accounting solely for income growth and over 180 per cent when also factoring in the impact on endangered species listed in the Red List Index.

The research team includes notable UK-based academics like Professor Mark Freeman from the University of York, Dr Frank Venmans from the LSE, and Professor Ben Groom from the University of Exeter. They highlight that current environmental valuation methods often undervalue nature over time compared to other goods and services. Their proposed uplift in ecosystem values aims to rectify this oversight and suggests its incorporation into future Treasury analyses supporting budgetary decisions.

Dr Venmans provides a specific example with coral reefs, predicting their decline due to climate change and emphasising the increased value of remaining reefs amidst rising household incomes. This scenario underscores the urgency for governments to reassess the long-term benefits of preserving ecosystems with enduring impacts. Professor Freeman underscores the urgency for governments to align the appraisal of ecosystem protection with other significant public investments, ensuring consistency across projects like HS2 and broader infrastructure spending.

The researchers stress that political decisions can mitigate biodiversity loss, underscoring the necessity for governments to comprehensively evaluate the ramifications of their policies today and in the future. Their work seeks to equip policymakers with robust tools to integrate the economic value of ecosystem services into decision-making frameworks, fostering sustainable development practices that safeguard natural resources for future generations. This comprehensive evaluation is crucial for making informed and responsible decisions.

More information: Moritz Drupp et al, Accounting for the increasing benefits from scarce ecosystems, Science. DOI: 10.1126/science.adk2086

Journal information: Science Provided by University of Exeter

Impact of the COVID-19 Pandemic on Declining Breast Cancer Screenings Among Older and Racial Minority Women

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Breast cancer stands as the second most common cancer among women in the United States, highlighting the critical importance of early detection through regular screening. However, the onset of the COVID-19 pandemic severely disrupted these efforts, leading to temporary suspensions of many screening programmes due to concerns over viral exposure and strain on healthcare systems. This study aimed to evaluate the pandemic’s impact on breast cancer screening utilisation across the U.S. using real-world electronic health records (EHR), focusing on changes in screening rates and follow-up behaviours.

Using the TriNetX Research Network, the study analysed data from 1,186,669 women eligible for breast cancer screening between January 2017 and February 2022. Researchers examined monthly screening frequencies, noting significant drops during the early pandemic months from February to April 2020, where volumes plummeted by 80.57%. Despite a gradual recovery towards pre-pandemic levels after June 2020, follow-up screening rates continued to decline. On average, the COVID-19 period saw a 2.47% reduction in follow-up screenings, indicating substantial missed opportunities for early detection.

The study also uncovered disparities in screening adherence, with older women over 65 and racial minority groups (excluding Hispanics) showing lower rates of returning for follow-up screenings during the pandemic. These findings suggest a heightened risk of late-stage diagnoses and poorer health outcomes among these demographics. The implications are profound, highlighting the need for targeted interventions to ensure equitable access to screening services and mitigate health disparities exacerbated by the pandemic.

The decrease in follow-up screening rates underscores missed opportunities for timely diagnosis and treatment of breast cancer, potentially leading to more advanced stages at diagnosis and poorer prognoses. Addressing these challenges requires innovative approaches such as telehealth for consultations and reminders, which could help bridge gaps in access to healthcare services, especially for vulnerable populations. Community-based interventions and culturally tailored outreach programmes ensure that all women receive the necessary support and information to adhere to screening guidelines.

Understanding the impact of medical comorbidities and social determinants on screening adherence during crises like COVID-19 is crucial for healthcare providers and systems. This knowledge enables them to tailor strategies effectively and deliver optimal care to diverse patient populations. By addressing disparities in screening participation and enhancing access to preventive services, healthcare providers can mitigate the long-term effects of disrupted healthcare delivery and improve public health resilience.

While the COVID-19 pandemic significantly disrupted breast cancer screening efforts in the U.S., it also underscores the need for resilient healthcare systems and targeted interventions to mitigate disparities and ensure continuous access to critical preventive services. By learning from these challenges, healthcare providers can enhance early detection, improve treatment outcomes, and bolster public health preparedness for future health crises.

More information: Andrew Chung et al, Breast Cancer Screening During the COVID-19 Pandemic in the United States: Results From Real-World Health Records Data, The Annals of Family Medicine. DOI: 10.1370/afm.3098

Journal information: The Annals of Family Medicine Provided by American Academy of Family Physicians

Exploring Early Career Work Patterns and Their Long-Term Health Impacts: Beyond the Traditional 9-5

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Research led by Wen-Jui Han from New York University, USA, published on April 3, 2024, in the open-access journal PLOS ONE, explores the enduring health impacts of early career work patterns. The study investigates how the hours worked during young adulthood can shape health outcomes decades later. It adopts a life-course perspective to examine the link between employment patterns and health in middle age. It uses data from The National Longitudinal Survey of Youth-1979 (NLSY79), which covers over 30 years and includes more than 7,000 individuals in the US.

The study reveals that a significant proportion of participants (26%) consistently adhered to stable standard work hours throughout their careers, while another third (35%) predominantly maintained traditional daytime schedules. In contrast, 17% started with standard hours in their 20s but later shifted to volatile work patterns involving evening, night, and variable hours. Additionally, 12% began with standard hours but transitioned to variable schedules later, and a final 10% experienced primary unemployment during this period.

Compared to those who predominantly worked traditional daytime hours throughout their careers, individuals with more volatile work schedules reported poorer sleep quality, shorter sleep duration, and a higher incidence of depressive symptoms by age 50. Particularly notable were the findings concerning individuals who maintained stable work hours in their 20s but transitioned to volatile schedules in their 30s, significantly impacting health outcomes similar to those observed in individuals with lower educational attainment.

Han’s research also highlights significant racial and gender disparities in work schedules and subsequent health outcomes. For instance, Black Americans were more likely to have volatile work schedules associated with poorer health outcomes, underscoring how certain demographic groups may disproportionately bear the negative consequences of such employment patterns.

The study suggests that volatile work schedules contribute to poor sleep quality, physical fatigue, and emotional exhaustion, rendering individuals more susceptible to an unhealthy lifestyle. Moreover, it indicates that the health effects of work schedules can accumulate over a lifetime, exacerbating societal health inequities.

Han emphasises that work, traditionally viewed as a means to secure resources for a decent life, has now become a health vulnerability due to increasing precariousness in work arrangements in an increasingly unequal society. Vulnerable social groups, such as women, Black individuals, and those with lower educational attainment, disproportionately experience the adverse health consequences associated with volatile work schedules.

More information: Wen-Jui Han et al, How our longitudinal employment patterns might shape our health as we approach middle adulthood—US NLSY79 cohort, PLoS ONE. DOI: 10.1371/journal.pone.0300245

Journal information: PLoS ONE Provided by PLOS

Understanding Alzheimer’s Disease: Exploring the Possibility of Symptomless Progression and Its Implications

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Everyone undergoes the ageing process uniquely, influenced by genetics, lifestyle, and environment. Some individuals achieve exceptional longevity, reaching their 90s or even 100s in robust health without needing medications or suffering from brain diseases. But what mechanisms enable these individuals to maintain their health as they age?

Luuk de Vries, along with colleagues Dick Swaab and Inge Huitinga from Joost Verhaagen’s group, delved into brains donated to the Netherlands Brain Bank for insights. This institution houses brain tissue from over 5,000 deceased donors with a diverse array of brain diseases, making it uniquely valuable due to its comprehensive medical histories and detailed disease courses documented alongside precise neuropathological diagnoses.

Within this repository, the researchers identified a remarkable subgroup: individuals who harboured Alzheimer’s disease pathology in their brains but exhibited no clinical symptoms during their lifetime—a cohort dubbed the ‘resilient’ group. The existence of such individuals raises profound questions about the underlying mechanisms that shield them from cognitive decline when others succumb.

Luuk de Vries explains, “The molecular and cellular processes at play in these resilient individuals remain unclear. We specifically sought donors with brain abnormalities indicative of Alzheimer’s yet who did not manifest cognitive decline. We identified 12 such donors, underscoring the rarity of this phenomenon. While we suspect genetics and lifestyle play pivotal roles in resilience, the precise mechanisms elude us.”

The findings suggest that maintaining an active lifestyle, engaging in cognitive challenges, and fostering robust social connections may help delay Alzheimer’s onset. Recent research also indicates that individuals involved in cognitively demanding tasks, such as complex jobs, may accumulate more Alzheimer’s pathology before symptoms emerge. Unravelling the molecular basis of resilience could unlock new avenues for developing medications that activate processes associated with resilience in Alzheimer’s patients.

Comparing the Alzheimer’s patients with the resilient group, the researchers observed distinct gene expression patterns. Notably, astrocytes—crucial brain cells with roles akin to garbage collectors and protective shields—appeared to produce higher levels of the antioxidant metallothionein in resilient individuals. Additionally, a microglia pathway commonly implicated in Alzheimer’s pathology seemed less active in the resilient group, potentially mitigating inflammation. Furthermore, the ‘unfolded protein response’, vital for clearing toxic misfolded proteins in brain cells, showed abnormalities in Alzheimer’s patients but remained relatively normal in resilient individuals. Moreover, there were indications of increased mitochondrial density in brain cells of resilient individuals, suggesting enhanced energy production capabilities.

However, the significance of these observed differences in cellular processes remains unclear—whether they represent causes or effects of resilience against Alzheimer’s disease. As Luuk de Vries notes, “Determining which processes initiate the disease progression is challenging with human data alone. Experimental manipulations in cellular or animal models are necessary to establish causality.” This critical step is now at the forefront of their research agenda.

Understanding why some individuals evade Alzheimer’s symptoms despite possessing brain pathology holds profound implications for future therapeutic strategies. By deciphering the mechanisms underpinning resilience, researchers aim to pave the way for novel treatments that could potentially activate resilience-promoting processes in Alzheimer’s patients, offering hope for mitigating the devastating effects of this neurodegenerative disease.

More information: Luuk E. de Vries et al, Gene-expression profiling of individuals resilient to Alzheimer’s disease reveals higher expression of genes related to metallothionein and mitochondrial processes and no changes in the unfolded protein response, Acta Neuropathologica Communications. DOI: 10.1186/s40478-024-01760-9

Journal information: Acta Neuropathologica Communications Provided by Netherlands Institute for Neuroscience

Decline in Medicare Outpatient Procedures Reported by Family Physicians Amidst Aging Population Trends

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Family physicians, operating primarily in their offices, are responsible for a wide range of procedures, from simple surgeries to joint injections. However, the training they receive can vary significantly. To address this, the Council of Academic Family Medicine (CAFM) issued crucial recommendations on the essential procedures that family physicians should be proficient in upon completing their residency training. This study, therefore, holds significant weight as it assesses how often family physicians perform these CAFM-recommended procedures under Medicare Part B, which covers outpatient services. By examining these clinical activities, the researchers sought to gain profound insights into the role of family physicians in U.S. primary care.

Researchers analysed a publicly available dataset containing information on Medicare activities, including usage, payments, and charges. They matched Medicare patient encounter codes with CAFM-recommended procedures to determine the frequency with which family physicians reported performing these procedures in outpatient settings from 2014 to 2021. The methods were categorised according to the organ systems they targeted.

In 2021, a total of 9,410 family physicians submitted 904,278 claims for CAFM-recommended procedures, which covered 444,309 patients. However, the data reveals a concerning trend. Nearly all (99.92%) of these procedures fell into five main clusters: skin procedures accounted for 51%, musculoskeletal procedures for 36%, eyes, ears, nose, and throat (EENT) procedures for 9%, pulmonary procedures for 2%, and anesthesia procedures for 2%. Despite a slight increase (from 2% to 6%) in skin, musculoskeletal, and anesthesia procedures between 2018 and 2019, there was an overall 33% decrease in outpatient procedure claims and a 36% decrease in the number of family physicians filing these claims between 2014 and 2021. Only 12% of family physicians reported CAFM outpatient procedure claims in 2021, which represented less than 1% of all patient encounter codes submitted that year.

The findings highlight a concerning trend where fewer family physicians are billing for CAFM-recommended procedures over time despite an ageing U.S. population that typically requires more healthcare services. While procedures may increasingly be handled by physician assistants, nurse practitioners, or specialists following referrals, this decline among family physicians could reduce patient access to care and convenience while increasing healthcare costs. This trend underscores the importance of ensuring that primary care providers remain equipped and incentivised to perform essential procedures, thereby maintaining comprehensive patient care across different healthcare settings.

More information: Robert McKenna et al, Family Physicians as Proceduralists for Medicare Recipients, The Annals of Family Medicine. DOI: 10.1370/afm.3096

Journal information: The Annals of Family Medicine Provided by American Academy of Family Physicians

Study Finds Climbing the Social Ladder Slows Progression of Dementia in Japan

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A newly published study led by researchers from Osaka University and featured in JAMA Network Open reveals compelling evidence that upward social mobility correlates with a reduced risk of dementia. Dementia, a group of conditions characterised by memory loss and cognitive decline, poses significant challenges to healthcare systems and profoundly affects the quality of life for patients and their families. Previous research has established links between socioeconomic status (SES) — encompassing factors like parental assets, education level, income, and occupational status — and susceptibility to dementia. However, the impact of SES changes over a person’s lifetime, known as social mobility, on dementia risk has been less clear.

Drawing from a robust dataset from the Japan Gerontological Evaluation Study, which tracked 9,186 participants aged 65 and older from 2010 to 2016, the study employed sophisticated clustering analysis to examine participants’ SES trajectories. Researchers identified six distinct patterns of SES transitions and analysed their association with dementia incidence using national long-term care service registries.

The findings underscore a significant relationship between upward social mobility and a decreased risk of dementia. Specifically, individuals experiencing upward SES transitions throughout their lives were associated with extended periods of dementia-free ageing compared to those with stable high SES since childhood. In contrast, downward transitions in SES were linked with heightened dementia risk, indicating the critical influence of socioeconomic conditions on cognitive health across the lifespan.

Lead author Ryoto Sakaniwa underscores the profound implications of the study’s findings for dementia prevention: “Our findings not only underscore the importance of socioeconomic mobility in promoting healthy longevity by reducing dementia risk, but they also provide a clear path for future research and intervention strategies. Improving socioeconomic conditions could potentially serve as a pivotal strategy in dementia prevention efforts, a fact that should not be overlooked.”

The study also explored potential mediators of this relationship, including lifestyle behaviours, comorbidities, and social factors. It found that lifestyle choices and physical health characteristics significantly mitigate dementia risk among individuals experiencing upward social mobility. Conversely, social factors appeared to exacerbate dementia risk in cases of downward mobility, underscoring the complex interplay between socioeconomic status and cognitive health.

Senior author Hiroyasu Iso highlights the potential for future research to build on the study’s findings, suggesting that targeted interventions addressing socioeconomic disparities could hold promise in mitigating cognitive decline and promoting healthier ageing. This potential for future research should inspire us to continue our efforts in understanding and preventing dementia.

The study’s findings provide compelling evidence that climbing the social ladder may contribute to prolonged cognitive health and reduced dementia risk. These findings not only underscore the importance of socioeconomic factors in shaping health outcomes across the lifespan, but they also highlight the urgency of addressing these issues. This should prompt further investigation into strategies for enhancing socioeconomic conditions as a means of preventing dementia and promoting overall well-being.

More information: Ryoto Sakaniwa et al, Socioeconomic Status Transition Throughout Life and Risk of Dementia, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.12303

Journal information: JAMA Network Open Provided by Osaka University

Research Uncovers Potential Heart Health Impacts of ‘Forever Chemicals’ on Older Women

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New research conducted at the University of Illinois Urbana-Champaign has unveiled significant connections between various types of per- and polyfluoroalkyl substances (PFAS), commonly known as “forever chemicals,” and an increased risk of cardiovascular diseases in postmenopausal women. The study, led by Alicia Arredondo Eve, a postdoctoral researcher in the Department of Food Science and Human Nutrition, delves into how PFAS chemicals interact with pro-inflammatory pathways in older women, shedding light on potential mechanisms underlying this heightened risk.

Previous studies had hinted at a possible link between PFAS exposure and cardiovascular disease during menopause, but the biological mechanisms remained poorly understood. Arredondo Eve explains that their focus was on specific PFAS chemicals and their impact on the cardiovascular health of older women, a demographic particularly vulnerable to such diseases.

PFAS, ubiquitous in daily life due to their use in products like nonstick pans, waterproof clothing, food packaging, and even in water supplies, pose a persistent health challenge. These chemicals accumulate in human tissues over time, with some variants capable of remaining in the environment for centuries. Premenopausal women generally have lower PFAS burdens due to mechanisms such as childbirth and breastfeeding, which help expel these chemicals. However, after menopause, PFAS levels tend to rise as these natural elimination pathways diminish.

The study analysed data and samples from 70 postmenopausal women in Turkey, a third of whom had been diagnosed with coronary artery disease, another third with coronary microvascular disease, and the remainder without any signs of heart disease. The researchers specifically examined two long-chain legacy PFAS, PFOS and PFOA, along with a newer short-chain variant, PFBS, using advanced machine-learning techniques to explore their relationships with blood metabolites and proteins.

Their findings highlighted distinct associations between PFOS and PFOA and different cardiovascular conditions: PFOS correlated closely with coronary artery disease, whereas PFOA was more predictive of coronary microvascular disease. Notably, both chemicals were found to interact with inflammatory pathways, known risk factors for these diseases, albeit somewhat unexpectedly. For instance, PFOA showed links to higher levels of specific amino acids and pro-inflammatory cytokines. In comparison, PFOS exhibited associations with lower levels of specific amino acids and different pro-inflammatory proteins.

Arredondo Eve and co-author Zeynep Madak-Erdogan underscored the complexity of PFAS’s effects, noting that despite similar chemical structures, different variants can impact the body uniquely. This underscores the need for nuanced approaches in research and regulatory efforts concerning PFAS exposure.

Despite the study’s significant findings, it underscores the challenge of eliminating PFAS once they enter the body, with limited options for removal. Instead, the researchers advocate for preventive measures, urging women to choose PFAS-free products like clothing and cookware to reduce exposure. They also stress the importance of broader public education and regulatory actions to mitigate environmental PFAS contamination.

Looking ahead, the research team plans to expand their investigations into PFAS’s broader impacts on women’s health, aiming to unravel more of the complex biological mechanisms underlying these associations. Their work adds to the growing body of evidence linking PFAS exposure to cardiovascular risks in postmenopausal women. It underscores the urgent need for informed policies and practices to protect public health from these persistent environmental pollutants.

More information: Alicia Arredondo Eve et al, PFAS and their association with the increased risk of cardiovascular disease in postmenopausal women, Toxicological Sciences. DOI: 10.1093/toxsci/kfae065

Journal information: Toxicological Sciences Provided by University of Illinois College of Agricultural, Consumer & Environmental Sciences