Daily Archives: 15 August 2024

Differences Observed in Survival Advantages for Individuals Receiving Bystander CPR During Cardiac Arrest

A study supported by the National Institutes of Health (NIH) has revealed significant race- and gender-based disparities in survival rates from out-of-hospital cardiac arrests among individuals who received bystander cardiopulmonary resuscitation (CPR). The research, published in Circulation, indicates that white adults are three times more likely to benefit from such interventions compared to Black adults, and men are twice as likely compared to women. These findings highlight substantial inequalities in survival outcomes, necessitating targeted efforts to ensure equitable CPR delivery across demographic groups. Paula Einhorn, M.D., a program officer at NIH’s National Heart, Lung, and Blood Institute (NHLBI), emphasized that CPR saves lives. Still, the disparities uncovered require a more profound understanding to achieve uniform survival chances for all CPR-needed patients.

The analysis covered 623,342 cardiac arrest cases in the United States from 2013 to 2022, revealing that nearly one in ten victims survived. About 40% of these patients received CPR from a bystander, which could include a family member, friend, or passerby. Those who received bystander CPR had, on average, a 28% greater chance of surviving compared to those who did not, with fewer instances of severe brain injuries among survivors. Yet, the benefits varied significantly when data were dissected by race, ethnicity, and biological sex. Native American and white adults experienced the highest increases in survival odds, while Black adults and women, especially Black women, consistently showed the most minor benefit.

Researchers conducted subgroup analyses based on neighbourhood diversity and average income to understand potential factors influencing the quality of administered CPR. The results consistently showed that Black adults and women were less likely to benefit from bystander CPR compared to white adults and men, regardless of the cardiac arrest victim’s income levels or residential areas. This prompts a concern about the equality of CPR applications across different communities.

Paul Chan, M.D., the study’s lead author and a cardiologist at Saint Luke’s Mid America Heart Institute, highlighted the need for a nuanced approach to improving survival rates. He pointed out the importance of examining whether CPR delivered by bystanders provides similar survival benefits to all patients, regardless of their demographic background. This includes questioning whether bystander CPR was performed well and equally for everyone so that irrespective of race, ethnicity, or sex, all patients can derive the same level of benefit from CPR.

Previously, studies had indicated that bystander CPR was less frequently performed on Black and Hispanic individuals and women in public spaces. CPR training and awareness programs have expanded nationally, including online courses and developing mannequins designed to resemble women’s bodies. Researchers suggest evaluating the accessibility and effectiveness of various CPR training methods could identify differences in survival outcomes and inform solutions to address these disparities.

Future investigations might focus on the type of training bystanders receive, the presence of multiple bystanders, which could indicate additional support, and the role of underlying health conditions in survival outcomes, considering similar emergency response times across groups. These findings challenge the healthcare community to consider not only the presence of bystander CPR but also its quality and inclusivity, ensuring that every individual, irrespective of race, ethnicity, or gender, has an equal chance of surviving a cardiac arrest.

More information: Paul S. Chan et al, Race and Sex Differences in the Association of Bystander CPR for Cardiac Arrest, Circulation. DOI: 10.1161/CIRCULATIONAHA.124.068732

Journal information: Circulation Provided by NIH / National Heart, Lung, and Blood Institute

Engaging in Dungeons and Dragons Enhances Mental Well-being

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Researchers at University College Cork (UCC) have recently conducted a study highlighting the mental health benefits of playing Dungeons and Dragons, suggesting the role-playing game could be a valuable therapeutic tool. Known for its rich fantasy setting and complex character development, Dungeons and Dragons (D&D) has become a global phenomenon, particularly noted for its collaborative and creative nature. This game demands long-term commitment and frequent interactions, fostering a supportive social environment among players.

The interest in the game surged notably during the COVID-19 pandemic, prompting this research to evaluate its effects on regular players’ mental health. The study identified numerous benefits associated with the game, such as escapism, self-exploration, creative expression, social support, and routine establishment—all contributing to improved mental well-being. These findings were published in the International Journal of Role-Playing, marking a significant advancement in understanding how recreational activities can influence psychological health.

Orla Walsh, the lead researcher and a PhD candidate at the UCC School of Applied Psychology, emphasized the unique aspects of D&D that support mental health. Players reported a profound sense of control and escapism within the game, which was particularly valuable during times of uncertainty in their external lives. Unlike other hobbies, D&D allows players to create and live within the worlds they build, offering a distinctive form of creative expression and escapism.

The study also underscored the game’s capacity to foster strong social connections and provide emotional support. The shared narrative and collaborative storytelling inherent in D&D gameplay create a deep sense of camaraderie and understanding among players, making it more than just a game but a potent social tool. This environment allows players to express themselves freely and explore personal and collective challenges in a supportive setting, fostering a sense of connection and understanding.

Dr. Conor Linehan, another researcher from the UCC School of Applied Psychology, pointed out that while some clinicians and community groups in the United States have already been using role-playing games like D&D therapeutically, the study advocates for a broader application. Such therapeutic use could promote skill development, emotional exploration, and problem-solving, enhancing personal growth and social connections. The findings suggest that incorporating D&D could significantly benefit therapeutic settings, providing a structured yet flexible emotional and psychological development framework.

This research paves the way for future studies and clinical applications, potentially transforming the use of role-playing games in therapy. By demonstrating the multiple benefits of D&D, from enhancing mental health to fostering community and creativity, the study provides a foundation for expanding the use of such games in psychological interventions globally. This could lead to a broader recognition of the therapeutic potential of role-playing games, making them a valuable tool in mental health strategies and offering hope for the future of mental health interventions.

More information: Orla Walsh et al, Roll for Insight: Understanding How the Experience of Playing Dungeons & Dragons Impacts the Mental Health of an Average Player, International Journal of Role-Playing. DOI: 10.33063/ijrp.vi15.321

Journal information: International Journal of Role-Playing Provided by University College Cork

Successful Hepatitis C Treatment Leaves Lasting Marks on Immune Cells

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Led by Director SHIN Eui-Cheol, the team at the Institute for Basic Science (IBS) Korea Virus Research Institute’s (KVRI) Center for Viral Immunology has brought to light significant insights regarding the persistent effects of chronic Hepatitis C virus (HCV) infection on the immune system, which endure even after successful treatment. The research revealed that “epigenetic scars” linger in the regulatory T cells, which show inflammatory traits long after the virus is eliminated. This occurs despite the use of highly effective direct-acting antivirals (DAAs), which have markedly increased cure rates for this disease.

The focus of the study was on patients who achieved a sustained virologic response (SVR) from DAA treatment. SVR, determined when no HCV is detectable in the blood 12 weeks post-treatment, strongly indicates the virus’s eradication. However, the study observed that the frequency of activated regulatory T cells (TREG) remained elevated during and after treatment, suggesting that the immune system does not fully recover even without the virus.

In-depth analyses, including RNA sequencing and ATAC-seq, showed that the transcriptomic and epigenetic landscapes of TREG cells from HCV patients remained altered long after the virus was eradicated. These cells exhibited prolonged inflammatory responses, such as increased TNF signalling, indicating long-term changes induced by the chronic infection. These activated TREG cells from HCV patients continued to produce inflammatory cytokines like TNF, IFN-γ, and IL-17A even after the virus was cleared.

The persistence of these inflammatory features in TREG cells has significant implications for the long-term management of patients treated for chronic HCV infection. Despite successful viral clearance, the continued immune system dysregulation suggests a potential for ongoing chronic inflammation and related health issues. Director SHIN Eui Cheol emphasized the importance of monitoring even after eradicating the virus to understand and fully manage these persistent immune changes.

The research team is now focusing on further investigating the mechanisms behind the sustained inflammatory state of TREG cells. By exploring potential therapeutic interventions that could reverse these epigenetic and transcriptomic changes, they aim to develop more effective strategies to ensure complete recovery and improve the quality of life for HCV patients.

Additionally, Director Shin highlighted an interest in whether other chronic viral infections might cause long-lasting epigenetic changes in the immune system. Identifying the clinical implications of these persistent immune alterations remains one of the team’s primary goals, potentially leading to broader applications in managing chronic viral infections beyond HCV.

More information: So-Young Kim et al, Epigenetic scars in regulatory T cells are retained after successful treatment of chronic hepatitis C with direct-acting antivirals, Journal of Hepatology. DOI: 10.1016/j.jhep.2024.06.011

Journal information: Journal of Hepatology Provided by Institute for Basic Science

Compulsive Eating Disorder More Persistent Than Once Believed

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Binge-eating disorder is estimated to affect between 1 per cent and 3 per cent of adults in the U.S. and is marked by periods when individuals experience uncontrollable eating. The disorder typically begins at around 25 years of age.

Historically, retrospective studies relying on potentially unreliable memories have suggested that the duration of binge-eating disorder spans seven to sixteen years. However, more recent prospective studies that follow individuals over time indicate that many may enter remission within a significantly shorter period, ranging from one to two years.

Researchers have observed that most prior prospective studies have notable limitations, such as small participant groups (fewer than 50 people) and a lack of representativeness, focusing predominantly on adolescent or young adult females with Body Mass Indexes (BMIs) under 30. This is particularly restrictive as approximately two-thirds of individuals with binge-eating disorder have BMIs exceeding 30.

To gain a deeper understanding of the progression of binge-eating disorder, a team of researchers conducted a five-year study with 137 adults from the community diagnosed with the disorder. These participants, aged 19 to 74 with an average BMI of 36, were evaluated at the outset and reassessed after 2.5 and 5 years.

Results after five years indicated that while many participants showed signs of improvement, a significant number continued to experience binge-eating episodes. Specifically, at the 2.5-year checkpoint, 61 per cent still met the full criteria for binge-eating disorder, with an additional 23 per cent displaying significant symptoms. Still, more was needed to meet the full diagnostic criteria. By the end of the study, these figures changed to 46 per cent meeting the full criteria and 33 per cent showing significant but sub-threshold symptoms. Notably, 35 per cent of those who were in remission at the 2.5-year mark had relapsed by the five-year follow-up. With changes in the diagnostic criteria for binge-eating disorder since the study’s inception, even more participants would likely meet the updated criteria at each follow-up.

Javaras pointed out that the sample consisted of community members who might not be undergoing treatment, making the study findings more reflective of the natural progression of binge-eating disorder. Comparisons with treatment-based studies suggest that intervention could expedite remission, highlighting the benefits of treatment for those with the disorder. Despite this, Javaras noted significant disparities in access to treatment for eating disorders.

The researchers found no clinical solid or demographic indicators that could predict the duration or likelihood of remission, suggesting that recovery chances are broadly similar across different groups.

Since completing the study, the research team has continued to explore and develop treatment options for binge-eating disorder. They are investigating the disorder’s neurobiological underpinnings using neuroimaging techniques, which could lead to improved or new treatments. Additionally, efforts are being made to enhance early detection of the disorder, as many affected individuals remain unaware of their condition, underscoring the urgent need for increased awareness and early screening to facilitate timely interventions.

More information: Kristin N. Javaras et al, The natural course of binge-eating disorder: findings from a prospective, community-based study of adults, Psychological Medicine. DOI: 10.1017/S0033291724000977

Journal information: Psychological Medicine Provided by McLean Hospital