Monthly Archives: August 2024

Pioneering Excellence in Nursing Home Care

Marilyn Rantz, a researcher at the University of Missouri, has spearheaded a groundbreaking program that enhances the quality of care in nursing homes and significantly reduces unnecessary hospitalizations, saving substantial costs for both Missouri nursing homes and Medicare. This economic benefit has allowed these facilities to retain their top staff better. Due to its remarkable success, the program is now recommended for nationwide adoption.

The initiative, known as the Quality Improvement Program for Missouri (QIPMO), was launched in 1999 by Rantz in collaboration with Mizzou’s Sinclair School of Nursing and the Missouri Department of Health and Senior Services. Over the past 25 years, this program has fostered a close-knit community, enabling Rantz and her expert team to work closely with numerous nursing home staff and administrators across Missouri, providing effective strategies to detect illnesses earlier, control infection spread, and enhance overall care quality.

Recent research underscores the effectiveness of the QIPMO program. A study published in the Journal of the American Medical Directors Association reviewed the program’s impact on all 510 participating Missouri nursing homes from 2020 to 2022. It monitored various quality metrics, such as urinary tract infections, high-risk pressure ulcers, antipsychotic usage, emergency room visits, and hospitalizations, confirming significant improvements across these facilities.

Rantz, a Curators’ Distinguished Professor Emerita with nearly 55 years of experience in the nursing industry, highlighted that the detailed data from the study conclusively shows that every nursing home participating in the QIPMO program witnessed overall enhancements. These improvements spanned multiple areas, including infection control, sanitation procedures, hand-washing education, and resident behaviour monitoring, ultimately improving the lives of hundreds—if not thousands—of residents.

The COVID-19 pandemic brought to light various chronic issues within U.S. nursing homes, such as staffing shortages, underpayment of staff, and a lack of personalized care. In response, Rantz was selected by the National Academies of Sciences, Engineering, and Medicine to join a committee of national experts focused on improving nursing home care quality. In 2022, this committee released a report to the U.S. Congress and nursing home associations nationwide, recommending the adoption of successful quality improvement programs like QIPMO in all 50 states.

Rantz and her collaborators at Mizzou and the Missouri Department of Health and Senior Services have set a high standard for nursing home care, which is now poised to influence practices across the nation. Their unwavering commitment to seeing these evidence-based best practices implemented throughout the country ensures the sustainability of the program, and that all nursing homes can achieve similar levels of care excellence and quality improvement.

More information: Marilyn Rantz et al, Longitudinal Evaluation of a Statewide Quality Improvement Program for Nursing Homes, Journal of the American Medical Directors Association. DOI: 10.1016/j.jamda.2023.12.010

Journal information: Journal of the American Medical Directors Association Provided by University of Missouri – Columbia

Study reveals persistent high use of aspirin among the elderly, despite associated dangers

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A comprehensive survey, which represents approximately 150 million adults annually, indicates that the use of aspirin for primary prevention of cardiovascular disease (CVD) continues to be widespread among older adults, despite guidelines advised otherwise by the American College of Cardiology and the American Heart Association. According to the study’s authors, these results underscore the critical need for physicians to actively engage in discussions about the use of aspirin, thoroughly assessing both the potential benefits and risks with their older patients. This significant finding has been documented in a recent publication in the Annals of Internal Medicine.

The research, conducted by a team from the Cleveland Clinic, involved a detailed analysis of data harvested from the National Health Interview Survey Sample Adult component, spanning the years 2012 through 2019 and including data from 2021. The study aimed to elucidate trends in the prevalence of aspirin usage, specifically for preventing CVD. Participants in the study, aged 40 years and above, were required to report their aspirin consumption. Furthermore, they were categorized by age group and CVD status, which was determined based on their self-reported history of various conditions such as stroke, myocardial infarction, coronary artery disease, or angina.

From the collected data, it was observed that the use of aspirin had seen a decline from 2018 to 2019. This decrease coincided with the release of new scientific evidence, leading to the American College of Cardiology and the American Heart Association revising their guidelines to advise against the routine use of aspirin therapy for primary prevention in older adults. Despite this decline, the usage of aspirin remained alarmingly high; nearly one-third of adults aged 60 or older who did not have CVD were still regularly taking aspirin in 2021. Additionally, close to one in every twenty older adults was using aspirin without any medical advice. Overall, the survey reported that in 2021, about 25.6 million adults in the U.S. were using aspirin, with 18.5 million adults aged 60 years or older.

These findings indicate that a substantial proportion of the older population continues to misuse aspirin for primary prevention of cardiovascular diseases. The persistence of this practice, despite updated clinical guidelines, suggests that there is a pressing need for enhanced patient education and physician intervention to curtail the unwarranted use of aspirin among older adults. This highlights the importance of tailored healthcare guidance and the need for ongoing review and communication of medical guidelines to ensure they are being adhered to by the public.

More information: Mohak Gupta et al, Aspirin Use Prevalence for Cardiovascular Disease Prevention Among U.S. Adults From 2012 to 2021, Annals of Internal Medicine. DOI: 10.7326/M24-0427

Journal information: Annals of Internal Medicine Provided by American College of Physicians

NIH research illuminates the pros and cons of incorporating AI into healthcare decision processes

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National Institutes of Health (NIH) researchers have discovered that an artificial intelligence (AI) model can accurately solve medical quiz questions designed to evaluate health professionals’ diagnostic skills using clinical images and concise text summaries. Despite this, physician evaluators noted errors in the AI’s image descriptions and explanations of its decision-making processes. These insights were detailed in a study published in npj Digital Medicine, led by the NIH’s National Library of Medicine (NLM) and Weill Cornell Medicine in New York City.

NLM’s Acting Director, Stephen Sherry, PhD, commented on the findings, stating, “The integration of AI into healthcare shows immense potential to aid medical professionals in diagnosing patients more swiftly, thus hastening the onset of treatment.” However, he also cautioned that “AI has not yet evolved sufficiently to supplant the nuanced expertise of human clinicians, which remains vital for precise diagnostics.”

The study involved the AI model and medical doctors responding to diagnostic queries from the New England Journal of Medicine (NEJM)’s Image Challenge. This online quiz presents actual clinical images and brief descriptions detailing patient symptoms and asks for the correct diagnosis from a set of options. The AI model was tasked with answering 207 such questions and providing detailed justifications for each answer, including image descriptions, relevant medical knowledge, and the reasoning process behind its choices.

Nine physicians from various specialities participated in the study to assess the AI’s performance. They answered questions first without any external resources (closed-book) and then with access to external information (open-book). After completing their answers, the physicians were presented with the correct diagnoses and the AI’s responses and rationales, which they were then asked to evaluate.

The findings indicated that the AI model and the physicians performed well in identifying the correct diagnoses. Intriguingly, the AI often outperformed the physicians in the closed-book setting, while the doctors excelled with access to external resources, particularly with the more challenging questions. However, the physicians consistently found faults in the AI’s image descriptions and explanatory reasoning, even in cases where the AI accurately identified the diagnosis. For example, the AI failed to recognize that two differently angled lesions on a patient’s arm were manifestations of the same condition, mistaking them for distinct issues due to their differing appearances.

These results underscore the need for further evaluation of multi-modal AI technologies before clinical deployment. Zhiyong Lu, PhD, NLM Senior Investigator and the study’s corresponding author, emphasized, “This technology could significantly enhance clinicians’ abilities by providing data-driven insights for better clinical decisions. Nevertheless, understanding its risks and limitations is crucial for effectively leveraging its potential in medical practice.”

The study utilized an AI model known as GPT-4V (Generative Pre-trained Transformer 4 with Vision), a multimodal AI capable of processing diverse data types, including text and images. Although the research scope was limited, it highlighted the potential benefits and challenges of using multimodal AI in enhancing medical decision-making. The researchers advocate for more extensive studies to better understand how these AI models compare with human physicians in diagnostic accuracy.

More information: Qiao Jin et al, Hidden flaws behind expert-level accuracy of multimodal GPT-4 vision in medicine, npj Digital Medicine. DOI: 10.1038/s41746-024-01185-7

Journal information: npj Digital Medicine Provided by NIH / National Library of Medicine

Recent research identifies the incidence and risk factors for hepatitis C virus reinfection among men with HIV, providing fresh perspectives on transmission

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This study provides new insights into the transmission of the hepatitis C virus (HCV), which predominantly affects the liver and is often contracted through the injection of drugs. However, this research explicitly addresses the transmission among men who have sex with men (MSM). Researchers undertook a prospective cohort study in New York City involving MSM with HIV who had previously cleared an initial HCV infection. The purpose was to explore the incidence and risk factors for HCV reinfection over nearly two decades. The study revisited two risk behaviours identified in earlier research: the receipt of semen in the rectum and sexualised methamphetamine use, including instances where methamphetamine was injected. The analysis used a multivariable approach with a Cox proportional hazards model.

The results revealed that the rate of HCV reinfection was ten times higher than the rate of primary infection in New York City, highlighting that sexual transmission of the virus is neither inefficient nor unusual. Moreover, the introduction of highly effective, direct-acting antiviral treatments did not reduce the reinfection rate, indicating that these treatments do not mitigate the spread of HCV among MSM in the city. Notably, the sole risk factor linked to reinfection was the receipt of semen into the rectum, whereas sexualised methamphetamine use did not pose a significant risk.

This finding underscores a broader implication: only a limited number of sexual networks exhibit a high prevalence of HCV, and sexualised methamphetamine use is more of an indicator of membership in these high-prevalence networks than a direct mediator of transmission. This distinction challenges the traditional understanding of HCV transmission dynamics within this community.

The significance of this research stems from the historical perspective that HCV was predominantly transmitted parenterally, not sexually, and that MSM was not considered at high risk for HCV infection. Initial reports of HCV outbreaks among MSM around twenty years ago showed low infection rates, reinforcing the belief that HCV transmission among this group was rare and atypical. The methods of transmission have been a point of contention, with most evidence pointing to sexual transmission. Yet, many experts continued to attribute these cases to conventional risk factors such as drug use and blood exposure. This study, however, affirms that sexual transmission through semen is a viable and standard route among MSM, independent of drug use.

Dr. Fierer commented on the research, noting, “This study enhances our previous work on HCV among MSM in New York City, offering the most definitive evidence to date that the primary mode of HCV transmission among MSM in the city is sexual, which is distinct from the traditional transmission route via blood contact during drug injection. Given that neither condoms nor current treatments have proven effective at preventing HCV, there is a pressing need for innovative prevention strategies. We are immensely grateful to the hundreds of men who initially came to us as patients and subsequently engaged as study participants, helping us to investigate this newly recognised transmission route. We are committed to continuing our collaborative efforts to develop effective interventions to curb this ongoing epidemic.” This statement highlights the ongoing challenges and the critical need for new approaches to address the spread of HCV within these communities.

More information: Daniel S Fierer et al, Hepatitis C Virus Reinfection Among Men Who Have Sex With Men With HIV in New York City, Clinical Infectious Diseases. DOI: 10.1093/cid/ciae297

Journal information: Clinical Infectious Diseases Provided by The Mount Sinai Hospital / Mount Sinai School of Medicine

Studies Provide Optimism and Comfort for Adults Struggling with Eating Disorders

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Research conducted at Curtin University has identified that an inpatient treatment methodology can substantially aid adults with eating disorders, not only in enhancing their physical health but also their psychological well-being. This method, known as ‘High-energy refeeding,’ which is typically employed to rehabilitate malnourished adolescents with anorexia nervosa, involves a rapid escalation of caloric intake over a short period to bolster nutritional health quickly. There was initial scepticism regarding applying this approach to adults with the same condition, but the recent findings suggest that such concerns may be unwarranted.

In a study spearheaded by the School of Population Health at Curtin, 97 voluntary hospital inpatients, split between 55 adults and 42 adolescents, all suffering from eating disorders, predominantly anorexia nervosa, underwent treatment using the high-energy refeeding protocol. The outcome was encouraging, showing that adults and adolescents exhibited similar positive responses, marked by notable weight gain and improved psychological health assessments. Fiona Salter, a Master’s student and lead researcher, had highlighted concerns that adult patients might be more susceptible to refeeding syndrome — a potentially fatal condition arising from a sudden reintroduction of nutrition to severely malnourished individuals, causing drastic shifts in body fluids and electrolytes.

Despite worries about the greater frequency of mental health issues in adults potentially complicating their medical care, the study recorded just one adult unable to tolerate the high-energy regimen due to oedema, where excess fluid accumulates in body tissues. Dr Emily Jeffery, a co-author of the study, elaborated that these findings affirm that high-energy refeeding can be safely administered to adults who are mild to moderately malnourished, delivering substantial nutritional and psychological benefits. However, she cautioned that the approach might need to be adjusted for severely malnourished adults to prevent complications.

The psychological improvements noted in adult patients were particularly significant, underscoring the critical role of psychological well-being in the treatment regime. Salter pointed out that while the physical restoration of nutritional health can be achieved relatively quickly, the psychological recovery from an eating disorder is a more extended process, often taking months or years. She emphasized the importance of maintaining these gains after discharge to support long-term psychological recovery.

Looking forward, Salter indicated that subsequent research would focus on the effectiveness of high-energy refeeding in less structured environments, such as intensive treatment day programs. The aim is to determine whether similar positive outcomes can be maintained when patient meals are only partially supervised, testing the adaptability of the high-energy protocol outside the strictly controlled hospital setting. This exploration will help in understanding how to extend best the benefits of this treatment approach to broader and potentially less controlled real-world settings.

More information: Fiona Salter et al, A prospective observational study examining weight and psychosocial change in adolescent and adult eating disorder inpatients admitted for nutritional rehabilitation using a high-energy re-feeding protocol, Journal of Eating Disorders. DOI: 10.1186/s40337-024-01015-x

Journal information: Journal of Eating Disorders Provided by Curtin University

Vegetarian Men and Women May Experience Higher Risk of Hip Fractures

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Both men and women who adopt a vegetarian lifestyle face a 50% increased risk of hip fracture compared to those who consume meat regularly, according to a comprehensive study. While it is known that vegetarian women are particularly susceptible to hip fractures, the reasons remain unclear, with previous research focusing on men being limited and inconclusive. This new research, conducted by the University of Leeds, involved analyzing data from 413,914 individuals, providing the first evidence that vegetarian men also face a higher risk compared to their meat-eating counterparts while also identifying potential risk factors for both genders.

Participants, recruited for the UK Biobank project between 2006 and 2010, provided detailed dietary information. They were classified into four categories: regular meat-eaters (consuming meat five or more times a week), occasional meat-eaters (less than five times a week), pescatarians (fish but no meat), and vegetarians (dairy but no fish or meat). The study linked these dietary profiles with hospital records to monitor hip fracture occurrences up to the year 2021. The findings, documented in a paper titled “Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: a prospective cohort study of 413,914 UK Biobank participants,” published in BMC Medicine and available online, reflect the thoroughness and rigour of the research.

The study revealed that among the nearly 414,000 participants, 3,503 cases of hip fractures occurred, translating to an overall incidence rate of 0.8%. Although the overall risk of hip fractures is low, vegetarians showed a significantly higher risk compared to regular meat-eaters, irrespective of gender. The risk among occasional meat-eaters was similar to that of regular meat-eaters. At the same time, pescatarians had a slightly elevated risk of 8% compared to regular meat-eaters, though this difference was not statistically significant.

In real-world terms, the researchers estimated that, on average, both regular and occasional meat-eaters would encounter 6.5 hip fractures. At the same time, pescatarians would face 7 cases, and vegetarians would see 9.5 cases. James Webster, a doctoral researcher at the School of Food Science and Nutrition who led the study, emphasized that while the risk of hip fracture among vegetarians translates to just three additional fractures per 1,000 people over a decade, the overall health benefits of a vegetarian diet, such as reduced risk of cancer and cardiovascular diseases, might outweigh the increased fracture risk, providing reassurance to those following a vegetarian diet.

Webster pointed out that a lower BMI could be a key factor in the elevated risk among vegetarians. The study also found vegetarians were about 17% less likely to meet protein intake recommendations than meat-eaters. He highlighted the importance of vegetarians ensuring a balanced protein-rich diet and maintaining a healthy BMI to support bone and muscle health.

Professor Janet Cade, who heads the Nutritional Epidemiology Group at the University of Leeds and supervised the research, underscored the significant health implications of hip fractures and the potential role of diet in mitigating risk. She reiterated that while vegetarian diets offer numerous health benefits, enhancing understanding of diet quality and the balance of essential nutrients could help reduce risks and promote better bone health in the future.

More information: James Webster et al, Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: a prospective cohort study of 413,914 UK Biobank participants, BMC Medicine. DOI: 10.1186/s12916-023-02993-6

Journal information: BMC Medicine Provided by University of Leeds

Delivering Health Care in a Patient’s Preferred Language Could Reduce Emergency Department Visits, Hospitalizations, and Mortality

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Recent research from the Institute for Clinical Evaluative Sciences (ICES) suggests that long-term care residents who primarily speak languages other than English or French experience fewer emergency department visits, hospitalizations, and deaths when their family doctor speaks their native language.

The study, published in BMJ Public Health, investigates the impact of language barriers in healthcare. It highlights that patients who encounter these barriers often face difficulties accessing services and receive care of lower quality and safety.

Focusing on a cohort of nearly half a million individuals receiving home care services in Ontario, Canada, from 2010 to 2018, researchers explored the concept of “language concordance.” This term refers to scenarios where patients received primary care from family physicians fluent in their native language.

Findings indicated that Allophones—individuals speaking languages other than English or French—benefited significantly from language-concordant care, reducing emergency department visits, hospitalizations, and mortality risks. Interestingly, the same was not valid for Francophones, whose outcomes were unaffected by whether their care was language-concordant or discordant.

Michael Reaume, a resident physician in internal medicine at the University of Manitoba, noted that the outcomes for Francophones likely remained stable because a substantial percentage (61%) of them already received care from French-speaking doctors. He suggested that this stability might indicate the effectiveness of policies like the French Language Services Act in ensuring access to language-appropriate care for the Franco-Ontarian population.

The study highlights that while the majority of home care recipients were Anglophone (80%), Francophones (2%) and Allophones (18%) represented a smaller portion of the cohort. Among Allophones, those who received care from doctors who spoke their language had fewer emergency department visits (53% versus 58%), hospitalizations (35% versus 38%), and deaths (14% versus 17%) compared to those receiving care from non-native language-speaking doctors.

Reaume emphasized the importance of systematically collecting data on patient and physician language preferences. Although physician language data is routinely collected in most parts of Canada, only three provinces and territories (Northwest Territories, Nova Scotia, and Prince Edward Island) include patient language information on health cards. He argues that such data is crucial for matching patients with physicians who speak their preferred language and identifying those who might benefit from professional interpreter services when direct language concordance is impossible.

More information: Michael Reaume et al, Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, Canada, BMJ Public Health. DOI: 10.1136/bmjph-2023-000762

Journal information: BMJ Public Health Provided by Institute for Clinical Evaluative Sciences

Melodies Set Our Brainwaves in Motion

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Have you ever instantly recognized a song from just a brief snippet or quickly picked up the rhythm of a chorus? Groundbreaking research conducted by the Center for Music in the Brain at Aarhus University and the Centre for Eudaimonia and Human Flourishing at the University of Oxford has unveiled what transpires in our brains when we identify and predict musical sequences. This understanding sheds light on the complex patterns of neural activity initiated when our favourite tunes play on the radio, involving regions that process sound, emotions, and memories. The auditory cortex starts this process by responding to the initial sounds and relaying information to other critical areas like the hippocampus, which handles memory, and the cingulate gyrus, which aids emotional and attention processing. This intricate feedback mechanism enables us to recognize and anticipate the unfolding of songs, enhancing the listening experience.

Associate Professor Leonardo Bonetti from the Center for Music in the Brain explains the significance of these findings in understanding our cognitive functions. He highlights how this research deepens our understanding of how the brain processes and anticipates music and contributes to the broader sense of mental functions. These insights are crucial for exploring how ageing and dementia-related diseases impact cognitive processes. The potential for these findings to influence the study of brain health is immense, offering new directions for research into cognitive decline and disorders.

The resonance of familiar music, like the intricate layers of ‘Bohemian Rhapsody’ or the nostalgic melodies of a childhood classic, may also play a pivotal role in the early detection of dementia. The researchers suggest that the brain’s response to music could lead to the development of screening tools that assess the risk of dementia by analyzing brain activity as individuals engage with music. This approach could provide a non-invasive method to identify those at higher risk of developing cognitive impairments.

During the study, the researchers analyzed the brainwaves of 83 participants as they listened to music, capturing the nuanced ways in which different brain regions interact when exposed to musical stimuli. These initial findings pave the way for further research, as noted by Leonardo Bonetti. The team at Aarhus University plans to continue their studies, focusing on how these neural mechanisms might change with age or in the presence of cognitive impairments. Such investigations are crucial for developing targeted interventions to improve cognitive function and quality of life for people affected by neurological conditions.

Looking ahead, the research team is committed to exploring these brain mechanisms more thoroughly. Understanding how our cognitive processes adapt and respond to music over time could lead to innovative strategies for enhancing brain health and cognitive function. These future studies will be vital in crafting interventions that preserve and enhance mental abilities, offering hope and improved life quality to individuals facing neurological challenges.

More information: Leonardo Bonetti et al, Spatiotemporal brain hierarchies of auditory memory recognition and predictive coding, Nature Communications. DOI: 10.1038/s41467-024-48302-4

Journal information: Nature Communications Provided by Aarhus University

Companions with Health Advantages: The Value of Partnership in Achieving Objectives

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Weekly targets, annual resolutions, and five-year plans are often so tantalisingly out of reach. Despite our best intentions, many of us need help to maintain the goals we set for ourselves. The next time you set a goal, consider teaming up with a friend. Recent field research led by Assistant Professor Rachel Gershon and published in Management Science reveals that collaborating with friends on our objectives might make them more achievable. Gershon, together with Cynthia Cryder from Washington University and Katy Milkman from the University of Pennsylvania, specifically investigated the impact of joint gym visits and discovered that attending with a friend, despite the challenge of aligning two schedules, increased gym attendance by 35%.

“Although it introduced the complication of coordinating with another, we observed that people became more motivated and more frequent gym-goers,” Gershon explains. “This highlights how social incentives, often overlooked, can aid in surmounting other obstacles in our path.” The study enlisted two group participants for a “Gym Bonus Month,” which spanned four weeks from February 1 to February 28. Each group paired up with a friend, and each gym visit earned them a $1 Amazon gift card. One group received this incentive every time they visited the gym, irrespective of their friend’s participation, while the other group’s reward depended on joint attendance.

The results showed that those who paid only when visiting the gym with their friends doubled their joint sessions and enhanced their overall gym attendance by 35%. Gershon and her team concluded that two significant advantages outweighed the logistical difficulties of syncing schedules. Firstly, individuals enjoyed their gym visits more when social, enhancing the likelihood of future visits. Secondly, there was a heightened sense of accountability when meeting a friend at the gym.

“Our research highlights two forms of accountability,” notes Gershon. “Individuals feel obliged to their friends, as they want them to receive the reward, but they might also worry about their reputation should they fail to meet expectations.” Despite the apparent benefits, Gershon and her colleagues found that when asked, over 80% of people preferred not to coordinate gym visits with a friend, highlighting a general reluctance to engage in joint activities despite the potential advantages. This reluctance, Gershon suggests, may stem from an underappreciation of the motivational boost and the stronger social connections that such arrangements can foster, connections that can make us feel more connected and part of a community.

The research also demonstrated that the social aspect of attending the gym was particularly beneficial for those who were less active initially. Among each pair, the friend who exercised less frequently before the study experienced a significant increase in gym visits, suggesting that social incentives can be incredibly potent for specific groups. Beyond the gym, these findings have broader implications for behaviour modification in various settings. For instance, companies aiming to enhance employee engagement in skills training might consider implementing joint-incentive schemes to increase participation and strengthen workplace relationships.

Furthermore, Gershon’s research into referral programs suggests additional benefits. Many organisations offer incentives, like a free month of membership, for recruiting friends. This strategy not only helps to engage new customers but can also increase the motivation of existing ones, demonstrating the decisive role of social networks in initiating and maintaining new activities. This role can inspire and motivate us to take on new challenges.

More information: Rachel Gershon et al, Friends with Health Benefits: A Field Experiment, Management Science. DOI: 10.1007/s00394-023-03123-x

Journal information: Management Science Provided by University of California Berkeley Haas School of Business

Recent Research Indicates that Alcohol Rehabilitation and Abstinence Lower the Incidence of Alcohol-Related Cancers

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A recent investigation by the Centre for Addiction and Mental Health (CAMH), Bordeaux University Hospital in France, and the World Health Organization (WHO) has established that individuals suffering from alcohol dependence who engage in rehabilitation programs or achieve sustained abstinence show a markedly reduced risk of developing cancers linked to alcohol consumption. The findings were published in a new article titled “Alcohol rehabilitation and cancer risk: a nationwide hospital cohort study in France” in the Lancet Public Health journal. This groundbreaking study is considered the most comprehensive to date in demonstrating the correlation between reduced or eliminated alcohol consumption and a decreased likelihood of all alcohol-related cancers, including those of the liver and throat.

The expansive retrospective cohort study scrutinised data from over 24 million French residents, all adults in mainland France, who were hospital-discharged between 2018 and 2021. The analysis revealed that around 6.3 per cent of men and 1.6 per cent of women were diagnosed with alcohol dependence, a condition strongly linked to an increased risk of specific cancers such as hepatocellular carcinoma, and cancers of the oral cavity, pharynx, larynx, oesophagus, and colon in both genders. However, the study also indicated that those who underwent rehabilitation or maintained abstinence were at a significantly lower risk of developing these cancers compared to those who remained dependent on alcohol without undergoing treatment. These findings highlight the crucial role of effective treatment strategies in mitigating cancer risks associated with alcohol dependency.

Dr Jürgen Rehm, a Senior Scientist at the Institute for Mental Health Policy Research at CAMH and the study’s senior author, expressed surprise at the significant impact of treatment interventions observed in the study. He noted that while the treatment for alcohol dependency is known to be effective, the recurrent nature of this chronic condition often overshadows the fact that periods of abstinence can substantially reduce the risk of cancer and other chronic diseases.

Dr. Michaël Schwarzinger, from the Department of Prevention at Bordeaux University Hospital and the lead author of the article, pointed out the general underestimation of alcohol dependence in comparison to other health issues in research and policy priorities. He emphasised that alcohol dependence continues to represent a severe yet primarily overlooked epidemic in France, particularly concerning given the country’s average annual alcohol consumption per adult is more than double the global average.

Dr. Carina Ferreira-Borges, the Regional Adviser for Alcohol, Illicit Drugs, and Prison Health at the WHO Regional Office for Europe, stated that while population-level policies such as increased alcohol taxes, reduced availability, and restricted marketing are effective strategies to curb alcohol-related harms, including cancers, the study underscores the importance of health systems’ responses. Enhancing access to alcohol rehabilitation and abstinence interventions within healthcare settings could significantly bolster national efforts to protect populations from preventable cancers. She advocated for increased investment in rehabilitation and treatment services for alcohol use disorders in France and other countries within the WHO European Region.

Dr. Leslie Buckley, Chief of Addictions at CAMH, underscored the relevance of these findings, especially in light of the rising hospital admissions in Canada for alcohol-attributable conditions, which surpass those for myocardial infarction. He highlighted the barriers to accessing evidence-based treatment, such as stigma and logistical challenges in receiving in-person care. Dr Buckley also pointed to innovative solutions like virtual treatment programs, which CAMH is researching. These programs mimic the intensity of traditional rehabilitation without the need for physical infrastructure, thus reducing wait times and enhancing treatment accessibility. With the anticipated increase in alcohol availability in Ontario, Dr Buckley stressed the importance of such accessible treatment options to manage potential increases in alcohol consumption effectively.

More information: Michaël Schwarzinger et al, Alcohol rehabilitation and cancer risk: a nationwide hospital cohort study in France. DOI: 10.1016/S2468-2667(24)00107-5

Journal information: Public Health Provided by Centre for Addiction and Mental Health

Charting the Heart to Avert Damage from Heart Attacks

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Researchers at the Victor Chang Cardiac Research Institute in Australia have developed an unprecedented integrated map of heart cells, shedding light on the processes behind cardiac fibrosis—a leading cause of heart failure. This innovative map lays the foundation for the development of precision drugs designed to prevent the scarring damage that occurs after a heart attack. When a heart attack strikes, it causes damage to the heart’s muscles, resulting in scar tissue that lacks the elasticity and contractility of healthy muscle. This permanent damage diminishes the heart’s ability to pump blood efficiently, often leading to heart failure.

Professor Richard Harvey led the study in collaboration with Dr Ralph Patrick and Dr Vaibhao Janbandhu from the institute. Professor Harvey emphasized that the research marks a significant advance in understanding cardiac fibrosis, which is prevalent in various heart diseases, including those exacerbated by high blood pressure. He pointed out the considerable investments in finding new drugs to control cardiac fibrosis, which have been mainly unsuccessful, underscoring the urgent need for innovative treatments capable of halting or even reversing this condition.

Professor Harvey explained that while fibrosis is a natural healing process of the body, in the heart, it can become excessive due to unresolved disease triggers, leading to scarring that severely impairs heart function and becomes a primary cause of heart failure. The team employed state-of-the-art technology to analyze gene expression in single cells. This allowed them to delineate the progression of cellular states involved in cardiac fibrosis and how these evolve. Their methodology involved analyzing RNA signatures from 100,000 individual cells, focusing on those involved in fibrosis, and integrating this data with findings from various pioneering studies on different heart conditions.

This comprehensive approach enabled the creation of an intricate cellular map of a mouse model heart, pinpointing cells and pathways that play roles in fibrosis. The researchers identified various cellular states, including resting, activated, inflammatory, and progenitor cells, as well as dividing cells and specialized cells known as myofibroblasts and matrifibrocytes. They discovered that myofibroblasts, which are absent in healthy hearts but are believed to drive scarring, begin to form three days after a heart attack, peaking on the fifth day and then transitioning into matrifibrocytes, which potentially hinder the scar’s resolution.

The findings, published in Science Advances, also explored heart disease models such as heart failure induced by conditions like hypertension due to aortic stenosis. Dr Janbandhu noted a surprising similarity in the progression of fibrosis across different types of heart diseases, with myofibroblasts appearing early on during hypertension and then transitioning into matrifibrocytes, similar to their behaviour after a heart attack. This discovery opens the doors to future therapies that could target specific cell types or processes across various heart conditions, offering hope for preventing permanent damage to healthy cells and improving patient outcomes.

The study, which utilized data from both mouse models and human patients, indicates that heart failure in humans can evolve over decades. This underscores the importance of regular monitoring and effective management of blood pressure, a major risk factor for severe heart conditions. Dr Janbandhu’s emphasis on the treatable nature of persistent high blood pressure and the potential to prevent devastating consequences through proactive management should inspire a sense of responsibility and proactivity in the audience.

More information: Ralph Patrick et al, Integration mapping of cardiac fibroblast single-cell transcriptomes elucidates cellular principles of fibrosis in diverse pathologies, Science Advances. DOI: 10.1126/sciadv.adk8501

Journal information: Science Advances Provided by Victor Chang Cardiac Research Institute

Investigating the Strategies for Addressing Market-Driven Epidemics

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A definition for market-driven epidemics (MDEs) could significantly alleviate the obstacles faced in timely and effective prevention and mitigation, suggests a study recently released in the open-access journal PLOS Global Public Health. The study’s authors, including Jonathan Quick from the Duke University School of Medicine in the U.S., highlight how certain consumer products contribute to global risk factors for premature deaths across all age groups, costing the global economy trillions of dollars. Despite concerted efforts, reducing mortality related to these products has proven challenging, slow, and frequently unsuccessful. Quick and his team have established a case definition for MDEs to tackle this issue, which occurs when companies intensively market harmful products, deny the associated risks, and obstruct mitigation measures. The paper outlines the application of this definition through the analysis of three MDE products: cigarettes, sugar, and prescription opioids. The researchers map out five phases of MDEs based on the history of these products: market expansion, evidence of harm, corporate resistance, mitigation, and market adaptation.

The study notes a significant decline in the consumption of these products in the U.S. from their consumption peaks to the latest data available: cigarette sales dropped by 82%, sugar consumption decreased by 15%, and prescriptions for prescription opioids went down by 62%. The turning point in consumption for each product was marked by convincing evidence of harm, professional concern, and significant public health advocacy or mobilization that countered corporate marketing and resistance efforts. The interval between initial suspicion of damage and consumption tipping point varied from one to five decades, mainly due to the time needed to accumulate adequate evidence of harm. The authors also discuss how market adaptation to the decreased consumption of these products has had both adverse effects, such as the geographical relocation of marketing efforts, and positive impacts, such as consumers moving away from sugar-sweetened beverages.

The authors argue that this is the inaugural comparative analysis of successful efforts to alter the consumption patterns of millions, potentially reducing the adverse health impacts associated with these products. The MDE epidemiological framework proposed by Quick and his colleagues aims to shorten the latent time between the described phases, offering the global health community a novel approach to confronting existing and emerging harmful products and their impacts on health, society, and the economy.

The analysis underscores that while each MDE is unique in terms of the specific product and circumstances, the underlying epidemiology of consumption and health impacts and the milestones of the epidemic should inform public health leaders in combating current MDEs and more rapidly identifying potential future ones. The patterns observed across various MDEs suggest that public health officials, researchers, and civil society can employ these mitigation strategies to save lives and mitigate the effects of ongoing and emerging MDEs.

In their conclusion, the authors emphasize: “The consumption of cigarettes and other harmful products results in millions of deaths and costs the world trillions of dollars annually. Our analysis of U.S. efforts against three such market-driven epidemics shows that lives can be saved through earlier and more definitive actions by public health authorities, researchers, and through public engagement,” asserting that “the consumption patterns of cigarettes and similar products often mimic those of infectious disease epidemics, causing widespread damage before an effective public health intervention is implemented. By recognizing these market-driven epidemics sooner and responding more decisively, we can save numerous lives.”

More information: Eszter Rimányi et al, Dynamics of combatting market-driven epidemics: Insights from U.S. reduction of cigarette, sugar, and prescription opioid consumption, PLOS Global Public Health. DOI: 10.1371/journal.pgph.0003479

Journal information: PLOS Global Public Health Provided by PLOS