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Controlling Chronic Inflammation: Applying the Brakes

Researchers at Weill Cornell Medicine have made a significant discovery linking two critical pathways that control the immune system in mammals. This discovery sheds new light on chronic inflammatory bowel diseases (IBD), which affect over 2 million people in the US and significantly impact their health and quality of life.

Our immune system uses various pathways to protect us from infections, but sometimes, these pathways can become overactive, leading to autoimmune diseases like IBD. One crucial immune factor involved in these diseases is Interleukin-23 (IL-23). It plays a role in fighting infections but can also contribute to inflammatory conditions like IBD, psoriasis, and rheumatoid arthritis. Until now, scientists didn’t fully understand why IL-23 could be beneficial in some situations and harmful in others.

In their study in Nature, researchers found that IL-23 influences a specific type of immune cell called group 3 innate lymphoid cells (ILC3s), which are crucial in protecting mucosal tissues such as the intestines and lungs. When IL-23 interacts with ILC3s, it increases the activity of a regulatory factor called CTLA-4. This factor helps prevent the immune system from attacking the body’s tissues and maintains a healthy balance with beneficial gut bacteria. This mechanism is essential for controlling inflammation in the gut, but it’s disrupted in IBD.

The research highlights ILC3s as a critical link between IL-23-driven inflammation and regulatory mechanisms that maintain gut health. Understanding this link could have broader implications, particularly in cancer treatment. It appears that manipulating these pathways could help to enhance cancer therapies. However, caution is needed because blocking CTLA-4 on ILC3s could worsen gut inflammation, a known side effect of some immunotherapy treatments.

Dr Gregory Sonnenberg, one of the study’s senior authors, emphasised the unexpected nature of their findings and the potential for developing more targeted therapies. By focusing on ILC3s and their response to IL-23, researchers hope to develop treatments to alleviate inflammation associated with IBD and possibly improve cancer therapies by fine-tuning how these pathways are manipulated.

The study used advanced techniques like single-cell RNA sequencing to confirm their findings across different types of immune cells in healthy intestines and in samples from IBD patients. This meticulous approach validated that the IL-23–CTLA-4 pathway is active in healthy intestines but impaired in inflamed intestines of IBD patients, suggesting a potential target for future therapies and instilling confidence in the research’s validity.

Overall, this research deepens our understanding of immune system regulation and opens doors for developing more effective treatments for chronic inflammatory diseases and enhancing cancer therapies. It underscores our immune system’s intricate balance and the potential benefits of precisely targeting specific pathways in disease treatment.

More information: Anees Ahmed et al, CTLA-4-expressing ILC3s restrain interleukin-23-mediated inflammation, Nature. DOI: 10.1038/s41586-024-07537-3

Journal information: Nature Provided by Weill Cornell Medicine

Researchers Recommend Refrigerating Lettuce to Minimize E. coli Contamination Risk

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Leafy green vegetables are crucial for their dietary fibre and nutrient content, yet they can harbour harmful pathogens. Lettuce is often implicated in US foodborne illness outbreaks. A recent study by the University of Illinois Urbana-Champaign examined E. coli contamination factors across romaine lettuce, green-leaf lettuce, spinach, kale, and collards.

Lead author Mengyi Dong, now a postdoctoral researcher at Duke University, conducted the research at the Department of Food Science and Human Nutrition (FSHN), ACES, U. of I. The study infected whole leaves of these vegetables with E. coli O157:H7 and observed outcomes after storage at four °C, 20°C, and 37°C. Results showed temperature and leaf surface properties like roughness and natural wax significantly influenced susceptibility.

“E. coli thrives at room temperature or higher on lettuce, but refrigeration at four °C sharply reduces its population. Waxy greens like kale and collards, however, exhibit slower growth in warmth but survive longer when refrigerated,” Dong noted. Despite this, kale and collards are less susceptible overall than lettuce, which is often consumed raw.

The study also compared intact and cut leaves inoculated with E. coli, revealing that spinach, kale, and collard juices possess antimicrobial properties that hinder bacterial growth. The researchers isolated juices from kale and collards, finding potential applications as natural antimicrobial agents in controlling foodborne pathogens throughout the supply chain.

“Vegetables, grown in soil, are naturally exposed to bacteria,” explained co-author Pratik Banerjee, an associate professor in FSHN and Illinois Extension specialist. While acknowledging this complexity, Banerjee emphasised adherence to industry best practices and federal food safety standards to ensure a safe US food supply.

Banerjee and Dong underscore the importance of not discouraging fresh produce consumption but advocate for following food safety protocols: thorough washing, refrigerated storage, and awareness of food recalls. Their findings support ongoing efforts in the research community and federal agencies to address food safety challenges comprehensively.

More information: Mengyi Dong et al, Fates of attached E. coli o157:h7 on intact leaf surfaces revealed leafy green susceptibility, Food Microbiology. DOI: 10.1016/j.fm.2023.104432

Journal information: Food Microbiology Provided by University of Illinois College of Agricultural, Consumer and Environmental Sciences

Surgical Intervention Enhances Quality of Life in Patients with Acoustic Neuroma: Study Findings

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Researchers at the University of California, San Diego School of Medicine have discovered that employing an innovative surgical technique to remove acoustic neuromas and slow-growing benign brain tumours enhances hearing preservation and quality of life for patients, alongside excellent facial nerve outcomes.

Published in the May 21, 2024, online edition of Otology & Neurotology, the study highlights significant improvements in patient outcomes following the surgical removal of acoustic neuromas using the middle fossa craniotomy approach. This method involves accessing the area above the inner ear and internal auditory canal, which is crucial for preserving hearing and overall well-being.

Key findings from the research, involving 71 participants, indicate that 68% of patients retained their hearing, with 94% achieving excellent facial nerve function at the one-year post-operative mark. Dr. Rick Friedman, MD, PhD, a professor at UC San Diego School of Medicine and neurotologist at UC San Diego Health, emphasised the transformative impact of preserving hearing, which directly influences patients’ quality of life.

Acoustic neuromas, or vestibular schwannomas, are tumours that develop on the nerve connecting the ear to the brain. Symptoms include tinnitus, hearing loss, dizziness, and balance issues, and if untreated, they can potentially lead to severe complications.

The middle fossa craniotomy approach is specifically tailored for smaller tumours, up to approximately 1.7 centimetres in size, confined to the internal auditory canal. This precise surgical technique involves meticulous tumour dissection while safeguarding surrounding brain structures and the inner ear to preserve hearing.

Julie Sifford, a patient from Las Vegas, highlighted the emotional and physical toll of living with an acoustic neuroma. After experiencing symptoms such as numbness, memory loss, and tinnitus, she sought medical attention and was diagnosed with the tumour in early 2023. Following extensive research and consultation with specialists at UC San Diego Health, she opted for the middle fossa craniotomy, prioritising the preservation of her hearing despite the inherent risks.

Dr. Marc Schwartz, MD, co-director of the acoustic neuroma program at UC San Diego Health, underscored the institution’s status as a Centre of Excellence for treating these tumours. The centre offers advanced surgical techniques and achieves superior patient outcomes. The centre’s multidisciplinary approach ensures comprehensive care, with many patients travelling internationally for treatment.

The study’s outcomes reinforce the importance of tailored treatment approaches and informed decision-making in managing acoustic neuromas. By prioritising patient-centric care and advancing surgical techniques, researchers aim to improve outcomes further and enhance the quality of life for patients globally.

More information: Jiramongkolchai, Pawina et al, Quality of Life for Patients with Sporadic Small Vestibular Schwannomas Following Middle Fossa Craniotomy, Otology & Neurotology. DOI: 10.1097/MAO.0000000000004202

Journal information: Otology & Neurotology Provided by University of California San Diego

Projected Population Shifts and Risk Factors Expected to Triple U.S. Cardiovascular Disease Costs by 2050

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Driven by an increasingly diverse and ageing population, coupled with a significant rise in risk factors such as hypertension and obesity, the projected costs associated with cardiovascular diseases (CVD) are set to triple by 2050, according to forecasts by the American Heart Association. This prediction highlights a potentially monumental health and economic burden, with an estimated 61% of US adults—more than 184 million people—expected to suffer from some form of CVD over the next three decades. This prevalence is anticipated to incur direct and indirect costs of $1.8 trillion.

The new projections, detailed in two presidential advisories published in the Association’s journal Circulation, build upon previous research to assess future CVD prevalence and economic impact trends. Over its century-long history, the American Heart Association has significantly reduced death rates from heart disease and stroke, achievements acknowledged as the organisation marks its centennial milestone. Despite these advancements, heart-related conditions remain the leading causes of death and disability in the US.

Karen E. Joynt Maddox, M.D., M.P.H., FAHA, chair of the advisory writing groups, emphasised the ongoing challenges CVD poses and the critical need to address future projections. The advisories aim to anticipate trends over the next 30 years and identify key areas requiring intervention to sustain progress. This proactive approach is essential in mitigating the forecasted increase in CVD cases and associated costs.

Cardiovascular disease encompasses a range of conditions, including coronary heart disease, stroke, hypertension, and heart failure. The prevalence of these conditions is expected to rise significantly, driven mainly by increases in high blood pressure, diabetes, and obesity across all age groups. Despite these concerning projections, positive shifts in health behaviours, such as a decline in smoking rates and improvements in physical activity levels, are noted, suggesting a growing awareness and commitment to healthier lifestyles.

Looking ahead, the demographic landscape of the US will play a pivotal role in shaping CVD trends. The ageing population, alongside demographic shifts towards more diverse racial and ethnic groups, underscores the need for targeted health strategies. Disparities in CVD prevalence and risk factors persist among different demographic groups, influenced by systemic factors, including socioeconomic status and access to healthcare.

The economic impact of CVD is projected to escalate dramatically, primarily due to soaring healthcare costs and lost productivity. Direct healthcare expenditures related to CVD are forecasted to quadruple, reflecting both inflationary pressures and the increasing prevalence of these conditions. Stroke, in particular, is anticipated to drive a significant portion of these costs, given its association with an ageing population and rising hypertension rates.

Dhruv S. Kazi, M.D., M.Sc., M.S., FAHA, vice-chair of the advisory writing groups, highlighted the urgency of strategic interventions to curb these rising costs and prevalence rates. Modelling scenarios suggest that targeted reductions in risk factors could yield substantial benefits, potentially averting millions of CVD events and deaths annually by 2050. These scenarios underscore the importance of early intervention and comprehensive healthcare policies aimed at prevention and treatment.

Looking towards the future, advancements in medical research and public health initiatives offer hope for reversing current trends in CVD. The development of innovative treatments and continued support for scientific discovery are crucial in tackling these challenges. Moreover, addressing broader social determinants of health, including poverty and structural racism, is essential to ensuring equitable access to healthcare and reducing disparities in CVD outcomes across diverse populations.

Nancy Brown, Chief Executive Officer of the American Heart Association, emphasised the organisation’s commitment to advancing cardiovascular health into its second century. She called for collaborative efforts across communities, industries, and policy-makers to implement practical solutions and improve health outcomes nationwide. This collective approach, bolstered by ongoing research and public engagement, aims to transform the trajectory of cardiovascular health in the US and beyond.

As the American Heart Association prepares to navigate the complexities of an evolving healthcare landscape, the focus remains on equipping individuals and communities with the tools needed to lead healthier lives. By addressing the root causes of CVD and investing in preventive strategies, there is potential to mitigate the projected burden and foster a future where cardiovascular health is optimised for all.

More information: Karen E. Joynt Maddox et al, Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050—Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association, Circulation. DOI: 10.1161/CIR.0000000000001256

Journal information: Circulation Provided by American Heart Association

A Roadmap Towards Achieving Health Equity in American Diets

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Poor diet remains a significant burden on American adults, posing major risks such as obesity, type 2 diabetes, cardiovascular disease, and certain cancers. According to the Food and Drug Administration, more than one million Americans die annually from diet-related diseases. The economic toll is staggering, too, with poor diet and food insecurity contributing an estimated $1.1 trillion to healthcare costs and lost productivity. These issues exacerbate health disparities across income levels, education, geographical locations, and racial and ethnic backgrounds.

Recent research from the Food is Medicine Institute at Tufts University’s Friedman School of Nutrition Science and Policy, published in the Annals of Internal Medicine, highlights some improvements in diet quality among U.S. adults from 1999 to 2020. Despite these gains, many Americans still have poor diet quality, and disparities persist or worsen over time.

Lead researcher Dariush Mozaffarian, director of the Food is Medicine Institute, notes that modest improvements in American diets have yet to be equitable across the population. Many Americans continue to experience barriers in accessing and consuming nourishing foods, hindering progress towards nutritional and health equity.

The study analysed data from 51,703 adults over ten National Health and Nutrition Examination Survey cycles, using the American Heart Association diet score to measure diet quality. It found a decrease in the proportion of adults with poor diet quality from 48.8% to 36.7% over the two decades studied, with a corresponding increase in those with intermediate diet quality. However, the percentage of adults with an ideal diet remained strikingly low, showing minimal improvement.

Fundamental dietary changes contributing to these trends included increased consumption of nuts, seeds, whole grains, poultry, cheese, and eggs, alongside decreased intake of refined grains, sugary beverages, and fruit juice. Consumption of fruits, vegetables, fish, shellfish, processed meats, potassium, and sodium remained relatively stable.

Despite these overall trends, disparities in diet quality improvement were evident across different demographic groups. Younger adults, women, Hispanic adults, and those with higher education, income levels, food security, and private health insurance showed more significant gains in dietary quality. Conversely, older adults, men, Black adults, and individuals with lower socioeconomic status or non-private health insurance saw less improvement or even worsening diet quality.

Junxiu Liu, the study’s first author, emphasised that while some progress is visible, particularly in reducing consumption of added sugars and fruit drinks, significant challenges remain, especially for marginalised communities. These groups continue to face higher rates of obesity and type 2 diabetes, underscoring the urgent need to address nutrition security and broader social determinants of health such as housing, transportation, fair wages, and structural racism.

Mozaffarian reiterated the urgency of addressing these issues comprehensively, advocating for policies and interventions that tackle not only dietary habits but also the underlying social and economic factors perpetuating poor health outcomes. He highlighted the importance of addressing nutrition security alongside other social determinants of health to mitigate the human and financial costs associated with inadequate diets.

While there have been some improvements in diet quality among Americans over the past two decades, these gains have been unevenly distributed across different demographic groups. Achieving nutritional and health equity requires concerted efforts to remove barriers to accessing nutritious foods and address the broader social determinants contributing to disparities in diet quality and related health outcomes.

More information: Junxiu Liu et al, Trends in Diet Quality Among U.S. Adults From 1999 to 2020 by Race, Ethnicity, and Socioeconomic Disadvantage, Annals of Internal Medicine. DOI: 10.7326/M24-0190

Journal information: Annals of Internal Medicine Provided by Tufts University

Exploring Brain Wave Functions through Precise Sound Stimulation

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A recent study reveals promising findings on using sound to improve sleep quality in individuals with dementia or cognitive decline, a group often plagued by sleep disturbances. These disruptions, affecting up to half of dementia patients, prompted researchers from the University of Surrey and the UK Dementia Research Institute Centre for Care Research & Technology at Imperial College London to investigate alpha rhythms, a brainwave associated with memory and perception.

The study, led by Senior Lecturer Dr Ines Violante, employed sound stimulation targeted at alpha rhythms, delivered at precise phases. This approach, known as Alpha Closed-Loop Auditory Stimulation (aCLAS), explores how the brain responds to such interventions in real-time. The team monitored participants’ brain electrical activity, synchronising sound bursts (pink noise) with specific alpha wave phases to observe varied effects on rhythm speed and brain region-specific responses.

Dr Henry Hebron, the study’s first author, highlighted the unexpected discovery that sound administered during certain alpha phases hindered deeper sleep stages without causing awakenings, contrasting with phases without disruption. This intriguing finding challenges our current understanding of sleep and cognition and opens up new avenues for research. He noted that this closed-loop method allowed for direct manipulation of alpha oscillations, suggesting potential applications in understanding neural behaviour linked to cognition and sleep.

The findings underscored the critical role of alpha rhythms in brain function, particularly in diseases like Alzheimer’s, where these rhythms are often slowed. Professor Derk-Jan Dijk, Director of the Surrey Sleep Research Centre, emphasised the implications for future research, particularly in exploring how manipulating alpha waves might enhance cognitive functions and sleep quality in dementia patients. Further investigations are now focusing on applying this technique to REM sleep, where alpha rhythms are present, but their precise role still needs to be clarified.

The study signifies a significant step towards leveraging non-invasive sound-based techniques to modulate brain oscillations effectively. The potential to enhance cognitive abilities and sleep patterns holds promise for improving the quality of life for individuals with dementia. These findings pave the way for future research and the development of innovative interventions that could significantly improve the lives of dementia patients.

More information: Henry Hebron et al, A closed-loop auditory stimulation approach selectively modulates alpha oscillations and sleep onset dynamics in humans, PLoS Biology. DOI: 10.1371/journal.pbio.3002651

Journal information: PLoS Biology Provided by University Of Surrey

Maintaining Leg Strength in Retirement Through Heavy Resistance Training

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Depletion of leg muscle strength has emerged as a robust predictor of mortality among older adults, underscoring the critical need for its preservation. However, there is hope in the form of resistance training, which can mitigate this decline. As individuals age, skeletal muscle mass and function naturally decline, often compromising mobility and autonomy. While existing research has predominantly focused on relatively short-term interventions spanning 6 to 9 months, there is potential for longer-term solutions.

In an effort to explore the enduring effects of prolonged, supervised resistance training, researchers conducted a follow-up study involving participants from the lIve active Successful Ageing (LISA) trial—a large-scale, randomised controlled trial. This investigation aimed to ascertain whether engaging in one year of rigorous resistance training with heavy loads could yield sustained benefits over an extended period, providing reassurance about the long-term effectiveness of this intervention.

Participants recently retired and in good health, were initially categorised by sex, BMI, and independent chair mobility before being randomly allocated to one of three groups: a heavy weightlifting regimen performed three times weekly (149 participants), a moderate intensity training programme incorporating bodyweight exercises and resistance bands (154 participants, also three times weekly), or a comparison group (148 participants) advised to maintain their usual physical activity levels.

Baseline measurements encompassed bone and muscle strength, as well as body fat levels, with subsequent assessments conducted at 1, 2, and 4 years post-intervention. After the study period, 369 participants remained available for evaluation, reflecting an attrition rate primarily attributable to lack of motivation or illness.

By the fourth year, participants averaged 71 years of age, predominantly female (61%), and sustained an active lifestyle equivalent to nearly 10,000 daily steps as monitored by activity trackers. Analysis revealed no significant differences among the groups in leg extensor power, handgrip strength, or lean leg mass—all indicators exhibited declines across cohorts.

Notably, leg strength remained preserved at initial levels exclusively within the heavyweight resistance training group, whereas declines were observed in both moderate-intensity and comparison groups. This disparity, potentially linked to nervous system adaptations prompted by resistance training, attained statistical significance.

Conversely, visceral fat levels remained unchanged in the weights resistance training and moderate-intensity exercise groups yet notably increased in the comparison group—a finding suggesting that specific physiological parameters may exhibit differential responses to exercise modalities over prolonged periods.

Acknowledging that study participants skewed healthier and more physically active than the general population, despite prevalent chronic conditions affecting 80% of cases, researchers cautioned against generalising the findings broadly. Nonetheless, they concluded that the study furnishes compelling evidence supporting the enduring efficacy of heavy resistance training during retirement years.

The implications underscore potential strategies for healthcare practitioners and policymakers to promote and advocate for sustained engagement in rigorous resistance training among older adults. The study’s findings provide compelling evidence supporting the enduring efficacy of heavy resistance training during retirement years, inspiring us to advocate for this approach and foster enhanced health outcomes and functional independence in later life.

More information: Mads Bloch-Ibenfeldt et al, Heavy resistance training at retirement age induces 4-year lasting beneficial effects in muscle strength: a long-term follow-up of an RCT, BMJ Open Sport & Exercise Medicine. DOI: 10.1136/bmjsem-2024-001899

Journal information: BMJ Open Sport & Exercise Medicine Provided by BMJ Group

Subtle Cognitive Decline Signals End of Driving for Older Adults

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Navigating the decision to relinquish driving privileges poses a significant challenge for older adults. Recent research from Washington University School of Medicine in St. Louis sheds light on this complex issue, suggesting that cognitive decline, rather than age or Alzheimer’s disease markers, often signals the time to stop driving. The study underscores that even minor cognitive changes can indicate impending retirement from driving, with women more likely than men to make this decision.

Published in Neurology, the study advocates for regular cognitive assessments tailored to detect subtle declines early on. These assessments, crucial for informed decision-making, could help older adults and their physicians enhance safety while preserving independence. According to Ganesh M. Babulal, PhD, OTD, the study’s lead author, proactive discussions about cognitive changes are essential. Early identification of risks allows for interventions that support driving skills and facilitate a smoother transition to alternative transportation options when necessary.

Despite older adults over 65 being among the most cautious drivers, age-related factors such as slower reactions, impaired vision, and cognitive decline increase their crash risk. Moreover, older drivers are more likely to suffer severe consequences when accidents occur than younger counterparts. However, ceasing to drive isn’t without its challenges—those who stop driving face higher risks of depression and isolation.

The research, which lasted over 5.6 years and involved 283 participants initially free of cognitive impairments, monitored changes through cognitive tests, including the Clinical Dementia Rating (CDR) and the Preclinical Alzheimer’s Cognitive Composite (PACC) score. Surprisingly, neither age nor Alzheimer’s biomarkers strongly influenced the decision to stop driving. Instead, cognitive impairment and declining PACC scores emerged as key predictors, highlighting the importance of monitoring subtle cognitive changes.

Gender also played a significant role, with women showing a higher likelihood of stopping driving during the study period compared to men. This finding challenges stereotypes about driving abilities between genders and underscores the proactive approach women often take in acknowledging changes in their driving skills.

Dr Babulal emphasises the need for healthcare providers to initiate conversations about driving cessation early on. He advocates for tailored interventions, such as driver rehabilitation programmes led by occupational therapists, which equip older drivers with strategies to adapt to physical and cognitive changes. Community support programmes also play a crucial role in educating older adults about safe driving practices and alternative transport options.

While most older adults eventually need to stop driving, the study underscores the benefits of proactive planning and support in maintaining independence and quality of life. By integrating routine cognitive assessments and fostering open discussions, healthcare providers can be pivotal in ensuring older adults navigate this transition confidently and safely.

More information: Ganesh M. Babulal et al, Predicting Driving Cessation Among Cognitively Normal Older Drivers, Neurology. DOI: 10.1212/WNL.0000000000209426

Journal information: Neurology Provided by Washington University School of Medicine

Advanced Facial Screening Tool Rapidly Detects Stroke Risk in Seconds

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A groundbreaking smartphone facial screening tool has been developed to revolutionise stroke detection. It offers paramedics the ability to identify stroke risk within seconds, far surpassing current technologies in speed and accuracy.

Strokes, a widespread global health concern, occur when blood flow to the brain is disrupted, depriving brain tissue of essential oxygen and nutrients. The timely detection of strokes is crucial, as even a few minutes delay can lead to irreversible brain damage. Recognising this urgency, a team of biomedical engineers at RMIT University has pioneered AI-driven software capable of swiftly assessing stroke risk via facial analysis. Published in Computer Methods and Programs in Biomedicine, their research is spearheaded by PhD scholar Guilherme Camargo de Oliveira under the guidance of Professor Dinesh Kumar.

From RMIT’s School of Engineering, Professor Kumar underscores the tool’s potential impact: “Early stroke detection is critical for enhancing recovery outcomes, reducing disability, and saving lives. Our smartphone tool empowers paramedics to swiftly determine stroke likelihood on the spot, ensuring timely hospital notification before the patient even reaches the ambulance.”

The smartphone tool, boasting an impressive 82% accuracy rate in stroke detection, complements rather than replaces comprehensive clinical diagnostics. It primarily identifies individuals who urgently require treatment and streamlines emergency response protocols. This innovation addresses a significant gap in current emergency care, where up to 13% of strokes are reportedly missed, particularly among women, people of colour, and patients presenting subtle symptoms.

The technology’s use of AI-enabled facial expression recognition is central to its analysis of facial symmetry and muscle movements known as action units. Leveraging the Facial Action Coding System (FACS), initially developed in the 1970s, the tool detects asymmetry—a hallmark sign of stroke-induced facial muscle impairment. The researchers validated the tool’s effectiveness in real-world scenarios by examining video recordings of facial expressions from stroke patients and healthy controls.

Looking ahead, the team aims to expand the tool’s capabilities beyond stroke detection. Collaborating with healthcare providers, they plan to integrate the technology into a comprehensive app that identifies various neurological conditions affecting facial expressions. This evolution seeks to enhance sensitivity and specificity, broadening its utility in emergencies and potentially transforming how paramedics approach critical patient care.

“Integration into existing emergency response protocols is paramount,” Kumar emphasises. “By collaborating closely with healthcare providers, we aim to ensure seamless adoption of this tool, equipping paramedics with a powerful ally in early stroke detection and improving outcomes for patients worldwide.”

More information: Guilherme C. Oliveira et al, Facial expressions to identify post-stroke: A pilot study, Computer Methods and Programs in Biomedicine. DOI: 10.1016/j.cmpb.2024.108195

Journal information: Computer Methods and Programs in Biomedicine Provided by RMIT University

Study Finds Higher Healthcare Costs Linked to Unplanned Utilization Among Patients with Cognitive Impairment

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Researchers from Duke-NUS Medical School and the NUS Yong Loo Lin School of Medicine utilised population-based Singapore Chinese Health Study data. They discovered that individuals with cognitive impairment spend, on average, 17 per cent more per year on healthcare compared to peers without cognitive impairment of the same age. Published in the Annals of the Academy of Medicine Singapore, the study underscores that these increased costs primarily stem from emergency department visits and subsequent admissions.

Health economist Assistant Professor Chay Junxing, from the Lien Centre for Palliative Care at Duke-NUS, who led the study, emphasised the significance of these findings: “This study provides the first quantification of additional healthcare expenditures among patients with cognitive impairment in Singapore. Emergency department visits and subsequent admissions emerge as the major cost drivers. Armed with this knowledge, we can develop strategies to mitigate these admissions.”

In 2019, an estimated 44,000 individuals in Singapore were living with some form of cognitive impairment, a number expected to rise with the ageing population. The Ministry of Health projects that by 2030, the number of people with dementia alone could reach 152,000, increasing further to 187,000 by 2050. As observed by the researchers, these projections suggest additional healthcare spending of S$106 million and S$131 million during these years.

The study’s projections underscore the urgency for novel approaches to manage the escalating burden of unplanned healthcare utilisation. Recommendations from the authors include proactive monitoring of individuals with cognitive impairment to mitigate risk factors for high-cost medical events.

Senior author Professor Eric Finkelstein, Executive Director of the Lien Centre for Palliative Care at Duke-NUS, highlighted the impending strain on healthcare resources: “Rising rates of cognitive impairment, coupled with Singapore’s ageing population, foreshadow increased pressure on healthcare services. Planners must anticipate this exponential growth in burden, focusing efforts on identifying at-risk patients and intervening before crises arise.”

The researchers advocate for collaborative efforts with nursing homes and other care facilities to enhance care across the illness continuum, yielding health and economic benefits. The study also reveals that individuals with cognitive impairment frequently utilise emergency services. Previous research has identified common reasons for these visits, such as pneumonia, heart failure, urinary tract infections, and fall-related injuries. Factors contributing to heightened emergency service use include increased susceptibility to injuries and infections, lower treatment adherence, and challenges in post-discharge care continuity.

Professor Patrick Tan, Senior Vice-Dean for Research at Duke-NUS, underscored the study’s insights into healthcare service utilisation: “Understanding patterns of healthcare service use provides critical insights into delivering not only cost-effective care but also improving patients’ quality of life. These findings underscore the need for expanded services targeting early identification of individuals at risk of cognitive impairment and better education for caregivers to support proactive management.”

The study highlights the escalating healthcare costs associated with cognitive impairment in Singapore, mainly driven by unplanned healthcare utilisation. Addressing these challenges requires innovative strategies for early intervention, enhanced caregiver education, and collaborative care approaches across healthcare settings.

More information: Junxing Chay et al, Healthcare burden of cognitive impairment: Evidence from a Singapore Chinese health study, Annals of the Academy of Medicine Singapore. DOI: 10.47102/annals-acadmedsg.2023253

Journal information: Annals of the Academy of Medicine Singapore Provided by Duke-NUS Medical School

Individuals with an Uncommon Longevity Mutation Might Also Enjoy Cardiovascular Protection

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A study illuminates potential cardiovascular health benefits in individuals affected by a rare condition known as growth hormone receptor deficiency (GHRD) or Laron syndrome.

GHRD is characterised by the body’s impaired ability to utilise its growth hormone, resulting in stunted growth. In mice, this condition has been linked to an unprecedented 40% extension of lifespan and reduced susceptibility to various age-related illnesses. However, the association between GHRD and cardiovascular disease risk in humans has been uncertain until now, leading to speculation that this longevity mutation observed in mice might elevate cardiovascular risk in humans.

Published in Med on April 26, 2024, the study is the culmination of nearly two decades of international collaboration between Valter Longo, a professor of gerontology at the USC Leonard Davis School of Gerontology, and endocrinologist Jaime Guevara-Aguirre of the Universidad San Francisco de Quito, Ecuador.

Over the past twenty years, Longo, Guevara-Aguirre, and their team have investigated the health and ageing processes among individuals with the genetic mutation responsible for GHRD. This rare mutation, identified primarily among Ecuadorians whose ancestors fled Spain during the Inquisition over three centuries ago, results in ineffective growth hormone receptors and a form of dwarfism.

Previous research by the team indicated that while GHRD (Laron syndrome) diminishes growth, it also appears to reduce the risk of several age-related diseases. Despite a higher incidence of obesity among Ecuadorians with GHRD, they demonstrate lower rates of cancer and Type 2 diabetes. Moreover, they exhibit healthier brain function and superior performance on cognitive and memory tests.

For their latest study, researchers assessed cardiovascular function, damage, and risk factors in GHRD subjects and their unaffected relatives. The study involved two phases of data collection conducted in Los Angeles and Ecuador, encompassing 51 participants, including 24 diagnosed with GHRD and 27 control subjects without the condition.

There are some key findings from the study. GHRD subjects exhibited lower blood sugar levels, reduced insulin resistance, and lower blood pressure compared to their unaffected relatives. They displayed smaller heart dimensions and comparable pulse wave velocity (a measure of arterial stiffness) but had thinner carotid arteries compared to the control group.
Despite higher levels of low-density lipoprotein (LDL) cholesterol, GHRD subjects showed a trend towards fewer atherosclerotic plaques in their carotid arteries compared to controls (7% vs 36%).

“These findings suggest that individuals with GHRD may have either normal or improved levels of cardiovascular disease risk factors compared to their unaffected relatives,” commented Longo, senior author of the study. “While the study sample size is limited, when combined with findings from research involving mice and other organisms, these human data provide valuable insights into the health implications of growth hormone receptor deficiency. They also suggest that pharmaceutical treatments or dietary interventions capable of replicating these effects could potentially reduce disease incidence and extend lifespan.”

The study underscores the complex interplay between growth hormone receptor deficiency, metabolic health, and cardiovascular risk, offering new avenues for further research and potential therapeutic strategies to enhance longevity and mitigate age-related diseases.

More information: Jaime Guevara-Aguirre et al, Normal or improved cardiovascular risk factors in IGF-I-deficient adults with growth hormone receptor deficiency, Med. DOI: 10.1016/j.medj.2024.03.022

Journal information: Med Provided by University of Southern California

Guidelines from the Endocrine Society Advocate Vitamin D Intake for Healthy Adults Under 75

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A recent clinical practice guideline from the Endocrine Society has issued crucial recommendations concerning vitamin D intake and testing for healthy adults under 75. The guideline suggests that exceeding the daily recommended allowance of vitamin D, as set by the Institutes of Medicine (IOM), is unlikely to provide additional health benefits for this demographic. Therefore, routine testing for vitamin D levels is deemed unnecessary for these individuals, empowering healthcare professionals to make informed decisions.

However, the guideline highlights specific populations that may benefit significantly from higher vitamin D intake beyond the IOM recommendations. These include children, pregnant individuals, adults over 75 years old, and adults with high-risk prediabetes. The guideline advises considering higher doses of vitamin D supplementation to potentially reduce the risks of various health conditions, instilling a sense of hope and optimism in the potential for improved health outcomes.

Published under the title “Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline,” the document emphasises evidence-based recommendations derived from clinical trials. It underscores the ongoing debate surrounding the relationship between vitamin D supplementation, disease prevention, and optimal blood levels of vitamin D for improved health outcomes, providing a robust and reliable framework for healthcare professionals to follow.

Dr. Marie Demay, chair of the guideline panel and affiliated with Harvard Medical School and Massachusetts General Hospital, explains that the guideline focused on addressing vitamin D requirements for disease prevention in generally healthy populations without specific conditions impairing vitamin D absorption or action. Unless clinically indicated, the guideline stresses routine testing for vitamin D levels in the identified beneficiary groups.

Key recommendations from the guideline include discouraging vitamin D supplementation beyond IOM-recommended levels for healthy adults under 75 while advocating for higher doses in children, pregnant individuals, older adults, and those with prediabetes to mitigate potential specific health risks. The guideline advises against routine testing for 25-hydroxyvitamin D levels across these groups, citing insufficient evidence to establish outcome-specific benefits based on current thresholds.

Despite advancements in understanding vitamin D’s role in health and disease, the guideline acknowledges limitations in existing evidence. Many clinical trials have yet to be specifically designed to assess specific health outcomes related to vitamin D, and participant baseline vitamin D levels have often been within what is considered adequate. Consequently, more supporting data is needed to prevent the guideline from defining precise blood-level thresholds for 25-hydroxyvitamin D adequacy or disease prevention targets.

This comprehensive guideline, published online and scheduled for the August 2024 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), provides a robust framework for vitamin D supplementation and testing practices in healthy populations under 75 years old based on currently available evidence and expert consensus from the Endocrine Society.

More information: Marie B Demay et al, Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism. DOI: 10.1210/clinem/dgae290

Journal information: The Journal of Clinical Endocrinology & Metabolism Provided by The Endocrine Society