Schoolchildren are learning about health through football (soccer)

A new study from the University of Southern Denmark shows that health knowledge in relation to diet, exercise, hygiene and wellbeing can be increased through a programme of football exercises as part of school lessons

UNIVERSITY OF SOUTHERN DENMARK FACULTY OF HEALTH SCIENCES

Research News  29-JAN-2021

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IMAGE: DANISH SCHOOLCHILDREN ARE LEARNING ABOUT HEALTH THROUGH FOOTBALL - BOTH GIRLS AND BOYS ARE ENJOYING IT! view more 

CREDIT: ROBERT WENGLER + 45 20430656 - ROBERT@WENGLER.DK - WWW.WENGLER.DK

Knowledge about health is a cornerstone in a child's development of physical and psychosocial health.

Since 2016, around 25,000 pupils in years 4-6 in 86 of Denmark's municipalities have taken part in the project "11 for Health in Denmark", an 11-week exercise and health education programme offered to all schools in a collaboration between the University of Southern Denmark and the Danish Football Association.

More than 3,000 of these pupils completed questionnaires before and after the programme aimed at determining their knowledge about health and understanding their experience of the 11-week programme.

An increase of 10 percentage points in health knowledge

The main article from this study, which has now been published in leading sports science journal the British Journal of Sports Medicine, confirms that the programme is meeting its key objectives:

"The participating children increased their knowledge about health in the areas of diet, exercise, hygiene and wellbeing to a greater extent than the control group, which followed the originally planned lessons in the 11 weeks between the questionnaires. There was a difference between the groups of more than 7 percentage points for both boys and girls, and in a number of key health areas the difference was more than 10 percentage points," says postdoc Malte Nejst Larsen, the article's lead author.

"The idea that children learn best if they can connect the learning to relevant activities is not new, but it's rare for such large studies to be carried out in real-world schools - and with such unambiguous results," he says.

CAPTION

Danish schoolchildren are learning about health through football - both girls and boys are enjoying it!

CREDIT

Robert Wengler + 45 20430656 - robert@wengler.dk - www.wengler.dk

Physical activity during coronavirus

The "11 for Health" concept was developed long before the coronavirus epidemic, but it has proven effective in relation to all the current challenges around health, fitness, physical activity, wellbeing and knowledge about hygiene.

The latest results show very clearly that it is possible to combine health learning with exercise that is fun, motivational and inclusive for all children - including those who have very little experience of sport. A good example is that the children doubled their knowledge about hand hygiene through the programme.

This was explained by the project's lead researcher Professor Peter Krustrup of the Department of Sports Science and Clinical Biomechanics at the University of Southern Denmark, who stresses that there was record-high participation in autumn 2020.

The researchers are also, therefore, delighted that the Nordea Foundation (Nordea-fonden), which has been supporting the project since 2018, has extended its support through to summer 2021. The project group is currently seeking funding for an ambitious expansion of the concept and a research study of the concept's long-term effects.

Both boys and girls like the project

The article also provides data on the children's opinion of the programme. These show very encouragingly that the girls rate the programme just as highly as the boys (4 on a scale of 1-5), despite the fact that the girls generally have considerably less experience of football than the boys.

Bent Clausen, Vice President of the Danish Football Association with a focus on amateur football, is delighted about this:

"It is great that '11 for Health' is able to have a broad reach and spark an interest in football in all children, both boys and girls, beginners and experienced players. After all, that is what football is really good at - including everyone no matter what their background. And with the school programme a natural next step, and an important aid for the associations, is getting new players and including them in the valuable communities within the football clubs."

CAPTION

Danish schoolchildren are learning about health through playing football.

CREDIT

Robert Wengler + 45 20430656 - robert@wengler.dk - www.wengler.dk

 

About the study

• Researchers from the University of Southern Denmark studied 3,117 participants in the "11 for Health in Denmark" project.
• The participants were boys and girls in year 5.
• The participants completed a questionnaire at the start of the study and again after 11 weeks.

The results show that:

• "11 for Health in Denmark" improves health knowledge in 10-13-year-old Danish children by up to approx. 10 percentage points.
• The teaching of "11 for Health in Denmark" is equally effective for girls and boys, and girls achieve the best outcomes for wellbeing.
• Girls and boys rate the programme equally highly.
• "11 for Health in Denmark" can play an important role in preventing diseases.

The "11 for Health in Denmark" project is financially supported by the Nordea Foundation (Nordena-fonden).

What are the prospects for "11 for Health"?

• Politicians, school heads, teachers and educators can use this knowledge and the "11 for Health in Denmark" programme when implementing health teaching in middle schools.
• The programme has the potential to motivate and engage more 10-13-year-old children, especially girls, in sports clubs after they have had a positive experience of football and physical activity.
• The scaled-up programme is tailored for use in western countries to promote a combination of health education and motivational physical activity, with broad-spectrum improvements in health knowledge, wellbeing, cognitive function and physiological health profile.

In connection with the publication of the "11 for Health in Denmark" main article in the British Journal of Sports Medicine, the editor writes in a leader that the Danish version of the concept can usefully be extended to the entire western world.

Football and inclusion: It all comes down to the right motivational climate

Sports psychology

UNIVERSITÄT LEIPZIG

Research News

 

IMAGE: ANNE-MARIE ELBE, PROFESSOR OF SPORTS PSYCHOLOGY AT LEIPZIG UNIVERSITY. view more 

CREDIT: PHOTO: SWEN REICHHOLD, LEIPZIG UNIVERSITY

This is the conclusion of a recent study by an international team of researchers, including Anne-Marie Elbe, Professor of Sports Psychology at Leipzig University. The finding is of social importance because experiences in adolescence in particular have a formative influence on attitudes and behaviour in later life.

In sport, football is considered a model of inclusion. "Remarkably, to the best of our knowledge, theory and research on feelings of inclusion in (youth) team sports is lacking," the authors write in their study. They add that filling this gap is important, because team sports are not necessarily inclusive by nature.

For their study, the Danish-Dutch-German team of researchers interviewed 245 boys aged 10 to 16 about their experiences. "We focused [on them] because particularly in these age groups, positive intercultural contact experiences tend to lead to more positive intergroup attitudes in adulthood," said the authors. The subjects belong to two Dutch football clubs that train very diverse teams. The majority of the study participants - 61.6 per cent - were classified as having "minority" social status. This means that the player himself or at least one of his parents was born outside the Netherlands.

For the research team, inclusion consists of two components, explains Anne-Marie Elbe from Leipzig University: "How strongly do I feel I belong to a team? And how strongly do I feel that I can be myself - so act authentically with regard to things like my other cultural background?" This understanding of inclusion is based on existing research by other scholars.

"Our assumption in the study was that there would be a relationship between a person's feeling of inclusion and what kind of motivational climate exists in the team, so the climate created by the coach," said Elbe. A distinction is made between a performance-oriented motivational climate on the one hand, where the aim is to be better than other players in your own team, and a task-oriented motivational climate on the other. With task-based standards, the focus is on the individual player and improving his own skills. Motivating each player to learn is important: does he succeed in doing a task well, or at least not doing it worse than before?

Professor Anne-Marie Elbe and her team of researchers have now shown that the young players' sense of inclusion correlated positively with a task-oriented training climate, while it correlated negatively with a climate based on competition. When both types of training were used side by side, non-migrant players still managed to cope well - without this impacting too heavily on their sense of belonging. Among the "minority" players, however, it was observed that their sense of inclusion was only stable where there was a stronger focus on task-based standards, and the competitive approach within their own team was either not emphasised or emphasised only to a limited extent.

"So you can't say that being a member of a football team in itself has positive effects. In order to achieve positive effects through football training, the coach needs to behave in a certain way and create a specific climate during the training session. There is a lot of potential in this, and it is of enormous significance to society," said Anne-Marie Elbe. "Our study helps extend the quantitative research on inclusion and sport."

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Anne-Marie Elbe worked at the University of Copenhagen until 2017, where she co-supervised the study - Silke Dankers' doctoral project. The project was carried out through the Team Sports and Health centre at the University of Copenhagen and supported by the Nordea fund. The researchers have now published their findings in the prestigious journal Psychology of Sport and Exercise.

Original title of the publication in Psychology of Sport and Exercise: "Perceived inclusion in youth soccer teams: The role of societal status and perceived motivational goal climate", doi: 10.1016/j.psychsport.2020.101882 , ISSN: 1469-0292

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Black, lung cancer, patients die sooner than white counterparts

Residential segregation and its socioeconomic effects impact lung cancer outcomes

THE SOCIETY OF THORACIC SURGEONS

Research News

 

CHICAGO (January 29, 2021) -- Structural racism thwarts a large proportion of black patients from receiving appropriate lung cancer care, resulting in worse outcomes and shorter lifespans than white patients with the disease, according to research presented at the 57th Annual Meeting of The Society of Thoracic Surgeons.

"Many studies have shown that there are disparities between the outcomes of black and white patients, but have done little to elucidate why these disparities are occurring," said Chandler Annesi, a medical student from Boston University School of Medicine in Massachusetts. "As we show in our research, segregation, the resulting devaluation of black communities, and other downstream factors have led to wide disparities in lung cancer outcomes."

For this study, Annesi, Michael Poulson, MD, and colleagues from Boston Medical Center in Massachusetts examined data from 193,369 white and 35,649 black patients who were diagnosed with non-small cell lung cancer (NSCLC) from 2004 to 2016 and living in one of the 100 most populous US counties. This information was obtained from a database of the Surveillance, Epidemiology, and End Results Program and National Cancer Institute.

An important demographic measure that researchers used was the index of dissimilarity (IoD), which establishes the "evenness" with which two groups are distributed across geographic areas. According to Annesi, the IoD helped determine the impact of segregation on stage at presentation, surgical resection, and survival.

"We show that disparities between black and white patients can be explained by the level of segregation of the county in which they live," said Dr. Poulson. "This is likely representative of factors like poverty, access to health care, and social mobility, which particularly affect black individuals in more segregated areas."

The researchers found that with increasing residential segregation, black patients were 30% more likely to be diagnosed with advanced stage NSCLC than white patients. Additionally, black patients had a 47% decreased likelihood of receiving surgery (one of the most common and effective treatments for early stage NSCLC), while white patients had an 18% decreased likelihood with increasing residential segregation.

"This study is a very novel contribution to the literature," said Thomas K. Varghese Jr., MD, MS, from the University of Utah in Salt Lake City, who was not directly involved in this research. "For too long, we've known that irrespective of the disease categories, minorities in general have worse outcomes. They also have more morbidity and more mortality. The outcomes just aren't the same. This particular study is an exploration into the why. Why is this occurring? And, uniquely the authors point out that where you live makes a huge difference in terms of cancer treatment outcomes, and we need to do something about it."

The results also demonstrated that median cancer-specific survival significantly differed between black patients in more segregated areas (10 months) and those in less segregated areas (12 months). The cancer-specific survival for black patients when compared to white patients was 10 months and 13 months, respectively.

"Black patients are more likely to die stage-for-stage when compared to their white counterparts. However, it is important to note that this increased mortality is based on discrimination, not on genetics, as we show in our study," said Dr. Poulson.

The study revealed that residential segregation and, ultimately, discriminatory practices reach into the health care system and impact the outcomes of black patients, but the underlying reasons for these complex and deep-seated lung cancer care disparities still are not fully understood.

According to Annesi, a long history of discriminatory practices have forced black Americans into blighted areas and the effects are still apparent today.

In general, people with lower socioeconomic status face more barriers and systemic-level issues, including poor access to high-quality health care, lack of insurance, limited availability of appropriate facilities, lower screening rates, delays in treatment after diagnosis, and lower treatment adherence.

"All of these factors are related to the discriminatory policies that lead black Americans to be more vulnerable to these conditions," said Annesi.

While many black patients live in urban areas with large hospital systems nearby, insurance coverage can greatly limit their ability to access that care. This is particularly apparent in states that do not have expanded Medicaid, leading to many individuals--who are disproportionately black--going without coverage, explained Annesi. The cost of transportation or lack of work flexibility also may preclude their ability to seek care. Similarly, copays (even small ones) may be burdensome for families that are barely able to afford groceries.

Another important factor is the financial distress that is associated with cancer management, which often prevents adequate care--starting prior to diagnosis, during imaging, and through treatment. The costs of care and the impact of some treatments on employment/disability are especially burdensome to those patients who are socioeconomically disadvantaged.

"Disparities are created and as such can be dismantled," said Annesi. "While it will take time and willingness to reverse discriminatory policies that have led to the disparities that we see today, health care teams can use this information to understand the unique barriers that black patients may face."

Addressing Barriers to Care and Raising Awareness

Importantly, physicians and all members of the health care team must become part of the solution and advocate for their patients at every level (individual, state, and federal). This involves identifying at-risk patients, particularly in "minoritized and marginalized" communities (especially those who are uninsured) and making sure they are prioritized within facilities offering discounted or free care. Also essential is working to make lung cancer screening available and convenient. "Simply catching disease at an earlier stage can vastly improve mortality," said Annesi.

Community cancer centers could help rectify some of the logistical challenges that patients face when they live in areas where access to care and lung screening is limited. However, Annesi explained that the centers would have to provide much of the care that the patients need (i.e., imaging, labs, treatment options) in order to be successful and limit the barriers that patients would face if required to travel elsewhere.

An integrated, multipronged approach is another "extremely important" strategy that may help reduce treatment and outcome gaps between black and white patients with lung cancer, according to Annesi. This type of intervention may include a "warning" system connected to electronic health records that sends alerts about missed appointments or milestones to the health care team. Also part of this strategy would be consistent communication among the various clinical teams, as well as relationships and open lines of communication between trained nurse navigators and patients.

"It is important to realize that race matters, and for patients and families, particularly black individuals, to know that lung cancer is not one's fault," said Annesi. "Years of discrimination have set up the background for these disparities, and it is imperative that hospitals and clinics address the difficulties that some patients too often encounter."

Structural racism is defined as the macrolevel systems, social forces, institutions, ideologies, and processes that interact with one another to generate and reinforce inequities among racial and ethnic groups.

###

For more information, contact Jennifer Bagley, Senior Media Relations Manager, at 312-202-5865 or jbagley@sts.org.

Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,500 cardiothoracic surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society's mission is to advance cardiothoracic surgeons' delivery of the highest quality patient care through collaboration, education, research, and advocacy.

Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children’s Hospitals, 2016-2019

Jennifer R. Marin, MD, MSc^1,2; Jonathan Rodean, MPP³; Matt Hall, PhD³; et alElizabeth R. Alpern, MD, MSCE⁴; Paul L. Aronson, MD, MHS⁵; Pradip P. Chaudhari, MD⁶; Eyal Cohen, MD, MSc⁷; Stephen B. Freedman, MDCM, MSc^8,9; Rustin B. Morse, MD, MMM¹⁰; Alon Peltz, MD, MBA¹¹; Margaret Samuels-Kalow, MD, MPhil, MSHP¹²; Samir S. Shah, MD, MSCE¹³; Harold K. Simon, MD, MBA¹⁴; Mark I. Neuman, MD, MPH¹⁵

Author Affiliations Article Information

JAMA Network Open. 2021;4(1):e2033710. doi:10.1001/jamanetworkopen.2020.33710

editorial comment ico

Key Points

Question  Does the use of diagnostic imaging for children receiving care in US pediatric emergency departments (EDs) differ by race and ethnicity?

Findings  This multicenter cross-sectional study of more than 13 million pediatric ED visits to 44 children’s hospitals demonstrated that non-Hispanic Black and Hispanic patients were less likely to undergo diagnostic imaging compared with non-Hispanic White patients.

Meaning  In these findings, race and ethnicity appear to be independently associated with imaging decisions in the pediatric ED, highlighting the need to better understand and mitigate these disparities.

Abstract

Importance  Diagnostic imaging is frequently performed as part of the emergency department (ED) evaluation of children. Whether imaging patterns differ by race and ethnicity is unknown.

Objective  To evaluate racial and ethnic differences in the performance of common ED imaging studies and to examine patterns across diagnoses.

Design, Setting, and Participants  This cross-sectional study evaluated visits by patients younger than 18 years to 44 US children’s hospital EDs from January 1, 2016, through December 31, 2019.

Exposures  Non-Hispanic Black and Hispanic compared with non-Hispanic White race/ethnicity.

Main Outcomes and Measures  The primary outcome was the proportion of visits for each race/ethnicity group with at least 1 diagnostic imaging study, defined as plain radiography, computed tomography, ultrasonography, and magnetic resonance imaging. The major diagnostic categories classification system was used to examine race/ethnicity differences in imaging rates by diagnoses.

Results  A total of 13 087 522 visits by 6 230 911 children and adolescents (mean [SD] age, 5.8 [5.2] years; 52.7% male) occurred during the study period. Diagnostic imaging was performed during 3 689 163 visits (28.2%). Imaging was performed in 33.5% of visits by non-Hispanic White patients compared with 24.1% of visits by non-Hispanic Black patients (odds ratio [OR], 0.60; 95% CI, 0.60-0.60) and 26.1% of visits by Hispanic patients (OR, 0.66; 95% CI, 0.66-0.67). Adjusting for confounders, visits by non-Hispanic Black (adjusted OR, 0.82; 95% CI, 0.82-0.83) and Hispanic (adjusted OR, 0.87; 95% CI, 0.87-0.87) patients were less likely to include any imaging study compared with visits by non-Hispanic White patients. Limiting the analysis to only visits by nonhospitalized patients, the adjusted OR for imaging was 0.79 (95% CI, 0.79-0.80) for visits by non-Hispanic Black patients and 0.84 (95% CI, 0.84-0.85) for visits by Hispanic patients. Results were consistent in analyses stratified by public and private insurance groups and did not materially differ by diagnostic category.

Conclusions and Relevance  In this study, non-Hispanic Black and Hispanic children were less likely to receive diagnostic imaging during ED visits compared with non-Hispanic White children. Further investigation is needed to understand and mitigate these potential disparities in health care delivery and to evaluate the effect of these differential imaging patterns on patient outcomes.

FULL ARTICLE & PDF

Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children’s Hospitals, 2016-2019 | Emergency Medicine | JAMA Network Open | JAMA Network

Black or Hispanic kids receive less medical imaging than white kids

UNIVERSITY OF PITTSBURGH

Research News

 

IMAGE: ASSOCIATE PROFESSOR OF PEDIATRICS, EMERGENCY MEDICINE AND RADIOLOGY, UNIVERSITY OF PITTSBURGH, AND MEDICAL DIRECTOR OF POINT-OF-CARE ULTRASOUND AT UPMC CHILDREN'S HOSPITAL OF PITTSBURGH. view more 

CREDIT: DAVID WALLACE

PITTSBURGH, Jan. 29, 2021 - A study led by UPMC Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine shows that Black children are 18% less likely to get imaging tests as part of their emergency department visit compared to White children. Hispanic children are 13% less likely to have imaging done than Whites.

The researchers suggest that this disparity results from overuse in White children, though underuse in minority children probably plays a part as well. The root cause likely stems from both patient preferences and implicit bias among providers.

"Something else is going on here that's beyond the clinical, that's beyond the diagnoses," said study lead author Jennifer Marin, M.D., M.Sc., associate professor of pediatrics, emergency medicine and radiology at Pitt, and medical director of point-of-care ultrasound at UPMC Children's Hospital. "Cultural factors that come with people's race, gender, religion, etc., should not be associated with testing when getting that test is clearly not beneficial to the patient and potentially harmful."

The study, published today in JAMA Network Open, used pediatric emergency department billing data from 52 hospitals across 27 states plus the District of Columbia from 2016 to 2019 to measure racial disparities across all types of diagnostic imaging. This is the largest, broadest study of its kind to date.

Even after controlling for confounding factors, such as health insurance, diagnosis and household income, the data showed that doctors were ordering significantly fewer imaging tests for Black and Hispanic children than for White children. The effect was even stronger among patients who weren't admitted to the hospital--suggesting they weren't severely injured or sick.

While the data cannot distinguish between a test that was warranted and a test that wasn't, prior research has shown examples of more frequent imaging in White children compared to other races, with no differences in clinical outcomes. The researchers suspect that the differences they see in testing are largely driven by unnecessary testing among Whites.

That's a concern because some forms of imaging, specifically CT scans and X-rays, expose children to radiation, which likely increases their cancer risk.

"An unnecessary CT at five years old is not the same as an unnecessary CT at 70 years old," Marin said. "If you think of it in terms of lifetime risk, a five-year-old has 80-ish years to go on and develop malignancy, versus a 70-year-old who only has 15 years."

False positives and waste in medical spending also are concerning when tests are being ordered unnecessarily.

"We may get an image and the radiologist may see something--and that something may not be of clinical significance--then the child has to be subjected to downstream testing and monitoring," Marin said. "That's an added burden and stress on the family and added cost on the health care system."

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Additional authors on the study include Jonathan Rodean, M.P.P., and Matt Hall, Ph.D., of Children's Hospital Association; Elizabeth Alpern, M.D., M.S.C.E., of Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine; Paul Aronson, M.D., M.H.S., of Yale School of Medicine; Pradip Chaudhari, M.D., of Children's Hospital Los Angeles and Keck School of Medicine of the USC; Eyal Cohen, M.D., M.Sc., of the Hospital for Sick Children; Stephen Freedman, M.D.C.M., M.Sc., of Alberta Children's Hospital; Rustin Morse, M.D., M.M.M., of Nationwide Children's Hospital; Alon Peltz, M.D., M.B.A., of Harvard Medical School; Margaret Samuels-Kalow, M.D., M.Phil., M.S.H.P., of Massachusetts General Hospital; Samir Shah, M.D., M.S.C.E., of Cincinnati Children's Hospital Medical Center; Harold Simon, M.D., M.B.A., of Emory University School of Medicine; and Mark Neuman, M.D., M.P.H., of Boston Children's Hospital and Harvard Medical School.

Additional Contact:
Andrea Kunicky
Mobile: 412-552-7448
E-mail: KunickyA@upmc.edu

To read this release online or share it, visit http://www.upmc.com/media/news/012921-Marin-Imaging-Racial-Disparities [when embargo lifts].

About UPMC Children's Hospital of Pittsburgh

Regionally, nationally, and globally, UPMC Children's Hospital of Pittsburgh is a leader in the treatment of childhood conditions and diseases, a pioneer in the development of new and improved therapies, and a top educator of the next generation of pediatricians and pediatric subspecialists. With generous community support, UPMC Children's Hospital has fulfilled this mission since its founding in 1890. UPMC Children's is recognized consistently for its clinical, research, educational, and advocacy-related accomplishments, including ranking in the top 10 on the 2020-2021 U.S. News & World Report Honor Roll of America's Best Children's Hospitals. UPMC Children's also ranks 15th among children's hospitals and schools of medicine in funding for pediatric research provided by the National Institutes of Health (FY2019).

About the University of Pittsburgh School of Medicine

As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.

http://www.upmc.com/media

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Researchers illustrate the need for 

anti-racism in kidney care, research

Hopeful for more discussion and honest self-reflection

BOSTON UNIVERSITY SCHOOL OF MEDICINE

Research News

 

(Boston)--There is a growing awareness of systematic inequality and structural racism in American society. Science and medicine are no exception, as evidenced by historical instances of discrimination and overt racism.

In a perspective piece in the Journal of the American Society of Nephrology, researchers from Boston University School of Medicine (BUSM), take an honest look at how the current practice of nephrology (kidney medicine) may have elements rooted in racist ideologies.

For twenty years, kidney function has been estimated based on lab tests and equations that consider black vs. non-black race. Many institutions are now reconsidering whether this practice is defensible, and several have stopped reporting kidney function based on racial identity. The researchers contemplate what other aspects of clinical practice and research may have subtle racist undertones.

Despite the fact that race is now understood as a social rather than biological construct, many examples in nephrology implicitly assume a biological basis for race. Examples include the use of race in estimating the risk for kidney stones in black vs. white individuals, for assessing the suitability of kidneys from black vs. white individuals for transplantation, and in studies of kidney function and physiology. "The practice and teaching of nephrology in graduate and medical school today continues to perpetuate an ideology that is non-scientific, misleading to students and trainees and ultimately, corrosive to society," explains corresponding author Sushrut S. Waikar, MD, the Norman Levinsky professor of medicine at BUSM.

According to Waikar, reporting kidney function separately for "black" and "white" patients is setting the stage for people to accept a biological basis for race. "Kidney function tests are among the most commonly reported tests by laboratories around the world. Tens of thousands of lab reports every day make a distinction between "black" and "white" kidney function. This may influence the way we think about race, leading to subtle and pervasive racism in everyday clinical medicine," he adds.

Waikar and Insa Schmidt, MD, MPH, nephrologists at Boston Medical Center, stress that physicians and scientists have a moral obligation to take a critical look at historical practices that may be rooted in racist ideology, and re-think the appropriate use of race in medicine. "We believe we have an obligation as doctors and researchers to be advocates for social justice and anti-racism. We also have to be honest and call out our own practices when they fall short of this ideal."

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Editor's Note:

I.M.S. has nothing to disclose. S.S.W. reports personal fees from Public Health Advocacy Institute, CVS, Roth Capital Partners, Kantum Pharma, Mallinckrodt, Wolters Kluewer, GE Health Care, GSK, Mass Medical International, Barron and Budd (vs. Fresenius), JNJ, Venbio, Strataca, Takeda, Cerus, Pfizer, Bunch and James, Oxidien, BioMarin, Baim Institute, and grants and personal fees from Allena Pharmaceuticals.

THIRD WORLD USA

COVID-19 pandemic led to decreased school meal access for children in need across Maryland

Despite best efforts to distribute free meals, study notes was a 58 percent drop in number of meals provided to children in need

UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE

Research News

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IMAGE: PHOTO OF DR. ERIN HAGER, STUDY AUTHOR view more 

CREDIT: UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE

School closures during COVID-19 have decreased access to school meals, which is likely to increase the risk for food insecurity among children in Maryland, according to a new report issued by researchers at the University of Maryland School of Medicine (UMSOM). The number of meals served to school-age children during the first three months of the pandemic dropped by 58 percent, compared to the number of free or reduced-price meals served the previous spring. As a result, thousands of children across the state were placed at increased risk of food insecurity, with many likely experiencing the health ramifications associated with the abrupt disruption in their access to regular meals.

"Food insecurity in children is associated with poor child health, low developmental and academic performance, and may co-occur with excess weight gain.," said study leader Erin Hager, PhD, Associate Professor of Pediatrics and Epidemiology & Public Health at UMSOM. "We found that despite the best efforts of food service providers across the state to ensure access to free meals during the pandemic, they were not able to reach every family in need. We need to learn more about what we can do to overcome these access challenges."

Dr. Hager and her colleagues worked with the Maryland State Department of Education (who funded this study), local school systems in the state, and food service providers to evaluate meal distribution during the first three months of the pandemic. During this time, and even now, all meals distributed are free to children under 18 years. They found that certain policies worked well to ensure access to free meals, including temporary waivers issued by Federal and State governments to enable flexibility in policies normally in place to support subsidized meals.

For example, families did not have to prove that their incomes were below a certain level in order to gain access to the meals. They could also pick up multiple meals and multiple days of food for their children during a single excursion.

"Leaders of the school meal programs throughout the state chose to place meal distribution sites in areas where the need was greatest," said Dr. Hager, "which we found to be very helpful for access." The staff who worked at these meal distribution sites reported in surveys and interviews that they were deeply concerned about not reaching enough children in need and worried about children going hungry during the unprecedented school closures.

Financial resources remained a concern for the leaders of the meal program. After examining the financial data, the researchers concluded that, without significant local, state, and federal support, the financial health of these programs will take a major hit during the pandemic, when revenues are greatly reduced and expenses have grown.

"The COVID-19 pandemic has exacerbated the crisis of food insecurity in our nation's children," said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore; the John Z. and Akiko K. Bowers Distinguished Professor; and Dean, University of Maryland School of Medicine. "We need to take a hard look at the lessons learned from this study to determine long-term solutions for providing meals to students when school is regularly not in session, including summer months and holidays."

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About the University of Maryland School of Medicine

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Scientists look to soils to learn how forests affect air quality, climate change

New research shed lights on the complex relationships between tree types, forest soil nutrients and microbes, and impact on environment

INDIANA UNIVERSITY

Research News

 

IMAGE: A MAP OF SAMPLING LOCATIONS ACROSS THE EASTERN UNITED STATES USED IN THE STUDIES. THE GREEN DOT INDICATES MOORES CREEK WHERE AM AND ECM DOMINATED PLOTS ARE LOCATED WHILE THE... view more 

CREDIT: GRAPHIC BY MUSHINSKI, ET AL.

Trees are often heralded as the heroes of environmental mitigation. They remove carbon dioxide from the atmosphere, which slows the pace of climate change, and sequester nutrients such as nitrogen, which improves water and air quality.

Not all tree species, however, perform these services similarly, and some of the strongest impacts that trees have on ecosystems occur below the surface, away from the eyes of observers. This complicates efforts to predict what will happen as tree species shift owing to pests, pathogens, and climate change as well as to predict which species are most beneficial in reforestation efforts.

Additionally, researchers have sought for years to understand how and why forests comprised of different mixtures of tree species differ in their functioning. Because of the large number of species on Earth, it is impractical to study each tree species' unique effects on carbon and nutrient cycling. Recently, there has been a push to classify trees into groups to help predict the consequences of tree species shifts.

Now, researchers at Indiana University -- in collaboration with scientists from West Virginia University, Jet Propulsion Laboratory, the University of Virginia, and the University of Warwick -- have found that classifying temperate forest trees based on the type of symbiotic fungi with which the trees associate can serve as a broad indicator of how the trees and forests function.

Nearly all trees associate exclusively with one of two types of mycorrhizal fungi. These specialized fungi form mutualistic relationships with tree roots--enhancing the tree's ability to obtain nutrients from soil in exchange for carbon from the tree. Because the type of fungi with which a tree often associates reflects and determines how trees function, grouping trees based on their mycorrhizal fungi has been proposed to be a good way to classify trees.

In two studies, published in Global Change Biology and Ecology Letters, the researchers reported that forest stands dominated by trees that associate with arbuscular mycorrhizal (AM) fungi differ from stands dominated by trees that associate with ectomycorrhizal (ECM) fungi in terms of how they store and retain carbon and nitrogen.

In the first study, the authors found that AM-associating trees such as maples, tulip trees, cherry, and ash, which produce fast-cycling detritus, promote soil microbial communities that have more genes capable of processing nitrogen. This leads to the release of nitrogen gases that reduce air quality. In contrast, ECM-associating trees such as oaks, hickories, beech, and hemlock produce slow-cycling detritus that promotes microbial communities with few nitrogen-cycling genes, leading to lower gaseous nitrogen losses.

To understand the link between tree species and the functioning of soil microbes near these trees, the researchers collected soils from 54 plots spread evenly across six forests in the eastern United States. Each site had both AM- and ECM-associating trees. They extracted DNA from the soils in each plot and looked for the abundance of genes critical to nitrogen cycling. They then placed soils in closed chambers in the laboratory to measure how much nitrogen gas is released from the soil and to determine whether this relates to the abundance of nitrogen-cycling genes.

"Regardless of which tree species were present, we found nearly 5-fold more nitrogen cycling potential in the plots dominated by AM trees," said Ryan Mushinski, the lead author of the study. "It's very exciting that the trend is consistent across the eastern United States, indicating we may be able to predict nitrogen-cycle activity, and more importantly the gaseous loss of nitrogen, in other temperate forests around the world."

Mushinski, who conducted the study as a postdoctoral researcher in the Department of Biology and O'Neill School of Public and Environmental Affairs at Indiana University, is continuing this work in his role as an assistant professor at the University of Warwick, U.K.

"Simplifying the complexity of forest soil, and being able to predict the spatial variability of soil emissions of nitrogen gases, was once thought to be an impossible task," said Jonathan Raff, an associate professor and atmospheric chemist in the O'Neill School and co-author of the study. "Some of these gases are very hard to measure," added Raff, whose lab made the measurements, "but these gases are incredibly important for air quality and climate change mitigation."

In the second study, led by Adrienne Keller, who was a Ph.D. student in the IU Department of Biology at the time of the study and now a postdoc at University of Minnesota, researchers found that forests dominated by AM trees enhance soil carbon storage by releasing carbon from their roots. Keller packed mesh cores with root-free soil and inserted the cores in the same 54 forest plots as Mushinski.

Because the soil inside the cores had a unique chemical signature, she was able to separate the carbon released from roots from the carbon already present in the soil. Keller found that roots of AM trees release more carbon to soil than the roots of ECM trees and that much of the root carbon sticks to the surface of soil minerals where it is protected from microbial decay. This means that root carbon may persist for decades or longer, especially in AM-dominated stands.

"It's challenging to measure how much carbon plants shuttle from their roots to the soil," Keller offered. "Here we were able to not only quantify the amount of root carbon sequestered in the soil, but also show that its magnitude rivals that of aboveground plant inputs."

"There's been a shift in our thinking over the past decade about what controls soil carbon storage," said Richard Phillips, professor of biology in the IU Department of Biology and co-author on both studies. "We used to think that slow decaying leaf detritus was the main driver of soil carbon storage, but we now know that fast-decaying compounds released by roots may be what causes soil carbon to persist." Phillips added.

While more work is needed to explore the generality of these patterns beyond eastern forests of the United States, the two studies indicate that as species come and go in our forests, the ecosystem consequences are likely to be difficult to predict. While AM trees may increase nitrogen-cycling rates--with negative consequences for things like air quality--they may also increase soil carbon storage which can, in turn, slow climate change. Given the number of initiatives to plant trees globally as part of global reforestation efforts (mostly to slow climate change), land managers would be wise to consider what's happening in the soils, where roots and soil microbes are carrying out critical but underappreciated ecosystem functions.

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Funding for the studies was provided by the U.S. Department of Agriculture (Agriculture and Food Research Initiative, National Institute of Food and Agriculture), the U.S. Department of Energy (Office of Biological and Environmental Research, Environmental System Science Program and Terrestrial Ecosystem Science Program), and the Smithsonian Center for Tropical Forest Science, ForestGEO Program.