Stepping-down asthma medication may reduce costs without worsening health out

Study suggests that many clinicians may be prescribing higher levels of treatment than is clinically indicated

PLOS

 

International guidelines for asthma treatment recommend clinicians find the minimum effective dose that can control symptoms, yet asthma patients are increasingly prescribed high doses of medication. A study published in PLOS Medicine by Dr. Chloe Bloom at Imperial College London, United Kingdom and colleagues found that stepping-down medication doses did not increase asthma exacerbations and could significantly reduce medication costs.

Over 5.4 million people receive asthma treatment in the UK and asthma medication comprises 13% of total primary care prescribing costs. Additionally, prolonged use and higher doses of asthma medications are associated with a higher risk for systemic adverse effects and high medication costs. To understand the symptoms, diagnoses, and prescription patterns, the researchers conducted a population-based observational study, accessing primary care electronic health records of 508,459 asthma patients treated in the UK between 2001-2017. Using clinical asthma codes, researchers then evaluated a cohort of regular asthma preventer users, analyzing changes in prescribed asthma medications and subsequent health outcomes for 31,379 patients who were stepped down in their asthma medicine prescriptions. The cost impact of medication step-down was then calculated for the cohort using 2019 drug costs.

Inhaled corticosteroids (ICS) are the second most prescribed medication, suggesting the potential to reduce costs considerably with appropriate stepping-down among asthma patients. Additionally, stepping-down just half of all suitable patients on long-acting β agonist (LABA) medication could save around £17 million, equivalent to 2% of the UK's asthma budget. This research is only the second real-world study to compare stepped-down patients to controls and one of the major strengths is inclusion of a nationally representative study population and large sample size. However, the researchers were limited in their ability to track which prescribed medications were dispensed and adhered to, a question that may be important for future studies.

According to the authors, "Although stepping-down of treatment is recommended by clinical guidelines, we found that it happened infrequently. Stepping down ICS or add-on therapy did not appear to worsen health outcomes but did appear to result in significant cost savings."

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Research Article

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003145

Funding: The authors received no specific funding for this work.

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests. CIB reports financial support outside the submitted work from Asthma UK, Chiesi, and AstraZeneca. AS reports that his institution received research support from Asthma UK for the Asthma UK Centre for Applied Research, outside the submitted work. AS is a member of the Editorial Board of PLOS Medicine. JKQ reports grants from MRC, GSK, BLF, Asthma UK, The Health Foundation, IQVIA, AstraZeneca, Chiesi, BI, Bayer; personal fees from AZ, Chiesi, BI, Bayer, and TEVA, outside the submitted work. LDP declares no competing interests associated with this manuscript.

Citation: Bloom CI, de Preux L, Sheikh A, Quint JK (2020) Health and cost impact of stepping down asthma medication for UK patients, 2001-2017: A population-based observational study. PLoS Med 17(7): e1003145. https://doi.org/10.1371/journal.pmed.1003145

Author Affiliations: Imperial College London, UK; University of Edinburgh, UK

Global warming boosts heat-related cardiovascular hospitalizations, study finds

PLOS

 

The impact of high temperatures on hospitalizations due to cardiovascular diseases has increased over the past two decades in Queensland, Australia, according to a new study published this week in PLOS Medicine by Shanshan Li and Yuming Guo of Monash University, Australia, and colleagues.

Extreme temperatures--both cold and hot--are known risk factors for cardiovascular morbidity and mortality. Global climate change is increasing the duration and intensity of such extreme temperatures. Previous studies have found a decrease in the association between hot temperatures and cardiovascular deaths, suggesting that people may have adapted to the warming climate. In the new study, researchers used data on 1,855,717 cardiovascular hospitalizations in Queensland, Australia between 1995 and 2016 to study the association between temperature and hospitalizations.

Between 1995 and 2016, the daily mean temperature in Queensland increased from 20.9°C to 21.7°C and the annual number of cardiovascular hospitalizations increased from 46,730 to 123,477. In all ages, sexes and climate zones, the relative risk of cardiovascular hospitalizations associated with high temperatures increased over time but the impact of cold temperatures decreased over time. The increasing magnitude of heat impacts was larger in men than in women (p=0.002) and larger in people aged less than 70 years compared to people aged 70 years and over (p<0 .001="" p="">

"Given the increased associations between hot temperatures and cardiovascular hospitalization and the acceleration of global warming, we highlight a worrying trend that the burden of cardiovascular healthcare facilities is to increase over time on high temperature days," the authors say.

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Research Article

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003104

Funding: The study was supported by Taishan Scholar Program. YG was supported by a Career Development Fellowship of the Australian National Health and Medical Research Council (#APP1107107 & #APP1163693). SL was supported by an Early Career Fellowship of Australian National Health and Medical Research Council (#APP1109193).

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: YG is a member of the Editorial Board of PLOS Medicine.

Citation: Lu P, Xia G, Zhao Q, Xu R, Li S, Guo Y (2020) Temporal trends of the association between ambient temperature and hospitalisations for cardiovascular diseases in Queensland, Australia from 1995 to 2016: A time-stratified case-crossover study. PLoS Med 17(7): e1003176. https://doi.org/10.1371/journal.pmed.1003176

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Cinnamon may improve blood sugar control in people with prediabetes

THE ENDOCRINE SOCIETY

 WASHINGTON--Cinnamon improves blood sugar control in people with prediabetes and could slow the progression to type 2 diabetes, according to a new study published in the Journal of the Endocrine Society.

It is estimated that nearly 90 million people in the United States have prediabetes, which occurs when blood sugar levels are higher than normal and often leads to type 2 diabetes. Identifying strategies to prevent the progression from prediabetes to type 2 diabetes is challenging, yet important for a large population.

"Our 12-week study showed beneficial effects of adding cinnamon to the diet on keeping blood sugar levels stable in participants with prediabetes," said the study's corresponding author, Giulio R. Romeo, M.D., of Joslin Diabetes Center in Boston, Mass. "These findings provide the rationale for longer and larger studies to address if cinnamon can reduce the risk of developing type 2 diabetes over time."

The randomized clinical trial investigated the effects of cinnamon supplementation in 51 participants with prediabetes. Participants were given a 500 mg cinnamon capsule or placebo three times a day for 12 weeks. The researchers found that cinnamon supplements lowered abnormal fasting glucose levels and improved the body's response to eating a meal with carbohydrates, which are hallmarks of prediabetes. Cinnamon was well tolerated and was not associated with specific side effects or adverse events.

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Other authors include Junhee Lee of the Kyung Hee University in Seoul, South Korea; Christopher M. Mulla of Joslin Diabetes Center and the Landstuhl Regional Medical Center in Landstuhl, Germany; Youngmin Noh of Joslin Diabetes Center and the Kyung Hee University; Casey Holden of Joslin Diabetes Center; and Byung-Cheol Lee of the Kyung Hee University.

The study was supported by the Ministry of Health and Welfare in South Korea.

The manuscript, "Influence of Cinnamon on Glycemic Control in Subjects with Prediabetes: A Randomized Controlled Trial," was published online.

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers.

The Endocrine Society is the world's oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at?http://www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

Asteroid shower on the Earth-Moon system 800 million years ago revealed by lunar craters

OSAKA UNIVERSITY

 

IMAGE: AN ASTEROID SHOWER ON THE EARTH-MOON SYSTEM view more 

CREDIT: ARTIST'S ILLUSTRATION, CREDIT: MURAYAMA/OSAKA UNIV.

A research team led by Osaka University investigated the formation ages of 59 lunar craters with a diameter of approximately 20 km using the Terrain Camera (TC) onboard the lunar orbiter spacecraft Kaguya.

Kaguya (formerly SELENE, for SELenological and ENgineering Explorer), is a Japanese Space Agency (JAXA) lunar orbiter mission.

This group demonstrated that an asteroid of 100 km in diameter was disrupted 800 million years ago (800 Ma) and that at least (4-5)×1016 kg of meteoroids, approximately 30-60 times more than the Chicxulub impact, must have plunged into the Earth-Moon system. Their research results were published in Nature Communications.

Since a thin layer of iridium (Ir) enrichment (a rare earth element) 65.5 Ma had been detected worldwide, it is thought that an asteroid of 10-15 km in diameter hit the Earth and caused or greatly contributed to the Cretaceous mass extinction.

The probability of an asteroid of this size striking Earth is thought to be once in 100 million years. It is known that impact craters on Earth created before 600 Ma have been erased over the years by erosion, volcanism, and other geologic processes. Thus, to find out about ancient meteoroid impacts on Earth, they investigated the Moon, which has almost no erosion.

They investigated the formation age distribution of 59 large craters with diameters larger than approximately 20 km by examining the density of 0.1-1 km-diameter craters in the ejecta of these 59 craters. One of these examples is the Copernicus crater (93 km in diameter) and its surrounding craters (Figure 2). The density of 860 craters with diameter of 0.1-1 km (shown in green) was examined to derive the age of the Copernicus crater. As a result, 8 of 59 craters were found to be formed simultaneously (17 by a spike model), a world first. (Figure 3)

Considering crater scaling laws and collision probabilities with the Earth and Moon, at least (4-5)×1016 kg of meteoroids, approximately 30-60 times more than the Chicxulub impact, must have struck the Earth immediately before the Cryogenian (720-635 Ma), which was an era of great environmental and biological changes.

In addition, given the disruption age and orbit elements of existing asteroid families, it is highly likely that the disruption of the parent body of C-type asteroid Eulalia caused an asteroid shower. A C-type asteroid is a class expected to contain carbon in analogy to the carbonaceous chondrites (meteorites).

Because Eulalia's surface reflectance is similar to that of near-Earth C-type asteroid Ryugu, Eulalia has drawn attention as a parent body of a C-type Rubble pile, a celestial body consisting of numerous pieces of rock near the Earth. (Sugita et al. 2019)

Ryugu was probed by the asteroid explorer Hayabusa2, an asteroid sample-return mission operated by JAXA.

From these considerations, they concluded that sporadic meteorite bombardment due to the disruption of asteroids 800 Ma caused the following:

-Some of the resulting fragments fell on terrestrial planets and the Sun,
-Others stayed in an asteroid belt as the Eulalia family, and
-Remnants had orbital evolution as a member of near-Earth asteroids.

This research suggests the following possibilities:

1. An asteroid shower may have brought a large amount of phosphorus (P) to the Earth, affecting the terrestrial surface environment,
2. A recent C-type asteroid shower may have contaminated the lunar surface with volatile elements,
3. The Eulalia family, the parent body of a near-Earth C-type asteroid, may have brought an asteroid shower to the Earth and the Moon.

Lead author Professor Terada says, "Our research results have provided a novel perspective on earth science and planetary science. They will yield a wide range of positive effects in various research fields."

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The article, "Asteroid shower on the Earth-Moon system immediately before the Cryogenian period revealed by KAGUYA" was published in Nature Communications at DOI: https://doi.org/10.1038/s41467-020-17115-6

About Osaka University

Osaka University was founded in 1931 as one of the seven imperial universities of Japan and is now one of Japan's leading comprehensive universities with a broad disciplinary spectrum. This strength is coupled with a singular drive for innovation that extends throughout the scientific process, from fundamental research to the creation of applied technology with positive economic impacts. Its commitment to innovation has been recognized in Japan and around the world, being named Japan's most innovative university in 2015 (Reuters 2015 Top 100) and one of the most innovative institutions in the world in 2017 (Innovative Universities and the Nature Index Innovation 2017). Now, Osaka University is leveraging its role as a Designated National University Corporation selected by the Ministry of Education, Culture, Sports, Science and Technology to contribute to innovation for human welfare, sustainable development of society, and social transformation.

Website: https://resou.osaka-u.ac.jp/en/top

Combining handwashing, mask-wearing and social distancing best in preventing COVID-19

PLOS

 

Both self-imposed prevention measures such as hand-washing, mask-wearing and social distancing, as well as government-imposed social distancing can help mitigate and delay a COVID-19 epidemic, according to a new study published this week in PLOS Medicine by Alexandra Teslya of University Medical Center Utrecht, Utrecht, The Netherlands and colleagues.

The coronavirus disease COVID-19 has spread to nearly every country in the world and public health policymakers are seeking recommendations on how to delay or flatten its peak. In the new study, researchers developed a computational model of the spread of COVID-19 based on known information about the epidemiology of the disease. They used the model to study the predicted effect of various prevention measures on the number and timing of coronavirus cases.

If a population quickly becomes aware of the coronavirus and effective prevention measures, self-imposed prevention measures can both diminish and postpone the peak number of cases, the model showed. If the efficacy of the self-imposed measures exceeds 50%, a large epidemic can be prevented. If self-imposed prevention measures are slow to catch on, however, they may only reduce the number of cases but not delay a peak. Early implementation of government-imposed social distancing, however, was found to delay but not reduce the peak of the COVID-19 epidemic. Combining self-imposed prevention measures--particularly if adopted quickly and by a large portion of the population--with government-imposed social distancing has the potential to both delay and shrink the peak of the epidemic. The model did not account for demographics or heterogeneity in contact patterns of different people.

"We stress the importance of disease awareness in controlling the ongoing epidemic and recommend that, in addition to policies on social distancing, government and public health institutions mobilize people to adopt self-imposed measures with proven efficacy in order to successfully tackle COVID-19," the authors say.

In an accompanying Perspective, Professor Yuming Guo of Monash University, Australia, and colleagues write that the new findings are important not only in minimizing initial outbreaks of COVID-19, but in strategies to prevent second epidemics. Improving awareness of self-imposed interventions is critical to prevent wide-spreading epidemics, particularly among ethnic minorities and elderly populations who are at risk. "Many of the self-imposed prevention strategies have very limited impact on the economy but contribute very significantly to epidemic control and are likely to play a very substantial role in control," they write.

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Research Article

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003104

Funding: This study was funded by the following: Fundação para a Ciência e a Tecnologia, project reference 131_596787873, awarded to GR, https://www.fct.pt; ZonMw 91216062, awarded to MEK, funded MEK and AT, https://www.zonmw.nl/en/; One Health European Joint Programme Horizon 2020 project 773830 (award recipient is not an author of this manuscript) funded NGG and MCJB, https://ec.europa.eu/programmes/horizon2020/en; and Aidsfonds Netherlands project P-29704 (award recipient is not an author of this manuscript) funded GR, https://aidsfonds.nl/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: MEK is a member of the Editorial Board of PLOS Medicine. The other authors have declared that no competing interests exist.

Citation: Teslya A, Pham TM, Godijk NG, Kretzschmar ME, Bootsma MCJ, Rozhnova G (2020) Impact of self-imposed prevention measures and short-term government-imposed social distancing on mitigating and delaying a COVID-19 epidemic: A modelling study. PLoS Med 17(7): e1003166. https://doi.org/10.1371/journal.pmed.1003166

Author Affiliations: University Medical Center Utrecht, Utrecht, the Netherlands

Perspective

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003240

Funding: The work is supported by the Bill & Melinda Gates Foundation. LZ is supported by the National Natural Science Foundation of China (Grant number: 8191101420); Outstanding Young Scholars Funding (Grant number: 3111500001); Xi'an Jiaotong University Basic Research and Profession Grant (Grant number: xtr022019003) and Xi'an Jiaotong University Young Talent Support Grant (Grant number: YX6J004). YG is supported by Career Development Fellowships of the Australian National Health and Medical Research Council (Grant number: APP1163693).

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: YG is a member of the Editorial Board of PLOS Medicine.

Citation: Zhang L, Tao Y, Shen M, Fairley CK, Guo Y (2020) Can self-imposed prevention measures mitigate the COVID-19 epidemic? PLoS Med 17(7): e1003240. https://doi.org/10.1371/journal.pmed.1003240

Author Affiliations: Monash University; Zhengzhou University, Zhengzhou, Henan, China; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, PR China

WHITE FOLKS WITH GUNS ON DRUGS

Rural firearm-suicides impacted by socioeconomic, environmental factors

Targeting areas with high opioid and firearm use may be a better strategy for prevention

BOSTON UNIVERSITY SCHOOL OF MEDICINE

(Boston)--In an attempt to address the escalating rate of self-inflicted firearm injury deaths in rural America, researchers are proposing interventions to reduce these suicides be community-based and include programs to reduce other diseases of despair, such as heart and liver diseases, diabetes and accidental opioid overdose. The recent decline in life expectancy of Americans has been attributed to these diseases of despair and appear to primarily afflict white rural America.

Given the gaps in understanding the socioeconomic and environmental factors related to firearm suicide deaths, researchers from Boston University School of Medicine (BUSM) sought to understand the patterns and clustering of rural counties in the U.S. based on firearm suicide and drug-related death rates in the context of economic and socioeconomic characteristics.

The researchers examined rural county-specific data from 2012 to 2016 of firearm suicide deaths, homicide rate, drug related mortality rate, opioid prescription rate, median home price, veteran population, violent crime rate, primary economic dependence of counties, county socioeconomic characteristics such as low employment, persistent poverty, population loss and whether the county is a retirement destination.

"Our findings suggest that the affected rural populations are very diverse and there are collective environmental risk factors, including the primary economies that play an important role in firearm suicide rates. Hence, focusing on actions related to firearms alone without considering the built environment may not reduce these deaths," explained corresponding author Bindu Kalesan, PhD, MPH, assistant professor of medicine at BUSM.

The study has important policy and prevention implications, researchers say. "While most programs focus on risk factors, including the temporary removal of firearms from home, safe storage and denying sale of firearms, we need to incorporate other factors such as primary economies, using a broader public health approach to target interventions in high-risk areas which can simultaneously reduce gun suicides and opioid deaths," added Kalesan, who also is an assistant professor of community health services at Boston University School of Public Health.

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These findings appear online in the Journal of Surgical Research.

Racial discrimination may adversely impact cognition in African Americans

BOSTON UNIVERSITY SCHOOL OF MEDICINE

(Boston)--Experiences of racism are associated with lower subjective cognitive function (SCF) among African-American women.

Rates of incident dementia and Alzheimer's Disease (AD) are higher in African Americans than in white Americans. In many studies, older African Americans perform more poorly on neuropsychological cognition tests compared to white Americans. Experiences of racism are common among African Americans, with 50 percent or more respondents to a 2017 national survey reporting such experiences. These institutional and daily forms of racism have been associated with increased risks of various conditions that can impair cognition, including depression, poor sleep, type 2 diabetes and hypertension.

Using data from the Black Women's Health Study (a prospective cohort study established in 1995, when 59,000 black women aged 21 through 69 years enrolled by completing health questionnaires) researchers from Boston University's Slone Epidemiology Center quantified the association between experiences of racism and SCF, based on six questions about memory and cognition.

They found that experiences of both daily and institutional racism were associated with decreased SCF. Women reporting the highest level of daily racism had 2.75 times the risk of poor SCF as women reporting the lowest level of daily racism. Women in the highest category of institutional racism had 2.66 times the risk of poor SCF as those who reported no such experiences.

"Our findings of a positive association of experiences of racism with poorer subjective cognitive function are consistent with previous work demonstrating that higher perceived psychological stress is associated with greater subjective memory decline," explains senior author Lynn Rosenberg, ScD, epidemiologist at the Slone Epidemiology Center at Boston University and a principal investigator of the Black Women's Health Study. "Our work suggests that the chronic stress associated with racial discrimination may contribute to racial disparities in cognition and AD," added Rosenberg, who is also a professor of epidemiology at Boston University School of Public Health.

Future work is needed to examine whether exposure to institutional and daily racism accelerates conversion to Alzheimer's dementia and/or increases levels of AD biomarkers, such as cerebrospinal fluid or PET markers of amyloid ? and tau pathology, according to the researchers.

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These findings appear online in the journal Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring.

This study was supported in part by the National Cancer Institute grants R01CA058420 and UM1CA164974, the National Institute on Aging grant R21AG060269 and Alzheimer's Association grant AARG-17-529566.

POST MODERN ALCHEMY

Lithium ion battery waste used in biodiesel production from discarded vegetable oil

Using mixtures of metal hydroxides as a catalyst provides way to make cleaner fuel in minutes at room temperature

AMERICAN INSTITUTE OF PHYSICS

 

IMAGE: THE TWO-PHASE SYSTEM CONTAINING BIODIESEL (UPPER PHASE) AND GLYCEROL (LOWER PHASE) view more 

CREDIT: GILBERTO MAIA DE BRITO

WASHINGTON, July 21, 2020 -- The production of biodiesel from vegetable oil has been around for more than 150 years, and the approach significantly reduces several pollutants associated with burning fossil fuels. Vegetable oils, however, can be notoriously difficult to use in an engine, providing low power output and release of unique toxic byproducts.

Brazilian researchers demonstrated a new chemical approach for producing biodiesel from domestic cooking oil waste by using hydroxide lithium mixed with either sodium hydroxides or potassium hydroxides as catalysts. Their work, published in the Journal of Renewable and Sustainable Energy, by AIP Publishing, could enable future studies related to the use of lithium from waste lithium ion batteries.

The work marks one of the first times lithium has been used for such purposes. Author Gilberto Maia de Brito said green engineering can yield solutions for a variety of problems at the same time.

"The results achieved in this work will make it possible to expand the use of new types of metallic catalysts to a higher level, such as lithium, applied to the production of biodiesel," he said. "Before, in practice, these were just restricted to sodium hydroxide and potassium hydroxide."

The group's technique draws on one proposed solution for creating biodiesel, called transesterification, which can yield fuel in a matter of minutes at room temperature.

The researchers collected waste cooking oil samples from fast food restaurants and homes, some of the biggest sources of waste disposed of inappropriately, and lithium hydroxide from lithium ion battery waste.

When catalyzed by the mixture of metal hydroxides, the transesterification reaction split the cooking oil into a biodiesel layer and a layer of glycerol, which itself can be used in a variety of ways such as producing food sweeteners, alleviating certain skin conditions and acting as a main reactant in making antifreeze.

With the right proportions of catalysts, the group was able to produce biodiesel with an average yield of 90%. They analyzed the biodiesel, using techniques ranging from infrared spectroscopy to chromatography to nuclear magnetic resonance studies, to assess the purity of their fuel.

"We were surprised that what came out was not only some results, but actually very good results related to the yield production," Maia de Brito said. "The fast phase separation and the main chemistry and physics properties of that biodiesel produced from lithium were also surprising."

Maia de Brito hopes to continue finding new ways to recover lithium from waste and use it to facilitate biofuel production even further.

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The article, "Eco-green biodiesel production from domestic waste cooking oil by transesterification using LiOH into basic catalysts mixtures," is authored by Gilberto Maia Brito, Mariana Borsoi Chicon, Edumar Ramos Coelho, Diêgo Nunes Faria and Jair Checon de Freitas. The article will appear in Journal of Renewable and Sustainable Energy on July 21, 2020 (DOI: 10.1063/5.0005625). After that date, it can be accessed at https://aip.scitation.org/doi/10.1063/5.0005625.

ABOUT THE JOURNAL

Journal of Renewable and Sustainable Energy is an interdisciplinary journal that publishes across all areas of renewable and sustainable energy relevant to the physical science and engineering communities. Topics covered include solar, wind, biofuels and more, as well as renewable energy integration, energy meteorology and climatology, and renewable resourcing and forecasting. See https://aip.scitation.org/journal/rse.

How adding green tea extract to prepared foods may reduce the risk for norovirus

In study, edible coating made with tea extract killed the virus and bacteria

OHIO STATE UNIVERSITY

COLUMBUS, Ohio - Infusing prepared foods with an edible coating that contains green tea extract may lower consumers' chances of catching the highly contagious norovirus by eating contaminated food, new research suggests.

Norovirus, which causes vomiting and diarrhea, sickens an estimated 48 million people in the United States every year and causes about 3,000 deaths. It's transmitted from person to person and through consumption of contaminated water and food.

Lots of things we consume contain what are known in the industry as edible films: They can enhance appearance, like wax that makes apples shiny; hold contents together, like plastic drug capsules; and prevent contents from seeping together by, for example, being placed between a prepared pie crust and the filling.

"In many cases, an edible film is in a product, but you are not aware of it," said Melvin Pascall, professor of food science and technology at The Ohio State University and senior study author. "We don't have to put that on the label since the material is edible. That's another way in which we use packaging - and the consumer doesn't have to know."

Some edible films are also enriched with antimicrobial agents that can kill or slow the growth of organisms that cause illness, such as E. coli and mold.

In this new study led by Pascall, adding green tea extract to a film-forming substance created a safe-to-eat barrier that killed norovirus as well as two types of bacteria.

While most antimicrobial packaging advances to date have emphasized fighting bacteria, this finding holds promise for a newer area of research into the concept of using edible film to kill a virus, Pascall said.

"Norovirus is a tough virus to work with - it is a non-enveloped virus, which is the type more resistant to sanitizers and antimicrobial agents," he said. "However, because it has public health concerns and has been implicated in a number of foodborne outbreaks, we wanted to look at the effects of green tea extract on norovirus."

The study is published in the International Journal of Food Science.

Pascall and his team created the films with a base substance called chitosan, a sugar found in the exoskeleton of shellfish. Chitosan is marketed as a weight-loss supplement and used in agricultural and medicinal applications, and has been studied extensively as a safe and readily available compound for edible film development.

Previous studies have suggested that chitosan has antimicrobial properties. But norovirus might exceed its bug-fighting abilities: In this study, the researchers found that chitosan by itself did not kill the virus.

To test the effects of green tea extract, the researchers dissolved it alone in water and added it to a chitosan-based liquid solution and dried film. Several different concentrations of the extract showed effectiveness against norovirus cells, with the highest level tested in this study killing them all in a day.

"We had tested the chitosan by itself and it didn't show much antimicrobial activity against the virus," Pascall said. "But when we added the green tea extract to chitosan, we saw that the film had antiviral properties - so we concluded the antiviral properties were coming from the green tea extract."

The scientists introduced at least 1 million virus cells to the solution and dried films. Those containing green tea extract lowered the presence of virus cells within three hours. The films with the highest concentration of green tea extract reduced norovirus to undetectable levels by 24 hours after the exposure.

Though norovirus was the focus of this work, the researchers also found that green tea extract lowered E. coli K12 and listeria innocua, surrogates for bacteria that also cause foodborne illness, to undetectable levels within 24 hours.

This study didn't identify how the killing happens - typically an antimicrobial agent disables organisms in ways that cause them to die or render them unable to reproduce. The researchers used mouse norovirus cells because human norovirus cells don't grow well in a lab setting.

There is still a lot of work to do before green tea extract-infused films are ready to enter the market. A tricky part of adding natural substances to edible packaging is ensuring that enough is used to deliver the microbe-killing effect without changing the taste or smell of the food.

"A higher concentration of a natural antimicrobial might cause a large drop in the target organism, but at the same time it defeats the purpose of the food by adding an objectionable taste or odor," Pascall said. "There is also the impact of the natural compound on the material itself - it may cause the film to become too brittle or sticky. These are things food scientists have to consider when using antimicrobial agents, especially those from natural sources."

It's also too soon to tell which kinds of food would be the best candidates for antiviral edible films made with green tea extract. It depends on whether the food would be exposed to heat, moisture or acidic conditions, for example. There is also a chance another natural substance could do an even better job - Pascall is conducting similar studies with other extracts.

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Co-authors Collins Amankwaah and Jaesung Lee of the Department of Food Science and Technology and Jianrong Li of the Department of Veterinary Biosciences, all at Ohio State, also worked on the study.

Front-line physicians stressed and anxious at work and home

New study reports moderate to severe stress levels in ER doctors during the frenetic early phase of COVID-19 pandemic

UNIVERSITY OF CALIFORNIA - SAN FRANCISCO

Amid the COVID-19 chaos in many hospitals, emergency medicine physicians in seven cities around the country experienced rising levels of anxiety and emotional exhaustion, regardless of the intensity of the local surge, according to a new analysis led by UC San Francisco.

In the first known study to assess stress levels of U.S. physicians during the coronavirus pandemic, doctors reported moderate to severe levels of anxiety at both work and home, including worry about exposing relatives and friends to the virus. Among the 426 emergency physicians surveyed, most reported changes in behavior toward family and friends, especially decreased signs of affection.

"Occupational exposure has changed the vast majority of physicians' behavior at both work and home," said lead author Robert M. Rodriguez, MD, a professor of Emergency Medicine at UCSF. "At home, doctors are worried about exposing family members or roommates, possibly needing to self-quarantine, and the effects of excess social isolation because of their work on the front line."

The results, which appear July 21, 2020, in Academic Emergency Medicine, found slight differences between men and women, with women reporting higher stress. Among male physicians, the median reported effect of the pandemic on both work and home stress levels was 5 on a scale of 1 to 7 (1=not at all, 4=somewhat, and 7=extremely). For women, the median was 6 in both areas. Both men and women also reported that levels of emotional exhaustion or burnout increased from a pre-pandemic median of 3 to a median of 4 after the pandemic started.

Lack of PPE was associated with the highest level of concern and was also the measure most often cited that would provide greatest relief. The doctors also voiced anxiety about inadequate rapid diagnostic testing, the risk of community spread by discharged patients, and the well-being of coworkers diagnosed with COVID-19.

But the survey also showed clear-cut ways of mitigating anxiety:

• Improve access to PPE;
• Increase availability of rapid turnaround testing;
• Clearly communicate COVID-19 protocol changes;
• Assure access to self-testing and personal leave for front line providers.

The responses came from faculty (55 percent), fellows (4.5 percent), and residents (about 39 percent), with a median age of 35. Most physicians lived with a partner (72 percent), while some lived alone (nearly 15 percent) or with roommates (11 percent). Nearly 39 percent had a child under age 18.

The study involved healthcare providers at seven academic emergency departments and affiliated institutions in California, Louisiana and New Jersey. Researchers noted that the majority of study sites were in California, which at the time of the survey had not yet experienced the large surges of patients seen in other areas of the country. But the study found that median levels of anxiety in the California sites were similar to those in the New Orleans and Camden sites, which were experiencing surges at the time.

"This suggests that the impact of COVID-19 on anxiety levels is pervasive and that measures to mitigate stress should be enacted universally," Rodriguez said. "Some of our findings may be intuitive, but this research provides a critical early template for the design and implementation of interventions that will address the mental health needs of emergency physicians in the COVID-19 pandemic era."

The study is longitudinal, with this first phase focused on the early "acceleration" phase of the pandemic. Subsequent studies will address stressors that have arisen throughout the course of the pandemic, including childcare and homeschooling demands, the economic impact of fewer patients overall in the ER, and possible development of long-term post-traumatic stress.

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Authors: From the University of California, co-authors are Anthony Medak, MD, of UC San Diego; Brian Chinnock, MD, of the UCSF-Fresno Medical Education Program; Remi Frazier, MS, of UCSF; and Richelle Cooper, MD, of UCLA.

Financial Support: None.

Disclosures: All the authors report no conflict of interest.

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