Drug linked to 45% lower risk of dying among COVID-19 patients on ventilators

Patients who received single intravenous dose of tocilizumab were also more likely to leave the hospital or be off ventilator within a month, despite double the risk of additional infection

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

 

IMAGE: THIS GRAPH SHOWS THE OUTCOMES OVER TIME FOR THE COVID-19 PATIENTS ON VENTILATORS TREATED WITH AND WITHOUT TOCILIZUMAB AT MICHIGAN MEDICINE, THE UNIVERSITY OF MICHIGAN'S ACADEMIC MEDICAL CENTER. THE... view more 

CREDIT: UNIVERSITY OF MICHIGAN/CLINICAL INFECTIOUS DISEASES

Critically ill COVID-19 patients who received a single dose of a drug that calms an overreacting immune system were 45% less likely to die overall, and more likely to be out of the hospital or off a ventilator one month after treatment, compared with those who didn't receive the drug, according to a new study by a team from the University of Michigan.

The lower risk of death in patients who received intravenous tocilizumab happened despite the fact that they were also twice as likely to develop an additional infection, on top of the novel coronavirus.

The study is published in the peer-reviewed journal Clinical Infectious Diseases after being available as a preprint last month.

It suggests a benefit from timely and targeted efforts to calm the "cytokine storm" caused by the immune system's overreaction to the coronavirus. Tocilizumab, originally designed for rheumatoid arthritis, has already been used to calm such storms in patients receiving advanced immunotherapy treatment for cancer.

The researchers base their conclusions on a thorough look back at data from 154 critically ill patients treated at Michigan Medicine, U-M's academic medical center, during the first six weeks of the pandemic's arrival in Michigan from early March to late April. The analysis looked at patients' records through late May.

During that time, when little was known about what would help COVID-19 patients on ventilators, about half of the studied patients received tocilizumab and half did not. Most received it within the 24-hour period surrounding their intubation.

This created a natural opportunity for comparing the two groups' outcomes in an observational study, though clinical trials are still needed to truly see if the drug provides a benefit, the authors say.

Promising result

Lead author Emily Somers, Ph.D., Sc.M., an epidemiologist who has studied both rheumatologic and immunologic diseases, says the research team went into their analysis uncertain whether they would find a benefit, a risk, or no clear effect associated with tocilizumab in the patients with life-threatening COVID-19. But they knew it was a critically important question that they were uniquely positioned to answer at that point in the pandemic.

"One role of epidemiology is to rigorously evaluate real-world data on treatment effects, especially when evidence from clinical trials is not available. We kept trying to prove ourselves wrong as signals of benefit emerged in the data, both because of the immediate implications of these data, and in part because of concern about the supply of the medication for other patients," she says. "But the difference in mortality despite the increase in secondary infection is quite pronounced, even after accounting for many other factors."

Somers is an associate professor in the U-M Medical School's Department of Internal Medicine and member of the U-M Institute for Healthcare Policy and Innovation. She co-leads the COVID-19 Rapid Response Registry, which is supported by the Michigan Institute for Clinical and Health Research.

The paper's co-first author is Gregory Eschenauer, Pharm.D., a clinical pharmacist at Michigan Medicine and clinical associate professor at the U-M College of Pharmacy. He and senior author Jason Pogue, Pharm.D., are members of the Michigan Medicine Antimicrobial Stewardship Program.

The ASP group developed treatment guidelines provided to Michigan Medicine physicians in mid-March that identified tocilizumab as a potentially beneficial therapy for the most severely ill COVID-19 patients. Those guidelines also pointed out its risks and the lack of evidence for its use in COVID-19, and recommended a dose of 8 milligrams per kilogram.

This led some physicians to choose to use it, while others did not - setting the stage inadvertently for a natural comparison.

More research needed

Pogue, clinical professor at the U-M College of Pharmacy and an infectious disease pharmacist at Michigan Medicine, notes that more robust data released in June from a large randomized controlled trial in the United Kingdom has led him to recommend the steroid dexamethasone as the first choice to treat critically ill COVID-19 patients.

"For a retrospective, single-center study, our data are robust. But at this time, due to the lack of randomized controlled trial data and the much higher cost, we recommend reserving tocilizumab for the treatment of select patients who decompensate while on or after receiving dexamethasone or in patients where the risks of adverse events from steroid therapy outweigh the potential benefits" says Pogue.

"Further studies of tocilizumab, which is more targeted than dexamethasone in addressing the hyperinflammatory process, could include combining these agents or comparing them head-to-head," he adds.

Pogue notes that a single dose of tocilizumab is roughly 100 times more expensive than a course of dexamethasone. He also notes that another drug that aims to treat cytokine storm by targeting the interleukin-6 (IL-6) receptor - one called sarilumab - appears to have failed to improve outcomes in a clinical trial in COVID-19 patients including those on ventilators.

Michigan Medicine had been participating in the sarilumab study at the time the patients in the current study were treated, but not all patients qualified because of the timing of their admission or issues around testing for COVID-19. The current study does not include any patients who received sarilumab.

If the evidence around IL-6 targeting bears out in further studies, the authors note that it will be important to select the dose and timing carefully, to address the cytokine storm without interfering with IL-6's other roles in activating the body's response to infections and its processes for repairing tissue.

More about the study

The majority of the patients were transferred to U-M from Detroit-area hospitals after diagnosis with COVID-19, and those who received tocilizumab were less likely overall to have been transferred while already on a ventilator.

By the end of the 28-day period after patients went on a ventilator, 18% of those who received tocilizumab had died, compared with 36% of those who had not. When adjusted for health characteristics, this represents a 45% reduction in mortality. Of those still in the hospital at the end of the study period, 82% of the tocilizumab patients had come off the ventilator, compared with 53% of those who didn't receive the drug.

In all, 54% of the tocilizumab patients developed a secondary infection, mostly ventilator associated pneumonia; 26% of those who didn't receive tocilizumab developed such infections. Such "superinfections" usually reduce the chance of survival for COVID-19 patients.

Hydroxychloroquine was included in the treatment guidelines for COVID-19 inpatients at Michigan Medicine for the first two and a half weeks of the study period, before being removed as evidence of its lack of benefit and risks emerged. In all, it was used in one-quarter of the patients who received tocilizumab and one-fifth of those who didn't. Similar percentages of the two patient groups received steroids, though none received dexamethasone.

The patients in the two groups were similar in most ways except for a slightly higher average age in the non-tocilizumab group, and lower rates of chronic obstructive pulmonary disease and chronic kidney disease among the tocilizumab patients.

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The study was supported by the National Institutes of Health [UL1TR002240, 1K12HL133304]; the Centers for Disease Control and Prevention [U01IP000974]; and an American Society for Transplantation and Cellular Therapy New Investigator Award.

The COVID-19 Rapid Response Registry is supported by the Michigan Institute for Clinical and Health Research (MICHR), and uses the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Clinical Characterization Protocol to standardize the clinical characterization of patients with COVID-19 so their data can be studied.

In addition to Somers, Pogue and Eschenauer, the study's authors are from several departments of the U-M Medical School, and from the U-M College of Pharmacy, School of Public Health, and MICHR. They are: Jonathan P Troost, PhD, Jonathan L Golob, MD PhD, Tejal N Gandhi, MD, Lu Wang, PhD, Nina Zhou, MS, Lindsay A Petty, MD, Ji Hoon Baang, MD, Nicholas O Dillman, PharmD, David Frame, PharmD, Kevin S Gregg, MD, Dan R Kaul, MD, Jerod Nagel, PharmD, Twisha S Patel, PharmD, Shiwei Zhou, MD, Adam S Lauring, MD PhD, David A Hanauer, MD MS, Emily Martin, PhD, Pratima Sharma, MD MS, and Christopher M Fung, MD.

Reference: Clinical Infectious Diseases, DOI:10.1093/cid/ciaa954

https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa954/5870306

Research: Crop plants are taking up microplastics

CHINESE ACADEMY OF SCIENCES HEADQUARTERS

 

IMAGE: LARGE GAPS BETWEEN EPIDERMAL CELLS AT THE SITE OF LATERAL ROOT EMERGENCE. view more 

CREDIT: YIC

Microplastics (MPs), i.e., tiny plastic particles less than 5 millimeters in length, can now be found throughout the ocean and other aquatic ecosystems, and even in our seafood and salt. As MPs have become ubiquitous, scientists have become concerned about the transfer of MPs from the environment to the food chain and the potential impact of MPs on human health.

Scientists from the Chinese Academy of Sciences (CAS) recently found that microplastics are indeed contaminating edible plants, including vegetables we eat. The study was published in Nature Sustainability on July 13.

The study was led by LUO Yongming, a professor both at the Yantai Institute of Coastal Zone Research (YIC) and the Nanjing Institute of Soil Science of CAS.

Most MPs are emitted to the terrestrial environment and accumulate in large amounts in soil. In addition, secondary particles are formed by the degradation of plastics. Wastewater, an important source of water for agricultural irrigation, also contains small-sized MPs.

Despite the prevalence of MPs throughout the environment, the matter of MP uptake by crop plants has not received much attention.

For decades, scientists believed that plastic particles were simply too large to pass through the physical barriers of intact plant tissue. But this new study disproves this assumption.

"Cracks at the emerging sites of new lateral roots of lettuce and wheat crops can take in MPs from the surrounding soil and water. Those MPs can then be transferred from the roots up to the edible parts of the crop," said Prof. LUO.

Scientists already knew that particles as tiny as 50 nanometers in size could penetrate plant roots. But Prof. LUO's group revealed that particles about 40 times that size can get into plants as well.

The MPs identified in this study were spherical plastic particles up to 2 micrometers in size with a small degree of mechanical flexibility. These features allowed the MPs to squeeze into the small apoplastic space of plant root cells.

Left: 0.2 μm polystyrene beads in lettuce root (a-b) and leaf (c); right: 2.0 μm polystyrene beads in wheat seedling root (a-d), stem (e-f) and leaf (g-h)

"Another mechanism is that at the lateral root emergence sites there are small cracks, and then the particles go through those cracks and enter the xylem vessels. Thus it is even possible that particles larger than the ones we studied might also be taken up by plants," said Dr. LI Lianzhen, first author of the study.

These findings shed new light on the possibility of food chain transfer of MPs. If MPs are getting into our crop plants, they are also getting into our meat and dairy. This raises obvious concerns about growing crops on fields contaminated with wastewater treatment discharge or sewage sludge, a process that could introduce MPs into the food chain. It also raises the key question of how MPs affect human health, a question for which there is as yet no clear answer.

Aside from the possible health impact, MPs in crops is also undesirable from the standpoint of agricultural sustainability.

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This work was supported by the National Nature Science Foundation of China and the Key Research Program of Frontier Sciences, CAS.

Military personnel at risk of suicide store firearms unsafely

Strategies focused on limiting access to personal firearms can prevent suicides

RUTGERS UNIVERSITY

Military personnel who are at a greater risk of suicide are more likely to unsafely store firearms in unlocked cabinets where they can access them easily, according to a Rutgers researcher.

Firearms account for approximately half of all suicide deaths in the United States and approximately two-thirds of all suicide deaths in the military.

"Ready access to firearms is a robust risk factor for death by suicide, with data demonstrating that suicide is up to five times as likely in homes with a firearm present," said lead author Michael Anestis, executive director of the New Jersey Gun Violence Research Center, and an associate professor in the Department of Urban-Global Public Health at the Rutgers School of Public Health.

The study, published in the journal Psychiatry Research, stresses the importance of interventions to assure safe firearm storage as a suicide prevention strategy.

Researchers examined firearm ownership and storage and suicide risk factors such as depression and lifetime and current suicidal ideation in 953 service members, about 80 percent whom were in the National Guard.

They found that 18 percent of the service members who owned a personal firearm stored them unsafely -- loaded and in an accessible, non-secure location like a bedside table rather than a gun safe -- with 9 percent exhibiting current suicidal ideation. The study, however, found no association between lifetime suicidal ideation and a greater likelihood to own firearms.

"The fact that firearm-owning service members who are experiencing or have experienced severe distress appear to be more prone to unsafe storage practices is particularly dangerous since they are often hesitant to seek mental health care or to disclose or change their firearm storage practices," said lead author Michael Anestis.

Effective interventions include providing education on firearm suicide risk and safe storage strategies including storing the ammunition separately, removing firing pins and allowing someone else to keep a key or code to a gun locking devise and removing firearms from the home during times of suicidal crisis.

"We cannot simply wait to know a service member is at high risk for suicide before we encourage safe storage or temporary storage away from home," Anestis said. "We may not know they are at risk until it is too late, so we need to promote these practices to everyone. If it becomes more difficult for a suicidal person to access a firearm, it is far less likely they will die."

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#WAGESFORHOUSEWORK

Mothers' paid work suffers during pandemic, study finds

Gender gap in work hours could have enduring consequences

WASHINGTON UNIVERSITY IN ST. LOUIS

IMAGE: CAITLYN COLLINS, ASSISTANT PROFESSOR OF SOCIOLOGY AT WASHINGTON UNIVERSITY IN ST. LOUIS, STUDIES GENDER INEQUALITY IN THE WORKPLACE AND IN FAMILY LIFE. view more 

CREDIT: WUSTL

When COVID-19 forced schools and daycares to shut down and millions of Americans to transition to working from home, some suggested the pandemic might equalize certain aspects of gender equality as men increased their household contributions.

Four months later, however, new research from Washington University in St. Louis finds early evidence that the pandemic has exacerbated -- not improved -- the gender gap in work hours, which could have enduring consequences for working mothers.

"Our findings indicate mothers are bearing the brunt of the pandemic and may face long-term employment penalties as a consequence," said Caitlyn Collins, assistant professor of sociology in Arts & Sciences and co-author of the study.

Between March and April, mothers' work hours fell four to five times as much as fathers', according to the study first published online in Gender, Work and Organization in July.

While mothers scaled back their work hours by about 5%, or two hours per week, fathers' work hours remained largely stable. The impact was greatest among mothers of primary school-aged children or younger children for whom caregiving and homeschooling demands are most intense.

Collins and co-authors -- Liana Christin Landivar at the Maryland Population Research Center; Leah Ruppanner at the University of Melbourne; and William Scarborough at the University of North Texas -- used data from the U.S. Current Population Survey to assess how dual-earner heterosexual married couples with children adjusted their work during the pandemic from February through April. The monthly labor statistics survey includes information from approximately 60,000 households across the United States.

They also examined a subset of households in which both mothers and fathers are employed in telecommuting-capable occupations. They found across all models, fathers' predicted work hours did not fall below 40 hours per week, indicating that while the pandemic had a major toll on all aspects of society, most fathers in heterosexual, dual-earner households continued to put in a full work week.

"Even among households in which both parents are able to work from home and are directly exposed to childcare and housework demands, mothers are scaling back to meet these responsibilities to a greater extent than fathers. Ultimately, our analyses reveal that gender inequality in parents' work hours has worsened during the pandemic," Collins said.

The cause of this inequity is unclear. Collins said it's possible in times of crisis families revert to more traditional gender roles in the household division of labor. Or, it could be that financial stress and the need to protect primary earners -- most often fathers -- caused mothers to assume more of the unpaid domestic work.

What remains clear to the researchers, however, is that this inequity can have long-term, disastrous effects on women's careers.

"Scaling back work is part of a downward spiral that often leads to labor force exits -- especially in cases where employers are inflexible with schedules or penalize employees unable to meet work expectations in the face of growing care demands," Collins and her co-authors wrote.

"We are also concerned that many employers will be looking for ways to save money and it may be at the expense of mothers who have already weakened their labor market attachment," they wrote.

Another potential consequence for the workplace: Future merit-based promotions and pay raises may disproportionately benefit men whose work commitments remained high during the pandemic.

The situation is not expected to improve in the near term as states reopen and onsite work resumes. Initially, telecommuting may have prevented some mothers from more extensive job loss as schools and daycares closed, Collins said. However, with summer camps closed, daycares operating at limited capacity and uncertainty about the coming school year, dual-earner households will be faced with tough choices on how to navigate paid work and family life.

"Flexibility is key right now," Collins said. "By easing work demands and allowing flexibility where possible in the coming months, employers can prevent long-term losses in women's labor force participation. And fathers should be encouraged to provide more hours of care for their children, even if it means sacrificing paid work hours to do so."

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Parasite infestations revealed by tiny chicken backpacks

New sensor technology improves poultry welfare

UNIVERSITY OF CALIFORNIA - RIVERSIDE

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VIDEO: FREE-RANGE CHICKENS HAVING THEIR BEHAVIOR MONITORED FOR BLOOD-FEEDING MITES. view more 

https://sciencesources.eurekalert.org/multimedia/pub/237241.php?from=470384

CREDIT: AMY MURILLO/UCR

Blood-feeding livestock mites can be detected with wearable sensor technology nicknamed "Fitbits for chickens."

To help farmers detect mite infestations, a team of entomologists, computer scientists, and biologists led by UC Riverside entomologist Amy Murillo has created a new insect detection system. The team's work is detailed in the journal Scientific Reports.

In recent years, concern for the well-being of livestock has given rise to more farms where poultry are allowed to roam. Though this freedom improves the quality of chickens' lives, free-range chickens are still subject to insect infestations.

"The trend in egg sales is 'cage free,' but that doesn't necessarily mean the chickens are insect free," Murillo said.

Of particular concern to scientists is the northern fowl mite, which Murillo said feeds on chicken blood and lives on hens in feathers surrounding "the butt area of the chicken."

In addition to the economic consequences of infected hens laying fewer eggs, mites can make the chickens sick and cause lesions to develop on their skin.

"Fowl mites are very unpleasant for the birds being fed upon and cause an itchy immune response," Murillo said.

To devise their detection system, Murillo's team first identified three key chicken pastimes closely linked to chickens' well-being: pecking, preening, and dustbathing. The team hypothesized they would see a big increase in preening and dustbathing among infected chickens because these activities keep feathers clean.

The team placed motion sensors into tiny backpacks the chickens could wear without discomfort. The next challenge was translating data from these sensors into algorithms that could be detected as behaviors.

Alireza Abdoli, a doctoral student in computer science at UCR, explained that quantifying fowl behavior isn't as simple as working with human behaviors like walking, because it isn't as regular.

In order to train a computer to recognize chicken behaviors, Abdoli had to take an unusual approach. He created an algorithm, or set of instructions, for the computer that considers the shape that the backpack sensor data makes on a graph, as well as features of the data such as mean and max.

"Most algorithms use either shape or features, but not both," Abdoli said. "Our approach is exciting because it increases the accuracy of the data so much and is key to making good decisions about the chickens' health."

Chicken wearing a behavior sensor meant to detect the presence of blood-feeding mites.

Traditional animal behavior studies have had to rely on video or visual observations, which can be both time consuming and prone to errors. Murillo did some flock observations at the beginning of the project to make sure the computer's conclusions about behaviors were accurate. Once they were certain, observations were no longer necessary, and the computer could take over.

Not only does this new approach increase the reliability of scientists' observations, it also increases the number of animals and length of time they can be tracked.

The flock in this study did suffer from a mite infestation, which the team related to an increase in cleaning behaviors. Once the birds were treated and healed, the data showed preening and dust baths went back to normal levels.

Far more than farm fashion, these "Fitbits for chickens" offer valuable information for livestock farmers.

"These results could let farmers know it's time to examine their birds for parasites," Murillo said. "And the tools we developed can also be used examine the effects of any change in a bird's environment or diet."

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Chemists advance solar energy storage aimed at global challenges

Utah State University researchers participate in multi-university effort to improve technology for rural electrification and saltwater desalination

UTAH STATE UNIVERSITY

IMAGE: IN A 2017 PHOTO, UTAH STATE UNIVERSIY CHEMISTS, FROM RIGHT, TIANBIAO LEO LIU, BO HU, CAMDEN DEBRULER AND ZAYN RHODES DISPLAY EMERGING BATTERY TECHNOLOGY. IN A MULTI-UNIVERSITY EFFORT, THE TEAM... view more 

CREDIT: M. MUFFOLETTO

LOGAN, UTAH, USA - Increasing demand for electrification in rural areas poses challenges, but also creates opportunities for development of decentralized electrification systems. Compared with conventional electrical grids based on large, centralized power generation stations commonly used in developed countries, a decentralized approach offers lower capital cost, a smaller footprint and nimble deployment.

Utah State University chemists Tianbiao "Leo" Liu, Bo Hu and Maowei Hu are among authors of a paper published July 13, 2020, in 'Nature Materials,' describing a solar flow battery design that combines energy conversion and storage in one unit. Collaborators on the project included Wenjie Li and Jin Song of the University of Wisconsin-Madison, Anita Ho-Baillie of the University of New South Wales and University of Sydney in Australia, Jr-Hau He of King Abdullah University of Science and Technology in Saudi Arabia and the City University of Hong Kong.

"This technology could expedite electrification in remote locations," says Liu, assistant professor in USU's Department of Chemistry and Biochemistry, whose participation in the research was supported by a National Science Foundation CAREER grant he received in 2019.

The design, he says, integrates photoelectrochemical solar cells with aqueous organic redox flow batteries (AORFBs).

"Each of these technologies offers advantages," Liu says. "The photovoltaic cells convert sunlight into electricity, while the flow batteries can be charged by the solar cells to store solar energy simultaneously. The integrated design produces very high voltage and very stable cycling."

The technology builds on research efforts Liu's lab reported on AORFBs in a 2018 paper in ChemComm.

"Battery storage of environmentally friendly energy resources, such as solar and wind, presents challenges because of unstable grid energy, heavy cycling that requires frequent charging and discharging, as well as irregular, full recharging," Liu says. "In addition, we need energy storage electrolyte solutions that are safe and affordable. AORFBs show great promise in fulfilling these needs."

Further, the Liu Lab is designing AORFBs for integrated saltwater desalination and energy storage, which the team reported in the April 27, 2020 online edition of Advanced Functional Materials. The research was supported by a Utah Science Technology and Research (USTAR) Initiative University Technology Acceleration Grants (UTAG) grant.

"Combining water desalination and energy storage into a bifunctional device offers the opportunity to address not one, but two growing global issues from one hardware installation," Liu says.

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Family caregiving may not harm health of caregivers after all

Transition to Family Caregiving study shows little chronic inflammation biomarker impact beyond normal aging in a nine-year period

JOHNS HOPKINS MEDICINE

 

For decades, family caregiving has been thought to create a type of chronic stress that may lead to significant health risks or even death, alarming potential caregivers and presenting a guilt-ridden obstacle for those needing help. Now, Johns Hopkins researchers have studied people as they transitioned to becoming caregivers for loved ones. Beyond the normal increases from aging, they found that caregivers didn't have significantly greater inflammation over a nine-year period. Such increases would have indicated that chronic stress from caregiving may have harmed their health.

A report on the findings was published online June 24 by the Proceedings of the National Academy of Sciences of the United States of America.

"The main takeaway point is that caregiving, while stressful in some situations, is not associated with clinically meaningful increases in inflammation," says David Roth, Ph.D., professor of medicine at the Johns Hopkins University School of Medicine, director of the Johns Hopkins Center on Aging and Health, and study co-author. "Our main goal for our research was to challenge past study findings, address potential caregivers' concerns about the toll on their health, and provide hope and relief to people needing or wanting to help."

"Family caregiving," Roth says, "appears to have minimal effects on physical health for most caregivers, and may even be associated with some health benefits similar to those sometimes attributed to volunteerism, such as a lower mortality rate."

As the number of people engaged in family caregiving grows, this news should come as a relief to those worried about a burden on their health.

In the United States alone, it is estimated that at least 17 million and perhaps as many as 40 million people are informal or dedicated family caregivers for older adults. Many assert that family caregiving is a mutually beneficial arrangement, but for some the extra stress may feel like a significant burden that may impact their health.

To investigate whether caregiving harms caregivers, the Johns Hopkins Medicine Transition to Family Caregiving study team examined data on 239 participants in the University of Alabama at Birmingham's ongoing Reasons for Geographic and Racial Differences in Stroke project who became caregivers. They were age 45 or older, and were compared to matched noncaregiving controls who were also assessed over the same time period. The controls were matched for seven factors: age + 5 years, sex, race, education level, marital status, self-rated health and self-reported history of serious cardiovascular disease. Of the caregivers and controls, 65% of each were women. The researchers looked at changes over time on six inflammation biomarkers often associated with loneliness, depression, suppressed immunity, cancer and increased mortality. The biomarkers included high sensitivity C reactive protein (CRP), D-dimer, tumor necrosis factor-alpha receptor 1 (TNFR1), and interleukin (IL)-2 IL-10 and IL-6. Researchers examined biomarkers in blood samples.

All participants were free of caregiving activities prior to the first blood sample taken. Participants completed a baseline interview and an initial in-home assessment. Blood samples were taken at that time. About nine years later, each participant was interviewed again, and trained examiners conducted another in-home assessment, at which time phlebotomists gathered updated urine and blood samples.

The Johns Hopkins Medicine Transition to Family Caregiving study team found general increases in inflammation biomarker levels over a nine-year period across both caregivers and noncaregiving controls, such as would be found in normal aging, but caregivers did not show greater elevations over time compared to the controls. Of the six biomarkers examined, only TNFR1 showed a significantly greater increase, of 0.14 standard deviation units among caregivers compared to controls. The researchers interpreted these findings as being consistent with other population-based studies that suggest minimal systemic inflammation in response to chronic caregiving stress.

"This study is one of the first population-based longitudinal studies to capture data on biomarkers of inflammation from individuals before and after they took on family caregiving responsibilities," says Roth. The researchers say this is an improvement over previous "convenience sample" studies, which surveyed small amounts of people who were simply available -- and were therefore vulnerable to report bias. By contrast, population health studies more accurately reflect a large and diverse group of people.

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Additional authors include Jin Huang, Orla Sheehan and Jeremy Walston of Johns Hopkins, William Haley of the University of South Florida, Virginia Howard and J. David Rhodes of the University of Alabama, and Mary Cushman and Peter Durda of the University of Vermont.

This work was supported by a cooperative agreement (U01 NS041588) co-funded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging (NIA), and by an additional grant from the NIA (RF1 AG050609).

The authors had no conflict of interest to report.

Association of state-level opioid-reduction policies with opioid poisonings in kids

JAMA PEDIATRI

 

What The Study Did: Researchers compared the rate of opioid poisonings in children and teens before and after implementation of state-level policies intended to decrease the amount of opioid medications prescribed and distributed.

Authors: Michael S. Toce, M.D., M.S., of Boston Children's Hospital, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamapediatrics.2020.1980)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflicts of interest and financial disclosures, and funding and support.

#  #  #

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2020.1980?guestAccessKey=f851c7ea-24ae-477d-bd7a-cce078a9084d&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=071320

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Association of plant, animal protein with long-term mortality

JAMA INTERNAL MEDICINE

 

What The Study Did: Dietary information from more than 400,000 U.S. adults was used to look at the association between consuming plant and animal protein and the risk of death over 16 years.

Authors: Jiaqi Huang, Ph.D., and Demetrius Albanes, M.D., of the National Cancer Institute in Bethesda, Maryland, are the corresponding authors.

To access the embargoed study: JVisit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamainternmed.2020.2790)

Editor's Note: The article includes funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, conflicts of interest and financial disclosures, and funding and support.

#  #  #

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.2790?guestAccessKey=ab0fed67-f846-4b43-997d-de626d4b97d0&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=071320

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Middle aged face more years of ill health than baby boomers

Despite expecting to live longer, people in their 40s and 50s in England are likely to suffer more years of ill health than older generations now in their 60s and early 70s, according to a new UCL-led study.

UNIVERSITY COLLEGE LONDON

 

Despite expecting to live longer, people in their 40s and 50s in England are likely to suffer more years of ill health than older generations now in their 60s and early 70s, according to a new UCL-led study.

The study, published in the journal Population Studies, compared generations born between 1945 and 1980 and found a greater prevalence of ill health among those born later, with these younger cohorts more likely to rate their health as poor and have clinically measured poor health at equivalent ages during their working lives.

The researchers concluded that, although life expectancy has increased in recent decades, many of the years gained are likely to be spent in poor health, with conditions such as diabetes and obesity affecting people earlier.

Lead author, Dr Stephen Jivraj (UCL Epidemiology & Public Health), said: "Our study shows that, for those born between 1945 and 1980, the overall trend is towards an increasing proportion of years in poor health, with some health conditions beginning at an earlier age.

"This has worrying implications for healthcare services, which already face increased demand because of an ageing population."

Researchers looked at data from 135,189 people aged between 25 and 64 who took part in the Health Survey for England (HSE), an annual household survey with a nationally representative sample, between the years of 1991 and 2014.

Participants were asked whether they had poor health, a long-term illness, and a range of chronic conditions such as cardiovascular disease and diabetes. Nurses also took objective measurements of hypertension, body mass index (BMI) and glycated haemoglobin (clinical diabetes).

Researchers compared the results for different age groups and used the data to calculate changes in healthy life expectancy over the generations as well as years likely to be spent in poor health.

They calculated that half of the gains in life expectancy between 1993 and 2003 would likely be spent in poor health, falling to a fifth of the gains between 2003 and 2013. Later-born cohorts were more likely to have diabetes, to be overweight and to report having cardiovascular disease and poor health in general. Later-born men were more likely to report high blood pressure.

Senior author, Professor George Ploubidis (UCL Centre for Longitudinal Studies), said: "Earlier in the 20th century, a rise in life expectancy went hand in hand with an increase in healthy lifespan - younger generations were living longer, healthier lives.

"It appears that, for those generations born between 1945 and 1980, this trend has stalled. Those born later are expected to live longer on average, but with more years of ill health."

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The study received funding from the Economic and Social Research Council.