Sunday, January 31, 2021

Black or Hispanic kids receive less medical imaging than white kids

UNIVERSITY OF PITTSBURGH

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

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

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 45 academic departments, centers, institutes, and programs; and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic and clinically based care for nearly 2 million patients each year. The School of Medicine has more than $563 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 student trainees, residents, and fellows. The combined School of Medicine and Medical System ("University of Maryland Medicine") has an annual budget of nearly $6 billion and an economic impact more than $15 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity, is an innovator in translational medicine, with 600 active patents and 24 start-up companies. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

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.

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.

Explaining to your child why behavior is wrong may not always work

UNIVERSITY OF MICHIGAN

Research News

Parents know the scenario all too well: their child misbehaves and it comes time for discipline.

Research conducted globally shows that spanking is not the best option. But verbal reasoning, which explains why the behavior is wrong, may not always have the intended positive effect if the parent is loud and abrupt, according to a new University of Michigan study.

The findings indicate both positive and negative outcomes that could have lasting consequences on children's emotional development. Verbal reasoning was associated with higher levels of getting along with others, but also with increased aggression and higher levels of distraction.

"Positive discipline doesn't always seem to have all that many positive benefits," said Andrew Grogan-Kaylor, professor of social work and lead author of the study published in the latest issue of International Journal of Behavioral Development.

"It's more likely that the long-term investments that parents make in children, such as spending time with them, letting them know they are loved and listening to them, have more positive effects than nonviolent discipline. This has yet to be thoroughly researched in a global context."

Research has continually shown that spanking leads to negative child outcomes, such as aggression and distraction, regardless of the context in which children are disciplined, including country, race and ethnicity, and neighborhood.

In the new study, researchers at U-M's Ann Arbor and Flint campuses analyzed different forms of punishment associated with children's behaviors in a global sample of nearly 216,000 families from 62 countries. The data came from the United Nations Children's Fund Multiple Indicator Cluster Surveys.

The results confirmed that spanking was not associated with children getting along with their counterparts. It also led to increased aggression and distraction. For nonviolent discipline, which involved verbal reasoning and taking away privileges, mixed outcomes occurred, Grogan-Kaylor said.

Verbal reasoning did promote one positive result: Children were more prosocial with others, especially in countries where this discipline was more common. Surprisingly, verbal reasoning also increased aggression, likely in cases when the parents used harsh tones and language, the study suggested.

"Verbal reasoning may have negative effects on children if it is not employed in a way that is developmentally appropriate for the child to understand why their behavior is inappropriate," Grogan-Kaylor said.

Meanwhile, children did not get along with other children and showed higher levels of aggression and became distracted when parents took away privileges.

So what's the best way to discipline a child? Grogan-Kaylor suggested providing them structure, keeping the lines of communication open and providing developmentally appropriate removal of privileges.

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Co-authors included Berenice Castillo, Garrett Pace, Kaitlin Ward, Shawna Lee and Heather Knauer of UM-Ann Arbor and Julie Ma of UM-Flint.

Abstract: Global perspectives on physical and nonphysical discipline: A Bayesian multilevel analysis

Andrew Grogan-Kaylor

Americans like sports, but heterosexual men especially do

Study finds that gender and sexuality predict sports fandom

OHIO STATE UNIVERSITY

Research News

COLUMBUS, Ohio - Nearly nine out of 10 Americans say they enjoy sports at least a little, but heterosexual men more commonly identify as passionate sports fans, a new study suggests.

A survey of nearly 4,000 American adults found that only 11% said they did not identify as sports fans at all. Over 40% were passionate fans, identifying themselves as being "quite a bit" or "very much so" sports fans.

About 60% of heterosexual men in the survey identified as passionate sports fans, compared to about 40% of both heterosexual women and lesbians. About 30% of gay men reported being passionate sports fans.

"We found that U.S. adults respond overwhelmingly that they are sports fans," said Chris Knoester, co-author of the study and associate professor of sociology at The Ohio State University.

"Sports fandom is an ingrained part of our culture and central in the lives of many people."

The study, published this week in the Sociology of Sport Journal, was led by Rachel Allison, associate professor of sociology at Mississippi State University.

"One of the advantages of the survey data in this study is that it has a relatively large sample of individuals who identify as a sexual minority or as nonbinary in terms of their gender identity, which has not been the case in most previous studies," Allison said.

"It allowed us to show that while heterosexual men are particularly likely to identify as strong sports fans, there are substantial numbers of people across gender and sexual identities who are also passionate fans."

Survey data came from the National Sports and Society Survey (NSASS), sponsored by Ohio State's Sports and Society Initiative.

The survey was completed by 3,993 adults who volunteered to participate through the American Population Panel, run by Ohio State's Center for Human Resource Research. Participants, who came from all 50 states, answered the survey online between the fall of 2018 and spring of 2019.

Because NSASS participants are disproportionately female, white and Midwestern, the researchers also weighted the survey results to reflect the U.S. population more accurately. This resulted in modest increases of about 5% in the population estimates of the number of passionate sports fans.

While there has been growing attention in the United States to women's sports, and to gay and lesbian participation in sports, there hasn't been good data on how a variety of gender and sexual identities are reflected in the larger sports fan community, Knoester said.

This study gives a preliminary look. About 27% of those surveyed identified as lesbian, gay, bisexual or a sexual identity other than heterosexual. About 3% of respondents identified as nonbinary.

Overall, heterosexual men tended to identify as "quite a bit" of a sports fan, the findings suggest. In contrast, heterosexual women, lesbians and gay men were more likely to say they were "somewhat" of a sports fan on average.

But while heterosexual men are clearly more likely to be big sports fans than gay men, lesbians and heterosexual women have similar interest in sports, according to the results.

"Identifying as lesbian does not seem to discourage sports fandom like identifying as gay does for men," Allison said.

The researchers also explored whether early childhood experiences shaped sports fandom in adults. As expected, people who said they thought of themselves as athletes during childhood and who frequently thought about sports were more likely to be fans as adults.

People who said they were mistreated in sports-related interactions during their lifetime - such as being called names or being bullied - were less likely to be sports fans as adults.

But the researchers did not find that childhood sports experiences or mistreatment accounted for gender and sexual identity differences in how much adults identified as sports fans.

Allison said it is clear that the historic masculine, heterosexual culture of sports is changing. She documented some of those changes in her book Kicking Center: Gender and the Selling of Women's Professional Soccer.

But she said the results of this new study suggest it may not have changed enough to make some women and sexual minorities comfortable to identify as sports fans.

"We've clearly moved beyond the era of open hostility to women, lesbians and gay men in sports," Allison said.

"But the extent to which we've moved from tolerant to fully inclusive cultures isn't necessarily clear. We may be in this period of transition."

Knoester and Allison said sports organizations on all levels, from professional to youth, still need to do more to be inclusive to individuals with different gender and sexual identities.

"You aren't born being a sports fan. The differences in fandom we found here in this study are socially and culturally produced to a great extent, and they can be changed," Knoester said.

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Contact: Chris Knoester, Knoester.1@osu.edu
Rachel Allison, Rallison@soc.msstate.edu

Written by Jeff Grabmeier, 614-292-8457; Grabmeier.1@osu.edu

TRUMP GUILIANI COCKTAIL

Remdesivir disrupts COVID-19 virus better than other similar drugs

UNIVERSITY OF CHICAGO

Research News

In the treatment of SARS-CoV-2, the virus that causes COVID-19, antiviral drug remdesivir has emerged as a promising candidate.

Remdesivir works by disrupting the virus's ability to replicate, but its exact mechanism has remained a mystery. Using advanced computational simulations, researchers at the Pritzker School of Molecular Engineering (PME) at the University of Chicago have revealed just how the drug works at the molecular level. They also found that two drugs that work in a similar manner, ribavirin and favilavir, do not bind as effectively to the virus.

"It's important to understand how remdesivir works at a molecular level," said Prof. Juan de Pablo, who led the research. "Now that we see that it is effective, and other drugs are not as effective, it can guide future efforts for treating COVID-19."

The results were published Jan. 6 in the journal ACS Central Science.

Understanding how drugs disrupt the virus

Remdesivir works by disrupting SARS-CoV-2's RNA polymerase, a key enzyme that the virus needs to replicate itself. When this enzyme is disrupted, the virus cannot multiply and spread within the body.

But in patients, the drug has produced varied results. Some clinical trials have shown that patients who received it recovered faster and had improved mortality rates, while other trials have shown that the drug did not reduce mortality or hospitalization lengths.

Since the beginning of the pandemic, de Pablo and his group have been using advanced computational simulations to systematically look at the different proteins that allow the virus to replicate or infect cells. They also have looked at the key candidate drugs that are already used to treat other diseases and could be repurposed to inhibit those processes in SARS-CoV-2. The simulations, which require months of extremely powerful computations, ultimately reveal what happens at the molecular level.

To better understand how treatments disrupt the RNA polymerase, de Pablo and his group simulated the interaction between the enzyme and three drugs that are already available, and that are meant to inhibit it: remdesivir, ribavirin, and favilavir. They found that remdesivir binds strongly to the virus, but ribavirin and favilavir do not bind as effectively. They also found that remdesivir destabilizes the virus's protein complex, also reducing its ability to replicate.

Now that simulations show that the drug should work at a molecular level, scientists could focus, for example, on finding better strategies to deliver the drug more effectively, de Pablo said.

A complete landscape of molecular targets

Previously, the group used computational analysis to reveal how the drug Ebselen binds to the virus' main protease, or MPro. Now, the group is also examining the mechanisms of a different set of drugs on different proteins, with the goal of creating a complete landscape of molecular targets.

"We've seen that the virus is not going away and is in fact starting to mutate," de Pablo said. "Efforts to find the best therapies, and the best ways to administer them, have to continue."

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Other authors on the paper include graduate students Fabian Byléhn, Walter Alvarado, and Gustavo R. Perez-Lemus, and postdoctoral researcher Cintia A. Menéndez.

Citation: "Modeling the Binding Mechanism of Remdesivir, Favilavir, and Ribavirin to SARS-CoV-2 RNA-Dependent RNA Polymerase," Byléhn et al, ACS Cent. Sci., Jan. 6., 2021. DOI: 10.1021/acscentsci.0c01242

Funding: National Science Foundation

FACTS PROVE GOP WRONG

COVID unemployment assistance puts food on the table: BU study

BOSTON UNIVERSITY SCHOOL OF MEDICINE

Research News

Another wave of COVID-19 is putting millions out of work, while tens of millions more remain unemployed, and Congress debates aid.

Now, a new Boston University School of Public Health (BUSPH) study shows that unemployment help directly translates to people being able to put food on the table.

The CARES Act--passed in March of 2020-- expanded unemployment insurance coverage, amount, and duration.

Published in JAMA Network Open, the study finds that receiving unemployment insurance cuts a person's risk of food insecurity by a third, and halves the likelihood of needing to eat less because of financial constraints. And receiving more coverage, such as the weekly $600 supplement included in CARES until last July, means an even bigger reduction in the risk of going hungry.

"There has long been a need to improve the proportion of people covered, the duration of coverage, and the amount of coverage in our unemployment insurance system. This paper speaks to the critical role that unemployment insurance can play in preventing people from facing food insecurity during a crisis," says study lead author Dr. Julia Raifman, assistant professor of health law, policy & management at BUSPH.

Raifman and colleagues used data from the Understanding Coronavirus in America study, looking at a sample of 2,319 people who had household incomes less than $75,000 and had been employed in February. By the end of July, 1,119 people (nearly half) had experienced unemployment.

Of those who lost their jobs, 415 reported food insecurity and 437 reported that they sometimes ate less because of financial constraints.

The researchers found that receiving unemployment insurance was associated with a 35.0% relative decline in a person's risk of food insecurity, and a 47.8% relative decline in the likelihood of having to eat less. Receiving larger amounts of unemployment insurance and/or the weekly $600 CARES supplement came with even more substantial declines in food insecurity and having to eating less.

The researchers also identified major disparities in who is facing food insecurity among those who have lost their jobs during COVID: 69.2% of Indigenous participants in the study reported food insecurity, as did 52.5% of Hispanic participants, 42.2% of Black participants, 40.3% of Asian participants, and 26.9% of non-Hispanic white participants.

They also found that 46.1% of households with kids faced food insecurity, compared to 32.8% of households without kids.

"It is heartbreaking that families with children are even more likely to face food insecurity," Raifman says. "The recent Booker/Pressley policy proposal to provide direct payments to children's families could make a big difference for their food security and short- and long-term health."

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About the Boston University School of Public Health

Founded in 1976, the Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations--especially the disadvantaged, underserved, and vulnerable--locally and globally.

Medicaid expansion in New York has improved maternal health, study finds

Policy intervention is particularly beneficial to low-income and minority women

COLUMBIA UNIVERSITY'S MAILMAN SCHOOL OF PUBLIC HEALTH

Research News

January 29, 2021 -- A study at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center has found that Medicaid expansion in 2014 in New York State was associated with a statistically significant reduction in severe maternal morbidity in low-income women during delivery hospitalizations compared with high-income women. The decrease was even more pronounced in racial and ethnic minority women than in White women. Until now there was little research on the link between ACA Medicaid expansion and maternal health outcomes. The findings are published online in the journal of the International Anesthesia Research Society, Anesthesia & Analgesia.

"Our findings indicate that the 2014 Medicaid expansion under the ACA in New York has contributed to reducing severe maternal morbidity in low- income women. These findings are of public health importance given the ongoing increase in maternal morbidity and mortality on the national level," said Jean Guglielminotti, MD, PhD, in the Department of Anesthesiology, Columbia Medical Center.

The researchers analyzed data from the 2006-2016 New York State Inpatient Database, a census of discharge records from community hospitals. They compared the changes in the incidence of severe maternal morbidity (SMM) as defined by the Centers for Disease Control and Prevention during delivery hospitalizations and discharges between low- and high-income women associated with the 2014 Medicaid expansion in New York State from January 1, 2006 to December 31, 2016.

For each year of the study period, the researchers calculated the volume of deliveries and delivery-related discharges, cesarean delivery rate, percent admission during a weekend, percent non-White women (i.e, racial and ethnic minority women), and percent Medicaid beneficiaries.

Of 2,286,975 delivery-related discharges in 173 hospitals, 611,020 were among low-income women (27 percent). Compared with high-income women, low- income women had a higher incidence of SMM (2.6% vs 1.9%, respectively).

Medicaid beneficiaries increased from 43 percent in the pre-expansion study period to 48 percent in the post-expansion study period. The proportion of the uninsured decreased 5 percent and by a decline of 9 percent among privately insured women. The 2014 New York State Medicaid expansion increased the income eligibility threshold for pregnant women from 200 percent to 223 percent of the Federal Poverty Level. According to earlier Columbia research, even though half of pregnant women are covered by Medicaid nationwide, up to 13 percent are uninsured in the month of delivery.

"We hypothesized that the introduction of Medicaid expansion in January 2014 would not be associated with an abrupt change in the incidence of SMM immediately after its introduction but rather with a gradual decrease over time," said Guglielminotti. "We based this on the fact that a pregnancy lasts 3 quarter-years and that the beneficial effect of health insurance coverage on maternal health outcomes during delivery hospitalizations is thought to be mediated by earlier prenatal care during pregnancy and a better quality of prenatal care."

While insured women may receive earlier and better care throughout pregnancy and postpartum, an earlier and higher utilization of prenatal care is also associated with better maternal and neonatal outcomes, according to the researchers. Secondly, insured women might seek earlier care if symptomatic of a complication without worrying about financial implications. In addition, care during hospitalization can be influenced by insurance type by removing financial barriers to care delivery such as the utilization of expensive procedures.

"Excess maternal morbidity and mortality in the United States, particularly in low-income and racial/ethnic minority women, is a growing public health concern," said Guohua Li, MD, DrPH, professor of Anesthesiology and Epidemiology at Columbia Mailman School of Public Health. "Our study suggests that Medicaid expansion under the ACA is an effective policy intervention to improve maternal health outcomes and reduce health disparities. "

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A co-author of the study is Ruth Landau, MD, Columbia University Irving Medical Center.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health

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Social & structural factors influence racial disparities in COVID-19 mortality

Rutgers study finds counties with higher percentage of adults without a high school diploma and households without internet access were strong predictors of COVID-19 mortality

RUTGERS UNIVERSITY

Research News

COVID-19 mortality racial disparities in the U.S. are associated with social factors like income, education and internet access, according to a Rutgers study.

The study, published in the Journal of Racial and Ethnic Health Disparities, highlights the need for public health policies that address structural racism.

The researchers investigated the association between COVID-19 cases and deaths in 2,026 U.S. counties from January to October 2020 and social determinants of health, which can raise the risk for infection and death.

They also looked at factors known or thought to impact COVID-19 outcomes, including the counties' population density, days since the first COVID-19 death and percent of residents who are over age 65, are smokers or who have chronic diseases such as obesity, diabetes, chronic obstructive pulmonary disease or high blood pressure.

The study found that a 1 percentage point increase in a county's percent of Black residents, uninsured adults, low birthweight infants, adults without a high school diploma, incarceration rate and households without internet increased that county's COVID-19 death rates during the time period examined.

Counties that were the most deprived socioeconomically had a 67 percent increase in the COVID-19 death rate.

Michelle DallaPiazza, lead author and an associate professor at Rutgers New Jersey Medical School, said the percent of households without internet, which provides updated knowledge of the pandemic and allows remote working and learning, and the percentage of adults without a high school diploma were the factors most associated with a county's COVID-19 death rate.

"The findings are consistent with historical health inequities in marginalized populations, particularly Black Americans," DallaPiazza said. "This adds to the extensive literature on racial health disparities that demonstrate that social and structural factors greatly influence health outcomes, and this is particularly true when it comes to COVID-19."

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Other authors include Ankur K. Dalsania, Matthew J. Fastiggi, Aaron Kahlam and Krishan Patel at Rutgers New Jersey Medical School; Rajvi Shah at Rutgers Robert Wood Johnson Medical School; and Stephanie Shiau and Slawa Rokicki at Rutgers School of Public Health.

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