Breathing, lung problems more common in low-income household

While air quality has improved and smoking has gone down overall in the United States in the last several decades, researchers say the level of breathing problems in lower-income households remains vastly higher than in higher-income households. Photo by Free-Photos/Pixabay

May 28 (UPI) -- People with lower household incomes in the United States have more breathing problems and lung-related illnesses like asthma than wealthier individuals, an analysis published Friday by JAMA Internal Medicine found.

Nearly half of those with annual household incomes in the lowest percentiles nationally experience shortness of breath or difficulty breathing, compared with just under 30% in the highest percentiles of household income, the data showed.

In addition, low-income people are three times more likely to report a "problem cough" than their wealthier peers.

Children and adults in low-income households are also at higher risk for asthma and chronic obstructive pulmonary disease than those living in wealthier homes, according to the researchers.

RELATED COVID-19 discriminates along racial, socioeconomic lines, study finds

These trends have generally remained the same, if not worsened, over the past 60 years, despite declines in smoking and improvements in air quality in the United States during the same period.

"From the 1960s to today, socioeconomic inequalities in lung health have persisted, and in some instances even worsened," study co-author Dr. Adam Gaffney told UPI in an email.

"This occurred despite improvements in air quality, overall smoking rates, healthcare access and workplace safety, suggesting that the benefits of these advances have not been equitably enjoyed, [so] our lungs reflect the inequalities of our society," said Gaffney, a pulmonary specialist and assistant professor of medicine at Harvard Medical School in Cambridge, Mass.

RELATED Better treatment, less smoking driving drop in U.S. cancer deaths

The findings are based on an analysis of lung health data for more than 215,000 people across the United States, for whom information on household income was available, from 1959 through 2018.

From 1971 through 2018, the percentage of people with the highest household incomes who were current or former smokers fell to 34% from 62%, the data showed.

Among those with the lowest household incomes, the percentage of current or former smokers rose to 58% from 56% over the same period, the researchers said.

RELATED Study: ACA reduced disparities in healthcare access

By 2018, 48% of those with the lowest household incomes nationally reported experiencing shortness of breath, up from 45% in 1971 and higher than the rate of 28% for wealthier individuals.

Just under 17% of people in the lowest-income households across the country suffered from a "problem cough" in 2018, compared with 6% of those in wealthier homes, up from 14% in 1988.

In 2017-18, the prevalence of asthma, or chronic shortness of breath, among children was 15% in the poorest households and 7% in the wealthiest ones.

Similarly, by 2018, 16% of adults in low-income households had been diagnosed with COPD, compared with just over 4% in wealthier residences.

A study published earlier this week also showed that people living in lower-income households, as analyzed by ZIP code, had more exposure to air pollution and high levels of heat.

"We all need safe air, safe workplaces and high-quality healthcare [so] we need to advocate for the policies that can make a difference," Gaffney said.

"We should move to improve air quality standards, workplace safety and achieve universal, comprehensive healthcare," he said.

Socioeconomic Inequality in Respiratory Health in the US From 1959 to 2018

Adam W. Gaffney, MD, MPH^1,2; David U. Himmelstein, MD^1,2,3; David C. Christiani, MD, MS, MPH^2,4; et alSteffie Woolhandler, MD, MPH^1,2,3

Author Affiliations Article Information

JAMA Intern Med. Published online May 28, 2021. doi:10.1001/jamainternmed.2021.2441

editorial comment icon

Key Points

Question  Have socioeconomic disparities in respiratory health improved in the past 6 decades in the US?

Findings  In this repeated cross-sectional analysis of national health examination surveys conducted from 1959 to 2018 and including 215 399 participants, socioeconomic disparities in respiratory symptoms, lung disease prevalence, and pulmonary function mostly persisted, and in some instances appeared to widen.

Meaning  Income- and education-based disparities in respiratory health have persisted, and potentially worsened, despite secular improvements in air quality and tobacco use, suggesting that the benefits of these improvements have not been equitably enjoyed; social class may function as an independent determinant of lung health.

Abstract

Importance  Air quality has improved and smoking rates have declined over the past half-century in the US. It is unknown whether such secular improvements, and other policies, have helped close socioeconomic gaps in respiratory health.

Objective  To describe long-term trends in socioeconomic disparities in respiratory disease prevalence, pulmonary symptoms, and pulmonary function.

Design, Setting, and Participants  This repeated cross-sectional analysis of the nationally representative National Health and Nutrition Examination Surveys (NHANES) and predecessor surveys, conducted from 1959 to 2018. included 215 399 participants aged 6 to 74 years.

Exposures  Family income quintile defined using year-specific thresholds; educational attainment.

Main Outcomes and Measures  Trends in socioeconomic disparities in prevalence of current/former smoking among adults aged 25 to 74 years; 3 respiratory symptoms (dyspnea on exertion, cough, and wheezing) among adults aged 40 to 74 years; asthma stratified by age (6-11, 12-17, and 18-74 years); chronic obstructive pulmonary disease ([COPD] adults aged 40-74 years); and 3 measures of pulmonary function (forced expiratory volume in 1 second [FEV₁], forced vital capacity [FVC], and FEV₁/FVC<0.70) among adults aged 24 to 74 years.

Results  Our sample included 215 399 individuals surveyed between 1959 and 2018: 27 948 children aged 6 to 11 years; 26 956 children aged 12 to 17 years; and 105 591 adults aged 18 to 74 years. Income- and education-based disparities in smoking prevalence widened from 1971 to 2018. Socioeconomic disparities in respiratory symptoms persisted or worsened from 1959 to 2018. For instance, from 1971 to 1975, 44.5% of those in the lowest income quintile reported dyspnea on exertion vs 26.4% of those in the highest quintile, whereas from 2017 to 2018 the corresponding proportions were 48.3% and 27.9%. Disparities in cough and wheezing rose over time. Asthma prevalence rose for all children after 1980, but more sharply among poorer children. Income-based disparities in diagnosed COPD also widened over time, from 4.5 percentage points (age- and sex-adjusted) in 1971 to 11.3 percentage points from 2013 to 2018. Socioeconomic disparities in FEV₁ and FVC also increased. For instance, from 1971 to 1975, the age- and height-adjusted FEV1 of men in the lowest income quintile was 203.6 mL lower than men in the highest quintile, a difference that widened to 248.5 mL from 2007 to 2012 (95% CI, −328.0 to −169.0). However, disparities in rates of FEV₁/FVC lower than 0.70 changed little.

Conclusions and Relevance  Socioeconomic disparities in pulmonary health persisted and potentially worsened over the past 6 decades, suggesting that the benefits of improved air quality and smoking reductions have not been equally distributed. Socioeconomic position may function as an independent determinant of pulmonary health.

Introduction

Over the past half century, air quality has improved in the US: regulations have reduced emissions of sulfur dioxide, nitrogen oxide, and ozone concentrations, and haze has cleared.¹ Adult smoking rates, meanwhile, have fallen from 42.6% to 13.7%.² In addition, although many people still face workplace hazards, safety regulations and economic change have reduced exposure to occupational pollutants such as silica and coal dust, causing deaths from pneumoconiosis to plummet.³

However, among both children and adults, socioeconomic disparities in respiratory symptoms, disease,^4,5 and function^6,7 remain, probably owing to persistent disparities in exposure to unclean air, tobacco smoke, dusts and gases in the workplace, nutrition, access to health care,⁸ or other factors.^6,9 Disparities in chronic obstructive lung disease (COPD) may have worsened in recent decades consequent to the growing socioeconomic divide in tobacco use.¹⁰ For instance, county-level geographic differences in COPD mortality widened from 1980 to 2014,¹¹ and inequalities in asthma morbidity and mortality may have persisted,^9,12-16 or even worsened in the twenty-first century.^4,5

Yet few studies of socioeconomic disparities in lung health have spanned the period that saw landmark policy changes affecting smoking (the 1964 Surgeon General’s Report), air quality (the 1970 Clean Air Act), occupational exposures (the establishment of OSHA in 1971), and health care access (Medicare, Medicaid, and the Affordable Care Act). Moreover, because reduced lung function is associated with elevated all-cause mortality (through mechanisms not fully understood),^17,18 increased socioeconomic disparities in lung function may contribute to the widening gap in life expectancy between poorer and wealthier Americans in the twenty-first century.^19,20

Using national health examination surveys conducted over 6 decades, we evaluated changes in socioeconomic inequality in respiratory health in the US.

READ ON DOWNLOAD PDF

Socioeconomic Inequality in Respiratory Health in the US From 1959 to 2018 | Asthma | JAMA Internal Medicine | JAMA Network

GUILTY PLEASURE BUTCH & SUNDANCE & BJ

RIP

B.J. Thomas, ‘Raindrops Keep Fallin’ On My Head’ singer, has died aged 78

The five-time Grammy winner had been diagnosed with lung cancer

By Matthew Neale
30th May 2021

B. J. Thomas performing at Carnegie Hall on May 3, 2017. CREDIT: Al Pereira/WireImage

B.J. Thomas has died at the age of 78 following complications from lung cancer.

The singer’s official Twitter page confirmed the news late last night (May 29). It tweeted: “It is with profound sadness we confirm the passing of BJ Thomas.”

Thomas had confirmed in March that he had been given a stage four lung cancer diagnosis, and was receiving treatment at a Texas health care facility.

The five-time Grammy winner started in the 1960s with his band Thomas And The Triumphs, later finding international success with ‘Raindrops Keep Fallin’ On My Head’ in 1969. The song was written by Burt Bacharach and Hal David for the film Butch Cassidy And The Sundance Kid, starring Robert Redford and Paul Newman.

‘Raindrops Keep Fallin’ On My Head’ went on to win an Oscar for Best Original Song. It spent four weeks at the top of the Hot 100 in early 1970, and was nominated for a Grammy the same year.



Besides ‘Raindrops’, Thomas had a slew of other hits, starting with his cover of Hank Williams’ ‘I’m So Lonesome I Could Cry’ in 1966.

Other songs that enjoyed success include ‘Hooked On A Feeling’ in 1968, ‘I Just Can’t Help Believing’ in 1970, ‘Rock And Roll Lullaby’ in 1972 and ‘(Hey Won’t You Play) Another Somebody Done Somebody Wrong Song’ in 1975.

Between 1977 and 1981, Thomas won a Grammy Award each consecutive year, including for his album ‘Home Where I Belong’ and recordings of hymns like ‘Amazing Grace’.

Thomas carried on releasing new music up until 2013, bowing out with an album of acoustic arrangements, ‘The Living Room Sessions’.

 

Revenge of the seabed burrowers

YALE UNIVERSITY

Research News

 

New Haven, Conn. -- The ancient burrowers of the seafloor have been getting a bum rap for years.

These prehistoric dirt churners -- a wide assortment of worms, trilobites, and other animals that lived in Earth's oceans hundreds of millions of years ago -- are thought to have played a key role in creating the conditions needed for marine life to flourish. Their activities altered the chemical makeup of the sea itself and the amount of oxygen in the oceans, in a process called bioturbation.

But did that bioturbation help or hinder the expansion of complex animal life? A new Yale study, published in the journal Earth and Planetary Science Letters, found that seabed burrowers were very helpful indeed.

"Bioturbating animals are one of our foremost examples of 'ecosystem engineers,'" said lead author Lidya Tarhan, an assistant professor of Earth and planetary sciences at Yale. "They play a major role in shaping the chemical composition of the oceans, and even, on geologic time scales, the atmosphere."

Bioturbating animals that live and burrow in the sediments of the seabed first became widespread and active during the early Cambrian Period, about 541 million years ago. They were part of the so-called "Cambrian Explosion," when most animal groups with sophisticated body plans and behaviors began to appear in rapid succession, according to the fossil record.

But there is much debate among Earth scientists about what impact these burrowers had on their surroundings.

For example, there is the relationship between bioturbation and the availability of phosphorous -- a critical nutrient that is necessary for all life. The availability of phosphorous determines the size of the global biosphere and the complexity of life it can support. Phosphorous reaches the seafloor primarily in the form of plankton, whose carcasses sink to the bottom of the ocean after death, and from ocean waters that circulate upward along the margins of continents.

A large body of recent research has suggested that early burrowers took phosphorous and buried it, effectively choking off the supply of this life-creating nutrient. The theory also suggests that bioturbation changed the way carbon is buried under the ocean floor, leading to a widespread reduction of oxygen in the water.

A separate body of research about bioturbation -- grounded in evolutionary theory and observations from the fossil record -- offers a much different premise. This theory holds that seabed burrowing would have led to more biological sophistication, not less, in terms of animal size and behaviors.

"We've long had these two major camps of thinking, fundamentally at odds with each other, regarding the role of the earliest animals in shaping ocean chemistry, habitability, and ecology," Tarhan said.

The Yale team's new work aims to resolve the matter.

For the study, Tarhan and her colleagues created new models of phosphorous cycling and bioturbation that more accurately depict both processes. For example, she said, earlier models did not account for the large amount of phosphorous-rich minerals that form in sediment on the ocean floor. Likewise, previous modeling assumed that bioturbation was an all-or-nothing activity that operated almost like an on-off switch, rather than a behavior that ramped up gradually.

"Our work has, for the first time, reconciled the two major frameworks regarding the role of early animals in driving changes in the evolutionary and biogeochemical landscapes of Earth's early oceans," Tarhan said. "Early burrowing animals did indeed foster the emergence of increasingly productive and complex ecosystems and helped further the Cambrian explosion, rather than stifling or delaying its impact."

###

Co-authors of the study are Noah Planavsky, an associate professor of Earth and planetary sciences at Yale, and Mingyu Zhao, a former postdoctoral researcher at Yale who is now at the University of Leeds.

Chimaeroid from Early Cretaceous reassessed in light of new data

A paper went out in Journal of Vertebrate Paleontology

KAZAN FEDERAL UNIVERSITY

Research News

 

The basis for this new take on the classification was laid in 1985, when John Long attributed a fossil tooth plate to a new species, Edaphodon eyrensis. The species was named after Lake Eyre, near which the tooth was found in 1978.

Asscoiate Professor Evgeny Popov had his doubts about the attribution. However, he had to study the fossil personally to advance his theory. The opportunity presented itself during a trip to Australia in 2010. The tooth plate was stored in a museum in Adelaide, South Australia.

"I didn't plan to go there, but I was able to negotiate a temporary transfer of the fossil to Victoria, where I was working with another collection of chimaeroid fossils. The tooth plate was photographed, drawn, measured and studied under a microscope," says Popov.

To further solidify his takeaways, Popov also visited Brisbane, Queensland, where he studied more chimaeroid specimens. As a result, the plate was attributed to Ptyktoptychion Lees, and the species received a new name - Ptyktoptychion eyrensis.

Interestingly, the place of discovery, which is now in the Australian moderate climate, was in polar latitudes during the Aptian age of the Cretaceous (125 to 113 Ma). The changes of polar day and night and frosty weather were not a hindrance for this fish in the shallow waters of prehistoric Australian seas.

###

Open, expressive family life may reduce social deprivation effects among adopted children

NIH/EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Research News

 

WHAT:

An environment in which family members support one another and express their feelings can reduce the effects of social deprivation on cognitive ability and development among adopted children, suggests a small study by researchers at the National Institutes of Health. In contrast, rule-driven households where family members are in conflict may increase an adopted child's chances for cognitive, behavioral and emotional difficulties.

The study was conducted by Margaret F. Keil, Ph.D., and colleagues in the Section on Endocrinology and Genetics at NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). It appears in Pediatric Research.

Researchers enrolled children who had spent at least eight months in Eastern European orphanages before their adoption by American families. The children ranged from 14 to 40 months of age and were evaluated with physical, psychological and developmental tests twice during the following two years. Families also responded to questionnaires on the children's development and on various aspects of their home lives. The study included 10 adopted children and 19 similar children born to American families.

Overall, the adopted children had significant deficits in growth, cognitive ability and development in comparison to the American-born children. However, differences were smaller among children from families scoring higher in cohesion, where family members provided help and support for each other, and expressiveness--families whose members are encouraged to express their feelings. Children had greater deficits if their families scored higher in conflict--open expression of anger and aggression--and in control--a family life run according to set rules and procedures.

The authors concluded that family cohesion and expressiveness could moderate the effects of pre-adoption adversity, while family conflict and adherence to rules could increase the risk for behavioral problems. The authors added that larger studies are needed to verify their findings.

###

WHO:

Margaret F. Keil, Ph.D., NICHD Section on Endocrinology and Genetics, is available for comment.

ARTICLE:

Keil, MF. Family environment and development in children adopted from institutionalized care. Pediatric Research.2020.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD leads research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all. For more information, visit https://www.nichd.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov.

BY WAY OF ANECDOTAL EVIDENCE,

I AM ADOPTED AND WAS ALWAYS TOLD SO

IT WAS FOLLOWED BY WE LOVE YOU

50 years of progress in women's health

UNIVERSITY OF CALIFORNIA - SAN DIEGO

Research News

 

Debates over women's health have long been contentious, but have also resulted in significant improvements in areas like equitable access to health care and survivorship. But the overall picture remains far from perfect. For example, the United States still has the highest rate of maternal death among high-income countries, particularly among African American women.

As the United States Supreme Court prepares to hear a Mississippi abortion case challenging the landmark 1973 Roe v. Wade decision, some experts are questioning whether women's health may be reversing course.

Cynthia A. Stuenkel, MD, clinical professor of medicine at University of California San Diego School of Medicine, and JoAnn E. Manson, MD, DrPH, professor of epidemiology at Harvard T.H. Chan School Of Public Health, review 50 years of progress in women's health in a perspective article published in the May 29, 2021 online issue of the New England Journal of Medicine.

"Reproductive justice is broader than the pro-choice movement and encompasses equity and accessibility of reproductive health care, as well as enhanced pathways to parenthood," wrote the authors.

In addition to Roe v. Wade, advances in reproductive health include:

• 1972 US Supreme Court ruling on Eisenstadt vs Baird ensuring unmarried persons equal access to contraception
• 2010 Affordable Care Act made contraceptives an insured preventive health benefit
• Advances in reproductive technologies, including in vitro fertilization, genetic testing and fertility preservation by cancer specialists

Advances in women's health go beyond reproduction, said the authors. As interest and focus has expanded to all stages of a woman's life, science has begun to catch up to the specialized needs of women and sex-specific risk factors for chronic diseases that disproportionately affect women's health, such as autoimmune diseases, mental health, osteoporosis and coronary heart disease.

• Progress in breast cancer care and prevention yielded a five-year overall survival rate of 90 percent
• The human papillomavirus (HPV) vaccine reduced cervical cancer mortality decreased by 50 percent

"Moving forward, it will be essential to recognize and study intersectional health disparities, including disparities based on sex, race, ethnicity, gender identity, sexual orientation, income and disability status. Overcoming these challenges and addressing these inequities will contribute to improved health for everyone," wrote the authors.

###

 Better choice of contraceptives can prevent breast cancer

An EPFL study into the distinct biological effects of different progestins on the breast shows that contraceptive-related breast cancer can be prevented by more informed choices about the composition of contraceptives.

WHERE IS THE MALE PILL, OH RIGHT ITS NOT 100% SAFE

ECOLE POLYTECHNIQUE FÉDÉRALE DE LAUSANNE

Research News

 

IMAGE: FLUORESCENCE STEREO MICROGRAPH OF A MOUSE MAMMARY GLAND INTRADUCTALLY INJECTED WITH NORMAL HUMAN BREAST EPITHELIAL CELLS. CREDIT: MARIE SHAMSEDDIN (EPFL). view more 

CREDIT: EPFL

Hormonal contraceptives, e.g. the pill, the patch, and the vaginal ring, contain synthetic hormones that prevent pregnancy by either stopping ovulation, changing the cervical mucus to stop sperm from passing through the cervix and finding an egg, or changing the womb's lining to prevent a fertilized egg from being implanted in it.

Despite their widespread use, hormonal contraceptives are known to increase the risk of breast cancer, which is the most common cause of cancer-related death among women worldwide, and also topped the list of most commonly diagnosed cancers in 2020.

The main component of hormonal contraceptives are progestins, which, mimic the female sex hormone progesterone. Progesterone is involved in a number of biological processes, including the menstrual cycle, pregnancy, and various aspects of fetal development, like brain programming.

Now, a team of scientists led by Professor Cathrin Brisken at EPFL's School of Life Sciences, have taken a thorough and close look at the different biological effects that different progestins in hormonal contraceptives have on the breast tissue - the mammary epithelium. The work is published in EMBO Molecular Medicine.

"Although we know how different contraceptive formulations affect the cardiovascular system, we know little about their effects on the breast," says Brisken. "So we developed new approaches to compare the most commonly used progestins in different hormonal contraceptives and were surprised to find that some of them stimulate cell proliferation in the breast - while others do not."

The researchers tested the effects of prolonged exposure to different progestins on human breast epithelial cells or HBECs, which line the inner layer of the breast. To do this, they developed "humanized" mouse mammary glands by grafting breast epithelial cells from donated human breast tissue from reduction mammoplasty samples into the animals' milk ducts and monitoring their growth in vivo.

"We found that HBECs engraft and proliferate in mouse milk ducts, maintaining hormone receptor expression and hormone responsiveness, which are crucial factors for establishing a relevant preclinical model and thereby to foster translational research," says Brisken.

The team realized that what distinguished the stimulatory and the innocuous progestins were their "androgenic properties" - a technical term for substances that trigger the development of male characteristics, such as body hair, muscle mass etc. This isn't as strange as it sounds: progesterone, mostly known as a female hormone, is used for the production of the famous male hormone testosterone in both women and men.

Some progestins have androgenic properties, acting like testosterone; some actually block them. The key is a protein known as the androgen receptor, which, when activated by an androgenic progestin, travels into the cell's nucleus where it regulates the expression of certain genes.

Working with the epithelial cells in a mouse model, the researchers found that androgenic progestins act through the androgen receptor to induce the expression of the protein Rankl, which plays an important role in cell proliferation in the mammary epithelium. This effect was not seen with anti-androgenic progestins.

The study showed that androgenic - but not anti-androgenic - progestins promote cell proliferation. "Exposing human breast epithelia to androgenic progestins for prolonged periods of time caused hyperproliferation and changes in the cells that are associated with early, pre-malignant lesions - at least in xenografted human breast epithelia," says De Martino.

"Hormonal contraception exposes women to different progestins with or without estrogen," says Brisken. "The androgenic properties of progestins determine their biological activity in the breast epithelium, and reveal an unexpected role for androgen receptor activity in the proliferation of breast epithelial cells."

The crucial insight of the study is that progestins with anti-androgenic activity may be a safer option with regards to breast cancer risk than testosterone-related compounds, e.g. the widely used contraceptive levonorgestrel ("Plan B"). "It might be possible to prevent breast cancer associated with contraception by making more informed choices taking the molecular composition of a contraceptive into account," concludes Brisken.

###

Other contributors

University Hospital of Lausanne (CHUV)
International Cancer Prevention Institute

Funding

Swiss National Science Foundation
Swiss Cancer League
Biltema ISREC Foundation Cancera Stiftelsen
Mats Paulssons Stiftelse
Stitelsen Stefan Paulssons Cancerfond
Joint Action and Learning Initiative (JALI)

Exoskeleton-assisted walking may improve bowel function in people with spinal cord injury

Research team shows that physical intervention plans that include walking, not just standing, may enhance multiple measures of bowel function

KESSLER FOUNDATION

Research News

 

IMAGE: TWO TYPES OF EXOSKELETONS WERE USED IN THIS MULTI-SITE STUDY, REWALK AND EKSO GT. THIS PHOTO SHOWS AN EKSO GT IN THE TIM & CAROLINE REYNOLDS CENTER FOR SPINAL STIMULATION... view more 

CREDIT: KESSLER FOUNDATION

East Hanover, NJ. May 28, 2021. A team of researchers has shown that physical intervention plans that included exoskeleton-assisted walking helped people with spinal cord injury evacuate more efficiently and improved the consistency of their stool. This finding was reported in Journal of Clinical Medicine on March 2, 2021, in the article "The Effect of Exoskeletal-Assisted Walking on Spinal Cord Injury Bowel Function: Results from a Randomized Trial and Comparison to Other Physical Interventions" (doi: 10.3390/jcm10050964).

The authors are Peter H. Gorman, MD, of the University of Maryland School of Medicine, Gail F. Forrest, PhD, of Kessler Foundation's Tim and Caroline Reynolds Center for Spinal Stimulation, Dr. William Scott, of VA Maryland Healthcare System, Pierre K. Asselin, MS, Stephen Kornfeld, MD, Eunkyoung Hong, PhD, and Ann M. Spungen, EdD, of the James J. Peters VA Medical Center.

Bowel dysfunction, a common experience after spinal cord injury, can lead to chronic constipation and incontinence, causing discomfort and frustration. In one survey, more than a third of men with spinal cord injury reported that bowel and bladder dysfunction had the most significant effect on their lives post-injury. Unfortunately, these issues are not easily managed.

Rehabilitation professionals have traditionally managed bowel dysfunction using approaches that target the gastrointestinal system or require manual intervention, but some newer research suggests that physical activity and upright posture may enhance bowel motility. However, few studies have explored the possibility that exoskeletal-assisted walking--in which a person with spinal cord injury wears a robotic suit, enabling them to stand and walk--may be an effective addition to existing intervention plans.

In this study, the research team investigated whether exoskeletal-assisted walking improved bowel function in people with chronic spinal cord injury. They performed a three-center, randomized, controlled, crossover clinical trial in which 50 participants completed 36 sessions of exoskeletal-assisted walking. The researchers evaluated bowel function as a secondary outcome in 49 participants. Bowel function was measured via a 10-question bowel function survey, the Bristol Stool Form Scale, and the Spinal Cord Injury Quality of Life Bowel Management Difficulties instrument.

Results showed that the exoskeletal-assisted walking program provided some improvement in bowel function when compared to a control group. "We saw a notable reduction in bowel evacuation time, with 24 percent of participants reporting an improved experience," said Dr. Forrest, co-author and associate director of the Center for Mobility and Rehabilitation Engineering Research at Kessler Foundation. "We also noted that participants' stools trended toward better consistency, supporting our hypothesis that this intervention may improve several measures of bowel function."

"Our results support the idea that walking, and not just standing, may have a beneficial effect on bowel function," said Dr. Gorman, co-author and chief of the Division of Rehabilitation Medicine at the University of Maryland Rehabilitation and Orthopaedic Institute. "Our goal is to improve the quality of life of those with chronic spinal cord injury, and these encouraging results will help inform future studies on the emerging field of mobility intervention."

###

Funding: Department of Defense/CDMRP SC130234, Award: W81XWH-14-2-0170, and National Center for the Medical Consequences of SCI (B9212-C, B2020-C) at the James J. Peters Veterans Affairs Medical Center. Additional local support was provided by the James Lawrence Kernan Endowment Fund, Baltimore, Maryland; a philanthropic gift from Dr. Bert Glaser at the Baltimore site; and The Bronx Veterans Medical Research Foundation at the Bronx site.

For information on current research studies, visit https://kesslerfoundation.org/research/studies/spinal-cord-injury, or email ResearchStudies@kesslerfoundation.org

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that improves cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. Learn more by visiting http://www.KesslerFoundation.org

Learn more about ongoing studies at Kessler Foundation at Join Our Research Studies | Kessler Foundation

Contact: Carolann Murphy, PA, Assistant Editor; Cmurphy@KesslerFoundation.org

HOMO ROBOTICUS

Exoskeleton therapy improves mobility, cognition and brain connectivity in people with MS

A pilot study led by Kessler Foundation researchers provided proof of concept for robotic-exoskeleton assisted exercise rehabilitation (REAER) in people with substantial MS-related neurological disability

KESSLER FOUNDATION

Research News

 

IMAGE: A RESEARCH PARTICIPANT IN THE MS PILOT STUDY DOES EXERCISE TRAINING IN THE EKSO NR AT KESSLER FOUNDATION. view more 

CREDIT: KESSLER FOUNDATION/JODY BANKS

East Hanover, NJ. May 28, 2021. A team of multiple sclerosis (MS) experts at Kessler Foundation led the first pilot randomized controlled trial of robotic-exoskeleton assisted exercise rehabilitation (REAER) effects on mobility, cognition, and brain connectivity in people with substantial MS-related disability. Their results showed that REAER is likely an effective intervention, and is a promising therapy for improving the lives of those with MS.

The article, "A pilot randomized controlled trial of robotic exoskeleton-assisted exercise rehabilitation in multiple sclerosis," (doi: 10.1016/j.msard.2021.102936) was published on April 4, 2021, by Multiple Sclerosis and Related Disorders. It is available open access at https://www.msard-journal.com/article/S2211-0348(21)00203-0/fulltext.

The authors, are Ghaith J. Androwis, PhD, Brian M. Sandroff, PhD, Peter Niewrzol, MA, Glenn R. Wylie, DPhil, Guang Yue, PhD, and John DeLuca, PhD, of Kessler Foundation, and Farris Fakhoury, DPT, of Kessler Institute for Rehabilitation.

It is common for people with MS to experience impairments in both mobility and cognition, and few therapies exist to manage the range of debilitating symptoms. This lack of treatment options is a major problem for people with MS, especially those with substantial MS-related neurological disability.

Previous research shows that exercise rehabilitation, such as walking, is an effective approach to symptom management, with some research suggesting that even a single exercise rehabilitation intervention can improve both mobility and cognition.

Yet there is a lack of efficacy of exercise rehabilitation on mobility and cognitive outcomes in people with MS who have substantial disability. Adaptive exercise rehabilitation approaches such as body-weight supported treadmill training and robot-assisted gait training have not demonstrated convincing results. Moreover, adaptive interventions lack key interactions between patients and therapists that may improve efficacy.

In this pilot study of 10 participants with significant MS-related neurological disability, researchers explored the use of robotic exoskeletons to manage symptoms. Rehabilitation exercise using robotic exoskeletons is a relatively new approach that enables participants to walk over-ground in a progressive regimen that involves close engagement with a therapist. The Foundation has dedicated a Ekso NR to MS studies to facilitate further research in this area.

As compared to conventional gait training, REAER allows participants to walk at volumes needed to realize functional adaptations--via vigorous neurophysiological demands--that lead to improved cognition and mobility. Effects on brain activity patterns were studied using the functional MRI capabilities of the Rocco Ortenzio Neuroimaging Center at Kessler Foundation.

Investigators compared participants' improvement after four weeks of REAER vs four weeks of conventional gait training, looking at functional mobility, walking endurance, cognitive processing speed, and brain connectivity.

The results were positive: Relative to conventional gait training, four weeks of REAER was associated with large improvements in functional mobility (ηp2=.38), cognitive processing speed (ηp2=.53), and brain connectivity outcomes, most significantly between the thalamus and ventromedial prefrontal cortex (ηp2=.72). "Four weeks is relatively short for an exercise training study," noted Dr. Sandroff, senior research scientist at Kessler Foundation and director of the Exercise Neurorehabilitation Research Laboratory. "Seeing improvements within this timeframe shows the potential for exercise to change how we treat MS. Exercise is really powerful behavior that involves many brain regions and networks that can improve over time and result in improved function."

"This is particularly exciting because therapy using robotic exoskeletons shows such promise for improving the lives of people with co-occurring mobility and cognitive disability, a cohort that likely has the greatest potential to benefit from this new technology," said Dr. Androwis, lead author and research scientist in the Center for Mobility and Rehabilitation Engineering Research at Kessler Foundation. "We're eager to design a larger trial to further study these effects. Based on our initial results, we're optimistic that this approach may be superior to the current standard of care."

###

Funding sources: National Multiple Sclerosis Society, USA (Collaborative Network of New Jersey), Award Number: CA1069-A-7; and Joy and Avi Avidan, New Jersey, USA.

About Kessler Foundation: Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that improves cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. Learn more by visiting http://www.KesslerFoundation.org.

Contact: Carolann Murphy, PA, Cmurphy@KesslerFoundation.org

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news relea

NOT JUST POSSIBLE

Climate change makes West Nile virus outbreaks 'plausible' in UK

Risk of mosquito-borne pathogen spreading to the country will increase as temperatures rise, say scientists

UK CENTRE FOR ECOLOGY & HYDROLOGY

Research News

  

IMAGE: THE COMMON HOUSE MOSQUITO (CULEX PIPIENS) CAN TRANSMIT THE WEST NILE VIRUS view more 

CREDIT: FABRIZIO MONTARSI, CC BY 3.0

Climate change will make outbreaks of West Nile virus more likely in the UK within the next 20-30 years, scientists say.

West Nile virus is spread by mosquitoes and has no vaccine. Most people have no symptoms, but it can cause serious neurological disease.

Scientists from the UK Centre for Ecology & Hydrology (UKCEH), Biomathematics and Statistics Scotland (BioSS) and the University of Glasgow developed a new model to determine the risk of a West Nile virus outbreak in the UK.

They found the risk is low for the next two to three decades, but will increase as temperatures rise.

Dr Steven White, a theoretical ecologist at UKCEH, said: "Knowing if or when a new disease will affect us is vitally important.

"West Nile virus is currently absent in the UK, but we do harbour the Culex pipiens mosquito, which can transmit the disease and potentially lead to spill-over into humans.

"West Nile virus is now endemic in Italy and there have been outbreaks in Germany, so it is moving into more temperate climates.

"Our model shows that the risk will steadily increase and that future outbreaks are plausible in the UK."

The team's mathematical model looked at the effects of temperature on the biological processes affecting the Culex pipiens mosquito population in the UK. They were able to capture how these seasonal changes might interact with faster replication of the virus under higher temperatures to drive outbreaks.

Dr David Ewing from BioSS, formerly a UKCEH PhD student when most of the research was carried out, said: "Our model shows the predicted risk of an outbreak increases substantially if the biting season goes on longer, or if new viral strains are introduced that replicate at a higher rate than the ones already studied.

"Most other approaches are simplified, but we've built in complex biological relationships. This model could be adapted to look at other viruses and diseases, or other mosquito or insect species."

Dr Ewing says the study shouldn't be cause for alarm, but to help the UK prepare. "While there's relatively little immediate danger, we can take steps to prepare for future outbreaks.

This could be as simple as ensuring doctors are aware of the symptoms, testing and who's most at risk of becoming seriously ill."

The research was reported in the Journal of the Royal Society Interface - DOI: doi/10.1098/rsif.2021.0049

###

Notes to editors

About West Nile virus

(From the World Health Organisation)

* West Nile virus can cause a fatal neurological disease in humans.

* However, approximately 80% of people who are infected will not show any symptoms.

* West Nile virus is mainly transmitted to people through the bites of infected mosquitoes.

* The virus can cause severe disease and death in horses.

* Vaccines are available for use in horses but not yet available for people.

* Birds are the natural hosts of West Nile virus.

* It is commonly found in Africa, Europe, the Middle East, North America and West Asia. WNV is maintained in nature in a cycle involving transmission between birds and mosquitoes. Humans, horses and other mammals can be infected.

About the Culex pipiens mosquito

* Culex pipiens is the most common mosquito species in the UK.

* In more northerly latitudes, such as the UK, they mainly feed on birds, not humans.

* Only females feed on blood (male Culex pipiens consume carbohydrate food sources) and are most active around sunset.

* Mosquito population levels tend to increase over the summer months, particularly in hot and wet summers which facilitate faster development and an increase in breeding sites.

* Over winter in the UK, the mosquito species stops taking blood meals and instead survives on sugary food sources as they enter diapause (akin to hibernation) as adults, inhabiting sheltered locations.

* The species is found in both temperate and tropical climates.

* Alongside West Nile virus, Culex pipiens are carriers of other diseases such as avian malaria.

About the UK Centre for Ecology & Hydrology (UKCEH)

The UK Centre for Ecology & Hydrology is a centre for excellence in environmental science across water, land and air. Our 500 scientists work to understand the environment, how it sustains life and the human impact on it - so that together, people and nature can prosper.

We have a long history of investigating, monitoring and modelling environmental change, and our science makes a positive difference in the world. The issues our science addresses include: air pollution, biodiversity, biosecurity, chemical risks, extreme weather events, droughts, floods, greenhouse gas emissions, land use, soil health, sustainable agriculture, sustainable ecosystems, sustainable macronutrient use, and water resources management.

The UK Centre for Ecology & Hydrology is a strategic delivery partner for the Natural Environment Research Council, part of UK Research and Innovation.

http://www.ceh.ac.uk @UK_CEH

About BioSS

BioSS specialises in the development and application of the quantitative methods needed to enhance scientific knowledge and impact. We are recognised internationally for our work at the interface between the mathematically-based sciences and a wide span of applied sciences covering agriculture and the rural economy, the environment, food and health.