ALL SMOKING PRODUCES TOXIC PARTICULATES

Smoking exposure during childhood may increase risk of rheumatoid arthritis

Longitudinal study uncovers significant influence of passive exposure to parental smoking on adult-onset incident seropositive rheumatoid arthritis

Peer-Reviewed Publication

BRIGHAM AND WOMEN'S HOSPITAL

A new study by investigators from Brigham and Women’s Hospital found a potential direct link between exposure to parental smoking during childhood and increased risk of seropositive rheumatoid arthritis (RA) later in life. Researchers utilized established longitudinal data from 90,923 women in the Nurses’ Health Study II (NHSII) to elucidate the relationship between passive smoking exposure and incident RA. Passive exposure was broken down into three categories, including maternal smoking during pregnancy, parental smoking during childhood, and years lived with smokers since age 18. Even with personal smoking accounted for, passive exposure to parental smoking during childhood was found to increase risk of incident seropositive RA by 75-percent. Findings are published in Arthritis & Rheumatology.

“There has been intense interest in mucosal lung inflammation from personal smoking as a site of RA pathogenesis,” said senior author Jeffrey A. Sparks, MD, MMSc, of the Department of Medicine at the Brigham. “But the majority of RA patients aren’t smokers, so we wanted to look at another inhalant that might precede RA.”

RA is an inflammatory disease characterized by arthritis at multiple joints and is associated with morbidity and mortality outcomes. Many people with RA have signs of lung inflammation, and while genetic and environmental factors contribute to risk of developing RA, smoking has long been implicated as a key RA risk factor. Personal (active) smoking is the most well-established environmental risk factor associated with RA, with passive smoking left relatively unexplored.

To link passive smoking and incident RA more conclusively, Sparks and colleagues used data from NHSII questionnaires collected biennially between 1989 and 2017 from 90,923 women aged 35-52 years. Researchers used participant medical records to confirm incident RA and serostatus. Statistical modeling was then used to estimate the direct effect of each passive smoking exposure on RA risk, as well as to control for other factors such as personal smoking.

A 75-percent higher risk of RA was found in individuals who experienced passive childhood exposure to parental smoking. This risk increased in participants who themselves became active smokers. Over the median follow-up of 27.7 years, 532 women in the cohort developed confirmed incident RA cases — the majority (352) of which were seropositive (positive for RA autoantibodies). Maternal smoking during pregnancy and years lived with smokers beyond age 18 showed no significant association with incident RA risk.

Although the all-female nurse participant pool led to high response rates and retention, the study is limited by the absence of men. The team intends to continue with longitudinal studies that encompass both men and women, as to provide critical insight into other rheumatoid conditions and even other autoimmune diseases.

“Our findings give more depth and gravity to the negative health consequences of smoking in relation to RA, one of the most common autoimmune diseases,” said lead and co-corresponding author Kazuki Yoshida, MD, ScD, of the Brigham’s Division of Rheumatology, Inflammation and Immunity. “This relationship between childhood parental smoking and adult-onset RA may go beyond rheumatology — future studies should investigate whether childhood exposure to inhalants may predispose individuals to general autoimmunity later in life.”

Conflict of Interest: None

Funding: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) under award number K23 AR069688 to Dr. Sparks. This work was additionally supported by the Rheumatology Research Foundation R Bridge Award, and by the National Institutes of Health (award numbers L30 AR066953, K24 AR052403, R01 AR049880, R01AR057327, R01 AR119246, R01 HL034594, P30 AR070253, P30 AR072577, P30 AR069625, UM1CA186107, U01 HG008685, 1OT2OD026553, and R03 AR075886). Dr. Yoshida was supported by the Rheumatology Research Foundation K Bridge Award, Brigham and Women's Hospital Department of Medicine Fellowship Award, and K23 AR076453 (NIAMS).

Nurses’ Health Study II was supported by the National Institutes of Health (U01 CA176726, R01CA67262, and U01 HL145386).

Paper cited: Yoshida K et al. “Passive Smoking Throughout the Life Course and the Risk of Incident Rheumatoid Arthritis in Adulthood Among Women” Arthritis Rheumatol. DOI: 10.1002/art.41939

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ARTICLE PUBLICATION DATE

18-Aug-2021

 

Investigators examine antibiotic prescribing following COVID-19 restrictions

Peer-Reviewed Publication

WILEY

In regions with high rates of COVID-19 spread, such as Europe and the United States, prescriptions for antibiotics in the community dropped dramatically after COVID-19 restrictions were introduced in early 2020. A study published in the British Journal of Clinical Pharmacology looked at antibiotic prescribing in Australia, which has had low COVID-19 rates.

Analyses of national claims data revealed that COVID-19 restrictions in Australia were associated with substantial reductions in community dispensing of antibiotics primarily used to treat respiratory infections, but antibiotics for non-respiratory infections were unchanged.

“The issue is that antibiotics should rarely be prescribed for common viral respiratory infections in the first place. These big reductions show how low general practitioners’ antibiotic prescribing could go if guidelines were followed more closely,” said co–senior Helga Zoega, PhD, of UNSW Sydney, in Australia.

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DOI

10.1111/bcp.15000

 

Vitamin D deficiency is a global health issue for the black community, finds new study from the University of Surrey

Reports and Proceedings

UNIVERSITY OF SURREY

Vitamin D is made when the skin comes into contact with sunshine; however, we can also get vitamin D from our food intake. It has several important functions within the body, but it is primarily known for promoting calcium absorption, which makes it a vital nutrient for bone health.

In a paper published by The European Journal of Clinical Nutrition, Surrey’s researchers conducted a systematic review of the vitamin D and dietary intakes of members of the black community across the globe. The findings suggest that people of African descent should consider taking vitamin D supplements and consume more vitamin D rich foods.

The researchers found that when looking at black individuals who live in low latitude countries (such as Brazil and South Africa), there was vitamin D sufficiency. However, in those who live at higher latitudes, such as in the UK, vitamin D deficiency and insufficiency was common.

The Surrey researchers' findings suggest that awareness of vitamin D deficiency needs to be highlighted in African-Caribbean populations, especially those living in countries like the UK where low dietary vitamin D intake was prevalent.

Rebecca Vearing, PhD research student from the Department of Nutritional Sciences at the University of Surrey, said: “As the majority of our vitamin D comes from exposure to sunlight, for many people getting enough vitamin D may be a real challenge. This research shows that eating a nutritionally balanced diet including foods that provide vitamin D -- such as oily fish, red meat, egg yolk and fortified foods such as breakfast cereals -- and taking regular supplements are key to boosting vitamin D status.”

These findings are supported by a second paper from Surrey published by The Journal of Nutrition, where researchers studied how vitamin D supplements and sunlight exposure affect the health of Brazilian women living in both the UK and Brazil.*

This first-of-its-kind study examined two groups of the same ethnic identity and sex, living in different countries in an identical way and looked at whether supplements or sunlight altered the vitamin D status of its participants.

Researchers studied 120 healthy Brazilian women in parallel, double-blind, randomised, placebo-controlled trials conducted at different latitudes in Brazil and England. Participants were chosen randomly to receive a daily vitamin D supplement or placebo for 12 weeks during the wintertime.

Researchers found that although vitamin D dietary requirements may vary considerably between participants in each country, a moderate dose of vitamin D supplementation is a remarkably effective strategy for raising and maintaining adequate vitamin D levels over the winter months in both the UK and Brazil.

The participants with the lowest initial vitamin D levels had the most significant increases in response to vitamin D supplements.

Overall, the study found that the effect of vitamin D supplements is not dependent on latitude.

Dr Marcela Mendes, visiting research fellow from the Department of Nutritional Sciences at the University of Surrey, said: “Our research looks at different ethnic groups, and our findings show that people might benefit from increasing consumption of foods that naturally contain vitamin D or are fortified with it, or even taking an additional supplement, in the autumn and winter, regardless of where they live.”

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JOURNAL

European Journal of Clinical Nutrition

DOI

10.1038/s41430-021-00980-9

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Global Perspective of the Vitamin D Status of African-Caribbean Populations: A Systematic Review and Meta-analysis

ARTICLE PUBLICATION DATE

18-Jul-2021

 

Researchers uncover new evidence that fetal membranes can repair themselves after injury

Peer-Reviewed Publication

QUEEN MARY UNIVERSITY OF LONDON

Scientists from Queen Mary University of London and UCL have shown that fetal membranes are able to heal after injury in a new study published today in Scientific Reports.

The integrity of the fetal membranes that surround the baby in the womb during pregnancy is vital for normal development. But fetal membranes can become damaged as a result of infection, bleeding, or after fetal surgery and even diagnostic tests during pregnancy, such as amniocentesis, which require doctors to make a hole with a needle in the fetal membrane sac.

Currently there are no clinical approaches available to repair or improve healing in the fetal membranes, and until now it was unclear if small holes in the membranes were able to heal themselves.

The international research team, which also includes scientists and clinicians from Nanyang Technological University, Singapore and University Hospitals Leuven, Belgium, created small defects using a needle in donated human fetal membrane tissue, to mimic damage caused during fetal surgery. A few days after injury, the researchers discovered a population of cells called myofibroblasts (MFs), which play an important role in wound healing, and found that these cells crawled towards the edges of the wound and into the defect site. This cell population produced collagen and started to pull the edges of the wound, contracting the tissues together and repairing the wound.   

The findings follow on from the team’s previous work that highlighted the importance of a protein called Connexin 43 (Cx43) in the process of wound healing and repair. Whilst in this study, the researchers show that Cx43 was expressed by two cell populations, amniotic mesenchymal cells (AMCs) and MFs, the localisation and levels of Cx43 measured were different. They also found that overexpression of this protein affected the ability of cells to migrate into the defect site and close the wound.

Dr Tina Chowdhury, Senior Lecturer in Regenerative Medicine at Queen Mary, said: “We have always thought that small diameter wounds created in human fetal membranes rarely heal by themselves but here we show that the tissues have the potential to do this. We found that Cx43 has different effects on cell populations found in the membranes and promotes transformation of AMCs into MFs, triggering them to move, repair and heal defects in the fetal membranes.”

The premature rupture of fetal membranes, known as preterm prelabour rupture of the membranes (PPROM), is a major cause of preterm birth accounting for around 40 per cent of early infant death. Therefore, the successful repair of fetal membranes could help reduce the risk of birth complications.

Anna David, UCLH Consultant and Professor in Obstetrics and Maternal Fetal Medicine and Director at the UCL Elizabeth Garrett Anderson Institute for Women’s Health and a co-author of the study, said: “Finding that the fetal membranes have this potential to heal is a huge step towards developing treatments for women with PPROM. It holds out hope that we may be able to delay or even prevent preterm birth, which will significantly improve baby outcomes.”

This research was funded by Great Ormond Street Hospital Children’s Charity (17QMU01), Rosetrees Trust (M808), KU Leuven University Fund, Little Heartbeats (https://www.little-heartbeats.org.uk/) and the Prenatal Therapy Fund, University College London Hospital Charity (https://www.justgiving.com/fundraising/uclh-prenatal-therapy-fund).

Notes to editors

• Research publication: ‘Cx43 mediates changes in myofibroblast contraction and collagen release in human amniotic membrane defects after trauma’ Eleni Costa, Babatunde O. Okesola, Christopher Thrasivoulou, David L. Becker, Jan A. Deprest, Anna L. David, Tina T. Chowdhury, Scientific Reports.
• For more information or a copy of the paper please contact:

• Sophie McLachlan

  Faculty Communications Manager (Science & Engineering)

  Queen Mary University of London

  sophie.mclachlan@qmul.ac.uk

  Tel: 020 7882 3787

  About Queen Mary

  Queen Mary University of London is a research-intensive university that connects minds worldwide. A member of the prestigious Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our world-leading research. In the most recent Research Excellence Framework we were ranked 5th in the country for the proportion of research outputs that were world-leading or internationally excellent. We have over 25,000 students and offer more than 240 degree programmes. Our reputation for excellent teaching was rewarded with silver in the most recent Teaching Excellence Framework. Queen Mary has a proud and distinctive history built on four historic institutions stretching back to 1785 and beyond. Common to each of these institutions – the London Hospital Medical College, St Bartholomew’s Medical College, Westfield College and Queen Mary College – was the vision to provide hope and opportunity for the less privileged or otherwise under-represented. Today, Queen Mary University of London remains true to that belief in opening the doors of opportunity for anyone with the potential to succeed and helping to build a future we can all be proud of.

  UCL – London’s Global University

  UCL is a diverse community with the freedom to challenge and think differently.

  Our community of more than 41,500 students from 150 countries and over 12,500 staff pursues academic excellence, breaks boundaries and makes a positive impact on real world problems.

  We are consistently ranked among the top 10 universities in the world and are one of only a handful of institutions rated as having the strongest academic reputation and the broadest research impact. 

  We have a progressive and integrated approach to our teaching and research – championing innovation, creativity and cross-disciplinary working. We teach our students how to think, not what to think, and see them as partners, collaborators and contributors.  

  For almost 200 years, we are proud to have opened higher education to students from a wide range of backgrounds and to change the way we create and share knowledge. 

  We were the first in England to welcome women to university education and that courageous attitude and disruptive spirit is still alive today. We are UCL.

  www.ucl.ac.uk| Follow @uclnews on Twitter | Watch our YouTube channel | Listen to UCL podcasts on SoundCloud | Find out what’s on at UCL Minds | #MadeAtUCL

  Find out how UCL is helping lead the global fight against COVID-19 www.ucl.ac.uk/covid-19-research

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JOURNAL

Scientific Reports

DOI

10.1038/s41598-021-94767-4

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Human tissue samples

ARTICLE TITLE

Cx43 mediates changes in myofibroblast contraction and collagen release in human amniotic membrane defects after trauma

ARTICLE PUBLICATION DATE

17-Aug-2021

STILL WORKING ON NO CARBON FOOTPRINT

Scientists develop alternative cement with low carbon footprint

Peer-Reviewed Publication

MARTIN-LUTHER-UNIVERSITÄT HALLE-WITTENBERG

Researchers at the Martin Luther University Halle-Wittenberg (MLU) in Germany and the Brazilian University of Pará have developed a climate-friendly alternative to conventional cement. Carbon dioxide (CO2) emissions can be reduced during production by up to two thirds when a previously unused overburden from bauxite mining is used as a raw material. The alternative was found to be just as stable as the traditional Portland cement. The results were published in Sustainable Materials and Technologies.

Houses, factories, staircases, bridges, dams - none of these structures can be built without cement. According to estimates, almost six billion tonnes of cement were produced worldwide in 2020. Cement is not only an important building material, it is also responsible for around eight per cent of manmade CO2 emissions. "Portland cement is traditionally made using various raw materials, including limestone, which are burned to form so-called clinker," explains Professor Herbert Pöllmann from MLU’s Institute of Geosciences and Geography. "In the process, the calcium carbonate is converted into calcium oxide, releasing large quantities of carbon dioxide." Since CO2 is a greenhouse gas, researchers have been looking for alternatives to Portland cement for several years. 

One promising solution is calcium sulphoaluminate cement, in which a large portion of the limestone is replaced by bauxite. However, bauxite is a sought-after raw material in aluminium production and not available in unlimited quantities. Together with Brazilian mineralogists, the MLU team has now found an alternative to the alternative, so to speak: They do not use pure bauxite, but rather an overburden: Belterra clay. "This layer of clay can be up to 30 metres thick and covers the bauxite deposits in the tropical regions of the earth, for example in the Amazon basin," explains Pöllmann. "It contains enough minerals with an aluminium content to ensure good quality cement. It is also available in large quantities and can be processed without additional treatment." Another advantage: The Belterra clay has to be removed anyway, so it does not have to be extracted only for cement production. 

Even though cement cannot be entirely produced without calcium carbonate, at least 50 to 60 percent of the limestone can be replaced by Belterra clay. The process has another environmentally relevant advantage: the burning process only requires 1,250 degrees Celsius (2282° Fahrenheit) - 200 degrees (392° Fahrenheit) less than for Portland cement. "Our method not only releases less CO2 during the chemical conversion, but also when heating the rotary kilns", says Pöllmann. By coupling these effects, CO2 emissions can be reduced by up to two thirds during cement production. 

In extensive laboratory tests, the mineralogists were able to prove that their alternative cement meets all the quality requirements placed on traditional Portland cement. Further research projects will now investigate whether there are also overburden sources in Germany suitable for cement production. "Raw materials containing clay minerals with a lower aluminium content could be used particularly in construction projects where lower-grade concrete is sufficient," explains Pöllmann. "There is still huge potential here to further reduce carbon dioxide emissions." 

 

Study: Negrão L.B.A., Pöllmann H., da Costa M. L., Production of low- CO2 cements using abundant bauxite overburden "Belterra Clay". Sustainable Materials and Technologies (2021). DOI: 10.1016/j.susmat.2021.e00299

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JOURNAL

Sustainable Materials and Technologies

DOI

10.1016/j.susmat.2021.e00299

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Production of low- CO2 cements using abundant bauxite overburden "Belterra Clay"

ARTICLE PUBLICATION DATE

26-May-2021

COI STATEMENT

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

UPDATED

Thwaites glacier: Significant geothermal heat beneath the ice stream

Researchers map the geothermal heat flow in West Antarctica; a new potential weak spot in the ice sheet’s stability is identified

Peer-Reviewed Publication

ALFRED WEGENER INSTITUTE, HELMHOLTZ CENTRE FOR POLAR AND MARINE RESEARCH

 

IMAGE: GEOPHYSICAL MEASUREMENTS WITH A MAGNETOMETER BEING TOWED WITH RV POLARSTERN'S BOARD HELICOPTER. view more 

CREDIT: ALFRED-WEGENER-INSTITUT / THOMAS RONGE

Ice losses from Thwaites Glacier in West Antarctica are currently responsible for roughly four percent of the global sea-level rise. This figure could increase, since virtually no another ice stream in the Antarctic is changing as dramatically as the massive Thwaites Glacier. Until recently, experts attributed these changes to climate change and the fact that the glacier rests on the seafloor in many places, and as such comes into contact with warm water masses. But there is also a third, and until nowone of the most difficult to constrain, influencing factors. In a new study, German and British researchers have shown that there is a conspicuously large amount of heat from Earth’s interior beneath the ice, which has likely affected the sliding behaviour of the ice masses for millions of years. This substantial geothermal heat flow, in turn, are due to the fact that the glacier lies in a tectonic trench, where the Earth’s crust is significantly thinner than it is e.g. in neighbouring East Antarctica. The new study was published today in the Nature online journal Communications Earth & Environment.

Unlike East Antarctica, West Antarctica is a geologically young region. In addition, it doesn’t consist of a large contiguous land mass, where the Earth’s crust is up to 40 kilometres thick, but instead is made up of several small and for the most part relatively thin crustal blocks that are separated from each other by a so-called trench system or rift system. In many of the trenches in this system, the Earth’s crust is only 17 to 25 kilometres thick, and as a result a large portion of the ground lies one to two kilometres below sea level. On the other hand, the existence of the trenches has long led researchers to assume that comparatively large amounts of heat from Earth’s interior rose to the surface in this region. With their new map of this geothermal heat flow in the hinterland of the West Antarctic Amundsen Sea, experts from the Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research (AWI) and the British Antarctic Survey (BAS) have now provided confirmation.

CAPTION

Geophysical measurements with a magnetometer being towed with RV Polarstern's board helicopter.

CREDIT

Alfred-Wegener-Institut / Thomas Ronge

“Our measurements show that where the Earth’s crust is only 17 to 25 kilometres thick, geothermal heat flow of up to 150 milliwatts per square metre can occur beneath Thwaites Glacier. This corresponds to values recorded in areas of the Rhine Graben and the East African Rift Valley,” says AWI geophysicist and first author of the study, Dr Ricarda Dziadek. 

Based on their data, the geophysicists are unable to put a figure on the extent to which the rising geothermal heat warms the bottom of the glacier: “The temperature on the underside of the glacier is dependent on a number of factors – for example whether the ground consists of compact, solid rock, or of metres of water-saturated sediment. Water conducts the rising heat very efficiently. But it can also transport heat energy away before it can reach the bottom of the glacier,” explains co-author and AWI geophysicist Dr Karsten Gohl.

Nevertheless, the heat flow could be a crucial factor that needs to be considered when it comes to the future of Thwaites Glacier. According to Gohl: “Large amounts of geothermal heat can, for example, lead to the bottom of the glacier bed no longer freezing completely or to a constant film of water forming on its surface. Both of which would result in the ice masses sliding more easily over the ground. If, in addition, the braking effect of the ice shelf is lost, as can currently be observed in West Antarctica, the glaciers’ flow could accelerate considerably due to the increased geothermal heat.”

CAPTION

RV Polarstern near an iceberg in Amundsen Sea.

CREDIT

Alfred-Wegener-Institut / Thomas Ronge

The new geothermal heat flow maps are based on various geomagnetic. field datasets from West Antarctica, which the researchers have collated and analysed using a complex procedure. “Inferring geothermal heat flow from magnetic field data is a tried and tested method, mainly used in regions where little is known about the characteristics of the geological underground,” explains Fausto Ferraccioli from the British Antarctic Survey and the Istituto Nazionale di Oceanografia e di Geofisica Sperimentale (OGS), one of the study’s co-authors.

The experts will soon find out how accurate their new assessment of the heat flow below Thwaites Glacier is. An international team led by British and American polar experts, which the AWI is also taking part in, is currently engaged in a major research project. In this context, collecting core samples down as far as the glacier bed and taking corresponding heat flow measurements are planned. The findings will provide the first opportunity to comprehensively verify the new heat flow maps from West Antarctica.

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DOI

10.1038/s43247-021-00242-3

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

High geothermal heat flow beneath Thwaites Glacier in West Antarctica inferred from aeromagnetic data

ARTICLE PUBLICATION DATE

17-Aug-2021

 

New report from Harvard and global experts shows investments in nature needed to stop the next pandemic

Protecting forests and changing agricultural practices are essential, cost-effective actions to prevent pandemics

Reports and Proceedings

HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH

Boston, Mass. - As the world struggles to contain COVID-19, a group of leading, scientific experts from the U.S., Latin America, Africa and South Asia released a report today outlining the strong scientific foundations for taking actions to stop the next pandemic by preventing the spillover of pathogens from animals to people. The report provides recommendations for research and actions to forestall new pandemics that have largely been absent from high-level discussions about prevention, including a novel call to integrate conservation actions with strengthening healthcare systems globally. 

The report from the International Scientific Task Force to Prevent Pandemics at the Source makes the case that investments in outbreak control, such as diagnostic tests, drugs and vaccines, are critical but inadequate to address pandemic risk. These findings come as COVID-19 vaccinations availability in many low- and middle-income countries remains inadequate—and even in wealthier nations vaccine coverage is far from reaching levels needed to control the Delta variant. 

“To manage COVID-19, we have already spent more than $6 trillion dollars on what may turn out to be the most expensive band aids ever bought, and no matter how much we spend on vaccines, they can never fully inoculate us from future pandemics,” said Dr. Aaron Bernstein, interim director of the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health and leader of the Scientific Task Force for Preventing Pandemics at the Source. “We must take actions that prevent pandemics from starting by stopping the spillover of diseases from animals to humans. When we do, we can also help stabilize the planet’s climate and revitalize its biosphere, each of which is essential to our health and economic welfare.”

Previous research by Dr. Bernstein and colleagues found that the costs of preventing the next pandemic—by reducing deforestation and regulating the wildlife trade—are as little as $22 billion a year, 2% of the economic and mortality costs of responding to COVID-19.

The task force found that spillover of possible pandemic pathogens occurs from livestock operations; wildlife hunting and trade; land use change—and the destruction of tropical forests in particular; expansion of agricultural lands, especially near human settlements; and rapid, unplanned urbanization. Climate change is also shrinking habitats and pushing animals on land and sea to move to new places, creating opportunities for pathogens to enter new hosts.

Agriculture is associated with greater than 50% of zoonotic infectious diseases that have emerged in humans since 1940. With human population growing, and food insecurity on the rise because of the pandemic, investments in sustainable agriculture and in the prevention of crop and food waste are critical to reduce biodiversity losses, conserve water resources, and prevent further land use change while promoting food security and economic welfare.

A key recommendation from the task force calls for leveraging investments in healthcare system strengthening and One Health to jointly advance conservation, animal and human health, and spillover prevention. A successful example of this integrated model comes from Borneo where a decade of work resulted in ∼70% reduction in deforestation and provided health care access to more than 28,400 patients and substantial decreases in diseases like malaria, tuberculosis and common diseases of childhood.

Additional recommendations for investments and research include:

Investment priorities:

• Conserve tropical forests, especially in relatively intact forests as well as those that have been fragmented.
• Improve biosecurity for livestock and farmed wild animals, especially when animal husbandry occurs near large or rapidly expanding human populations.
• Establish an intergovernmental partnership to address spillover risk from wild animals to livestock and people from aligned organizations such as FAO, WHO, OIE, UNEP, and Wildlife Enforcement Networks.
• In low- and middle-income countries, leverage investments to strengthen healthcare systems and One Health platforms to jointly advance conservation, animal and human health, and spillover prevention.

Research priorities:

• Establish which interventions, including those focused on forest conservation, wildlife hunting and trade, and biosecurity around farms, are most effective at spillover prevention.
• Assess the economic, ecological, long term viability and social welfare impacts of interventions aimed at reducing spillover. Include cost-benefit analysis that considers the full scope of benefits that can come from spillover prevention in economic analyses.
• Refine our understanding of where pandemics are likely to emerge, including assessments of pandemic drivers like governance, travel, and population density. 
• Continue viral discovery in wildlife to ascertain the breadth of potential pathogens and improve genotype-phenotype associations that can enable spillover risk and virulence assessments.

The task force was convened by Harvard Chan C-CHANGE and the Harvard Global Health Institute (HGHI). The findings laid out in their inaugural report will be translated into international policy recommendations to inform the G20 summit in October and the 26th United Nations Climate Change Conference (COP26) in November.

###

About Harvard Chan C-CHANGE

The Center for Climate, Health, and the Global Environment at Harvard T. H. Chan School of Public Health (Harvard Chan C-CHANGE) increases public awareness of the health impacts of climate change and uses science to make it personal, actionable, and urgent. Led by Dr. Aaron Bernstein, the Center leverages Harvard’s cutting-edge research to inform policies, technologies, and products that reduce air pollution and other causes of climate change. By making climate change personal, highlighting solutions, and emphasizing the important role we all play in driving change, Harvard Chan C-CHANGE puts health outcomes at the center of climate actions. To learn more visit https://www.hsph.harvard.edu/c-change/. 

About Harvard Global Health Institute

The Harvard Global Health Institute is committed to surfacing and addressing some of the most persistent challenges in human health. We believe that the solutions to these problems will be drawn from within and beyond the medicine and public health spheres to encompass design, law, policy, business, and other fields. At HGHI, we harness the unique breadth of excellence within Harvard and are a dedicated partner to organizations, governments, scholars, and committed citizens around the globe. We convene diverse perspectives, identify gaps, design new learning opportunities, and advise policy makers to advance health equity for all. You can learn more at globalhealth.harvard.edu. 

 

 

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ARTICLE TITLE

Report of the Scientific Task Force on Preventing Pandemics

ARTICLE PUBLICATION DATE

18-Aug-2021

 

Study: As cities grow in size, the poor 'get nothing at all'

by Santa Fe Institute

A scene from Los Angeles, CA. Credit: Max Böhme via Unsplash.

Cities are hubs of human activity, supercharging the exchange of ideas and interactions. Scaling theory has established that, as cities grow larger, they tend to produce more of pretty much everything from pollution and crime to patents and wealth. On average, people in larger cities are better off economically. But a new study published in the Journal of the Royal Society Interface builds on previous research that says, that's not necessarily true for the individual city-dweller. It turns out, bigger cities also produce more income inequality.

"Previous literature has looked at [urban scaling] through a lens of homogeneity," says Santa Fe Institute (SFI) Omidyar Fellow Vicky Chuqiao Yang, an author on the study. These studies have shown a per-capita increase in wealth as cities grow. "But we know from other literature, especially in economics, that many societies are unequal and economic outputs are not distributed evenly."

Using data from municipal areas across the U.S., the authors took another look at urban wealth through a lens of heterogeneity. Breaking the income in their dataset into deciles, the team found that, as cities grow larger, the top ten percent of income earners gain an increasingly large portion of the wealth.

"For a long time, what has often been thought about in urban scaling is the whole system," says co-author Chris Kempes, also of the Santa Fe Institute along with co-author Geoffrey West. Kempes and West have worked closely together to study scaling relationships in systems from cities to biological organisms.

But it's not just wealth that tends to increase as cities grow; the cost of living also increases. So, the authors factored in an adjustment for housing prices. With that adjustment, their analysis showed that, as cities get bigger, the housing costs increase at a faster rate than lower-decile income.

"For the lower decile, there is no proportional increase in wealth. So, the city is not increasing economic benefit, but it's not decreasing it either," says Kempes. "However, since costs do go up, the experience of the poorest individuals gets worse."

Across the world, civilization is undergoing rapid urbanization. More than half the world's humans currently live in urban settings, and in the coming decade, researchers predict the number of megacities—those with 10 million people or more—will quadruple. "There is an urgent need for a quantitative and predictive theory for how larger urban areas affect a wide variety of city features, dynamics, and outcomes," write the authors.

The questions in this study were initially raised by co-authors Cate Heine, Elisa Heinrich Mora, and Jacob J. Jackson, who together spanned two cohorts of Undergraduate Complexity Researchers at the Santa Fe Institute.

According to West, the new results emphasize that inequality is primarily an urban phenomenon, arising from underlying social dynamics "that desperately need to be addressed." He speculates that poorer city dwellers are missing out on the increased social interactions that are credited with driving innovation and wealth creation in large metropolises.

"What was a huge surprise in this research was that, as the city grows, there's no advantage to people in the bottom 10-20th percentiles. As you go down the income deciles, the value-added for city-dwellers got less and less in a systematic way… so much so that, in the bottom decile you get nothing at all. There's even evidence that you're losing quality of life," says West. "Here we found that rich are getting even richer than we thought and the poor are getting even poorer than we thought."Does urban scaling apply to Europe's oldest cities, too?

More information: Elisa Heinrich Mora et al, Scaling of urban income inequality in the USA, Journal of The Royal Society Interface (2021). DOI: 10.1098/rsif.2021.0223

Journal information: Journal of the Royal Society Interface 

Provided by Santa Fe Institute 

 

Worsening GP shortages in disadvantaged areas likely to widen health inequalities

Peer-Reviewed Publication

UNIVERSITY OF CAMBRIDGE

Areas of high socioeconomic disadvantaged are being worst hit by shortages of GPs, a trend that is only worsening with time and is likely to widen pre-existing health inequalities, say researchers at the University of Cambridge.

In a study published today in the BJGP Open, a team from the University of Cambridge looked at the relationship between shortages in the healthcare workforce and levels of deprivation. The team found significantly fewer full time equivalent (FTE) GPs per 10,000 patients in practices within areas of higher levels of deprivation. This inequality has widened slightly over time. By December 2020, there were on average 1.4 fewer FTE GPs per 10,000 patients in the most deprived areas compared to the least deprived areas.

The same was the case for total direct patient care staff (all patient-facing general practice staff excluding GPs and nurses), with 1.5 fewer FTE staff per 10,000 patients in the most deprived areas compared to the least deprived areas.

The lower GP numbers in deprived areas, was compensated, in part, by more nurses.

The analysis used data captured between September 2015 and December 2020 from the NHS Digital General Practice Workforce collection. They compared this workforce data against practice population sizes and levels of deprivation across England.

In addition to their report, the team have today launched an interactive dashboard that maps local-level primary care workforce inequalities to accompany the national-level analysis done in the paper. Clear local-level inequalities in GP distribution can be seen within West, North and East Cumbria, Humber, Coast and Vale, and Coventry and Warwickshire STP (Sustainability and Transformation Plan) areas, among others. 

Workforce shortages, especially in primary care, have been a problem for health care systems for some time now, and the gap between the growing demand for services and sufficient staff has been widening. Although the number of consultations in general practice has been increasing, staff numbers have not kept up with demand. The number of GPs relative to the size of population has been decreasing since 2009, and the GP workforce is ageing. Doctors are increasingly working part-time, which suggests that shortages will grow steadily worse.

In 2015, then-Secretary of State for Health Jeremy Hunt promised an additional 5,000 GPs for the NHS by 2020, but this was not achieved. Instead, it is predicted that there will be a shortage of 7,000 GPs by 2024.

Dr John Ford from the Department of Public Health and Primary Care at the University of Cambridge, the study’s senior author, said: “People who live in disadvantaged regions of England are not only more likely to have long-term health problems, but are likely to find it even more difficult to see a GP and experience worse care when they see a GP. This is just one aspect of how disadvantage accumulates for some people leading to poor health and early death.

“There may be some compensation due to increasing number of other health professionals, which may partially alleviate the undersupply of GPs in more socioeconomically disadvantaged areas. But this is not a like-for-like replacement and it is unlikely to be enough.”

The researchers say there are a number of reasons that may account for why GP workforce shortages disproportionately affect practices in areas of higher deprivation. Previous studies have suggested that the primary driver of GP inequality was the opening and closing of practices in more disadvantaged areas, with practice closures increasing in recent years.

Claire Nussbaum, the study’s first author, added: “The government has made reducing health inequalities a core commitment, but this will be challenging with the increasing shortage of GPs in areas of high socioeconomic disadvantage, where health needs are greatest. The primary care staffing inequalities we observed are especially concerning, as they suggest that access to care is becoming increasingly limited where health needs are greatest.

“Addressing barriers to health care access is even more urgent in the context of COVID-19, which has widened pre-existing health and social inequities.”

The researchers say that the imbalance in recruitment of staff within primary care must be addressed by policymakers, who will need to consider why practices and networks in disadvantaged areas are relatively under-staffed, and how this can be reversed. Potential options include increased recruitment to medical school from disadvantaged areas, incentivisation of direct patient care posts in under-staffed areas, enhanced training offers for these roles, and offering practices and networks in under-staffed areas additional recruitment support.

Expanded use of additional roles under the Additional Roles Reimbursement Scheme, designed to provide financial reimbursement for Primary Care Networks to build workforce capacity, may partially alleviate GP workload in overstretched practices, but the report’s authors argue that there is a risk that additional workforce will gravitate to more affluent areas, further perpetuating inequity in primary care staffing.

Dr James Matheson, a GP at Hill Top Surgery in Oldham, said: "People living in socioeconomically disadvantaged areas shoulder a much higher burden of physical and mental health problems but have less access to the GPs who could support them towards better health. For the primary care teams looking after them this means a greater workload with fewer resources - a burnout risk which can further exacerbate the problem.

“General Practice in disadvantaged areas is challenging but also enjoyable and professionally rewarding but now, more than ever, we need to see a more equitable distribution of workforce and resources to ensure it is sustainable."

Reference

Nussbaum, C et al. Inequalities in the distribution of the general practice workforce in England. BJGP Open; 18 Aug 2021; DOI: 10.3399/BJGPO.2021.0066

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JOURNAL

BJGP Open

DOI

10.3399/BJGPO.2021.0066

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Inequalities in the distribution of the general practice workforce in England

ARTICLE PUBLICATION DATE

17-Aug-2021