Cooling away the pain: Pusan National University researchers develop bioresorbable, implantable device to block pain signals from peripheral nerves

Researchers test the efficacy of a soft, bioresorbable, implantable device to block pain signals from sciatic nerves of rat models

Peer-Reviewed Publication

PUSAN NATIONAL UNIVERSITY

 

IMAGE: A SOFT, BIORESORBABLE, IMPLANTABLE DEVICE DEVELOPED BY RESEARCHERS FROM PUSAN NATIONAL UNIVERSITY PROVIDES A FOCUSED, REVERSIBLE, AND PRECISE COOLING EFFECT TO BLOCK PAIN SIGNALS FROM PERIPHERAL NERVES view more 

CREDIT: PUSAN NATIONAL UNIVERSITY

Owing to their high efficacy, opioids are used widely for the management of neuropathic pain, despite the increasing rates of opioid addiction and deaths due to overdose. To avoid these side effects, there is an urgent need for pain management approaches that can substitute opioid use.

It is well known that cold temperatures numb the sensation in our nerves. Evidence suggests that cooling peripheral nerves can in fact reduce the velocity and amplitude of neural signals that cause pain, leading to pain relief. What’s great about this approach is that if made possible, it will be completely reversible and non-addictive.

To this end, a team of researchers led by Professor Min-Ho Seo from Pusan National University developed a soft, bioresorbable, implantable device with the potential to cool peripheral nerves in a minimally invasive, focused manner. “Scientists already knew that low temperatures could numb the nerves in the body. But demonstrating this phenomenon with a small device at a clinical level was not an easy task,” said Prof. Seo while discussing the study, which was published in Volume 377 Issue 6601 of Science on June 30, 2022.

To develop the device, the team designed a microfluidics system formed with a bioresorbable material—poly(octanediol citrate)—with interconnects carrying a liquid coolant to a serpentine chamber. To top it off, a Magnesium temperature sensor for real-time temperature monitoring was incorporated at its distal end. The intensity and localization of the cooling effect was regulated by perfluoro pentane (PFP) and dry nitrogen gas (N2)—the two components of the liquid coolant, as well as the geometry of the serpentine chamber.

Next, the team tested the device by implanting it into the sciatic nerves of living rat models with neuropathic pain associated with spared nerve injury. After a three-week evaluation, the team found that the device successfully delivered cooling power to the peripheral nerves of the rats, which led to a reduction in their pain. Fortunately, the delivery of the cooling power occurred in a minimally invasive, stable, and precise manner. What’s more, this application was localized and reversible, and remained effective for almost 15 minutes during one session.

On being submerged in phosphate-buffered saline solution at 75°C, the device, which was made of bioresorbable materials, dissolved within 20 days and got eliminated in approximately 50 days. These findings imply that it has the potential to naturally degrade and get resorbed in the human body.

So, what are the future applications of this device? “The developed device can be used to treat pain after surgery. Since it is connected to an external source of fluid and power like a commercial intravenous (IV) device, it can easily be controlled by the patient. This way, our implantable device will be able to provide targeted and individualized relief without the drawbacks of the addictive pain medications,” said Prof. Seo in response.

With such progress underway, patients with neuropathic pain will finally be able to receive safe and sustainable treatment, without the risk of adverse effects associated with opioid use!

 

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Reference

DOI: https://doi.org/10.1126/science.abl8532

Authors: Jonathan T. Reeder1,2,3, Zhaoqian Xie4,5, Quansan Yang3,6†, Min-Ho Seo2,3,7†, Ying Yan8, Yujun Deng9, Katherine R. Jinkins3, Siddharth R. Krishnan2,3, Claire Liu3,10, Shannon McKay10, Emily Patnaude10, Alexandra Johnson10, Zichen Zhao4,5, Moon Joo Kim11§, Yameng Xu12, Ivy Huang2,3, Raudel Avila6, Christopher Felicelli13, Emily Ray14, Xu Guo4,5, Wilson Z. Ray8,14, Yonggang Huang2,3,6,15, Matthew R. MacEwan8,14, John A. Rogers2,3,6,10,16,17,18

Affiliations:

1Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA

2Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA

3Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA

4State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China

5Ningbo Institute of Dalian University of Technology, Ningbo, China

6Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA

7School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Busan, Republic of Korea.

8Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA

9State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China

10Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA

11Department of Chemical Engineering, Northwestern University, Evanston, IL, USA

12The Institute of Materials Science and Engineering, Washington University, St. Louis, MO, USA

13Department of Pathology, Northwestern University, Evanston, IL, USA 14Department of Biomedical Engineering, Washington University, St. Louis, MO, USA

15Departments of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA

16Department of Chemistry, Northwestern University, Evanston, IL, USA

17Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL, USA

18Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA

 

About Pusan National University
Pusan National University, located in Busan, South Korea, was founded in 1946, and is now the no. 1 national university of South Korea in research and educational competency. The multi-campus university also has other smaller campuses in Yangsan, Miryang, and Ami. The university prides itself on the principles of truth, freedom, and service, and has approximately 30,000 students, 1200 professors, and 750 faculty members. The university is composed of 14 colleges (schools) and one independent division, with 103 departments in all.    

Website: https://www.pusan.ac.kr/eng/Main.do

 

About Assistant Professor Min-Ho Seo
Dr. Min-Ho Seo received his B.S. degree (Magna cum laude, 2011) in nanomechatronics engineering from Pusan National University and his M.S. and Ph.D. degrees (2013 and 2018, respectively) in electrical engineering from the Korea Advanced Institute of Science and Technology (KAIST). Between 2018 and 2019, he was a postdoctoral research fellow at the Information and Electronics Research Institute at KAIST, following which from 2019 until 2020, he joined the Center for Bio-integrated Electronics at Northwestern University in USA as a postdoctoral researcher.

Since 2020, he has been affiliated with the School of Biomedical Convergence Engineering, Pusan National University, where he works as an assistant professor. His research interests include nano/microelectromechanical systems, biomedical devices and electronics, flexible and wearable electronics, and physical, chemical, hydrogen, and optical sensor devices and electronics.

Lab website: http://sites.google.com/view/mhseogroup

ORCID ID: Prof. Min-Ho Seo:0000-0002-9990-9227

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JOURNAL

Science

DOI

10.1126/science.abl8532 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Soft, bioresorbable coolers for reversible conduction block of peripheral nerves

Preparing for future coronavirus variants using artificial intelligence

Peer-Reviewed Publication

ETH ZURICH

SARS-​CoV-2 is constantly mutating and each new variant often catches the world by surprise. Take for example the highly mutated Omicron variant that emerged last November and required health authorities to develop a rapid response strategy even though, initially there were no answers to important questions: How protected are vaccinated and previously infected people against the new variant? And are antibody therapies still effective against this new version of the virus?

Researchers led by Professor Sai Reddy from the Department of Biosystems Science and Engineering at ETH Zurich in Basel have now developed a way of using artificial intelligence to answer such questions, potentially even in real-​time immediately after a new variant emerges.

Exploring the multitude of potential variants

Since viruses mutate randomly, no one can know exactly how SARS-​CoV-2 will evolve in the coming months and years and which variants will dominate in the future. In theory, there is virtually no limit to the ways in which a virus could mutate. And this is the case even when considering a small region of the virus: the SARS-​CoV-2 spike protein, which is important for infection and detection by the immune system. In this region alone there are tens of billions of theoretical possible mutations.

That’s why the new method takes a comprehensive approach: for each variant in this multitude of potential viral variants, it predicts whether or not it is capable of infecting human cells and if it will be neutralized by antibodies produced by the immune system found in vaccinated and recovered persons. It is highly likely that hidden among all these potential variants is the one that will dominate the next stage of the COVID-​19 pandemic.

Synthetic evolution and machine learning

To establish their method, Reddy and his team used laboratory experiments to generate a large collection of mutated variants of the SARS-​CoV-2 spike protein. The scientists did not produce or work with live virus, rather they produced only a part of the spike protein, and therefore there was no danger of a laboratory leak.

The spike protein interacts with the ACE2 protein on human cells for infection, and antibodies from vaccination, infection or antibody therapy work by blocking this mechanism. Many of the mutations in SARS-​CoV-2 variants occur in this region, which allows the virus to evade the immune system and continue to spread.

Although the collection of mutated variants the researchers have analysed comprises only a small fraction of the several billion theoretically possible variants – which would be impossible to test in a laboratory setting – it does contain a million such variants. These carry different mutations or combinations of mutations.

By performing high-​throughput experiments and sequencing the DNA from these million variants, the researchers determined how successfully these variants interact with the ACE2 protein and with existing antibody therapies. This indicates how well the individual potential variants could infect human cells and how well they could escape from antibodies.

The researchers used the collected data to train machine learning models, which are able to identify complex patterns and when given only the DNA sequence of a new variant could accurately predict whether it can bind to ACE2 for infection and escape from neutralizing antibodies. The final machine learning models can now be used to make these predictions for tens of billions of theoretically possible variants with single and combinatorial mutations and going far beyond the million that were tested in the laboratory.

Next-​generation antibody therapy

The new method will help develop the next generation of antibody therapies. Several of such antibody drugs were developed to treat the original SARS-​CoV-2 virus and approved for use in the United States and Europe. Among these, five antibody drugs were removed from clinical use and many others under clinical development were discontinued because they could no longer neutralise the Omicron variant. To address this challenge, the new method may be applied to identify which antibodies have the broadest activity.

“Machine learning could support antibody drug development by enabling researchers to identify which antibodies have the potential to be most effective against current and future variants,” says Reddy. The researchers are already working with biotechnology companies that are developing next generation COVID-​19 antibody therapies.

Identifying variants able to escape immunity

Additionally, the method developed at ETH Zurich could be applied to support the development of next generation COVID-​19 vaccines. The focus here is on identifying virus variants that still bind to the ACE2 protein – and can therefore infect human cells – but cannot be neutralised by the antibodies present in vaccinated and recovered people. In other words, variants that can escape the human immune response. This was indeed the case with the Omicron variant that escaped from most antibodies and this winter resulted in many breakthrough infections in vaccinated and previously infected people. Therefore, similar to antibody therapies, it is a major advantage if vaccines could induce antibodies that provide protection against potential future viral variants.

“Of course, no one knows which variant of SARS-​CoV-2 will emerge next,” Reddy says. “But what we can do is identify key mutations that may be present in future variants, and then work to develop vaccines in advance that provide a broader range of protection against these potential future variants.”

Faster decision making for public health

Finally, this machine learning method can also support public health, as when a new variant emerges, it can rapidly make predictions on whether antibodies produced by existing vaccines will be effective. In this way, it can accelerate the decision-​making process related to vaccinations. For example it may be that people who received a particular vaccine produce antibodies that are not effective against a new variant and should thus receive booster vaccinations as soon as possible.

Reddy points out that the technology could also be adapted for other circulating viruses, such as influenza, as predicting future influenza variants may support the development of seasonal flu vaccines.

This research was funded by the Botnar Research Centre for Child Health as part of the Fast Track Call for emergency response to the COVID-​19 pandemic.

Reference

Taft JM, Weber CR, Gao B, Ehling RA, Han J, Frei L, Metcalfe SW, Overath M, Yermanos A, Kelton W, Reddy ST: Deep mutational learning predicts ACE2 binding and antibody escape to combinatorial mutations in the SARS-​CoV-2 receptor binding domain, Cell, 31 August 2022 (Journal Pre-​Proof), doi: 10.1016/j.cell.2022.08.024

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JOURNAL

Cell

DOI

10.1016/j.cell.2022.08.024 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Deep mutational learning predicts ACE2 binding and antibody escape to combinatorial mutations in the SARS-​CoV-2 receptor binding domain

Technology transfer deficits jeopardize climate targets

Peer-Reviewed Publication

INSTITUTE FOR ADVANCED SUSTAINABILITY STUDIES E.V. (IASS)

Many developing countries have made their nationally determined climate contributions submitted under the Paris Agreement conditional on receiving climate finance, technology transfer, and capacity-building support. However, developed countries have so far failed to deliver tech transfer to the extent promised. According to a new study, public-private partnerships and other energy initiatives can only partially make up for this shortfall. While their role in supporting the growth of low-carbon energy systems in the Global South is proving crucial, their contribution in terms of technology transfer is insufficient.

Developed countries have pledged to provide US$100 billion annually from public and private sources for climate finance starting in 2020. Technology transfer is an important part of this: While developing and emerging countries need climate finance to build out clean energy solutions, knowledge is pivotal to harnessing their benefits.

This has not been achieved to date - and not only because climate financing is lacking. "Most patents for low-carbon technologies are held by companies in the Global North. This gives them a significant competitive advantage. They only share their knowledge when it is beneficial for them," explains co-author Andreas Goldthau (Institute for Advanced Sustainability Studies, Potsdam/University of Erfurt). China is the only emerging market that has successfully attracted technology transfer through foreign direct investment. In order to tap into the Chinese market, companies were willing to "transfer" their technologies, i.e. share their knowledge.

China's recipe for success is not easily transferable

China's success in building a low-carbon technology sector can be broadly attributed to the high innovation capacity of Chinese industry as well as various policy measures. "These include the promotion of joint ventures and knowledge transfer, but also local content requirements that compel foreign investors to use products or services made in China. China was able to push through these measures by leveraging its large and profitable market," says lead author Silvia Weko (IASS/University of Erfurt). In other developing and emerging economies, similar efforts have proven ineffective or even counterproductive.

There, foreign investment in low-carbon energy systems and associated knowledge transfer remains critically insufficient. As a consequence, many developing countries continue to invest in predominantly fossil fuel technologies. There are concerns that countries may become locked in to high-carbon energy systems as a result.

A stronger focus on promoting low-carbon technology transfer is needed

What options are available to countries that want to increase the transfer of technology but are unable to achieve this through market mechanisms or policy? Technology transfer initiatives, such as public-private partnerships or platforms like the United Nations Climate Technology Center and Network (CTCN), work to advance energy transitions in the Global South. Such initiatives were intended to fill the gap in the market, but their track record is mixed, according to the IASS researchers' analysis.

Weko and Goldthau identified 71 initiatives that include technology transfer among their goals. Many of these are active in countries where only a small proportion of the population has access to electricity. Their efforts to support the development of sustainable energy systems in these countries are largely successful. However, just 26 of the 71 initiatives studied actually pursue technology transfer activities.

In order to increase knowledge transfer to developing countries and emerging economies, industrialized countries must keep their funding promises and provide greater support to the United Nations Climate Technology Center and Network, the researchers argue. The transfer gap cannot be closed with the current patchwork approach. Trade and regional cooperation also offer opportunities for countries to pool resources and demand in order to negotiate better terms.

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JOURNAL

Energy Policy

DOI

10.1016/j.enpol.2022.113192 

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Bridging the low-carbon technology gap? Assessing energy initiatives for the Global South

Overall warming of up to 5°C in this century projected for the Eastern Mediterranean and Middle East

Unprecedented and societally disruptive extreme weather events, including heat waves, droughts, dust storms and torrential rains, will soon become a reality unless immediate, ambitious, and transboundary climate action is taken.

Peer-Reviewed Publication

MAX PLANCK INSTITUTE FOR CHEMISTRY

A new report prepared by an international group of scientists and published in the authoritative journal Reviews of Geophysics, identifies the EMME* as a climate change hot spot, and concludes that the region is warming almost two times faster than the global average, and more rapidly than other inhabited parts of the world. For the remainder of the century, projections based on a business-as-usual pathway indicate an overall warming of up to 5°C or more, being strongest in the summer, and associated with unprecedented heatwaves that can be societally disruptive. Further, the region will experience rainfall shortages that compromise water and food security. Virtually all socio-economic sectors are expected to be critically affected, with potentially devastating impacts on the health and livelihoods of the 400 million people of the EMME, with worldwide implications.

The report, which was prepared under the auspices of the Max Planck Institute for Chemistry and The Cyprus Institute, in preparation to COP27, which will take place in Egypt in November 2022, provides an updated, comprehensive assessment of measurement data and recent climate analyses, covering a wide range of time scales, phenomena and possible future pathways. It identifies the region as a climate change hot spot, and also signals that the EMME is rapidly overtaking the European Union as a source of greenhouse gases, and becoming a major emitter at the global scale.

In addition to the average increase in temperatures, the researchers call attention to the emergence of extreme weather events with potentially disruptive societal impacts. These include the strongly increasing severity and duration of heatwaves, droughts and dust storms, and torrential rains which are expected to trigger flash floods. The assessment also comprises a discussion of atmospheric pollution and land-use change in the region, considering urbanization, desertification and forest fires, and includes recommendations for possible climate change mitigation and adaptation measures.

“Business-as-usual pathways for the future”, meaning projections assuming no immediate, ambitious climate action to avert the current climate trajectories, “imply a northward expansion of arid climate zones at the expense of the more temperate regions”, explains Dr George Zittis of the Cyprus Institute, first author of the study. As a result, mountainous climate zones with snow will diminish during this century. The combination of reduced rainfall and strong warming will contribute to severe droughts. The sea level in the EMME is projected to rise at a pace similar to global estimates, though many countries are unprepared for the advancing seas. “This would imply severe challenges for coastal infrastructure and agriculture, and can lead to the salinization of costal aquifers, including the densely populated and cultivated Nile Delta”, warns Zittis.

The projected changes will critically affect virtually all socio-economic sectors, particularly under a business-as-usual scenario. Jos Lelieveld, Director of the Max Planck Institute for Chemistry, Institute Professor at the Cyprus Institute and coordinator of the assessment, notes: “People living in the EMME will face major health challenges and risks of livelihood, especially underprivileged communities, the elderly, children and pregnant women.” To avoid the most extreme of severe weather events in the region, the scientists highlight that immediate and effective climate action is urgent. “The motto of COP 27 is well chosen: Together for just, ambitious implementation now”, states Jos Lelieveld. “Since many of the regional outcomes of climate change are transboundary, stronger collaboration among the countries is indispensable to cope with the expected adverse impacts. The need to meet the goals of the Paris Agreement has become more important than ever”, concludes Lelieveld. The study notes that meeting the main Paris Agreement targets could stabilize the annual temperature increase in the EMME to about 2°C by the end of the century, rather than the devastating 5°C which is projected under a business-as-usual scenario.

Possible adaptation options and policy recommendations noted in the report to contribute to meeting these targets stress the need for rapid implementation of decarbonization actions with a particular emphasis on the energy and transportation sectors, which dominate greenhouse gas emissions in the EMME. The report also stresses the importance of transformational changes toward climate resilience to adapt to increasingly challenging environmentally conditions. Priority areas include the coping with limited water resources and preparing for more frequent weather extremes such as heat waves that will be particularly challenging for the growing urban population.

The report has been published in the American Geophysical Union Open Access Journal with the highest impact factor in Earth sciences. It was motivated by the Cyprus Government Initiative for Coordinating Climate Change Actions in the EMME, launched in 2019, aiming at the development of a joint Regional Climate Action Plan to address the specific needs and challenges EMME countries are facing, and advance coordinated action towards the goals of the Paris Agreement. At the political level, an EMME Heads of State Summit will be held in autumn 2022 when the Regional Action Plan is expected. 

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JOURNAL

Reviews of Geophysics

DOI

10.1029/2021RG000762 

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Climate change and weather extremes in the Eastern Mediterranean and Middle East

Gamma rays from neighboring galaxy related to millisecond pulsars

Peer-Reviewed Publication

UNIVERSITEIT VAN AMSTERDAM

 

IMAGE: A SMALL SATELLITE GALAXY OF THE MILKY WAY – CALLED THE SAGITTARIUS DWARF GALAXY – HAS BEEN OBSERVED FROM EARTH THROUGH GIANT LOBES OF GAMMA RADIATION (THE SO-CALLED FERMI BUBBLES). ALTHOUGH THE DWARF GALAXY IS STUFFED WITH DARK MATTER, THIS IS UNLIKELY TO BE THE CAUSE OF THE OBSERVED EMISSION. view more 

CREDIT: IMAGE: O. MACIAS.

A team of researchers, including UvA physicists and astronomers, has studied gamma rays caused by the Sagittarius Dwarf, a small neighbouring galaxy of our Milky Way. They showed that all the observed gamma radiation can be explained by millisecond pulsars, and can therefore not be interpreted as a smoking gun signature for the presence of dark matter. The results were published in Nature Astronomy this week.

The center of our galaxy is blowing a pair of colossal bubbles of gamma radiation (the magenta structures in the image above) that span a whopping 50,000 light-years across. Discovered with the Fermi Gamma-ray Space Telescope about a decade ago, the source of this hourglass-shaped phenomenon remains unclear.

These Fermi bubbles are patched with a few enigmatic substructures of very bright gamma-ray emission. One of the brightest spots, the so-called Fermi cocoon, is found in the southern lobe (magnified inset in the figure below) and was originally thought to be due to past outbursts from the Galaxy’s supermassive black hole.

A team including Oscar Macias at the University of Amsterdam & Kavli IPMU and Roland Crocker at the Australian National University analyzed data from the GAIA and Fermi space telescopes to reveal that the Fermi cocoon is actually due to emission from the Sagittarius dwarf galaxy.

This satellite galaxy of the Milky Way is seen through the Fermi bubbles from our position on Earth (see first figure). Due to its tight orbit around our galaxy and previous passages through the galactic disk, it has lost most of its interstellar gas and many of its stars have been ripped from its core into elongated streams.

Given that the Sagittarius dwarf is completely quiescent — it has no gas, and no stellar nurseries — there are only a few possibilities for its gamma-ray emission, including (1) a population of unknown millisecond pulsars or (2) dark matter annihilations.

Millisecond pulsars are the remnants of certain types of stars, significantly more massive than the Sun, that are in close binary systems, and now blast out cosmic particles as a result of their extreme rotational energies. The electrons fired by millisecond pulsars collide with low-energy photons of the Cosmic Microwave Background, propelling them to become high-energy gamma radiation.

Crocker, Macias and collaborators have convincingly demonstrated that the gamma-ray cocoon is explained by millisecond pulsars in the Sagittarius dwarf, and that the dark matter hypothesis is strongly disfavoured. This discovery sheds light on millisecond pulsars as efficient accelerators of highly energetic electrons and positrons. It also suggests that similar physical processes could be ongoing in other dwarf satellite galaxies of the Milky Way. This is highly significant because dark matter researchers have long believed that an observation of gamma rays from a dwarf satellite would be a smoking gun signature for dark matter annihilation.

This study compels a reassessment of the high energy emission capabilities of quiescent stellar objects, such as dwarf spheroidal galaxies, and their role as prime targets for dark matter annihilation searches.

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JOURNAL

Nature Astronomy

DOI

10.1038/s41550-022-01777-x 

ARTICLE TITLE

Gamma-ray emission from the Sagittarius dwarf spheroidal galaxy due to millisecond pulsars

ARTICLE PUBLICATION DATE

5-Sep-2022

CAPTION

Gamma-ray image of the Fermi bubbles (blue) overlaid on a map of RR Lyrae stars (red) observed by the GAIA telescope. The shape and orientation of the Sagittarius dwarf (Sgr) match those of the Fermi cocoon perfectly well – a bright substructure of gamma-ray radiation in the southern part of the Fermi bubbles. This is strong evidence that the Fermi cocoon is due to energetic processes occurring in the Sagittarius dwarf galaxy, which from our perspective, is located behind the Fermi bubbles.

CREDIT

Image: Crocker, Macias, Mackey, Krumholz, Ando, Horiuchi et al. (2022)

A WORKPLACE UNION ISSUE

Frequency of premenstrual anxiety, mood swings a public health issue, study finds

More than 64% of women experience mood swings or anxiety

Peer-Reviewed Publication

UNIVERSITY OF VIRGINIA HEALTH SYSTEM

 

IMAGE: JENNIFER L. PAYNE, MD, DIRECTOR OF THE REPRODUCTIVE PSYCHIATRY RESEARCH PROGRAM AT THE UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE, LED A NEW STUDY THAT FOUND PREMENSTRUAL SYMPTOMS ARE A PUBLIC HEALTH ISSUE. view more 

CREDIT: UVA HEALTH

Premenstrual mood swings and anxiety are so common – experienced by more than 64% of women – that they represent a “key public health issue globally,” according to a new UVA Health study.

The UVA Health study found that most women have premenstrual symptoms every menstrual cycle, and those symptoms regularly affect their day-to-day lives. One of the most common symptoms, regardless of age, is mood swings or anxiety, the researchers found. At least 61% of women in all age groups surveyed reported mood-related symptoms every menstrual cycle, which the researchers say suggests “that premenstrual mood symptoms are a key public health issue globally.”

“Our study demonstrates that premenstrual mood symptoms are incredibly common worldwide,” said Jennifer L. Payne, MD, the study’s senior author and director of the Reproductive Psychiatry Research Program at the University of Virginia School of Medicine. “More important, a majority of women reported that their premenstrual symptoms interfered with their everyday life at least some of the time.”

Better Understanding Premenstrual Symptoms

To better understand the type of premenstrual symptoms women experience and how those symptoms affect their daily lives, the researchers analyzed more than 238,000 survey responses from women ages 18-55 from 140 countries on the Flo app, which helps women track their menstrual cycle or track their mood or physical symptoms during and after pregnancy.

The most common symptoms reported were food cravings, experienced by 85.28% of the women surveyed, followed by mood swings or anxiety (64.18%) and fatigue (57.3%), according to researchers from the UVA School of Medicine, Johns Hopkins University and Flo Health. Among the study respondents, 28.61% said their premenstrual symptoms interfered with their everyday life during every menstrual cycle, while an additional 34.84% said their premenstrual symptoms interfered with their everyday life sometimes.

“The incidence of reported premenstrual mood and anxiety symptoms varied significantly by country from a low of 35.1% in Congo to a high of 68.6% in Egypt,” Payne said. “Understanding whether differences in biology or culture underlie the country level rates will be an important future research direction.”

A group of symptoms – absentmindedness, low libido, sleep changes, gastrointestinal symptoms, weight gain, headaches, sweating or hot flashes, fatigue, hair changes, rashes and swelling – was significantly more frequent among older survey respondents, the researchers found. The increase in physical symptoms among older survey respondents “makes sense,” the researchers said, as many of these symptoms are associated with perimenopause, a transition period to menopause marked by irregular menstrual cycles.

Payne is hopeful that this survey data will help women get better care by making healthcare providers more aware of how frequently these symptoms – especially anxiety and mood-related symptoms – occur. 

“There are a number of treatment strategies that are available to treat premenstrual symptoms that interfere with a woman’s every day functioning,” she said. “Increasing awareness of how common these symptoms are, and that if they impact functioning that there are treatments available, will help women improve their quality of life.”

Findings Published

The researchers have published their findings in the Archives of Women’s Mental Health. The research team included Liisa Hantsoo, Shivani Rangasawmy, Kristin Voegtline, Rodion Salimgaraev, Liudmila Zhaunova and Payne. Payne holds a patent titled “Epigenetic Biomarkers of Postpartum Depression.” 

To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog at http://makingofmedicine.virginia.edu.

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JOURNAL

Archives of Women s Mental Health

DOI

10.1007/s00737-022-01261-5 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

High blood pressure awareness, control improved with better access to primary health care

Better access to primary health care was associated with improved high blood pressure awareness and control, according to a study in Circulation: Cardiovascular Quality and Outcomes journal

Peer-Reviewed Publication

AMERICAN HEART ASSOCIATION

DALLAS, Sept. 6, 2022 — Having easier access to primary care physicians may increase high blood pressure awareness and control regardless of where a person lives, according to new research published today in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed journal of the American Heart Association.

According to the American Heart Association, nearly half of all Americans have hypertension (high blood pressure), and many don’t even know they have it. High blood pressure is often called the “silent killer“ because high blood pressure often has no obvious symptoms. The best ways to protect yourself are to be aware of the risks and make healthy life changes that matter.

In a new study, researchers note that health care professionals at community clinics and primary care practices may help expand awareness and detection of high blood pressure by providing affordable treatment and management. High blood pressure is a leading preventable risk factor for cardiovascular disease, and effective blood pressure control reduces the associated cardiovascular health risks.

“Access to primary care is the key to hypertension management, however, many Americans have limited access to primary care where they live. This is especially true of people in economically disadvantaged neighborhoods or people from diverse racial and ethnic groups, particularly among African American individuals,” said senior study author Brisa Aschebrook-Kilfoy, Ph.D., an associate professor of public health sciences at the University of Chicago in Illinois.

It is well known that better access to primary health care is linked to improved high blood pressure awareness and control. This study sought to clarify if people living in disadvantaged neighborhoods may benefit from better access to primary care health professionals.

In this study, neighborhood socioeconomic status was assessed using the Area Deprivation Index (ADI) created by the Health Resources & Services Administration (HRSA) over three decades ago. The ADI was chosen because it allows for rankings of neighborhoods by socioeconomic disadvantage in a region of interest (e.g., at the state or national level), and it is valuable to inform health delivery and policy, especially for the most disadvantaged neighborhood groups. ADI is composed of 17 indicators covering income, education, employment and housing quality. In this study, socioeconomically disadvantaged neighborhoods were defined as those in census tracts ranked in the 50th percentile and above.

“Some argue that minority health disparities are solely the product of socioeconomic factors, or that increasing the number of primary care professionals in diverse racial and ethnic neighborhoods would not reduce health disparities and improve public health. To our knowledge, there is little research to support or rebut this argument,” said first study author Jiajun Luo, Ph.D., a post-doctoral fellow at the University of Chicago’s Institute for Population and Precision Health. “We conducted this study to examine whether accessibility of primary care is associated with better hypertension control and awareness across various socioeconomic and neighborhood factors.”

The study examined Chicago, one of the most racially segregated cities in the U.S. Chicago’s South Side is the largest African American urban community in the U.S., with substantial challenges including poverty, violence and decreased access to fresh, healthy foods. According to the study, a 30-year gap in life expectancy has been observed between people who live in the South Side neighborhoods and Chicago’s wealthier northern neighborhoods, which may be largely attributable to higher rates of high blood pressure, heart disease and stroke.

The researchers analyzed the health data for more than 5,000 predominantly African American adults who participated in the Chicago Multiethnic Prevention and Surveillance Study (COMPASS) between 2013 to 2019. COMPASS is a long-term initiative at the University of Chicago exploring the health of Chicagoans, primarily those who live in communities on the South Side. MAPSCorps, a non-profit organization, provided location information for primary care professionals providing care in those Chicago neighborhoods.

More than half of the study participants were smokers, and they reported an annual household income of less than $15,000 and more than 37% were obese according to body mass index (BMI). Most of the study population resided in a Chicago neighborhood with an ADI rank higher than the 70th percentile (communities with the most disadvantages).

Researchers also evaluated spatial accessibility, which is a composite score that considers the distance between an individual’s residence and local primary health care facilities; the number of physicians-to-population ratio; and the effect of distance to primary care on an individual’s willingness to seek primary health care. A higher spatial accessibility score indicated better accessibility to primary care. The primary health care professionals included family physicians, general practitioners and general internists.

The research found:

• Nearly 80% of the COMPASS participants had documented hypertension, using the standard American Heart Association guideline-based blood pressure criteria of measures ≥130 mm Hg systolic (top number) or ≥80 mm Hg diastolic (bottom number).

• Nearly 38% of those with hypertension did not have their blood pressure under control  (were not receiving treatment based on self-report), and 41% were not aware they had high blood pressure.
• Spatial accessibility scores ranged from 16.4 (lower access to primary care) to 86.6 (higher access) per 100,000 residents.

• Adults living in areas with the fewest primary health care professionals had 37% increased odds of having hypertension when compared to the adults living in neighborhoods with the most primary care physicians.
• The listed associations existed in both poor and wealthy neighborhoods, suggesting that residents in all neighborhoods may benefit from increasing the number of primary care professionals.
• When stratified by neighborhood type (advantaged or disadvantaged), accessibility to primary care was not associated with use of anti-hypertension medications among those who reported they had hypertension prior to enrolling in the study.

“Based on these findings, we need to encourage primary care physicians to expand access to people who live in underserved communities with the fewest primary care professionals,” Aschebrook-Kilfoy said. “Mobile health units may be one approach to increase primary care service in underserved areas by eliminating the challenge of getting transportation to and from an office visit. The use of anti-hypertension medications also needs to be studied and addressed, especially as it was not linked to primary care accessibility in this study.”

While the method used in this study to measure spatial accessibility can be used anywhere with sufficient location information about primary care professionals, a major limitation of this study is that these specific results may not be representative of other communities and population groups, such as middle-class urban communities or people from other diverse racial and ethnic groups, etc.

Co-authors are Muhammad G. Kibriya, Ph.D.; Paul Zakin, B.S.; Andrew Craver, M.P.H.; Liz Connellan, M.P.H.; Saira Tasmin, Ph.D.; Tamar Polonsky, M.D.; Karen Kim, M.D.; and Habibul Ahsan, M.D. Authors’ disclosures are listed in the manuscript.

The National Institutes of Health (NIH) funded this study.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

• Available multimedia is on the right column of the news release link - https://newsroom.heart.org/news/high-blood-pressure-awareness-control-improved-with-better-access-to-primary-health-care?preview=6a07c9731682435547cd35a04381d791
• After Sept. 6, view the manuscript and editorial online here.
• AHA news release: Second annual special issue spotlights disparities research, impact on health equity (July 2022)
• AHA news release: Lifetime discrimination may increase risk of hypertension among African Americans (July 2020)
• AHA health information: High Blood Pressure and African Americans
• AHA health information: Target BP
• Follow AHA/ASA news on Twitter @HeartNews
• Follow news from the AHA’s Circulation: Cardiovascular Quality and Outcomes journal @CircOutcomes

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

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JOURNAL

Circulation

DOI

10.1161/CIRCOUTCOMES.121.008845 

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