Undergraduate research program will take community-based approach to Arizona health challenges

A health-informatics training initiative funded by the National Library of Medicine aims to get future researchers PHIREd up about addressing close-to-home health, environmental and engineering issues.

Grant and Award Announcement

UNIVERSITY OF ARIZONA COLLEGE OF ENGINEERING

 

IMAGE: KACEY ERNST, PROFESSOR AND PROGRAM DIRECTOR IN THE UNIVERSITY OF ARIZONA MEL & ENID ZUCKERMAN COLLEGE OF PUBLIC HEALTH, AND VIGNESH SUBBIAN, ASSOCIATE PROFESSOR OF BIOMEDICAL ENGINEERING AND SYSTEMS AND INDUSTRIAL ENGINEERING AT THE UARIZONA COLLEGE OF ENGINEERING ARE COLLABORATING ON A GRANT TO CREATE THE PLACE-BASED, CULTURALLY RESPONSIVE HEALTH INFORMATICS RESEARCH EDUCATION, OR PHIRE, PROGRAM. view more 

CREDIT: UNIVERSITY OF ARIZONA COLLEGE OF ENGINEERING

Many engineers and biomedical researchers share a desire to improve the world around them. While some seek solutions to universal problems, others strive to improve lives in ways that are specific to local communities. For instance, food deserts, aging populations, climate and air quality in Arizona represent a unique intersection of applied health-related research opportunities.

With a five-year $570,000 grant from the National Library of Medicine, a team of University of Arizona professors is creating the Place-based, culturally responsive Health Informatics Research Education, or PHIRE, program. Health informatics is the field of study focused on optimal use of data and information, often supported by technology, to address questions in biomedical research and improve the health of individuals and communities. Place-based training engages students in research projects that respond to local health and environmental needs while considering all the strengths a particular place has to offer, such as its history, culture, people and ecology.

Principal investigator Vignesh Subbian, an associate professor of biomedical engineering and systems and industrial engineering, and an associate director at the Center for Biomedical Informatics & Biostatistics, said he is inspired by UArizona’s identity as a public R1 research university, land-grant university, and Hispanic-Serving Institution that is on the land and territories of Indigenous peoples.

“What that all means to me is we need to be doing work, whether it’s an education project or a research project, that serves our community,” he said. “It got me thinking, how can we leverage this to motivate students? Students are often interested in working on problems they can relate to.”

The grant is part of the National Library of Medicine’s Short-Term Research Education Experiences to Attract Students to Biomedical Informatics/Data Science Careers and Enhance Diversity award initiative, which totals $8 million in investment to 12 institutions over five years.

Developing partnerships to increase health equity

Some place-based issues take a particularly large toll on communities that have been historically marginalized. These include inequitable access to clean water on Native Nations, poor infrastructure to access health care and digital technology in rural areas, and structural and systematic barriers to addressing disparities in healthy aging. Therefore, another major goal of the project is to recruit and retain students from historically minoritized groups to examine problems in impacted communities — sometimes their own communities.

“This moves the research questions from the abstract to the concrete,” said collaborating principal investigator Kacey Ernst, professor and program director in the Epidemiology and Biostatistics Department in the Mel & Enid Zuckerman College of Public Health. “It can generate new questions, better interpretation, and can drive a passion for the work that may not be there otherwise. This engagement serves underrepresented and marginalized communities by providing their voices in the research. Ideally, they will identify and drive the questions being asked based on their knowledge and context of the community.”

A three-pronged mission

The team intends for half of each cohort to be made up of transfer students, so they are partnering with regional community colleges such as Pima Community College, Arizona Western College, and Cochise College. The program involves 10 UArizona colleges; the College of Engineering; the College of Social and Behavioral Sciences; the College of Agriculture and Life Sciences; the Eller College of Management; the College of Science; and all five health sciences colleges.

“The 20 faculty we brought together all come from different backgrounds, demographically and intellectually,” Subbian said. “It really represents the interdisciplinary nature of the program.”

A wide range of faculty also means a wide range of existing research areas for students to tap into, ranging from research into EPA Superfund sites to nutrition in rural communities. But more importantly, students can all pull from what they already know about their own communities and combine it with what they’re learning to propose their own research questions.

“Complex questions need to be tackled through multiple lenses,” Ernst said. “I am excited to work with faculty across campus and get a bird’s-eye view of all the exciting work they are doing. Most of all, I look forward to working with the students to build the program, helping them to find confidence and a passion for research that can make a difference.”

PHIRE will recruit a group of 60 undergraduate students, or 12 students every year across five years, to offer three major training components. During a 12-week summer research experience, students will learn how to responsibly work with health datasets to answer regionally relevant questions, such as how air quality affects life expectancy, or how rural communities are affected by their distance from specialty clinics such as post COVID care centers.

Then, PHIRE scholars will earn thematic undergraduate minors related to biomedical and health informatics. To enhance both parts of this experience and improve retention and graduation rates for students studying informatics — now and in the future — the program will offer training on culturally responsive practices to both program faculty and the PHIRE Scholars.

“It takes diverse teams to solve some of our world’s most pressing challenges, but individuals who come from communities directly affected by these problems offer a unique and critical perspective for creative solutions,” said Elizabeth “Betsy” Cantwell, Senior Vice President for Research and Innovation. “Provost Liesl Folks and I launched the Undergraduate Research Task Force earlier this year to ensure all UArizona students are exposed to high-impact research activities. This initiative is an excellent example of furthering that mission while at the same time serving our Arizona community.”

Illinois Tech joins Chicago ARC as founding innovation partner in pursuit of innovative and equitable health care

Illinois Tech to help tackle health care inequities through market-driven, community-informed solutions to support the region’s underserved

Business Announcement

ILLINOIS INSTITUTE OF TECHNOLOGY

 

IMAGE: ILLINOIS TECH JOINS CHICAGO ARC. view more 

CREDIT: CHICAGO ARC

CHICAGO—December 7, 2022—The Chicago ARC and founding innovation partner Illinois Institute of Technology (Illinois Tech) announced today that they will come together to focus on equity in the management of chronic diseases and access to quality behavioral health services, including those for substance use disorder, as the first priorities for action using market-driven, community-informed solutions and the attraction of startups. Innovation and health care partners, which represent nearly 750 health care delivery and training locations across Illinois and neighboring states, gathered this week to set the strategic direction for the Chicago ARC venture collaborative at its first meeting.

Illinois Tech and the University of Illinois at Urbana-Champaign are the first institutions to join the Chicago ARC venture collaborative as founding innovation partners, with a formalized commitment of their expertise and capabilities to support the success of health systems and startups. 

“Illinois Tech is an established leader in offering a distinctive education and unique research program focused on using science, technology, and design thinking to address current and emerging human health issues,” says Illinois Tech Interim Provost Kenneth T. Christensen. “We’re thrilled to join the Chicago ARC collaborative venture as a founding innovation partner to tackle health care inequities through market-driven, community-informed solutions and to foster health technology innovation to support the region’s underserved.”

Chicago ARC partners have aligned on a vision to create a community of health innovation in Chicago and across Illinois and the Midwest, accelerating community-relevant innovation, technology, and partnerships, as well as positioning the region as a global destination for innovators and startups that are looking to transform health care and impact society. Chicago ARC partners will create collaboration and impact in the initial health care focus areas by sharing best practices through workshops and exchanges, by collaboratively developing and evaluating new approaches, and by serving as a network to pilot and scale innovative solutions. By doing so, the partners will create replicable models to improve access, quality, and cost of care, and will address health inequities and the social determinants of health.  

“Chicago ARC brings together the best global technology, startups, and care models with the health equity needs of health care providers and the communities they serve,” comments Chicago ARC Executive Director Kate Merton. “Today, we are able to share incredible progress toward defining collaboration priorities where, together with our partners, we can drive equitable innovation to transform health care in Chicago, Illinois, and across the Midwest. And, by focusing on real-world needs that represent urban and rural communities across the U.S., we will bring technologies to market significantly faster than the traditional incubator and accelerator approaches.”

Chicago ARC’s health care partners will define health equity market needs, contribute best practices, and serve as committed pilot sites and customers for technologies that meet defined solution requirements. 

Stephen K. Klasko, the former president of Thomas Jefferson University and former CEO of Jefferson Health and a North American Ambassador for Sheba Medical Center and ARC, notes “Chicago ARC is taking radical collaboration to the next level by bringing together the amazing traditional health care ecosystem in Chicago and Fourth Industrial Revolution technologies to bring population health, social determinants, and health equity from philosophic and academic exercises to the mainstream of clinical care in Chicago and beyond.”

“The Chicago ARC and its network of leading partner organizations creates the ideal way for Sheba to translate our learnings and best practices to the U.S. health care market. The commitment, collaboration, and expertise of the partners at the table demonstrates why the Chicago ARC model and this region are the perfect place for Sheba and our startup network to focus in the U.S.,” adds Professor Eyal Zimlichman, the deputy director general, chief transformation officer, and chief innovation officer at Sheba Medical Center.

Working together with Chicago ARC, Illinois Tech, as a founding innovation partner, will seek to accelerate needs-driven solution development, commercialization of new innovations, and ensure that new solutions and enabled care models benefit all patients.

“Illinois Tech is committed to liberating the collective power of difference to advance technology and progress for all,” says Illinois Tech President Raj Echambadi. “As the only technology-focused university in the global city of Chicago, Illinois Tech brings a purpose-driven focus to education, research, and innovation while serving as an engine for opportunity and economic mobility. We are excited to partner with Chicago ARC to empower health system partners and startups in their mission to innovate and solve some of the most pressing challenges facing health care today.”

“Making Chicago the preferred destination for groundbreaking startups is a top priority for World Business Chicago,” says World Business Chicago CEO Michael Fassnacht. “The Chicago ARC and its significant network of health care and innovation partners are delivering on the vision for Chicago and Illinois as the global hub for health equity innovation. The resulting collaborations and approaches will move the needle on equitable health care locally and create replicable models that scale across the U.S.”

Working in extreme heat puts strain on foetus

Peer-Reviewed Publication

LONDON SCHOOL OF HYGIENE & TROPICAL MEDICINE

The foetuses of women working in the fields in extreme heat can show signs of strain before their mothers are affected, new research has shown.

The study, which involved 92 pregnant subsistence farmers in The Gambia, is the first to measure the impacts of heat stress on the foetuses of manual workers.

Findings include that for every degree Celsius increase in heat stress exposure there was a 17% increase in foetal strain as indicated by raised foetal heart rate and slower blood flow through the umbilical cord.

Overall, the team led by researchers at the Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine (LSHTM) and LSHTM found that even a modest rise in body temperature from performing manual tasks in extreme heat produced evidence of physiological strain in both mother and foetus.

The research is published in The Lancet Planetary Health.

Dr Ana Bonell, Wellcome Trust Global Health Clinical PhD Fellow at LSHTM and lead author, said: “Climate change has led to increasingly extreme temperatures worldwide and Sub-Saharan Africa is particularly vulnerable to climate impacts. Our study found that pregnant subsistence farmers in The Gambia commonly experience levels of extreme heat above recommended outdoor working limits, and that this can have significant effects on their health and the health of their babies. The results suggest we have to find effective interventions to protect these women and reduce adverse birth outcomes.” 

Study author Jainaba Badjie from MRC The Gambia at LSHTM said: “Despite the growing scientific evidence linking maternal heat exposure to adverse birth outcomes, including premature birth, low birth weight, and still birth, up until now there has been little research into the physiological mechanisms responsible for these outcomes. We urgently need to understand these mechanisms so that we can find better ways to support mothers and babies in these conditions.”

For the study, participants in West Kiang, The Gambia, were encouraged to perform their usual daily tasks during field visits and were fitted with a wearable device to record maternal heart rate, skin temperature and estimated energy expenditure.

Portable ultrasound devices were used to record foetal heart rate, umbilical artery blood flow at the start of each visit (used as the baseline), at a mid-point during a worker’s shift, and then at the end of the shift.

Maternal symptoms of heat illness were also collected. Nausea, vomiting, headache, dizziness, weakness, muscle ache, fatigue and dry mouth, were common among participants, with over half of the women reporting that they experienced at least one symptom during field visits.  

Analysis of the data showed strong links between heat stress exposure and maternal heat strain, which was also found to be associated with foetal strain. Maternal heat stress was also strongly linked to foetal strain even when controlling for maternal heat strain, indicating that other biological factors need to be considered.

The researchers suggest that an important physiological factor to consider in future work is the diversion of blood from the placenta to the skin which appears to occur at lower core temperatures than highlighted by previous studies. The findings also highlight the need for further work to identify and evaluate interventions that will help pregnant agricultural workers in Sub-Saharan Africa to adapt to working in extreme heat.  

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JOURNAL

The Lancet Planetary Health

ARTICLE TITLE

A cohort study assessing the effect of environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in The Gambia, West Africa

ARTICLE PUBLICATION DATE

7-Dec-2022

Study shows substantial rise in type 2 diabetes among young people over past 30 years

Less developed countries and women under 30 particularly affected. Body weight is main contributing factor across all countries, say experts

Peer-Reviewed Publication

BMJ

Rates of type 2 diabetes in adolescents and young adults globally have risen substantially from 1990 to 2019, finds an analysis of the latest data from over 200 countries and regions in The BMJ today.

The findings show that countries with a low-middle and middle sociodemographic index (a measure of social and economic development) and women aged under 30 were particularly affected, and high body mass index was the main attributable risk factor in all countries.

The researchers argue that weight control is essential in reducing the burden of early onset type 2 diabetes, but countries should establish specific policies to deal with this problem more effectively.

Type 2 diabetes traditionally develops in middle-aged and older people and carries increased risks of serious complications including heart disease, vision loss, and death. 

Data suggest that early onset of type 2 diabetes (diagnosis before the age of 40) is becoming increasingly common. But no study has specifically described the global burden of early onset type 2 diabetes, or the variations between the sexes and in countries with different levels of socioeconomic development. 

Risk factors for early onset type 2 diabetes in different countries are also unclear.

To fill these knowledge gaps, researchers used data from the Global Burden of Disease Study 2019 to estimate new cases (incidence), deaths and disability adjusted life years (DALYs) - a combined measure of quantity and quality of life - due to type 2 diabetes in adolescents and young adults (aged 15-39 years) from 204 countries and territories between 1990 and 2019.

They also examined the proportional DALY attributable to different risk factors, and data were assessed by age, sex and sociodemographic index.

The results show that the age standardised incidence rate for type 2 diabetes in adolescents and young adults globally increased from 117 per 100,000 population in 1990 to 183 in 2019, and the age standardised DALY rate increased from 106 per 100,000 in 1990 to 150 per 100,000 in 2019.

The age standardised mortality rate was modestly increased from 0.74 per 100,000 in 1990 to 0.77 per 100,000 in 2019.

When grouped by countries with different sociodemographic indexes, countries with a low-middle and middle sociodemographic index had the highest age standardised incidence rate and age standardised DALY rate in 2019, whereas countries with a low sociodemographic index had the lowest age standardised incidence rate but the highest age standardised mortality rate.

Women generally had higher mortality and DALY rates than men at ages under 30 years, but differences between the sexes were reversed in those aged over 30 years except in countries with a low sociodemographic index.

The main attributable risk factor for DALY for early onset type 2 diabetes was high body mass index in all regions by sociodemographic index.

The contribution of other risk factors varied across regions, however, with higher proportions of ambient particulate air pollution (12% v 7%) and smoking (13% v 4%) in countries with a high sociodemographic index and higher proportions of household air pollution from solid fuels (17% v 0.07%) and diet low in fruit (9% v 6%) in countries with a low sociodemographic index.

The researchers point to some study limitations, such as differences in the definition of type 2 diabetes and a high probability of underdiagnosis in many countries. And while several techniques were used to reduce bias and inaccuracy in the data, bias cannot be fully ruled out.

Nevertheless, they point out that they comprehensively evaluated the global, regional, and national temporal trends for early onset type 2 diabetes and the corresponding contributions of risk factors based on the Global Burden of Disease Study 2019.

“Our study showed a clear upward trend of the burden of early onset type 2 diabetes from 1990 to 2019,” they write. “These findings provide a basis for understanding the epidemic nature of early onset type 2 diabetes and call for urgent actions to deal with the issue from a global perspective.”

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JOURNAL

The BMJ

DOI

10.1136/bmj-2022-072385 

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: systematic analysis of the Global Burden of Disease Study 2019

ARTICLE PUBLICATION DATE

7-Dec-2022

Common medicine can stop the transmission of HIV infection from mother to child

Peer-Reviewed Publication

KAROLINSKA INSTITUTET

Antiviral drugs almost completely reduce the risk of mothers passing on HIV infection to their children, even in a low-income country with a high HIV incidence such as Tanzania, according to a new study in Lancet HIV by researchers from Karolinska Institutet. The discovery raises hopes of achieving the World Health Organization’s goal of eliminating the spread of infection from mother to child. 

The UN organization UNAIDS estimates eleven per cent of children born to HIV-positive mothers in Tanzania are infected with HIV in the womb, during childbirth or via breast milk. But that number is most likely significantly lower in reality, according to the new study.  

The researchers examined more than 13,000 HIV-positive, pregnant women, at several health centres in one of Africa’s largest cities, Dar es Salaam, in Tanzania. The women were offered antiviral treatment through maternity care between 2015 and 2017.  

Only 159 infants were infected 

The women were followed for 18 months after giving birth when most of them had stopped breastfeeding. When the researchers examined the mothers’ children, they discovered that only 159 of the more than 13,000 infants had been infected with HIV by the age of 1.5 years. Taking into account the margin of error, this means a risk of 1.4 per cent.

The risk of infection was more than twice as high among women who sought care late in pregnancy or had advanced HIV. Conversely, the risk of infection was only 0.9 per cent in those who had already received HIV treatment when they became pregnant. 

“HIV transmission from mother to child can in principle be stopped completely with modern antiviral drugs. But so far it has not been demonstrated in low-income countries in Africa with a high incidence of HIV infection,” says Goodluck Willey Lyatuu, physician and postdoctoral researcher at the Department of Global Public Health at Karolinska Institutet and first author of the study.

Early diagnostics are important 

The goal of the World Health Organization (WHO) is to eliminate the transmission of HIV infection from mother to child, and since 2012 new recommendations have been introduced, that all pregnant women with HIV should begin lifelong antiviral treatment. This has resulted in a sharp reduction in the risk of transmission of infection between mother and child even in resource-poor countries. 

“However, it is still important to improve early HIV diagnosis, optimise follow-up measures and offer specialist support to young mothers,” says Anna Mia Ekström, clinical professor of global infectious disease epidemiology with a focus on HIV at the Department of Global Public Health at Karolinska Institutet and corresponding author of the study.

The study is limited by challenges that may be typical in low-resource health systems, such as incomplete follow-up and missing data, and that risk factors such as stigma linked to HIV are rarely or never routinely investigated.

“But it is one of the largest cohort studies published from Africa on the risk of HIV transmission from mother to child where the baby is followed until the end of the breastfeeding period,” says Anna Mia Ekström.

The study was funded by Sida. 

Publication: “Vertical HIV transmission within 18 months postpartum among women on lifelong antiretroviral therapy for HIV in Dar es Salaam, Tanzania: a prospective cohort study”, Goodluck Willey Lyatuu, Roseline Urrio, Helga Naburi, Peter Lyaruu, Brenda Simba, Hellen Siril, Emmanuel Philipo, Lameck Machumi, Ayoub Kibao, Deborah Kajoka, Mukome Nyamhagatta, David Sando, Gunnel Biberfeld, Nicola Orsini, Charles Kilewo, Anna Mia Ekström, Lancet HIV, online December 8, 2022, doi: 10.1016/S2352-3018(22)00289-2

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JOURNAL

The Lancet HIV

DOI

10.1016/S2352-3018(22)00289-2 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Vertical HIV transmission within 18 months postpartum among women on lifelong antiretroviral therapy for HIV in Dar es Salaam, Tanzania: a prospective cohort study

ARTICLE PUBLICATION DATE

7-Dec-2022

Racial and ethnic disparities in swimming skills found across generations

Culturally tailored intergenerational swimming programs could help eliminate racial disparities in drowning

Peer-Reviewed Publication

ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO

A parent survey from Ann & Robert H. Lurie Children’s Hospital of Chicago published in the journal Pediatrics found intergenerational trends in swimming skills, with stark racial and ethnic differences.

Comfort with their own swimming skills was reported by fewer parents who identified as Latine (less than 25 percent) and Black (28 percent), compared to White parents (56 percent). Similarly, their children’s swimming competence was affirmed by less than 33 percent of Black parents and less than 40 percent of Latine parents, compared to nearly 60 percent of White parents.

The survey also revealed that over 26 percent of Black parents and over 32 percent of Latine parents reported that they never learned to swim, compared to less than 4 percent of White parents. Likewise, fewer Black and Latine children had swimming lessons, compared to White children (46 percent, 47 percent and 72 percent, respectively).

“Our results underscore that racial and ethnic gaps in swimming competence run in families, and that children are less likely to swim when their parents can’t swim,” said senior author Michelle Macy, MD, MS, Emergency Medicine physician at Lurie Children’s and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “To improve swimming abilities in Black and Latine communities, we need to address swim comfort and skills for both parents and their children. Expanding access to pools and affordable, culturally tailored water safety programs are critically important strategies to help eliminate racial disparities in child drownings.”

In swimming pools, Black children ages 10-14 years drown at rates over 7 times higher than White children, according to the latest data from the Centers for Disease Control and Prevention (CDC).

The survey used the Voices of Child Health in Chicago Parent Panel to ascertain parent and child experiences with swim lessons and swimming skills. Dr. Macy and colleagues analyzed responses from 1,283 parents of 2,148 children aged 4 years and older. Participants represented the racial and ethnic diversity of Chicago.

Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Emergency medicine-focused research at Lurie Children’s is conducted through the Grainger Research Program in Pediatric Emergency Medicine.

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JOURNAL

PEDIATRICS

Babies born to Black mothers in rich countries twice as likely to die in first weeks of life

Largest analysis of perinatal outcomes finds disparities in outcomes based on race and ethnicity in high and upper-middle income countries

Peer-Reviewed Publication

UNIVERSITY OF BIRMINGHAM

Babies born to Black mothers in richer countries are more likely to be stillborn or die in the first four weeks of life than those born to white women, new research has found.

A new meta-analysis published in the Lancet today (Thursday 8 December) funded by the National Institute for Health and Care Research, the research partner of the NHS, and the health charity Wellbeing of Women, shows significantly worse survival and health impacts for babies born to women from Black and ethnic minority groups across high and upper-middle income countries including the UK, US, and Canada.

Drawing on 2.2 million pregnancies across 20 countries, the team of researchers from the University of Birmingham, Birmingham Children’s Hospital, Ramon y Cajal Hospital Madrid, and St George’s University London found that Black women were twice as likely to experience neonatal mortality, where their baby dies in the first 28 days after being born, as well as having a stillborn baby, compared to white women. Black mothers also experienced worse outcomes including preterm birth and small-for-gestation-age babies leading to increased risk of health complications.

The study found that Hispanic mothers experienced worse neonatal mortality with three times as many babies dying in the first four weeks after birth compared to white women across the countries considered for the study. The analysis also found that mothers from South Asia and East Asia had significantly higher rates of preterm birth and small-for-gestation-age babies.

Professor Shakila Thangaratinam from the University of Birmingham and lead author of the study said:

“Our analysis shows that babies of mothers from underserved and underrepresented racial and ethnic groups being more likely to die or face serious complications is a global phenomenon. Simply put, it’s not good enough that women who aren’t white are more likely to either lose their baby either during pregnancy or in the first weeks of life, or experience complications that can have a significant impact on their quality of life.

“Race and ethnic disparities in perinatal care is not located to one specific country or region, which means that there is a systemic issue across richer countries that needs to be addressed as an international community. Taken together with strong evidence that ethnic minority mothers themselves are at increased risk of death or major health complications during pregnancy, this paper further supports the need to urgently understand how healthcare systems are struggling to provide the right care for underserved families.”

Global need to address disparities

The disparities in pregnancy outcomes highlighted between groups of underserved and under-represented mothers and white mothers highlights the need for global action.

Although the analysis of 51 papers demonstrates the scale of disparities between groups, the research group point out that a lack of data to identify the scale of the risks faced by women from racial and ethnic minority backgrounds.

Dr John Allotey, Lecturer in Epidemiology and Women’s Health at the University of Birmingham said:

“We urgently need to answer the question about why these systematic disparities exist around the world. We do already know that there are barriers that disproportionately affect women from racial and ethnic minority backgrounds, and part of addressing this tragic perinatal outcome gap is having better data on underserved populations.

“More data will enable clinicians to plan better interventions to serve minority mothers, and also provide better accountability to close the gap.”

JOURNAL

The Lancet

METHOD OF RESEARCH

Meta-analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Effects of race and ethnicity on perinatal outcomes in highincome and upper-middle-income countries: an individual participant data meta-analysis of 2 198 655 pregnancies

ARTICLE PUBLICATION DATE

8-Dec-2022

Incoherent use of ethnoracial categories in biomedical literature on COVID-19

The authors studied articles on COVID-19 to understand how the terms “race”, “racial” or “ethnicity” co-exist in the biomedical literature about COVID-19 that used terms “gene”, “genetic”, and “genomic”

Peer-Reviewed Publication

INTERDISCIPLINARY CENTRE FOR ETHICS, JAGIELLONIAN UNIVERSITY IN KRAKÓW

Researchers from Adam Mickiewicz University in Poznań (Poland) and the Interdisciplinary Centre for Ethics of Jagiellonian University in Kraków (Poland) have analyzed the full texts of 119 articles from the Lit Covid database published in 2020 and 2021 to reconstruct the theoretical background assumptions about ethnoracial categories that researchers implicitly assume in their studies. Their results were recently published in Medicine, Health Care and Philosophy.

Soon after the outbreak of the pandemic, scientists started to study and report so-called racial differences in the incidence and mortality of COVID-19. Most scholars emphasized that it is racism, not races themselves, that generate disparities in health. But there were also opposing voices that assumed that racial groups are distinct biological populations and that some differences may be caused by biological factors.

Previous studies demonstrated that researchers using racial categories in biomedical studies are often unsure of their references. There are also reports on enormous differences in the way in which racial categories are reported, both between countries and institutions, as well as between individual scientists. In addition, some studies noticed the spillover of US regulatory standards regarding race/ethnicity into the European Union.

Researchers from Poland proposed five interpretations of ethnoracial terms that appeared in the examined papers and labeled them as (a) folk, (b) demogeographic, (c) socio-cultural, (d) multileveled, and (e) institutional. Most of the analyzed articles did not present any definitions of the racial/ethnic terms and their uses differed significantly, making it difficult to compare and interpret research using ethnoracial categories in genetic contexts, as well as to draw practical conclusions from them. Moreover, in about 60% of the analyzed articles, the category of race referred (either implicitly or explicitly) to some genetic differences between representatives of different populations distinguished according to folk racial classifications or geographical origin.

The authors of the article conclude that what is termed “race” or “ethnicity” in one article may mean something else in another. They also argue that the tendency to biologize ethnoracial categories in genetics and genomics may be explained to some extent by the biases of reductionism, which is largely inscribed in the methodology of genetic research. In this understanding, many health disparities are interpreted as the result of genetic differences, although it would be more appropriate to treat them as the effects of societal racism.

“The most basic “feature” of reductionism that fosters the biologization of social categories is that reductionist methods and explanations usually concentrate on internal factors (most often decomposed and cited in isolation) while ignoring or simplifying the environment of the system in the study,” says Dr. Joanna Karolina Malinowska from Adam Mickiewicz University.

Another result of the research is the observation that replacing the word “race” with “ethnicity” (a growing trend in biomedical sciences) may be problematic. Malinowska and Żuradzki point out that since the term “ethnicity” usually refers to cultural phenomena, using it in reference to ancestry can lead to the mistaken impression that the cultural sphere is reducible to biological factors.  

“We believe that the current institutional framework in the US (in contrast to the majority of EU countries) that requires the use of ethnoracial categories to collect and report data in submissions for clinical trials may reinforce the assumption that ethnoracial categories are biologically relevant – says Prof. Tomasz Żuradzki, head of the Interdisciplinary Centre for Ethics at Jagiellonian University. Instead, we propose a reversed regulatory framework in which researchers should justify why they want to use ethnoracial categories as variables and proxies in their research.”

This research received funding from National Science Centre (NCN) in Poland (no. UMO-2020/39/D/HS1/00636), and from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement 805498).

The paper is available via the following link: https://link.springer.com/article/10.1007/s11019-022-10122-y

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JOURNAL

Medicine Health Care and Philosophy

DOI

10.1007/s11019-022-10122-y 

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Reductionist methodology and the ambiguity of the categories of race and ethnicity in biomedical research: an exploratory study of recent evidence

Racial, ethnic, socioeconomic disparities in insulin pump use have persisted over 20 years

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES

UCLA Research Brief

 

FINDINGS

While use of insulin pumps to manage type 1 diabetes has grown over 20 years, there has been no improvement in racial, ethnic, and socioeconomic disparities in their use. By the end of the period studied, insulin pump use was 67% among non-Hispanic whites, 41% among Hispanics, 29% among Blacks, and 46% among other racial and ethnic groups. In addition, 70% of people with bachelor’s degrees or higher used the pumps, compared with 56% among those with some college, 40% among holders of high school degrees, and 18% among those with no high school education. By income level, 74% of those with household incomes of $75,000 or more, 66% with $50,000 to 74,999, 51% with $25,000 to $49,999, and 41% with less than $25,000, used the pumps.

 

BACKGROUND

Insulin pump use has been shown to lead to improvements in glycemic control, quality of life, satisfaction with treatment, and lower diabetes distress. Overall use has grown over two decades from about 32% to 59% among people with type 1 diabetes.

 

METHOD

The researchers examined data from the SEARCH for Diabetes Youth Study, a multicenter, observational, and population-based study of youth under 20 years of age. They broke up the analysis across four time periods between 2001 and 2019: 690 youth and young adults with type 1 diabetes in 2001-2005, 1,706 in 2006-2010, 2,385 in 2011-2015, and 2,257 in 2016-2019.

 

IMPACT

Research is needed on ways to improve access to insulin pumps and address persistent inequities in use of the devices, which are known to improve health and quality of life for people with type 1 diabetes.

 

COMMENT

“Diabetes technology has numerous benefits for patients with type 1 diabetes, but the problem is that there is a huge divide in who actually has access to these technologies,” said study lead Dr. Estelle Everett, assistant professor of medicine in the division of endocrinology, diabetes & metabolism at the David Geffen School of Medicine at UCLA. “Our study found that over the past 20 years, despite the overall increase in the use of insulin pumps, racial-ethnic minority groups and those of lower socioeconomic status still have unequal access to this very beneficial management tool. This is very concerning because these groups have more challenges managing their diabetes and have higher risk of complications with diabetes, so they may actually gain the most benefit from diabetes technology use. Changes in the approach to diabetes care and health policies are needed to ensure equal access to this life changing diabetes device because everyone deserves an equal opportunity to improve their diabetes health.”

AUTHORS

Additional co-authors are Lauren Wisk of UCLA; Davene Wright of Harvard University; Adrienne Williams of DNA Solutions LLC; Jasmin Divers of New York University; Dr. Catherine Pihoker and Dr. Jason Mendoza of University of Washington; Angela Liese of University of South Carolina; Anna Bellatorre of University of Colorado; Dr. Anna Kahkoska and Elizabeth Mayer-Davis of University of North Carolina at Chapel Hill; and Ronny Bell of Wake Forest University.

FUNDING

The SEARCH for Diabetes in Youth Cohort Study (1R01DK127208-01 and 1UC4DK108173) is funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and supported by the Centers for Disease Control and Prevention. The Population Based Registry of Diabetes in Youth Study (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, and U18DP006139) is funded by the Centers for Disease Control and Prevention (DP-15-002) and supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.

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JOURNAL

Diabetes Technology & Therapeutics

DOI

10.1089/dia.2022.0340 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

A longitudinal view of disparities in insulin pump use among youth with type 1 diabetes: The SEARCH for Diabetes in Youth Study

ARTICLE PUBLICATION DATE

7-Dec-2022

Mekong Delta will continue to be at risk for severe flooding

Peer-Reviewed Publication

HOKKAIDO UNIVERSITY

 

IMAGE: BAOTS IN THE MEKONG RIVER DELTA (PHOTO: TSUYOSHI WATANABE). view more 

CREDIT: TSUYOSHI WATANABE

The Mekong River Delta is the agricultural heartland of Vietnam; it is affected by droughts and flooding, which have become more severe in recent years. If severe weather events can be more accurately predicted, risk assessments in the regions can be improved. This, in turn, will reduce the negative effects of floods and droughts in the region.

A team led by Tsuyoshi Watanabe at Hokkaido University has revealed the clearest picture yet of how the El Niño Southern Oscillation (ENSO) affected rainfall in the Mekong Delta over the last hundred years. Their findings were published in the journal Scientific Reports. They correlated water salinity data from reef coral samples with historical weather records and uncovered that the ENSO has caused seasons of heavy and light rainfall, resulting in patterns of both flooding and droughts, respectively. 

The ENSO occurs in the central and Eastern tropical Pacific ocean, in irregular cycles of two to seven years. It consists of the El Niño (warming of the ocean surface), La Niña (cooling of the ocean surface) and neutral (neither warming, nor cooling). 

“We found that heavy rains and flooding have become more severe in recent years, driven by changes in the ENSO due to global warming,” said Watanabe, corresponding author of the study. “The Mekong River Delta will continue to be faced with a higher risk of severe flooding.”

El Niño and La Niña have significant effects on weather patterns and extreme weather events in these regions. Understanding the weather patterns caused by ENSO in the Mekong River Delta (MRD) is critical to ensuring a stable food supply.

The team headed by Watanabe discovered a reef coral on Con Dao Island, 90 km south of the MRD. From a core sample of this coral, they were able to determine monthly fluctuations in the salinity of the surrounding water. “Reef corals have growth rings, similar to trees,” says Watanabe. “These rings preserve a record of the salinity of the surrounding water in each year. The reef coral we sampled was on Con Dao Island, close to the MRD; as a result, the salinity records can be associated with increased or decreased rainfall in the MRD—and hence with flooding or droughts.”

Combining the salinity data with historical annual rainfall maximums allowed the team to extend rainfall data back to 1924.

Analysis of this rainfall data showed that the hydrological changes in the MRD are affected by El Niño and La Niña in the Central Pacific Ocean —  associated with light rain and heavy rain in the MRD respectively.  In particular, heavy rain in the MRD is strongly associated with La Niña in the recent past, while the association between light rain and El Niño have been consistent during the last century. 

This improved understanding of the effects of the ENSO in the Mekong River Delta will allow for more accurate weather predictions in the future. This should also enable better preparation for extreme weather events, increasing both safety of the population and food security. 

This press release is dedicated to the memory of Dr. Tung Thanh Phan, co-first author, who unexpectedly passed away on October 28, 2022. This study is partially based on the results of his doctoral research.

(Left) A map showing the amount of rainfall across South East Asia in October from 1980 to 2005 (Takaaki K. Watanabe, Tung Thanh Phan, et al. Scientific Reports. December 7, 2022). (right) A satellite photo of the Mekong River Delta (Google Earth).

CREDIT

Takaaki K. Watanabe, Tung Thanh Phan, et al. Scientific Reports. December 7, 2022; Google Earth

Members of the Coral Reef Environmental Earth Sciences Laboratory including key members of the research team. From the left, Atsuko Yamazaki (co-author), Kevin Garas, Kaeru Takeuchi, Tung Thanh Phan (co-first author), Tsuyoshi Watanabe (corresponding author), Takaaki K. Watanabe (co-first author) and Motoya Odajima (Photo: Tsuyoshi Watanabe).

CREDIT

Tsuyoshi Watanabe

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JOURNAL

Scientific Reports

DOI

10.1038/s41598-022-20597-7 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Nonstationary footprints of ENSO in the Mekong River Delta hydrology

ARTICLE PUBLICATION DATE

7-Dec-2022