It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Sunday, December 11, 2022
Aging societies: How can we design societies that benefit older and younger people?
The National Academy of Medicine’s Global Roadmap for Healthy Longevity says we have an unprecedented opportunity
COLUMBIA UNIVERSITY'S MAILMAN SCHOOL OF PUBLIC HEALTH
The success of longevity interventions is putting countries on paths to becoming aging societies, in which the number of individuals aged 65 and older is equal to the number of people aged 15 and younger. This outcome may lead to resistance to investments in healthy longevity, according to aging experts, if concerns are raised that the needs of older individuals will overwhelm societies, exacerbate ageism, and divide populations.
The National Academy of Medicine in the United States addressed this possibility as its first-ever Grand Challenge, and in June 2022 published the Global Roadmap for Healthy Longevity, developed by an independent and interdisciplinary global commission co-chaired by Linda P. Fried, MD, MPH, dean of Columbia University Mailman School of Public Health and John Eu-Li Wong, Isabel Chan Professor in Medical Sciences and senior vice president of health innovation and translation at the National University of Singapore. A commentary in the Dec. 2, 2022 Nature Aging, by Dr. Fried, Dr. Wong, and Victor J. Dzau, MD, president of the National Academy of Medicine, reviews the findings and recommendations of the Global Roadmap.
“We are at a critical inflection point, perhaps even a precipice, between the realization of our negative assumptions or pursuing an optimistic future of healthy longevity, avoidable disability, and social challenges,’” says Dr. Fried, who is also Director of the Robert N. Butler Columbia Aging Center. “With most countries expected to be aging societies by 2050, the lead time to be fully prepared is short.”
“The health of a population is a priceless asset. A healthy society is far better prepared to face crises, be it extreme weather events or pandemics. Having populations able to continue contributing well into their older age will allow all to reap the investments in human capital made throughout life, which in turn will unlock the social and economic capital of older people to a degree which has yet to be realized,” says Dr. Wong, who is also senior advisor at the National University Health System.
“Across the globe, investing in health, well-being, and sense of purpose of older adults has the potential to yield great rewards that benefit individuals of all ages and society at large,” observes National Academy of Medicine President Victor J. Dzau. “Enabling healthy longevity allows people to be productive, contribute to their communities, generates social and economic capital, and fulfills an individual’s sense of purpose. All of society - governments and leaders across sectors - must work in tandem to cultivate healthy longevity to build societies that support longer, healthier, meaningful lives.”
Global Roadmap’s findings and recommendations include:
If health is realized in longer lives, older adults can bring unpercented assets at a potential scale that could create a longevity dividend good for all ages
The costs of inaction to create health longevity have critical implications, including the high risk of young people aging with more ill health.
The principles and vision (Vision 2050) for healthy longevity will allow for people to live long lives with health; for older populations to be valued; and for engagement in meaningful and productive activities, leading to intergenerational wellbeing and cohesion.
Implementing Vision 2050 demands an all-of-society effort, an aligned transformation of multiple sectors of society, and governmental leadership.
To initiate the transformation to healthy longevity requires social cohesion and the design of environments that are user-centered.
The returns on investment would be high, measured in enhanced human, social, and financial capital and multigenerational wellbeing.
“Governments should work to build the dividend of healthy longevity in collaboration with the business sector and civil society. This includes developing policies and systems that encourage older adults who want to remain working to do so, improving broadband accessibility to reduce the digital divide, and supporting lifelong learning,” notes Fried. “We are at the forefront of an unprecedented opportunity to realize healthy longevity that we must not miss if we want a generation of substantial social and economic benefits for all ages. By contrast, the costs to society are extraordinary if we continue to increase our years of ill health and widening disparities.”
The authors declare no competing interest.
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.
IMAGE: ILLUSTRATION SHOWS A GRAPHICAL ABSTRACT OF THE RESEARCH.view more
CREDIT: LO LAB, UC RIVERSIDE.
RIVERSIDE, Calif. -- The Salton Sea, the body of water in Southern California’s Coachella Valley and Imperial Valley, is shrinking over time as the planet warms and exposing more lakebed and new sources of dust in the process. High levels of dust already plague the region, a situation likely to worsen as the sea continues to shrink due to climate change.
Not surprisingly, the communities surrounding the Salton Sea have high rates of childhood asthma (20–22.4%) — much higher than the California average of 14.5%.
A University of California, Riverside, mouse study, led by Dr. David Lo, a distinguished professor of biomedical sciences in the School of Medicine, has found that dust collected at sites near the Salton Sea triggered lung neutrophil inflammation in mice. Neutrophils are a type of white blood cells that help fight infection.
“We now have an important direct demonstration that chronic exposures to Salton Sea dust may have a role in the asthma in residents closest to the Salton Sea,” said Lo, who directs the Bridging Regional Ecology, Aerosolized Toxins, & Health Effects, or BREATHE, Center. Housed in the UC Riverside medical school, the center addresses critical issues in air quality and health.
“What residents near the sea are breathing is dissolved material from the sea, with microbial components that can promote inflammation,” Lo said. “As the sea continues to dry up and expose more dust-producing lakebed, it could increase concern for the residents, especially as climate change drives chronic drought in the region.”
Lo explained that dust can cause several pulmonary diseases. In the Salton Sea, contaminants such as pesticides, herbicides, heavy metals, and microbial toxins may be enriched in the dust. To examine the potentially harmful effects of this dust, the study, published in the journal Science of the Total Environment, used an environmental exposure chamber at UC Riverside.
The research team collected dust at four sites, three of which were 0.6, 2, and 4 miles from the Salton Sea lakebed. Dust from a fourth site, located 20 miles from the northwest border of the Salton Sea shoreline, served as the control; the dust here produced no significant lung inflammation.
From the dust they collected, Lo and his colleagues made aqueous extracts and filtered out inert and larger particulate material such as fibers and sand. They then injected suspensions of fine aerosols into the environmental exposure chamber. The mice were exposed to the aerosols for two days (to study acute innate response) or seven days (to study allergic-type response).
“Interestingly, material from dust at the Salton Sea induced strong pulmonary inflammation in the mice, but not the allergic profile more commonly associated with clinical asthma,” Lo said.
“The lung inflammation looks like it is triggered by bacterial components rather than classic allergens like mold, dust mites, or pollen,” he said. “What we are seeing is decidedly different from a classic allergic response. Our next step is to see if this pattern is also true among residents of the region.”
The study has implications for other terminal lakes — those with no outlet — such as the Dead Sea in Israel and Jordan, the Great Salt Lake in Utah, and Mono Lake in Northern California.
“The environmental crisis at the Salton Sea may be occurring at these terminal lakes also or where rivers and lakes are shrinking and causing an ecosystem change,” Lo said. “This may be a warning sign that global warming and drying lakes and chronic drought — think of Lake Powell in Arizona and Utah or Lake Mead in Nevada — are also what we need to pay closer attention to because evaporating waters here are changing the ecology and local environment. These terminal lake regions are unique as they have increasing levels of dust, which can trigger high levels of pulmonary inflammation.”
Lo stressed that understanding dust-triggered inflammation, the mechanisms behind it, and its interaction with allergens and allergic development is crucial and needs more funding to advance.
“Only additional research on this topic will allow us to address in depth the negative health impacts of the dust and develop viable strategies to address them,” he said.
The study was funded by the National Institute on Minority Health and Health Disparities of the National Institutes of Health, or NIH, through a grant to the UCR Center for Health Disparities, which Lo directs. The content of this article does not necessarily represent the NIH’s official views.
Lo was joined in the research by Trevor A. Biddle, Keziyah Yisrael, Ryan Drover, Qi Li, Mia R. Maltz, Talyssa M. Topacio, Jasmine Yu, Diana Del Castillo, Daniel Gonzales, Hannah L. Freund, Mark P. Swenson, Malia L. Shapiro, Jon K. Botthoff, Emma Aronson, and David R. Cocker III.
The research paper is titled “Aerosolized aqueous dust extracts collected near a drying lake trigger acute neutrophilic pulmonary inflammation reminiscent of microbial innate immune ligands.”
The University of California, Riverside is a doctoral research university, a living laboratory for groundbreaking exploration of issues critical to Inland Southern California, the state and communities around the world. Reflecting California's diverse culture, UCR's enrollment is more than 26,000 students. The campus opened a medical school in 2013 and has reached the heart of the Coachella Valley by way of the UCR Palm Desert Center. The campus has an annual impact of more than $2.7 billion on the U.S. economy. To learn more, visit www.ucr.edu.
UC Riverside research at the Salton Sea is multidisciplinary, bringing together faculty and graduate students from the School of Medicine, the Marlan and Rosemary Bourns College of Engineering, and the College of Natural and Agricultural Sciences.
Aerosolized aqueous dust extracts collected near a drying lake trigger acute neutrophilic pulmonary inflammation reminiscent of microbial innate immune ligands
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.
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
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.”
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.
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
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.”
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
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
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.
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
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
