Most older adults are wary of mixing health care and religion or spirituality, poll finds

But majority see role for health care providers in finding meaning or hope in the face of illness, and are comfortable discussing their beliefs with their providers

Reports and Proceedings

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

When it comes to matters of personal beliefs, most older Americans prefer to keep their health care and their spiritual or religious lives separate, a new University of Michigan poll finds.

But they do see a role for their health care providers in helping them cope with illness by looking for meaning or hope.

In all, 84% of people between the ages of 50 and 80 say that they have religious and/or spiritual beliefs that are somewhat or very important to them, including 71% who cited religious beliefs and 80% who cited spiritual beliefs, according to new data from the National Poll on Healthy Aging. About 40% of these older adults say those beliefs have gotten more important to them as they grow older.

Among older adults with religious or spiritual beliefs that are important to them, 19% say their beliefs have influenced their health care decisions, and 28% say they want health care providers to ask them about their beliefs.

Meanwhile, 77% of all older adults, regardless of beliefs, say health care providers should keep their own personal beliefs separate from how they deliver care.

The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, U-M’s academic medical center.

For the new report, the poll team worked with Adam Marks, M.D., M.P.H., a hospice and palliative care physician at Michigan Medicine, and L.J. Brazier, M.Div., a chaplain at Michigan Medicine’s Department of Spiritual Care.

“While 45% of older adults say their religious beliefs are very important to them, and 50% say that about their spiritual beliefs, even this group largely wants to keep this aspect of their lives separate from their health care,” says Marks, an associate professor of geriatric and palliative medicine. “But a sizable majority of all older adults – whether or not they say belief is important to them – reported that they’d turn to health care workers to help them find deeper meaning in their illness, and 78% believe health care workers will help them find hope when they’re having a health-related challenge.”

Brazier notes that many health care systems have a way to record the religious affiliation of patients in their electronic medical records, and that medical students and others training for health professions are told to ask their patients about any beliefs that might affect their future care.

Having this information available can help providers ensure that patients with strongly held beliefs or specific religious affiliations receive everything from appropriate hospital food to visits with chaplains of a specific faith tradition when they’re having a health crisis or nearing the end of life.

But for those who do not follow a faith tradition or have strongly held beliefs, having that information available to health providers can also be helpful.

“Being a religious or spiritual person, or not following a faith tradition or spiritual practices, is a highly personal matter,” says poll director Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System. “So perhaps it’s not surprising that only about a quarter of all people in this age range say they’ve talked about their beliefs with a health care provider, though this rose to about one-third of those who say their religious or spiritual beliefs are very important to them.”

In all, 70% of those who say their beliefs are somewhat or very important to them reported feeling comfortable discussing their beliefs with their health care providers.

Even if patients don’t want to discuss their beliefs with their health providers at a typical appointment, it’s important for providers to know if patients with significant health needs, or those experiencing a health crisis, are connected to a faith community that can help provide support.

In all, 65% of the older adults whose religious or spiritual beliefs are important to them said they belong to a community of people who share their beliefs.

The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in July 2022 among 2,163 adults aged 50 to 80. The sample was subsequently weighted to reflect the U.S. population. Read past National Poll on Healthy Aging reports and about the poll methodology

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METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

Novel wearable belt with sensors accurately monitors heart failure 24/7

Wearable device measures all physiological parameters associated with heart failure

Peer-Reviewed Publication

FLORIDA ATLANTIC UNIVERSITY

 

IMAGE: THE LIGHTWEIGHT BELT CONTINUOUSLY MONITORS ALL OF THE PHYSIOLOGICAL PARAMETERS ASSOCIATED WITH HEART FAILURE IN REAL TIME, 24/7. view more 

CREDIT: FAU COLLEGE OF ENGINEERING AND COMPUTER SCIENCE

There are about 64 million cases of heart failure worldwide. According to the American Heart Association, 6.2 million adults in the United States have heart failure and that number is estimated to increase to 8 million by 2030. Heart failure is a progressive clinical syndrome characterized by a structural abnormality of the heart, in which the heart is unable to pump sufficient blood to meet the body’s requirements.

There are currently two heart failure monitoring systems available. However, they are costly and pose risks because they are surgically implanted under the skin. Moreover, about half of patients with heart failure do not need an implantable device or do not qualify for the thoracic (area between the neck and abdomen) monitoring these devices provide. There is a critical need for non-invasive solutions to monitor heart failure progression around the clock.

Researchers from Florida Atlantic University’s College of Engineering and Computer Science in collaboration with FAU’s Christine E. Lynn College of Nursing have developed a prototype of novel wearable device that can continuously monitor all of the physiological parameters associated with heart failure in real time.

The technology is based on sensors embedded in a lightweight belt conveniently worn around the waist to monitor thoracic impedance, electrocardiogram (ECG), heart rate and motion activity detection. The system uses different sensors for sensing these parameters. Thoracic impedance is a critical bio-signal to monitor heart failure progression. Similarly, ECG is a vital bio-signal to diagnose and predict cardiovascular diseases. ECG measures electrical signals through the heart using a Holter monitor, which is not suitable for point-of-care use.

For the study, published in Scientific Reports, researchers tested the wearable device in different conditions including sitting, standing, lying down and walking. For each condition, results were obtained for each of the sensors sequentially. The physiological parameters selected are significant in determining heart failure symptoms. 

Findings showed that all of sensors kept track of the changes for all of the different conditions. The position sensor correctly highlighted the change in position in different conditions and could be used to identify different states of the wearer of the device. In addition, the heart rate sensor continually kept track of the heart rate. Importantly, the device correctly highlighted minute changes in thoracic impedance.

Like most ECG monitors, the ECG sensor in the wearable device was very sensitive to motion, particularly while walking. However, even while walking the ECG sensor retained its QRS complex (the electrical impulse as it spreads through the ventricles of the heart) along with R-peaks (intervals of the QRS complex), which are important indicators for left ventricular hypertrophy, indicative of an increase in the size of myocardial fibers in the main cardiac pumping chamber. 

“All of the sensors we integrated into our belt module can easily be worn for a long period of time without affecting the patient’s daily activities,” said Waseem Asghar, Ph.D., senior author and an associate professor in FAU’s Department of Electrical Engineering and Computer Science. “Importantly, continuous and real-time monitoring of heart failure symptoms could alert patients and their health care providers of the patient’s declining health. In turn, health care providers could intervene with medications to avoid patient hospitalization.”

The researchers expect that their technology will have higher predictive values for heart failure with increased specificity and high sensitivity.

“Approximately 1 in 4 patients with heart failure are readmitted within 30 days of discharge from the hospital and about half are readmitted within six months,” said Mary Ann Leavitt, Ph.D., co-author and an assistant professor in FAU’s Christine E. Lynn College of Nursing. “Health care wearable devices such as the prototype we have developed have the potential to decrease hospital readmissions in a cost-effective way that also is safe and convenient for the wearer.”

Based on the study results, the researchers are currently testing the module over a set of diverse subjects to develop an algorithm to predict heart failure over the test set.

“This wearable device to monitor heart failure is my main project in Dr. Asghar’s Micro and Nanotechnology Lab in Medicine, which has important social implications for the fastest-growing cardiovascular disease in the U.S.,” said Sheikh Muhammad Asher Iqbal, first author, a research assistant and a Ph.D. student in FAU’s Department of Electrical Engineering and Computer Science. “We are developing a noninvasive solution that can be used by all heart failure patients for better management, diagnosis and prognosis that will be able to serve the masses.”

Study co-authors are Imadeldin Mahgoub, Ph.D., Tecore Professor; and Sarah E. Du, Ph.D., an associate professor, both in FAU’s Department of Electrical Engineering and Computer Science. 

This research was supported by FAU’s Institute for Sensing and Embedded Network Systems Engineering (I-SENSE) and FAU’s College of Engineering and Computer Science.

- FAU -

About FAU’s College of Engineering and Computer Science:

The FAU College of Engineering and Computer Science is internationally recognized for cutting edge research and education in the areas of computer science and artificial intelligence (AI), computer engineering, electrical engineering, biomedical engineering, civil, environmental and geomatics engineering, mechanical engineering, and ocean engineering. Research conducted by the faculty and their teams expose students to technology innovations that push the current state-of-the art of the disciplines. The College research efforts are supported by the National Science Foundation (NSF), the National Institutes of Health (NIH), the Department of Defense (DOD), the Department of Transportation (DOT), the Department of Education (DOEd), the State of Florida, and industry. The FAU College of Engineering and Computer Science offers degrees with a modern twist that bear specializations in areas of national priority such as AI, cybersecurity, internet-of-things, transportation and supply chain management, and data science. New degree programs include Master of Science in AI (first in Florida), Master of Science and Bachelor in Data Science and Analytics, and the new Professional Master of Science and Ph.D. in computer science for working professionals. For more information about the College, please visit eng.fau.edu. 

 

About the Christine E. Lynn College of Nursing:

FAU’s Christine E. Lynn College of Nursing is nationally and internationally known for its excellence and philosophy of caring science. The College was ranked No.11 nationwide by U.S. News and World Report in 2021 for “Best Online Master’s in Nursing Administration Programs” and No. 32 for the “Best Online Master’s in Nursing Programs.” In 2020, FAU graduates earned a 95.9 percent pass rate on the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) and 100 percent AGNP Certification Pass Rate. FAU’s Christine E. Lynn College of Nursing is fully accredited by the Commission on Collegiate Nursing Education (CCNE). For more information, visit nursing.fau.edu.

 

About Florida Atlantic University:
Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 30,000 undergraduate and graduate students across six campuses located along the southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, FAU embodies an innovative model where traditional achievement gaps vanish. FAU is designated a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report and a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.fau.edu.

 VIDEO

JOURNAL

Scientific Reports

DOI

10.1038/s41598-022-23680-1 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Development of a wearable belt with integrated sensors for measuring multiple physiological parameters related to heart failure

New report tracks latest trends in global cardiovascular health

Cardiovascular disease is leading cause of death worldwide; High blood pressure, high cholesterol, dietary risks and air pollution leading causes of cardiovascular disease worldwide

Peer-Reviewed Publication

AMERICAN COLLEGE OF CARDIOLOGY

Cardiovascular disease (CVD) remains the leading cause of death across the globe, according to a new “almanac”-style special issue of the Journal of the American College of Cardiology (JACC). The issue looks at 18 specific cardiovascular conditions and 15 risk factors across 21 global regions to provide a broad view of the global burden of cardiovascular disease. While CVD rates are high globally, Central Asia and Eastern Europe were estimated to have the highest rates of CVD mortality. High blood pressure, high cholesterol, dietary risks and air pollution were the leading causes of CVD worldwide.

The Global Burden of Cardiovascular Diseases Collaboration is an alliance between JACC, the Institute for Health Metrics and Evaluation, and the National Heart, Lung, and Blood Institute. Serving as an update to “The Global Burden of Diseases, Injuries, and Risk Factors Study 2019,” the 2022 publication includes data from 204 countries and territories, highlighting the leading global modifiable cardiovascular risk factors, their contribution to disease burden and recent prevention advancements.

“We need to keep shining a light on the current state of cardiovascular health across the globe. Cardiovascular health has a major impact on our quality of life and the health care system as a whole,” said Gregory A. Roth, MD, MPH, senior author of the paper and associate professor in the Division of Cardiology and director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation at the University of Washington. “Over 80% of cardiovascular disease is preventable. With this update, we are measuring some alarming global trends and reviewing the current interventions that can help countries make good, evidence-based choices for their health systems.”

This special report assessed deaths using vital and sample registration data and produced estimates for the 15 leading environmental (air pollution, household air pollution, lead exposure, low temperature, high temperature), metabolic (systolic blood pressure, LDL-cholesterol, body mass index, fasting plasma glucose, kidney dysfunction) and behavioral (dietary, smoking, secondhand smoke, alcohol use, physical activity) risks for cardiovascular diseases.

The CVD mortality rates are broken down by location, along with age, sex and time categories since 1990. The report also looked at disability-adjusted life years (DALYs), the years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs).

“It is truly exciting to see this multi-year Global Burden of Cardiovascular Diseases Collaboration culminate into a dedicated issue of the Journal to inform the global cardiovascular community,” said Valentin Fuster, MD, PhD, an author of the paper, director of Mount Sinai Heart, physician-in-chief of The Mount Sinai Hospital and editor-in-chief of JACC. “This issue focuses both on the modifiable risk factors, as well as the global cardiovascular disease and death rates in 21 regions across the world.”

Key takeaways from the report:

• Ischemic heart disease is the leading cause of cardiovascular death, accounting for 9.44 million deaths in 2021 and 185 million DALYs.
   
• High systolic blood pressure remains the leading modifiable risk factor for premature cardiovascular deaths, accounting for 10.8 million CV deaths and 11.3 million deaths overall in 2021. The all-cause DALYs due to high blood pressure were 2,770 per 100,000 people.
   
• Dietary risks accounted for 6.58 million CV deaths and 8 million deaths overall in 2021. Dietary risks include food types that are under-consumed globally (fruits, vegetables, legumes, whole grains, nuts and seeds, milk, fiber, calcium, omega-3 fatty acids and poly unsaturated fatty acids) and over-consumed (red and processed meats, sugar-sweetened beverages, trans-fatty acids and sodium). All-cause DALYs due to dietary risks were 2,340 per 100,000 people.
   
• Central Asia, Central Sub-Saharan Africa and Eastern Europe were the regions with the highest rates of CVD burden attributable to elevated systolic blood pressure. The regions with the highest rates of CVD burden attributable to dietary risk were Central Asia, Oceania and Eastern Europe.
   
• Central Asia had the highest age-standardized total CVD mortality at 516.9 deaths per 100,000. In contrast, high-income Asia Pacific had the lowest age-standardized total CVD mortality at 76.6 deaths per 100,000 people.
   
• Since 1990, Australasia had the largest percent reduction (64.2%) in age-standardized CVD per 100,000 out of all other regions. This percent decrease was highest in ischemic heart disease at 71.8%.

“This visual atlas serves as a timely reminder about the importance of modifiable risk factors for heart disease, like high blood pressure,” said George A. Mensah, MD, an author of the paper and director of the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute. “Deaths due to hypertension have steadily increased in the U.S. for the past 20 years, which mirrors trends in other regions and leaves researchers eager to find practical and innovative solutions.”

“Of really great concern is the finding that high blood pressure control rates have progressively declined in the U.S. over the last decade,” he added.

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The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its more than 56,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org. 

The ACC’s family of JACC Journals rank among the top cardiovascular journals in the world for scientific impact. The flagship journal, the Journal of the American College of Cardiology (JACC) — and family of specialty journals consisting of JACC: Advances, JACC: Asia, JACC: Basic to Translational Science, JACC: CardioOncology, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, JACC: Case Reports, JACC: Clinical Electrophysiology and JACC: Heart Failure — pride themselves on publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.

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JOURNAL

Journal of the American College of Cardiology

DOI

10.1016/j.jacc.2022.11.001 

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Global Burden of Cardiovascular Diseases and Risks Collaboration, 1990-2021

ARTICLE PUBLICATION DATE

12-Dec-2022

Despite soaring overdose rates, Americans face barriers to treatment

OHSU addiction medicine specialists call for flexible, individualized treatment in new publication

Peer-Reviewed Publication

OREGON HEALTH & SCIENCE UNIVERSITY

Despite the fact that a record 107,000 Americans died of fatal drug overdoses last year, patients in need of treatment are forced to navigate a punishing gauntlet to get the care they need, a group of addiction medicine specialists from Oregon Health & Science University argue in a new publication.

“Most people who need and want treatment for opioid addiction cannot access it,” they write in a perspective published in the Journal of General Internal Medicine.

The co-authors include OHSU’s Honora Englander, M.D., professor of medicine (hospital medicine and general internal medicine and geriatrics); Ximena Levander, M.D., M.C.R., assistant professor (general internal medicine and geriatrics); and Jessica Gregg, M.D., Ph.D., chief medical officer of Fora Health Treatment & Recovery in Portland and an associate professor of medicine in the OHSU School of Medicine.

They describe the current system as “maximally disruptive care.”

To access medication for opioid use disorder — the gold standard for effective treatment — people must make daily visits to methadone clinics to get treatment, or they must find a clinician with a federal waiver to prescribe buprenorphine. Those with complicating medical conditions typically find little help, and they’re often faced with enormous treatment burdens, including having to stand in line just to receive medication the day after being discharged from the hospital for life-threatening illnesses.

“Maximally disruptive care for opioid addiction is not an accident,” they write. “Rather, demands on patients are part of the treatment paradigm. Patients must ‘earn’ methadone take-home doses or ‘work the steps’ to be worthy of treatment.”

Englander cited the example of one recent patient who was admitted to OHSU Hospital with a high-risk pregnancy.

OHSU’s Project IMPACT, the in-hospital addiction team that Englander leads, connected with the patient because of her addiction to fentanyl — a cheap and potent opioid that has surged into Oregon and the nation over the past two years. The patient was highly motivated to stop using the drug and needed methadone, a medication that reduces opioid cravings and treats opioid use disorder. Because she was pregnant, she needed methadone in the morning and evening.

Yet, to get treatment after discharge she would have to travel to a clinic, a 45-minute drive from her home on the Oregon coast.

That’s because federal regulations established in 1971 require methadone to be dispensed through a federally certified opioid treatment program. Federal regulators eased those regulations during the COVID-19 pandemic, but a nationwide survey published by Levander and co-authors a year ago reveal that many opioid treatment program leaders nonetheless continue to resist easing access.

For Englander’s patient on the coast, the requirement was insurmountable because she didn’t have a car.

“Even if she did have a car, that’s three hours of driving every day,” Englander said. “She wanted to be off fentanyl; she wanted to be a healthy parent. Imagine having to travel to a methadone clinic 1 ½ hours roundtrip twice a day while pregnant or days after delivering your baby just to receive the treatment that allows your family to be healthy.”

To reduce these barriers, the authors call for a minimally disruptive approach that would create flexible, adaptive, context-sensitive, individualized, coherent and holistic treatment options for opioid use disorder.

“Minimally disruptive medicine is a framework that focuses on achieving patient goals while imposing the smallest possible burden on patients’ lives,” the authors write. Programmatic and policy changes, they argue, could “begin to address disparities and inequities, and save lives.”

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JOURNAL

Journal of General Internal Medicine

DOI

10.1007/s11606-022-07939-x 

ARTICLE TITLE

Envisioning Minimally Disruptive Opioid Use Disorder Care

Eating disorder behaviors more severe among transgender and gender non-conforming youth in Canada

Eating disorders and related behaviors spiked among all Canadian adolescents and young adults during the COVID-19 pandemic

Peer-Reviewed Publication

UNIVERSITY OF TORONTO

Eating disorders affect many adolescents and young adults with diverse identities in Canada. Yet, the portrayal of these disorders in both the media and in research often focus on white, cisgender women.

A new study, analysing data from over 2,700 adolescents and young adults across all 13 provinces and territories in Canada, found that those who identified as transgender and gender non-conforming reported the most severe eating disorder attitudes and behaviours, while sexual minority (i.e., gay, lesbian, bisexual) cisgender women and cisgender men reported elevated eating disorder attitudes and behaviours compared to their heterosexual counterparts.

“The findings serve as a reminder to healthcare professionals that eating disorders impact not only cisgender women, but also people with diverse gender and sexual identities. Diverse presentations of disordered eating behaviours must also be considered,” says lead author Laura Hallward, a postdoctoral fellow at Western University in the School of Kinesiology.

When compared with heterosexual cisgender men, gay cisgender men had more severe eating attitudes and behaviours and were between 1.5 to 2.5 times more likely to engage in eating disorder behaviours. In addition, cisgender women were between 2 to 3 times more likely to engage in eating disorder behaviours when compared to heterosexual cisgender men.

“Previous research into eating disorders among sexual and gender minorities often group everyone together, overlooking differences that may occur between identities,” says Hallward. “Our study highlights that eating disorder attitudes and behaviours differ considerably based on people’s gender identity and sexual orientation.”

To date, there has been limited large-scale epidemiological research investigating eating disorders and related behaviours among Canadian adolescents and young adults with diverse gender and sexual identities. “More research needs to continue to separately examine how the intersection of gender and sexual identities influence eating disorder psychopathology,” says Hallward.

Impact of COVID-19

Published in the International Journal of Eating Disorders, the study drew data from the 2021 Canadian Study of Adolescent Health Behaviours. The researchers found that eating disorders spiked among Canadian adolescents and young adults during the COVID-19 pandemic. In total, 11% of all participants reported a lifetime eating disorder diagnosis from a healthcare professional compared to between 1-3% reported by Statistics Canada in 2015.

“Among all participants, the prevalence of a lifetime eating disorder diagnosis was over 3 times that of prior Statistics Canada findings from 2015,” says senior author Kyle T. Ganson, an assistant professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work. “Compared to prior research pre-pandemic, participants in our sample also had greater eating disorder attitudes and behaviours. These findings continue to emphasize the likely impact of the COVID-19 pandemic on young people.”

The study’s authors argue that their research highlights the need to develop prevention, assessment, and treatment methods that consider the various presentations of disordered eating for adolescents and young adults among diverse sexual and gender identities in Canada, especially in the context of the pandemic.

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JOURNAL

International Journal of Eating Disorders

DOI

10.1002/eat.23872 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Examination of eating disorder psychopathology across sexual and gender identities among a Canadian sample

Microparticles could help prevent vitamin A deficiency

Fortifying foods with new polymer particles containing vitamin A could promote better vision and health for millions of people.

Peer-Reviewed Publication

MASSACHUSETTS INSTITUTE OF TECHNOLOGY

CAMBRIDGE, MA -- Vitamin A deficiency is the world’s leading cause of blindness, and in severe cases, it can be fatal. About one-third of the global population of preschool-aged children suffer from this vitamin deficiency, which is most prevalent in sub-Saharan Africa and South Asia. 

MIT researchers have now developed a new way to fortify foods with vitamin A, which they hope could help to improve the health of millions of people around the world. In a new study, they showed that encapsulating vitamin A in a protective polymer prevents the nutrient from being broken down during cooking or storage. 

“Vitamin A is a very important micronutrient, but it’s an unstable molecule,” says Ana Jaklenec, a research scientist at MIT’s Koch Institute for Integrative Cancer Research. “We wanted to see if our encapsulated vitamin A could fortify a food vehicle like bouillon cubes or flour, throughout storage and cooking, and whether the vitamin A could remain biologically active and be absorbed.”

In a small clinical trial, the researchers showed that when people ate bread fortified with encapsulated vitamin A, the bioavailability of the nutrient was similar to when they consumed vitamin A on its own. The technology has been licensed to two companies that hope to develop it for use in food products. 

“This is a study that our team is really excited about because it shows that everything we did in test tubes and animals works safely and effectively in humans,” says Robert Langer, the David H. Koch Institute Professor at MIT and a member of the Koch Institute. “We hope this opens the door for someday helping millions, if not billions, of people in the developing world.”

Jaklenec and Langer are the senior authors of the new study, which appears this week in the Proceedings of the National Academy of Sciences. The paper’s lead author is former MIT postdoc Wen Tang, who is now an associate professor at South China University of Technology. 

Nutrient stability

Vitamin A is critical not only for vision but also the functioning of the immune system and organs such as the heart and lungs. Efforts to add vitamin A to bread or other foods such as bouillon cubes, which are commonly consumed in West African countries, have been largely unsuccessful because the vitamin breaks down during storage or cooking. 

In a 2019 study, the MIT team showed that they could use a polymer called BMC to encapsulate nutrients, including iron, vitamin A, and several others. They showed that this protective coating improved the shelf life of the nutrients, and that people who consumed bread fortified with encapsulated iron were able to absorb the iron. 

BMC is classified by the FDA as “generally regarded as safe,” and is already used in coatings for drugs and dietary supplements. In the new study, the researchers focused on using this polymer to encapsulate vitamin A, a nutrient that is very sensitive to temperature and ultraviolet light. 

Using an industrial process known as a spinning disc process, the researchers mixed vitamin A with the polymer to form particles 100 to 200 microns in diameter. They also coated the particles with starch, which prevents them from sticking to each other.

The researchers found that vitamin A encapsulated in the polymer particles were more resistant to degradation by intense light, high temperatures, or boiling water. Under those conditions, much more vitamin A remained active than when the vitamin A was free or when it was delivered in a form called VitA 250, which is currently the most stable form of vitamin A used for food fortification.

The researchers also showed that the encapsulated particles could be easily incorporated into flour or bouillon cubes. To test how well they would survive long-term storage, the researchers exposed the cubes to harsh conditions, as recommended by the World Health Organization: 40 degrees Celsius (104 degrees Fahrenheit) and 75 percent humidity. Under those conditions, the encapsulated vitamin A was much more stable than other forms of vitamin A.  

“The enhanced stability of vitamin A with our technology can ensure that the vitamin A-fortified food does provide the recommended daily uptake of vitamin A, even after long-term storage in a hot humidified environment, and cooking processes such as boiling or baking,” Tang says. “People who are suffering from vitamin A deficiency and want to get vitamin A through fortified food will benefit, without changing their daily routines, and without wondering how much vitamin A is still in the food.”

Vitamin absorption

When the researchers cooked their encapsulated particles and then fed them to animals, they found that 30 percent of the vitamin A was absorbed, the same as free uncooked vitamin A, compared to about 3 percent of free vitamin A that had been cooked. 

Working with Biofortis, a company that does dietary clinical testing, the researchers then evaluated how well vitamin A was absorbed in people who ate foods fortified with the particles. For this study, the researchers incorporated the particles into bread, then measured vitamin A levels in the blood over a 24-hour period after the bread was consumed. They found that when vitamin A was encapsulated in the BMC polymer, it was absorbed from the food at levels comparable to free vitamin A, indicating that it is readily released in bioactive form.

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Two companies have licensed the technology and are focusing on developing products fortified with vitamin A and other nutrients. A benefit corporation called Particles for Humanity, funded by the Bill and Melinda Gates Foundation, is working with partners in Africa to incorporate this technology into existing fortification efforts. Another company called VitaKey, founded by Jaklenec, Langer, and others, is working on using this approach to add nutrients to a variety of foods and beverages. 

The research was funded by the Bill and Melinda Gates Foundation. Other authors of the paper include Jia Zhuang, Aaron Anselmo, Xian Xu, Aranda Duan, Ruojie Zhang, James Sugarman, Yingying Zeng, Evan Rosenberg, Tyler Graf, Kevin McHugh, Stephany Tzeng, Adam Behrens, Lisa Freed, Lihong Jing, Surangi Jayawardena, Shelley Weinstock, Xiao Le, Christopher Sears, James Oxley, John Daristotle, and Joe Collins.

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JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2211534119 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Enhanced stability and clinical absorption of a form of encapsulated vitamin A for food fortification

ARTICLE PUBLICATION DATE

12-Dec-2022

A step in the direction of artificial organs. Scientists find out what stem cell networks look like and where they came from

An ancient fish called a ‘living fossil’ has helped researchers understand the basics of stem cells. This will further stem cell research and be a step in the direction of creating artificial organs

Peer-Reviewed Publication

UNIVERSITY OF COPENHAGEN - THE FACULTY OF HEALTH AND MEDICAL SCIENCES

 

IMAGE: COELACANTH-FISH AND OTHER ANIMALS view more 

CREDIT: BY WORANOP SUKPARANGSI

A beating heart. A complicated organ that pumps blood around the body of animals and humans. Not exactly something you associate with a Petri dish in a laboratory.

But that may change in the future, and save the lives of people whose own organs fail. And the research is now one step closer to that.

To design artificial organs you first have to understand stem cells and the genetic instructions that govern their remarkable properties.

Professor Joshua Mark Brickman at the Novo Nordisk Foundation Center for Stem Cell Medicine (reNEW) has unearthed the evolutionary origins of a master gene that acts on a network of genes instructing stem cells.

“The first step in stem cell research is to understand the gene regulatory network that supports so-called pluripotent stem cells. Understanding how their function was perfected in evolution can help provide knowledge about how to construct better stem cells," says Joshua Mark Brickman.

Pluripotent stem cells are stem cells that can develop into all other cells. For example, heart cells. If we understand how the pluripotent stem cells develop into a heart, then we are one step closer to replicating this process in a laboratory.

A 'living fossil' is the key to understanding stem cells

The pluripotent property of stem cells - meaning that the cells can develop into any other cell - is something that has traditionally been associated with mammals.

Now Joshua Mark Brickman and his colleagues have found that the master gene that controls stem cells and supports pluripotency also exists in a fish called coelacanth. In humans and mice this gene is called OCT4 and they found that the coelacanth version could replace the mammalian one in mouse stem cells.

In addition to the fact that the coelacanth is in a different class from mammals, it has also been called a ‘living fossil,’ since approximately 400 million years ago it developed into the form it has today. It has fins shaped like limbs and is therefore thought to resemble the first animals to move from the sea onto land.

“By studying its cells, you can go back in evolution, so to speak,” explains Assistant Professor Molly Lowndes.

Assistant Professor Woranop Sukparangsi continues:

"The central factor controlling the gene network in stem cells is found in the coelacanth. This shows that the network already existed early in evolution, potentially as far back as 400 million years ago.”

 

And by studying the network in other species, such as this fish, the researchers can distill what the basic concepts that support a stem cell are.

"The beauty of moving back in evolution is that the organisms become simpler. For example, they have only one copy of some essential genes instead of many versions. That way, you can start to separate what is really important for stem cells and use that to improve how you grow stem cells in a dish," says PhD student Elena Morganti.

Sharks, mice and kangaroos

In addition to the researchers finding out that the network around stem cells is much older than previously thought, and found in ancient species, they also learned how exactly evolution has modified the network of genes to support pluripotent stem cells.

The researchers looked at the stem cell genes from over 40 animals. For example sharks, mice and kangaroos. The animals were selected to provide a good sampling of the main branch points in evolution.

The researchers used artificial intelligence to build three-dimensional models of the different OCT4 proteins. The researchers could see that the general structure of the protein is maintained across evolution. While the regions of these proteins known to be important for stem cells do not change, species-specific differences in apparently unrelated regions of these proteins alter their orientation, potentially affecting how well it supports pluripotency.

“This a very exciting finding about evolution that would not have been possible prior to the advent of new technologies. You can see it as evolution cleverly thinking, we don not tinker with the ‘engine in the car’, but we can move the engine around and improve the drive train to see if it makes the car go faster," says Joshua Mark Brickman.

You can read the entire study "Evolutionary origin of vertebrate OCT4/POU5 functions in supporting pluripotency" in Nature Communications.

The study is a collaborative project spanning Australia, Japan and Europe, with vital strategic partnerships with the groups of Sylvie Mazan at the Oceanological Observatory of Banyuls-sur-Mer in France and professor Guillermo Montoya at Novo Nordisk Foundation Center for Protein Research at University of Copenhagen.

 

What are stem cells? Stem cells are non-specialized cells found in all multicellular organisms. Stem cells have two properties that distinguish them from other cell types. On the one hand, stem cells can undergo an unlimited number of cell divisions (mitoses), and on the other hand, stem cells have the ability to mature (differentiate) into several cell types. A pluripotent stem cell is a cell that can develop into any other cell, such as a heart cell, hair cell or eye cell.

 

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JOURNAL

Nature Communications

DOI

10.1038/s41467-022-32481-z 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

Cells

ARTICLE TITLE

Evolutionary origin of vertebrate OCT4/POU5 functions in supporting pluripotency

UC San Diego health recognized for health equity in care of sickle cell crisis

Telemedicine program designed to reduce health disparities

Grant and Award Announcement

UNIVERSITY OF CALIFORNIA - SAN DIEGO

 

IMAGE: THE CAPH AWARD WAS ACHIEVED WITH THE LEADERSHIP OF CHAD VANDENBERG, MPH, CHIEF QUALITY AND PATIENT SAFETY OFFICER, SRILA GOPAL, MBBS, MEDICAL DIRECTOR OF THE ADULT SICKLE CELL PROGRAM, AND THE ENTIRE TEAM AT UC SAN DIEGO HEALTH. view more 

CREDIT: UC SAN DIEGO HEALTH

UC San Diego Health has been awarded the prestigious 2022 California Association of Public Hospitals and Health Systems (CAPH) Quality Leaders Award (QLA) in the category of health equity. Every year, CAPH showcases the most impressive initiatives that improve and advance high-quality, equitable health care among member systems. 

Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. This year’s award recognizes UC San Diego Health for forward thinking in establishing same-day infusion treatment protocols for individualized pain control for patients with sickle cell disease, a population of patients that often face racial discrimination. 

“On behalf of the medical team at UC San Diego Health, I am thrilled to accept this award from CAPH. The award recognizes our universal commitment to caring for patients in a safe, timely and equitable manner, regardless of race or ethnicity,” said Srila Gopal, MBBS, hematologist and medical director of the adult sickle cell program at UC San Diego Health. “In this case, we developed a novel approach to caring for patients with sickle cell disease in medical crisis.”

“Sickle cell disease is a disease of significant health care disparities,” said Patty Maysent, CEO, UC San Diego Health. “Our team took the initiative to investigate the issue and to develop an effective telemedicine strategy and program to help patients receive patient-centered care in a timely fashion.”

During the pandemic, UC San Diego Health launched a same-day infusion program for patients with sickle cell disease in extreme pain. The outpatient program is an alternative to the emergency department. 

“Patients are typically seen on the same day of reporting symptoms and as soon as an infusion slot becomes available,” said Gopal.

Sickle cell disease is a devastating inherited blood disorder that disproportionally affects individuals of African and Hispanic descent. Patients with the condition periodically experience excruciating pain when unhealthy red blood cells block blood flow through tiny blood vessels to the chest, abdomen and joints. Over time, the lack of oxygen to organs and tissues causes permanent damage.

The condition affects approximately 100,000 Americans and occurs in approximately 1 out of every 365 Black or African-American births. The estimated life expectancy for adult patients in California is 42 to 47 years old, a decade less than the rest of the country. 

“For patients in sickle cell crisis, intense pain can be accompanied by anemia and infections leading to tissue damage and strokes,” said Gopal. “Unfortunately, these patients often face bias and discrimination from providers who incorrectly assume that requests for pain management are a ‘drug seeking’ behavior for opioids rather than a legitimate health emergency.”

Episodes of pain for these patients represent a “vaso-occlusive crisis” that must be addressed without delay to protect vital organs. Treatment may include supportive care including fluids, pain medication and occasionally antibiotics and blood transfusions.

“What we have seen as a result of implementation is that our emergency room unitization has significantly decreased,” said Gopal. “The program is an effective way to see patients in an outpatient setting while facilitating compassionate care.”

The telehealth program enables easy communication between medical providers and patients, allowing the medical team to attend to patient needs in a timely fashion, despite pressures of the pandemic. Care is coordinated among infusion and outpatient sickle cell teams, including nurse case managers, physicians, advanced care providers and schedulers.

Gopal and team hope to expand the program to further increase the number of patients treated, offer treatment after-hours and also collaborate with the emergency department in redirecting patients to the infusion center for treatment.

Adults with sickle cell disease have limited access to care in California. Recognizing this need, UC San Diego Health established a comprehensive adult sickle cell program and is part of the Networking California for Sickle Cell Care program.

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