Detrimental secondary health effects after disasters and pandemics

Researchers from Osaka University showed an increase in major non-communicable diseases after the Fukushima disaster and COVID-19 outbreak

Peer-Reviewed Publication

OSAKA UNIVERSITY

 

IMAGE: FIG. (A) CHANGE IN PREVALENCE OF DISEASES AFTER THE FUKUSHIMA DISASTER (FUKUSHIMA PREFECTURE); (B) CHANGE IN PREVALENCE OF DISEASES AFTER THE COVID-19 OUTBREAK (THE WHOLE OF JAPAN). ERROR BARS REPRESENT 95% UNCERTAINTY INTERVALS. view more 

CREDIT: MICHIO MURAKAMI, SHUHEI NOMURA: ANNUAL PREVALENCE OF NON-COMMUNICABLE DISEASES AND IDENTIFICATION OF VULNERABLE POPULATIONS FOLLOWING THE FUKUSHIMA DISASTER AND COVID-19 PANDEMIC,INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION,2022,103471, HTTPS://DOI.ORG/10.1016/J.IJDRR.2022.103471.

Osaka, Japan - Disasters and pandemics can affect the physical and psychological health of the people involved even after the events have occurred. These effects can include non-communicable chronic diseases. Now, researchers at Osaka University have identified the similarities and differences in secondary health effects in people who have experienced disasters and pandemics.

After the devastating Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Station accident in Japan in 2011, non-communicable diseases have increased since that time. In a seven-year follow-up after the Fukushima disaster, a previous study revealed the age-adjusted prevalence of diabetes in both evacuees and non-evacuees significantly increased. Similar concerns existed regarding the COVID-19 pandemic and its potential impact on chronic illnesses. This meant many restrictions were implemented to ensure the safety and health of the people of Japan. To stop the spread of infection, people were encouraged to stay at home and work from home. Perhaps as a result of this, increased body weight among certain populations and mental disorders were observed.

In this study, the changes in the prevalence of diseases in Japan, including hypertension, hyperlipidemia, diabetes, and mental disorders, before and after the Fukushima disaster and the COVID-19 pandemic were reviewed using a health insurance dataset over a long period of time. First, the changes in the prevalence of hypertension, hyperlipidemia, diabetes, and mental disorders over nine years following the Fukushima disaster were analyzed. Second, the changes in prevalence before and after the COVID-19 pandemic were examined. Results were examined by age and sex to determine the most significantly affected groups.

Results of this study showed that the prevalence of all four diseases increased in Fukushima Prefecture after the Fukushima disaster and in the whole of Japan after the COVID-19 outbreak as well. The increased rates of hypertension, hyperlipidemia, diabetes, and mental disorders were higher in females aged 40-74 years after the Fukushima disaster. However, after the COVID-19 outbreak, the increase in prevalence rates of all four diseases was higher among males aged 0-39 years.

“This study has shed some light on identifying the vulnerable populations involved and assessing the secondary effect of disasters on the mental and physical health of these people” says lead author, Michio Murakami.

The importance of supporting secondary health effects after disasters and pandemics are now being recognized and can lead to improved post-disaster policies and recommendations that focus on health promotion and effective prevention strategies.

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The article, “Annual prevalence of non-communicable diseases and identification of vulnerable populations following the Fukushima disaster and COVID-19 pandemic,” was published in the International Journal of Disaster Risk Reduction at DOI: https://doi.org/10.1016/j.ijdrr.2022.103471

About Osaka University

Osaka University was founded in 1931 as one of the seven imperial universities of Japan and is now one of Japan's leading comprehensive universities with a broad disciplinary spectrum. This strength is coupled with a singular drive for innovation that extends throughout the scientific process, from fundamental research to the creation of applied technology with positive economic impacts. Its commitment to innovation has been recognized in Japan and around the world, being named Japan's most innovative university in 2015 (Reuters 2015 Top 100) and one of the most innovative institutions in the world in 2017 (Innovative Universities and the Nature Index Innovation 2017). Now, Osaka University is leveraging its role as a Designated National University Corporation selected by the Ministry of Education, Culture, Sports, Science and Technology to contribute to innovation for human welfare, sustainable development of society, and social transformation.

Website: https://resou.osaka-u.ac.jp/en

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JOURNAL

International Journal of Disaster Risk Reduction

DOI

10.1016/j.ijdrr.2022.103471 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Annual prevalence of non-communicable diseases and identification of vulnerable populations following the Fukushima disaster and COVID-19 pandemic

Scientists release UK roadmap for managing key ingredient behind all the food we eat

As phosphate fertiliser prices remain at very high levels after spiking this year, scientists are calling for urgent measures to manage phosphorus, a vital element essential for food production.

Reports and Proceedings

LANCASTER UNIVERSITY

As phosphate fertiliser prices remain at very high levels after spiking this year, scientists are calling for urgent measures to manage phosphorus, a vital element essential for food production, but which is also behind environmental pollution in our rivers and lakes.

 

In launching the UK’s first comprehensive national transformation strategy into phosphorus, researchers say they are providing a roadmap for how the nation can better manage this important resource.

 

The strategy outlines a pressing need for new solutions and scaling-up of existing phosphorus innovations to prevent future damage to aquatic biodiversity and habitat, reduce reliance on risky import markets and to unlock new opportunities for agriculture.

 

Phosphorus is a lynchpin of our food system – plants cannot grow without it and has no substitute.

 

Crop and livestock production in the UK is almost entirely dependent on imported phosphorus in feeds and fertilisers – the UK imports around 174,000 tonnes of phosphorus annually.  Much of these imports derive from phosphate rock from countries including Russia, Morocco and China. The price of phosphate fertiliser quadroupled between mid 2020 and mid 2022 due to supply disruptions and market concentration in China. The ongoing war in Ukraine is serving to highlight the food security risks associated with reliance on imports of critical farm inputs like phosphorus.

 

Despite volatile prices and supply disruptions, phosphorus use in the UK is still highly inefficient, with less than half of imported phosphorus used productively to grow food. Mismanagement of phosphorus over decades has led to it being a major contributor to environmental problems. Wastewater discharges, along with excess phosphorus accumulating in agricultural soils and leaching into our rivers, lakes and other waterways, are contributing to issues such as algal blooms.

 

The ‘UK Phosphorus Transformation Strategy’ – a major output from the RePhoKUs project, led by Lancaster University and involving the University of Technology Sydney, University of Leeds, AFBI, UK CEH and funded under the UK’s Global Food Security research programme – sets out the challenges and key steps needed for the UK to adopt resilient, efficient and sustainable management of phosphorus.

 

Professor Paul Withers, of Lancaster University and lead investigator of the RePhoKUs project, said: “At present the UK does not have a coherent plan for managing phosphorus across the food system, either nationally, regionally or within catchments. This needs to change urgently.

 

“Transforming the way phosphorus is used in the UK food system is essential. Getting it right provides huge benefits to food and water security, tourism opportunities, and to maintain a clean healthy environment to boost biodiversity and the natural world for generations to come – but it requires all sectors to come on board.”

 

The strategy’s recommendations, co-developed with national stakeholders through extensive consultation with farmers, regulators, policy-makers, food producers, wastewater companies, and environmental managers, highlight a number of priorities to enable the UK to transition towards using phosphorus more sustainably:

 

• Develop and deploy at scale new technologies and innovations that can recover phosphorus from animal manure, wastewater and food waste, and redistribute as viable, cost-effective and renewable fertilisers.
• Provide incentives that encourage investment in technologies and lower barriers to create new markets for a renewable phosphorus fertiliser sector.
• Improve, align and make coherent policies and governance that recognise and manage phosphorus as a scare resource, as well as a pollutant.
• Provide tailored knowledge, research and advice for farmers on tapping soil legacy phosphorus, and using recycled phosphorus.
• Better engage stakeholders across the whole phosphorus value chain to set strategic direction and support implementation via bespoke and diverse local phosphorus solutions.
• The creation of nutrient stakeholder platform and UK nutrient data sharing dashboards to help inform phosphorus management

 

Aside from the phosphorus sources in wastewater treatment plants servicing towns and cities, the report highlights that phosphorus is unevenly concentrated across the UK. Where livestock farming is most intensive, predominantly in the west of England and Northern Ireland, then surpluses of phosphorus (largely in manure) are higher. The excess phosphorus applied in England’s North West region alone is equivalent to nearly £30 million of fertiliser.

 

In areas where arable crops are grown, which tends to be predominantly in the east of the country, there is a deficit and the need to use phosphorus-based fertilisers because crops are taking up more than is applied.

 

However, the logistics of moving bulky manure from one part of the country to another are impractical. Finding new innovative ways to extract and relocate phosphorus from manure will be key in addressing these regional imbalances.

 

There is currently billions of pounds of phosphorus locked in UK top soil from decades of applications of fertiliser and manure – accessing and managing this legacy phosphorus ‘bank’ is central to improving efficiency and reducing imports, the team of scientists behind the new strategy argue.

 

One of the report’s lead authors, Associate Professor Brent Jacobs said: “The good news is there are many pockets of innovation and initiatives already under way in different sectors in the UK. These can be learned from, scaled-up and integrated to help overcome some of the challenges associated with phosphorus use.

 

“Theoretically there is enough phosphorus circulating in the food system and in our soils. One of the pathways to achieving sustainable phosphorus use will involve developing and deploying new technologies that can extract legacy phosphorus from soils and manures and develop new renewable fertiliser markets.”

 

The authors highlight the need for all of the different actors and sectors involved in food production, across catchment areas and government departments, which are currently operating in a fragmented manner, to work more closely and to adopt innovative solutions to transition towards using phosphorus more sustainably.

 

Professor Julia Martin-Ortega of the University of Leeds and co-author of the report said: “As the UK food system is undergoing fundamental policy change, our report provides a timely opportunity to integrate urgently needed actions across all sectors of the food chain into regional and national policy and governance, tapping into huge potential wins for the environment and the economy.”

 

For the full UK Phosphorus Transformation Strategy report please visit: http://wp.lancs.ac.uk/rephokus/publications/

 

The report was produced as part of the RePhoKUs project (The role of phosphorus in the sustainability and resilience of the UK food system) funded by BBSRC, ESRC, NERC, and the Scottish Government under the UK Global Food Security research programme (Grant No. BB/R005842/1).

The value of people’s values: Study shows how relational values contribute towards sustainability

New study underscores the significance of relational values in improving people’s participation in the sustainable management of social-ecological systems

Peer-Reviewed Publication

RITSUMEIKAN UNIVERSITY

 

IMAGE: THE STUDY HIGHLIGHTS THE IMPORTANCE OF RELATIONAL VALUES IN GAINING PEOPLE’S SUPPORT FOR SUSTAINABLE MANAGEMENT STRATEGIES IN SESS. THESE RELATIONAL VALUES WERE ALSO FOUND TO BE ASSOCIATED WITH PRO-SES BEHAVIOR, WHICH CAN HELP MAKE SES MANAGEMENT PLANS SUCCESSFUL. view more 

CREDIT: TAKURO UEHARA FROM RITSUMEIKAN UNIVERSITY

In today’s world of excess, human-nature dynamics have become quite distorted and exploitative. Therefore, sustainable and mindful coexistence within our natural ecosystems has become the need of the hour. This is where sustainable social-ecological systems (SESs) come into play. SESs are complex adaptive systems that envelope the intricate interactions between people and their surroundings. Effectual SES management requires balancing the improvement of human well-being along with conservation of ecosystem integrity. However, the success of an SES management plan rests upon the understanding, support, and participation of the people of the SES. To ensure this support and involvement, it is integral that management decisions align with people’s wishes and the values they place on their natural environment.

Earlier studies have mainly focused on the instrumental and intrinsic values of nature. Instrumental value pertains to the necessity of something in achieving a particular end, whereas intrinsic value is when the thing is desirable in itself. However, few studies have looked into the significance of relational values of nature. These are values that arise from human–nature connectedness and encompass a sense of place, identity, and well-being that can motivate environmental stewardship. Overcoming this paucity of research, a new study from Japan, which was published in Frontiers in Marine Science on December 8, 2022, has become the first to quantitatively reveal the essential role of relational values in people’s readiness to participate in and support SES management. “Relational values are preferences associated with positive human-nature relationships that are valued by people. Our research shows that by managing SESs that respect these relationships, SESs can become a more desirable state,” says Prof. Takuro Uehara, a professor at Ritsumeikan University, Japan, and the lead researcher of the study.

Residents from three SESs surrounding the Seto Inland Sea in Japan were surveyed for the study. These included people from Kobe-Hanshin (N=1136), Harima (N=864), and Kagawa (N=1000). The study evaluated how relational values affect people’s proclivity towards sustaining their SES. This was measured by pro-SES behavior scales that were specifically designed for the studied SESs. These one-of-a-kind behavior-measuring scales included factors related to the sustainable utilization of natural resources and active human interaction with nature. These scales were created to be in line with the local conservation policies and the Japanese concept of ‘satoumi’ — human–nature interactions that enhance ecosystem services while conserving nature.

The study found that while relational values correlate and overlap with instrumental and intrinsic values to some degree, they are also non-substitutable and important in their own right for the successful management of SESs. The study shows that integrating relational values — either as a single value class or as part of pooled values — is crucial for gaining the public’s support for SES management. It also demonstrates that fostering such relational values can promote pro-SES behavior among people. This can be achieved by improving environmental education, encouraging the consumption of locally sourced foods, and increasing opportunities for more nature-based leisure activities for the community. These results resonated across the three SESs, despite their social, demographic, cultural, and environmental differences.

Overall, this study makes a strong case for incorporating relational values into SES management plans in order to achieve a desirable state of SESs, which is both human- and ecosystem-centric. “Relational values are typically place-based, and our study shows that these values can uniquely and meaningfully contribute towards understanding pro-SES behavior, which could have important management implications for individual SESs. In order to create a systemic change towards sustainability, relational values can be a deep leverage point since people are generally more willing to be involved in activities that support what they value,” comments Prof. Uehara.

Perhaps it is high time that relational values are given due credit in helping make SESs and the world more sustainable.

***

Reference

DOI: https://doi.org/10.3389/fmars.2022.1001180  

 

About Ritsumeikan University, Japan

Ritsumeikan University is one of the most prestigious private universities in Japan. Its main campus is in Kyoto, where inspiring settings await researchers. With an unwavering objective to generate social symbiotic values and emergent talents, it aims to emerge as a next-generation research university. It will enhance researcher potential by providing support best suited to the needs of young and leading researchers, according to their career stage. Ritsumeikan University also endeavors to build a global research network as a “knowledge node” and disseminate achievements internationally, thereby contributing to the resolution of social/humanistic issues through interdisciplinary research and social implementation.

Website: http://en.ritsumei.ac.jp/

 

About Professor Takuro Uehara from Ritsumeikan University, Japan

Dr. Takuro Uehara is a Professor at the College of Policy Science, Ritsumeikan University in Osaka, Japan. He has a Ph.D. in Systems Science with a focus on Economics from Portland State University, USA. He currently works on issues related to social-ecological systems, primarily using systems science and economics. His current research topics include social-ecological modeling, the economic valuation of nature, sustainability, resilience, satoumi, relational values, and marine plastic pollution. Prof. Uehara has also authored research papers published in leading journals in the field, including Ecological Economics, Ecology and Society, Ecosystem Services, Journal of Environmental Management, People and Nature, and Sustainability Science.

 

Funding information

This study was supported by the Japan Society for The Promotion of Science [Grant/Award Number: 18H03432].

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JOURNAL

Frontiers in Marine Science

DOI

10.3389/fmars.2022.1001180 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The importance of relational values in gaining people’s support and promoting their involvement in social-ecological system management: A comparative analysis

ARTICLE PUBLICATION DATE

8-Dec-2022

Scientists' use of hydrogel materials leads to stem cells developing like human embryos

Peer-Reviewed Publication

UNIVERSITY OF NEW SOUTH WALES

Materials scientists at UNSW Sydney have shown that human pluripotent stem cells in a lab can initiate a process resembling the gastrulation phase – where cells begin differentiating into new cell types – much earlier than occurs in mother nature.

For an embryo developing in the womb, gastrulation occurs at day 14. But in a dish in a lab at UNSW’s Kensington campus, Scientia Associate Professor Kris Kilian oversaw an experiment where a gastrulation-like event was triggered within two days of culturing human stem cells in a unique biomaterial that, as it turned out, set the conditions to mimic this stage of embryo development.

“Gastrulation is the key step that leads to the human body plan,” says A/Prof. Kilian.

“It is the start of the process where a simple sheet of cells transforms to make up all the tissues of the body – nerves, cardiovascular and blood tissue and structural tissue like muscle and bone. But we haven’t really been able to study the process in humans because you can’t study this in the lab without taking  developing embryonic tissue.”

“So it’s really exciting that we were able to see this happening in vitro.”

The achievement, which was reported today in the journal Advanced Science, has not only implications for our understanding of human embryonic development, but also new treatments in medicine including cell therapy, targeted drug development and CRISPR gene-editing technologies.

The most important time in your life

Developmental biologist Lewis Wolpert once said: “It is not birth, marriage or death, but gastrulation which is truly the most important time in your life.” Gastrulation is the key event in an embryo’s development when a mass of undifferentiated cells begin the first steps of a long journey in the womb towards formation of a human being. This is one of the reasons that work on embryos left over from IVF is forbidden beyond 14 days, when gastrulation occurs.

A/Prof Kilian says that up until now, it has been difficult to study this process in humans because of obvious ethical constraints.

“Controlling gastrulation using materials alone will provide an entirely new way for studying human development,” he says.

“We currently can’t do this because embryo research beyond 14 days is often viewed as unethical, and it’s currently impossible in vivo because you’d need to observe an embryo in a pregnant human mother.”

But while there are animal models to study – such as mice and zebrafish – and other researchers have induced gastrulation-like events in the lab using chemicals including growth factors, this is the first time culture conditions alone have initiated gastrulation outside of a human body.

“Our method could lead to a new approach to mimic human embryogenesis outside of a person,” A/Prof Kilian says.

Miniature organs and CRISPR gene splicing

In the medical sciences, the ability to induce gastrulation in ‘synthetic’ embryos like those created by the UNSW team could also help in creating body tissue or even miniature organs based on a patient’s own genetic code. These so-called ‘organoids’, which are barely visible to the naked eye, are already being developed using stem cells for medical research, such as testing the effectiveness of certain drugs. But the process requires chemicals to stimulate the cells into forming differentiated organ tissue which is time consuming and expensive.

A/Prof. Kilian says controlling gastrulation by using only hydrogel materials to stimulate what happens naturally could be a quicker and more cost-effective solution.

“The thing that really excites us about this is the potential to make therapeutically useful cells much faster and more reproducible,” says A/Prof. Kilian.

“Our method could provide a way to initiate ‘organogenesis’ – with an array of hundreds of well-defined cell aggregates in a single well – leading to faster and more well-defined structures that could then be turned into brain, liver, gut, potentially any solid organ tissue.

“This approach could also revolutionise drug development including RNA and CRISPR/Cas9 approaches by providing a more reproducible way to mimic human tissue in a lab. For instance, you could make an organoid from a patient’s cells, then test therapies aimed at correcting mutations or restoring function.”

A hydrogel home is just right

The secret to the success of the UNSW team’s work in the lab is in the structure of the culture that the stem cells were seeded into. Using a technique adapted from the semiconductor industry, defined regions are fabricated across a hydrogel for cells to stick to. This combination of geometric confinement and the soft gel that mimics the surface of a human uterus coaxes the cells to start gastrulation-like processes.

“We discovered that if you take pluripotent stem cells and you put them in a very confined and soft environment, it’s akin to what the cells might experience in a mother's uterus,” says A/Prof. Kilian.

“That viscoelastic, soft, squishy material gives them just enough cues that they initiate this gastrulation-like process all on their own.”

This contrasts greatly with the standard practice that’s been used in labs more recently that forces a type of gastrulation process using growth factors and chemical supplements on hard plastic or glass dishes.

“Unsurprisingly, previous research culturing stem cells on glass or plastic have failed to recapitulate the signals that happen in a body. But using our soft substrates mimicking embryonic tissue, we can coax the cells to spatially organise and begin the early morphogenesis that could ultimately create a person.”

But, A/Prof. Kilian cautions, while the team has discovered the conditions that emulate the first stage of gastrulation, it doesn’t appear to go any further.

“We can’t make a person this way,” he says.

“This method only demonstrates the early, but very crucial stage in development. The impact lies in being able to study this all-important stage of human development, and to use the generated structures for developing therapies.”

Serendipity can be a big part of discovery

As with most great discoveries in science, serendipity played a role. The team weren’t actively looking to bring on gastrulation when they dropped some stem cells onto the hydrogel substrate.

Lead author Dr Pallavi Srivastava was surprised by what she observed.

“Initially I was trying to get stem cells to attach to our hydrogels and planned to differentiate them in the conventional way,” she says.

“The difference between cells cultured on glass and those on our gels was very striking. I remember thinking, ‘wow, something is going on here. I need to investigate’. This led to a big shift in my project, and ultimately this exciting discovery.”

The researchers are hopeful they can continue exploring the benefits of their discovery by understanding how materials can guide embryogenesis and beyond. A/Prof. Kilian says that while this finding is exciting, more work is needed to guide the gastrulation-like processes to form useful tissues.

“This is really the first step in what we hope is a platform technology for producing useful tissue models. Triggering gastrulation is not enough – now we need to provide other signals to keep differentiation going.”

Discovering the next set of materials signals may allow creation of virtually any solid tissue for research purposes, A/Prof. Kilian says, and for generating useful cell types for regenerative medicine.

“Considering pluripotent stem cells can now be generated from blood or tissue samples, the future is wide open for regenerating tissues and organs from a patient’s own cells.”

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JOURNAL

Advanced Science

DOI

10.1002/advs.202203614 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Human embryos

ARTICLE TITLE

Defined microenvironments trigger in vitro gastrulation in human pluripotent stem cells

ARTICLE PUBLICATION DATE

15-Dec-2022

Management strategy makes a difference in C-section rates, study finds

The business strategies adopted by physician practice management companies influence rates of Cesarean sections for low-risk patients.

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - BERKELEY HAAS SCHOOL OF BUSINESS

For physicians, it seems like a no-brainer: Management experts, often private equity firms, offer to take over the logistical and financial drudgery of their practices, leaving the doctors to focus on patient care.

A new Haas School of Business study found that the business strategies used by physician practice management companies (PPMCs) also impact patient care.

The study, published in the journal Management Science, examined the strategies adopted by PPMC-owned obstetrician and gynecologist practices and found they influenced rates of Cesarean sections for low-risk patients.

Specifically, OB-GYN practices acquired by PPMCs that focus on patient and clinical management lead to significantly lower rates of C-sections. PPMC-owned practices that focus on providing financial management services lead to higher C-section rates.

“Even though PPMCs say they preserve physician autonomy, managerial changes do appear to influence physician treatment choices,” said study author Ambar La Forgia, an assistant professor at the Haas School of Business, UC Berkeley.

Value-based management vs financial management

La Forgia tracked three PPMC-owned practices that together accounted for more than 40% of Florida’s OB-GYNs between 2006 to 2014. One PPMC focused on attracting “value” based contracts, which link payment to clinical performance by providing clinical management services, while two focused on raising revenue by providing financial management services and negotiating higher-paying fee-for-service contracts, which link payment to quantity of services.

C-sections are more profitable than vaginal births because insurance companies typically pay out more in reimbursements. So a rise in the number of C-sections can raise a red flag, causing doubts about whether some of those performed on mothers at low risk for childbirth complications are necessary. Unnecessary C-sections can increase risks for both mother and infant in a myriad of ways.

Divergence in C-section rates

La Forgia found a remarkable divergence: The OB-GYN practice that focused on clinical management cut C-sections for low-risk women by 22%. Those that focused on financial management showed a 10% to 11% rise in C-sections.

“What surprised me was finding that one of these for-profit management companies lowered C-sections,” La Forgia said. “It’s a pleasant surprise that leads to a more nuanced story to tell, because you can’t make a blanket statement about PPMCs.’”

La Forgia turned to Florida to track how physician practices performed after a PPMC takeover because public information laws include hospital discharge records that allowed her to link patient records to individual doctors and practices.

Low-risk mothers

The study concentrated on records for 1.26 million women who were at low risk for C-sections (defined as single live babies born after 37 weeks to women with no prior C-section and in the vertex, or headfirst, presentation). The births were overseen by 1,693 physicians, with C-section rates of 24% for low-risk patients.

La Forgia also hand-collected marketing materials to track and parse the details of a PPMC’s management approach. For example, the PPMC that focused on clinical management advertised providing clinical data tracking and analytics to help standardize care and attract value-based contracts. “This was a forward-looking strategy because it can take a while to improve quality and negotiate these types of contracts, especially since they were not very common within the time period of this study,” La Forgia said.

Another notable data point: the two financially managed PPMCs performed more C-sections on privately insured patients than those insured by Medicaid, the government insurance program that typically covers people with lower incomes. Florida, La Forgia notes, is one of the few states where Medicaid reimburses physicians at the same rate for C-sections and vaginal births.

Growing influence of PPMCs

In today’s healthcare landscape, physicians generally have the option to keep running their own practice, sell to a hospital, or sell to a PPMC. Why choose a PPMC over a hospital? Autonomy, La Forgia said. Under hospital ownership, doctors typically become salaried employees of the hospital.

“PPMCs advertise themselves as an alternative to hospitals while still being relatively independent and getting to stay in private practice,” La Forgia said. However, “This research shows that even PPMCs claiming to preserve physician autonomy can alter clinical outcomes for better or for worse.”

The influence of PPMCs on patient care has only increased in the years beyond those covered by this study, La Forgia writes. By 2019, the three PPMCs she examined delivered roughly 1 in every 25 babies in the United States.

“Although I find that PPMCs influence C-sections regardless of changes in competition, the PPMCs do amass considerable market power, and their growth may eventually lead to more salient anticompetitive effects,” La Forgia writes in the study.

La Forgia noted that in recent years there’s been a noticeable shift in philosophy among some PPMCs to pursue value-based contracts over fee-for-service contracts.

“In fact, a lot of the [PPMCs] that originally billed themselves as financial management companies have changed their offerings to focus more on population health once they saw that this is a potentially lucrative angle,” she said. “That may be a good sign for patients.”

Read the full paper:

The Impact of Management on Clinical Performance: Evidence from Physician Practice Management Companies
By Ambar La Forgia
Management Science, November 2022

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JOURNAL

Management Science

DOI

10.1287/mnsc.2022.4571 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The Impact of Management on Clinical Performance: Evidence from Physician Practice Management Companies

Tackling crowd management in subways during pandemics

Sharon Di wins NSF grant to work with NYC’s MTA to develop machine learning and traffic models to optimize traffic flow during pandemics

Grant and Award Announcement

COLUMBIA UNIVERSITY SCHOOL OF ENGINEERING AND APPLIED SCIENCE

 

IMAGE: SHARON DI view more 

CREDIT: NA

Mass transit, and subways in particular, are essential to the economic viability and environmental sustainability of cities across the globe. But public transit was hit hard during the COVID pandemic and subways especially experienced substantial drops in ridership. Spurred on by a Columbia Engineering Transit Design Challenge in 2020, researchers from across the University have been collaborating on a project to strengthen both the preparedness and resilience of transit communities facing public health disasters.

The team, led by Civil Engineering Professor Sharon Di, recently won a $2,500,000 four-year grant from the National Science Foundation to tackle crowd management in subways. The project--”Preparing for Future Pandemics: Subway Crowd Management to Minimize Airborne Transmission of Respiratory Viruses”--is focused on developing a system for public transit communities, including riders, workers, and agencies, that will help transit riders to make informed decisions and adapt travel behavior accordingly and provide transit agencies engaged in planning and policymaking with recommendations for mitigating virus transmission risks to riders and workers. 

“We think our system, which we’re calling Way-CARE, will be transformative, especially for people in low-income communities who are among the most impacted by reduced accessibility to safer travel modes,” said Di, who is a leader in transportation management. “We expect our project to improve the social, economic, and environmental well-being of those who live, work, and travel within cities.” 

Credit: Kits Pix/Shutterstock

The team, which includes Co-PIs Jeffrey Shaman (Columbia Climate School; Mailman School of Public Health); Marco Giometto, Xiaofan Jiang, and Faye McNeill (Columbia Engineering); Ester Fuchs (School of International and Public Affairs); and Kai Ruggeri (Columbia University Irving Medical Center), is working with New York City’s Metropolitan Transportation Authority and local rider communities in Harlem and at Columbia on the Way-CARE project. They hope that their system will enable smart city transit operators to access real-time sensing information collected from subway stations and/or trains for crowd management.

The researchers are integrating sensing and crowd and airflow modeling with public health expertise on a microscale applied to subway crowd management. They are developing coupled airborne dispersion and epidemiological models that account for microscale processes--the transport of droplets and aerosols--that affect respiratory virus transmission. In addition, they are integrating behavioral science data that will help inform travel choices and policy making. 

“This is an important interdisciplinary collaboration,” said Shaman, an epidemiologist who is a leader in infectious disease modeling. “The transmission of respiratory viruses is not directly observed, and the microscale processes influencing infection risk are not well known. Our project will address these shortcomings by advancing understanding of the physical, biological, and behavioral features that enable transmission of respiratory viruses in subway settings, and equip transit officials and the public with real-time information that improves worker and rider safety.”

Pandemic’s many effects on older women documented in journal

Peer-Reviewed Publication

THE GERONTOLOGICAL SOCIETY OF AMERICA

A new supplemental issue to The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, titled “The Impact, Experience, and Challenges of COVID-19: The Women’s Health Initiative  (WHI),” explores key areas on how older women initially responded to the threat of COVID-19, their concerns about the pandemic, and aspects of their prior health and well-being that may have influenced the impact of COVID-19 on their lives. 

 

The WHI represents one of the largest and most diverse longitudinal studies conducted in postmenopausal women. Three decades after its 1992 launch, 52,543 women continue to be actively engaged in the core of this landmark study, with a mean age of 86.6 (ranging from 73 to 106 years of age). The WHI is funded by the National Heart, Lung, and Blood Institute; the journal supplement was made possible by support from Wake Forest University Health Sciences.

 

The supplement’s articles are based on survey research conducted among 49,695 WHI participants between June and October 2020. In addition to the data derived from the survey, authors were able to draw from detailed historical data available on the participants prior to the pandemic, as well as annual data collected concurrently with the COVID-19 survey. A follow-up survey was conducted from June to December 2021.

 

“The long history of participation preceding COVID-19 and continued participation in study activities during COVID-19 allowed for a deep characterization of the impact and experience among older women, while accounting for past and current individual health behaviors and outcomes,” wrote guest editors Sally A. Shumaker, PhD, Andrea Z. LaCroix, PhD, and Jennifer W. Bea, PhD.

 

The researchers’ findings showed that the COVID-19 pandemic was associated with impacts on health and well-being, living situations, lifestyle, health care access, and SARS-CoV-2 testing and preventive behaviors.

 

WHI participants were more likely to report very good or good levels of well-being, but in lower frequency in the fall of 2020 compared to the summer. Respondents reported being very concerned about the pandemic (more commonly reported among urban residents), with many participating in preventive behaviors including wearing a face mask (which were more commonly practiced in the summer compared to the fall).

 

The most common disruption in living arrangements included having family or friends move in, although a higher proportion of respondents in the fall compared to the summer reported moving into a care facility and/or having their care provider come to help. Many women reported changes in medication and health care access, which included delays in getting prescriptions filled and health care appointment conversions to telephone or online (the latter more commonly reported among urban residents).

 

There were notable changes in lifestyle factors; for example, over half of women reported less physical activity or exercise compared to before the pandemic, which was more commonly reported among women residing in urban areas. A lower proportion of women reported consuming alcohol compared to reports from prior to the COVID-19 pandemic.

 

“While the women in the WHI demonstrated remarkable resiliency overall, these findings help guide our response to those multifaceted social, psychological, and physical struggles and comorbidities that are not only associated with COVID-19 infection in an older population, but also with the societal and infrastructure barriers in the context of the COVID-19 era,” Shumaker, LaCroix, and Bea wrote. “As COVID-19 and our societal response to it evolves, it is important to continue to study the impact on high-risk groups, such as the older women in the WHI.”

 

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The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences is a peer-reviewed publication of The Gerontological Society of America (GSA), the nation’s oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society.

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JOURNAL

The Journals of Gerontology Series A

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Critical care medicine organizations urge house leadership to stop Medicare payment cuts

Business Announcement

AMERICAN SOCIETY OF ANESTHESIOLOGIST

CHICAGO – Today, the American Society of Anesthesiologists (ASA), Society of Critical Care Anesthesiologists (SOCCA), and Society of Critical Care Medicine (SCCM) sent a formal communication to Speaker of the House of Representatives Nancy Pelosi, House Majority Leader Charles Schumer, and House Minority leaders Kevin McCarthy and Mitch McConnell, strongly urging them to take immediate action to stop pending Medicare physician payment cuts.

The medical organizations called on Congress to block all pending payment cuts for critical care services and the services of other physicians. Without congressional action, the cuts will be effective January 1, 2023.

“Critical care physicians provide advanced life support, specialized monitoring and sophisticated, high level medical care to patients with life-threatening health conditions,” said ASA President Michael W. Champeau, M.D., FASA. “It is essential the Congress support the health care leadership consistently demonstrated by these professionals.” 

“Congress must work to ensure that there is sufficient economic support, especially from Medicare, to ensure patients’ access to high-quality critical care services,” said SOCCA President Michael H. Wall, M.D., FCCM, FASA.

“In recent years, critical care medicine has been on the frontlines of the COVID-19 pandemic, caring for some of the most medically challenging patients seen since the critical care specialty was created, especially at-risk Medicare patients with multiple medical diseases or conditions in the high-risk environments,” according to SCCM President, Sandra L. Kane-Gill, PharmD, MSc, FCCM.

The communication notes that “Medicare payments for critical care services are already broken. Payment freezes and meager updates over the years have resulted in current payments rates that are insufficient. In the current economic environment of high inflation, this is even more true. We find it unthinkable that Congress is considering Medicare payment cuts for critical care and other physician services.”

Read the letter for details on critical care physician concerns about the proposed payment cuts.

ABOUT THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on Twitter.

ABOUT THE SOCIETY OF CRITICAL CARE ANESTHESIOLOGISTS
The Society of Critical Care Anesthesiologists is dedicated to the support and development of anesthesiologists who care for critically ill patients of all types. SOCCA fosters the knowledge and practice of critical care medicine by anesthesiologists through education, research, advocacy, and community.

For more information about SOCCA, please visit www.socca.org.

ABOUT THE SOCIETY OF CRITICAL CARE MEDICINE
The Society of Critical Care Medicine is the largest nonprofit medical organization dedicated to promoting excellence and consistency in the practice of critical care. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. The Society offers a variety of activities that ensure excellence in patient care, education, research, and advocacy. SCCM's mission is to secure the highest-quality care for all critically ill and injured patients.

For more information about SCCM, please visit the Society of Critical Care online at www.SCCM.ORG.
 

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