Sunday, February 05, 2023

Accepting anxiety for peace of mind

Meditation therapy effective in reducing suffering for anorexia patients

Peer-Reviewed Publication

KYOTO UNIVERSITY

Mindfully accepting anxiety 

IMAGE: THE PROCESS OF MINDFULNESS MEDITATION AND BRAIN REGIONS WITH REDUCED ACTIVITY AFTER THE MINDFULNESS PROGRAM. view more 

CREDIT: KYOTOU / ROBIN HOSHINO

Kyoto, Japan -- Sadly, many family members, friends, and celebrities have suffered from anorexia nervosa, or AN, a severe psychiatric illness associated with intense anxieties concerning weight, shape, and self-esteem. AN is characterized by an eating disorder, food restriction, voluntary vomiting, and extreme emaciation.

Mindfulness meditation has already become a globally recognized method for addressing AN. Its effectiveness in clinically treating neurogenic emaciation, however, was not previously studied.

A team of researchers at Kyoto University's Graduate School of Medicine has now found that mindfulness meditation does reduce such anxieties. Results from the study show changes in the activity of brain regions involved in anxiety.

The team's mindfulness meditation program has seen a significant decrease in obsessive thoughts about test subject's self-image and brain activity associated with related emotions.

"Our results suggest that the participants in the study became better at accepting their anxiety as it is," says lead author Tomomi Noda.

Mindfulness and meditation work hand-in-hand. The former teaches practitioners to hone their awareness of their present experience and their ability to not judge and rather accept their circumstances. The latter is the medium by which mindfulness can be approached.

"We focused on the possibility that patients with AN try to avoid their crippling anxiety about weight gain and self-image by restricting food or vomiting," adds co-author Masanori Isobe.

A 4-week mindfulness intervention program examined neural changes using tasks designed to induce weight-related anxiety. The researchers then regulated this anxiety by helping patients accept their current situations and experiences at face value, instead of avoiding them.

The researchers used functional magnetic resonance imaging -- or fMRI -- to analyze attention regulation in relation to eating disorders. The study's results support the subjective experiences of the researchers, although it was unexpected to them that several global events, such as the Covid-19 pandemic and the Russo-Ukrainian war, were significant factors in patients' anxieties.

"We anticipate practical implications of our results in clinical psychiatry and psychology and broader research into mitigating suffering through mindfulness, using the strategy of self-acceptance to regulate attention," concludes group leader Toshiya Murai.

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The paper "Neural correlates of a mindfulness-based intervention in anorexia nervosa" will appear on 2 February 2023 in BJPsych OPEN, with doi: https://doi.org/10.1192/bjo.2022.637

About Kyoto University

Kyoto University is one of Japan and Asia's premier research institutions, founded in 1897 and responsible for producing numerous Nobel laureates and winners of other prestigious international prizes. A broad curriculum across the arts and sciences at both undergraduate and graduate levels is complemented by numerous research centers, as well as facilities and offices around Japan and the world. For more information please see: http://www.kyoto-u.ac.jp/en

 

JOURNAL

BJPsych Open

DOI

10.1192/bjo.2022.637 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Neural correlates of a mindfulness-based intervention in anorexia nervosa

ARTICLE PUBLICATION DATE

2-Feb-2023

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THIRD WORLD U$A

Pregnant people in rural communities less likely to have adequate health insurance


Rural residents have lower rates of continuous health insurance before, during and after pregnancy compared to those in urban cities.


Peer-Reviewed Publication

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

ANN ARBOR, Mich. – Women and birthing people in rural America are at higher risk of adverse maternal health outcomes, including maternal morbidity and mortality. Now, a new study sheds light on one possible factor: lower enrollment in health insurance.

Residents of rural communities had lower rates of continuous health insurance before, during and after pregnancy compared to those in urban cities, according to the Michigan Medicine led research in Obstetrics & Gynecology, or “The Green Journal.”

“Being uninsured during the time of pregnancy has been associated with less adequate prenatal and postpartum care, which decreases opportunities to address risk factors affecting health outcomes for both the birthing person and baby,” said lead author Lindsay Admon, M.D., M.Sc., an assistant professor of obstetrics and gynecology at the University of Michigan Medical School and obstetrician-gynecologist at U-M Health Von Voigtlander Women’s Hospital.

“Our study suggests that uninsurance disproportionately affects rural residents during pivotal stages of pregnancy. We hope these findings help inform policies that address rural–urban inequities in maternity care access and maternal health across the country.”

Previous studies indicate that rural Americans – who often have less access to local obstetric services and need to drive farther for care – face higher risks of severe maternal complications and death than their urban peers.

A lack of health insurance may exacerbate these inequities, authors of the new study say.

Michigan Medicine researchers analyzed survey data from 154,992 postpartum individuals in 43 states between 2016-2019, including roughly 16 %, or 32,178, rural residents.

They compared rates of those without any insurance or had gaps in coverage between rural and urban residents during preconception, at the time of birth, and postpartum.

In each of the three periods, rural residents who were non-Hispanic white, married, and with intended pregnancies experienced greater odds of less adequate or consistent insurance compared to their urban counterparts. They were also less likely to have commercial health insurance during any of those times.

Rural residents who identified as Spanish-speaking and Hispanic, however, had the highest rates of pre-pregnancy uninsurance, followed by those from Indigenous communities.

“Rural inequities persisted regardless of age, marital status or insurance type. But these differences were even more significant among specific racial and ethnic groups,” Admon said.

Nearly 13% of people living in rural areas were also uninsured by three months postpartum, representing approximately 156,000 rural residents across participating states.

With rural residents more likely to be insured by Medicaid, Admon notes, there’s greater risk of losing access since pregnancy-related Medicaid coverage typically ends 60 days after delivery. 

This lack of coverage the year after pregnancy is especially worrisome, Admon says, since rural residents without postpartum insurance in the study were more likely to be older than 35 and have obesity or chronic hypertension compared with uninsured urban residents.

“It’s extremely concerning to see that postpartum individuals at greater risk of medical complications in the postpartum year are more likely to be uninsured,” Admon said.

“Postpartum insurance disruptions are associated with lower rates of receiving recommended care to address concerns like complications related to hypertension or depression.”

She said multiple policy approaches may be considered to address inequities. Among them: efforts to improve access to commercial insurance through policies that incentivize smaller employers to provide affordable health insurance coverage for families.

“We need to explore policies that help increase insurance enrollment during all phases of pregnancy and that account for rural differences in employment and employment-based insurance,” she said.

“Health insurance is critical to accessing quality healthcare and improving maternal health in the U.S.”

JOURNAL

Obstetrics and Gynecology




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Dual blood thinners under prescribed after minor or warning stroke, especially in women

American Stroke Association International Stroke Conference 2023, Abstract 43

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • In a recent study, less than half of the people were prescribed dual blood-thinning therapy, despite evidence that starting two anti-platelet blood thinning medications, such as aspirin or clopidogrel, may reduce the short-term risk of recurrent stroke after a minor stroke or a transient ischemic attack (TIA) - also known as a warning stroke.

  • In the analysis of medications prescribed to nearly 3,000 stroke survivors at discharge from stroke centers in Maryland, only 40% of patients were prescribed dual anti-platelet therapy, and women were significantly less likely to be prescribed two anti-platelet medications compared to men. This gender gap in treatment echoes under-treatment of women in other aspects of cardiovascular disease care.

  • Increasing the use of dual anti-platelet therapy, particularly in women, may lead to a lower rate of stroke recurrence after a minor stroke or TIA.

DALLAS, Feb. 2, 2023 — Despite evidence that starting two blood-thinning medications shortly after a minor stroke or a warning stroke (transient ischemic attack - TIA) may prevent a second – possibly more serious – clot-caused stroke within a few months, the treatment regimen is underused especially among women, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Blood thinners, such as aspirin and clopidogrel, prevent platelets from sticking together and forming blood clots. Prescribing two anti-platelet medications at the same time is known as dual antiplatelet therapy (DAPT). In recent trials, DAPT has been shown to reduce the short-term risk of another stroke in people with a recent minor stroke (mild, non-disabling symptoms) or with a TIA. As with most strokes, a TIA is caused by a clot temporarily blocking blood flow to the brain, however, TIA symptoms usually only last a few minutes and result in no permanent brain injury or physical disability.

“All stroke survivors, regardless of sex, should receive optimal proven medications for stroke prevention including DAPT when medically appropriate,” said Jonathan Solomonow, M.D., lead author of the study and chief resident in neurology at the University of Maryland Medical Center in Baltimore.

To gauge how often DAPT was being prescribed when people with a minor stroke or TIA were discharged, the researchers reviewed the electronic health records of 2,953 adults admitted to one of the hospitals of the University of Maryland Stroke Clinical Network. The Maryland network includes nine stroke centers located in urban, suburban and rural hospitals serving a diverse population. All were treated for minor stroke or TIA between 2018 and 2021. None were taking blood thinning medication such as warfarin or apixaban before the stroke or TIA. The participants were average age 67 years; 42% were age 70 or older; 48% women, 37% Black adults and 60% white adults.

The analysis found:

  • DAPT was underutilized across all hospitals reviewed, prescribed to just 40% of the overall patients.
  • Men were more likely than women (43% vs. 37%, respectively) to be prescribed DAPT.
  • The percentage of patients receiving DAPT did not differ significantly by race, age or whether the person was treated at a stroke center that delivers specialized stroke care.

“There are an increasing number of options available to prevent and reduce the risk of a recurrent stroke, including high blood pressure medications, statins to control cholesterol and dual blood thinners. Patients and their family members should inquire about the use of DAPT after a stroke or TIA to consider if DAPT may be beneficial,” Solomonow said.

The gender gap noted in the study could not be explained by differences in insurance coverage or in anticipated side effects of the medications, Solomonow added.

“The gender gap was not entirely surprising because there is extensive literature indicating that women with cardiovascular disease tend to be undertreated. For example, some studies show that women with heart disease or stroke are not prescribed  statins as frequently as men. In addition, women with atrial fibrillation receive ablation less often than men,” Solomonow said. “Further research is needed to examine whether women are less likely to receive other proven therapies, such as statins for stroke prevention and anti-coagulation for atrial fibrillation.”

The study analyzed data from a single health system in Maryland, so the findings need to be confirmed in other settings including hospitals that are not certified stroke centers.

“Identifying systemic inequities is essential to improving patient care across all demographics. It would be useful for other centers to explore whether sex differences are present in other parts of the U.S. or health care systems in other countries,” Solomonow said.

Co-authors are Jamie R. Marks, Ph.D.; Karen L. Yarbrough, C.R.N.P.; Prachi Mehndiratta, M.B.B.S.; and Seemant Chaturvedi, M.D. Authors’ disclosures are listed in the abstract.

The study was funded by the department of neurology at the University of Maryland.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:


Smartphone app may help identify stroke

symptoms as they occur


American Stroke Association International Stroke Conference 2023, Abstract WMP120

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • A new smartphone application called FAST.AI may recognize common stroke symptoms as they are happening.
  • Preliminary research suggests the app might be as accurate at diagnosing stroke as a neurologist.
  • Early recognition of stroke symptoms may result in more timely treatment, which may minimize the long-term effects of a stroke and improve chances for a full recovery.

DALLAS, Feb. 2, 2023 — A new smartphone application called FAST.AI may help people who are having a stroke or their family and caregivers recognize common stroke symptoms in real time, prompting them to quickly call 9-1-1, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Heart Association, stroke is the No. 5 cause of death and a leading cause of disability in the U.S. About 85% of all strokes in the U.S. are ischemic strokes, which are caused by a blood clot in a blood vessel that blocks the flow of blood to the brain.

FAST.AI is a fully automated smartphone application for detection of severe stroke using machine learning algorithms to recognize facial asymmetry (drooping of the muscles in the face), arm weakness and speech changes – all common stroke symptoms. This study is ongoing, and the mobile application is still in development and not available to the public.

The smartphone application uses a facial video of the patient to examine 68 facial landmark points; sensors that measure arm movement and orientation; and voice recordings detect speech changes. Information from each test was sent to a database server for analysis.

Researchers validated FAST.AI’s performance by testing nearly 270 patients with a diagnosis of acute stroke (41% women; average age of 71 years) within 72 hours of hospital admission at four major metropolitan stroke centers in Bulgaria (St. Anna University Hospital in Sofia; University Hospital Haskovo in Haskovo; University Hospital Pulmed in Plovdiv; and University Hospital “Prof. Dr. Stoyan Kirkovich” in Stara Zagora) from July 2021 to July 2022. Neurologists who examined the patients tested the app then compared the FAST.AI results with their clinical impressions.

The analysis found:

  • The smart phone app accurately detected stroke-associated facial asymmetry in nearly 100% of patients.
  • The app accurately detected arm weakness in more than two-thirds of the cases.
  • And while the slurred speech module remains to be fully validated and tested, preliminary analyses confirmed that it may be able to reliably detect slurred speech, according to the researchers.

Clot-busting medication should be administered within three hours (up to four-and-a-half hours in certain eligible patients) after symptoms begin. And the faster the treatment is administered, the more likely for a better recovery: on average, 1.9 million brain cells die every minute that a stroke goes untreated, according to the American Stroke Association, a division of the American Heart Association. Previous research has found that stroke patients who are treated within 90 minutes of their first symptoms were almost three times more likely to recover with little or no disability in comparison to those who received treatment more than 90 minutes after symptoms begin.

“Many stroke patients don’t make it to the hospital in time for clot-busting treatment, which is one reason why it is vital to recognize stroke symptoms and call 9-1-1 right away,” said study author Radoslav I. Raychev, M.D., FAHA, a clinical professor of neurology and a vascular neurologist at the University of California, Los Angeles. “These early results confirm the app reliably identified acute stroke symptoms as accurately as a neurologist, and they will help to improve the app’s accuracy in detecting signs and symptoms of stroke.”

A limitation of the study is that neurologists (not the individuals, family members or caregivers) conducted the screenings and taught patients how to use the application.

American Stroke Association volunteer expert and EPI and Stroke Council member Daniel T. Lackland, Dr.P.H., FAHA, professor and director of the Division of Translational Neurosciences and Population Studies in the department of neurology at the Medical University of South Carolina in Charleston, South Carolina, applauded the research as a promising tool to address a major health challenge – how to prompt individuals with stroke symptoms to seek care in a short window of opportunity.

“This abstract describes a validated approach for an easy assessment of signs of a stroke and the prompt to seek care. The app may help individuals assess the signs of a stroke without the need to recall the warning signs, ” said Lackland, who was not involved in the study.

Co-authors are Jeffrey L. Saver, M.D., FAHA; David S. Liebeskind, M.D., FAHA; Svetlin Penkov, Ph.D.; Daniel Angelov, Ph.D.; Krasimir Stoev; Todor Todorov; Teodora Sakelarova, M.D.; Dobrinka Kalpachka, M.D.; Hristiana Pelyova, M.D.; Rostislava Ruseva, M.D.; Svetlana Velcheva, M.D.; Emanuela Kostadinova, M.D.; Denislav Dimov, M.D.; Kolarova Anna, M.D.; Teodora Manolova, M.D.; Filip Alexiev, M.D., Ph.D.; and Ivan Milanov, M.D., Ph.D.  Authors’ disclosures are listed in the abstract.

The app is owned by Neuronics Medical, of which Raychev is a co-founder. Boehringer Ingelheim funded the study through a research grant with no app ownership. The Bulgarian Society of Neurology helped with study organization. Study senior author, Ivan Milanov is president of the Bulgarian Society of Neurology.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.

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Nematodes can help us detect indoor air impurities

Peer-Reviewed Publication

UNIVERSITY OF TURKU

Untreated control sample 

IMAGE: PHOTOS 1 & 2: THE TRANSGENIC NEMATODES USED IN THIS STUDY EXPRESS GREEN FLUORESCENT PROTEIN (GFP). PRODUCTION OF GFP IS ENHANCED UPON EXPOSURE OF THESE MILLIMETER-LONG NEMATODES TO INCREASING CONCENTRATIONS OF HARMFUL COMPOUNDS. THE OVERALL INDOOR AIR TOXICITY CAN BE EVALUATED BASED ON THE AMOUNT OF FLUORESCENCE AS WELL AS MOTILITY AND MORTALITY OF THE ANIMALS. PHOTO 1 SHOWS AN UNTREATED CONTROL SAMPLE. view more 

CREDIT: PÄIVI KOSKINEN

Good quality indoor air is crucial to our well-being, while impurities in the air can compromise our working capacity and health. Researchers at the University of Turku in Finland have developed a new method for measuring indoor air quality, making use of fluorescent strains of nematodes.

Microbial or chemical contaminants in the air can be toxic or irritative and cause allergic reactions, asthma or other diseases in exposed individuals. However, there are currently no widely accepted methods for monitoring the risks associated with exposure to hazardous indoor air agents, so novel approaches are needed.

In a project carried out in the Department of Biology at the University of Turku, researchers developed a new method for indoor air diagnostics by taking advantage of transgenic strains of Caenorhabditis elegans nematodes. These strains produce green fluorescent protein (GFP) when forced to either smell or taste harmful biological or chemical impurities. The amount of this fluorescence can easily be measured by spectrometry.

“Such nematodes had previously been used to monitor the biological effects of heavy metals and other environmental agents, so we thought they might also be suitable for monitoring indoor air quality,” says the leader of the project, University Lecturer Päivi Koskinen.

“When we exposed nematodes to fungal samples collected from moisture-damaged buildings, we indeed observed significantly increased amounts of fluorescence,” continues Koskinen.

The researchers observed that with the new method, it is also possible to detect other impurities in the indoor air, such as surfactants used in cleaning products or volatile compounds produced by phtalates (softeners of plastic carpets) degrading under moist conditions.

“The nematodes cannot tell us what kind of toxic compounds there are in the air, but they can provide an unbiased opinion on health risks associated with indoor air and on the need for more thorough technical investigations,” explains Koskinen.

Photos 1 & 2: The transgenic nematodes used in this study express green fluorescent protein (GFP). Production of GFP is enhanced upon exposure of these millimeter-long nematodes to increasing concentrations of harmful compounds. The overall indoor air toxicity can be evaluated based on the amount of fluorescence as well as motility and mortality of the animals. Photo 2 shows a sample exposed to black mold (Stachybotrys sp.).

CREDIT

Päivi Koskinen

JOURNAL

Pathogens

DOI

10.3390/pathogens12020161 

ARTICLE TITLE

Biomonitoring of Indoor Air Fungal or Chemical Toxins with Caenorhabditis elegans nematodes

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Preparing Europe for the next pandemic: Building the European Health Union

Initiated during the pandemic by the European Commission, the European Health Union shall build the foundation in a European Union in which the Member States detect, prepare and respond collectively to future health threats and crises.

Peer-Reviewed Publication

EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL (ECDC)

Sandra Gallina, Director-General of the of the Directorate-General for Health and Food Safety [1], notes in her editorial that the EU Health Security Framework was reinforced “to make use of the lessons learned and, recognise the limitations of our collective response to the pandemic at EU level”. Thus, to learn from experiences and to further strengthen the EU's preparedness and resilience towards cross-border health threats and other crises, a reinforced EU Health Security Framework was initiated [1]. Together, the European Medicines Agency (EMA), the European Health Emergency Preparedness and Response Authority (HERA) and the European Centre for Disease Prevention and Control (ECDC) are in the forefront to protect the health of the Europeans.

The mandates for both EMA and ECDC have recently been reinforced [2,3], while HERA [4] was established in 2021 to further strengthen Europe's capacity to prevent, detect and respond rapidly to cross-border health crises. EMA's new role will enable it to improve access to medicines and medical devices between EU countries. ECDC’s strengthened mandate further enhances the Centre’s capacity to provide the robust and independent scientific expertise needed to support prevention, preparedness and response planning to prevent and control serious cross-border health threats.

What can be expected in the future?

Maarit Kokki and ECDC Director Andrea Ammon [3] describe in their editorial how ECDC plans to operate under its new mandate. The EU Health Task Force (EUTHF), to be established and coordinated by ECDC, is one example of what to expect from the agency: in disease outbreak situations, the EUTHF will provide hands-on support to EU countries and third countries. Moreover, to give  assistance in their preparedness and response planning. Ann Enhanced Emergency Capacity will be created consisting of EUTHF public health experts from EU/EEA countries as well as ECDC experts and fellows from the ECDC fellowship programme. During their deployment, experts will support outbreak investigations or preparedness and response activities.

EMA’s Executive Director Emer Cooke [2] explains in her editorial how the extended mandate has enabled to implement tools that will help manage medicine shortages in future public health emergencies. For example, a new executive body, the Medicine Shortages and Safety Steering Group (MSSG), has been set up to respond broadly to medicine supply problems caused by public health emergencies or other major events. It will also coordinate rapid action across the EU where necessary.

The role of HERA as another building block of the EU Health Emergency Framework is outlined by its Director-General Pierre Delsaux [4]. During a public health crisis, the Emergency Framework Regulation allows HERA to enter a crisis mode, which can be triggered by e.g., a declaration of a public health emergency at EU level. In this mode, HERA can take required actions that ensure adequate and timely access to and provision of medical countermeasures relevant to emergencies in Europe. If and when the emergency framework is not activated, HERA works in preparedness mode together with EU countries, ECDC and EMA as well as international partners on activities such as intelligence gathering and threat assessment and promoting advanced research and development of medical countermeasures, to only name a few.

Protecting the health of Europeans through close collaboration

Although the organisations have their separate tasks, the framework is built for close and efficient collaboration. Emer Cooke [2] describes how ECDC will provide epidemiological data to EMA to help forecasting the needs of medicines and to gather specific data from countries and supply-chain stakeholders. These forecasts will be important for HERA to build EU manufacturing capacities and stockpiles. In addition, to launch emergency procurements and emergency deployment of medical countermeasures such as vaccines.

One example where all the new tools were applied, is the 2022 mpox (formerly monkeypox) outbreak mainly affecting the community of men who have sex with men (MSM) in Europe: ECDC Epidemic Intelligence picked up the signals of an outbreak, with next steps including contacting EMA, who would then act as an advisor for HERA. Here, the role of EMA was to help identifying the available both authorised and unauthorised treatments as well as vaccines for mpox.

A common insight from the editorials is the need for multi-sectoral collaboration and cross border coordination in order to effectively face future health threats. In addition, authors note it is imperative that lessons learned are not only listed but also acted on. Kokki and Ammon [3] state that “to ensure this, continuous political will and sustained investment in public health at national and at EU level are needed”.

As the key players of the EU Health Security Framework, ECDC, EMA and HERA will together contribute to better preparedness for and to respond quickly to future cross-border health threats in the EU as well as build resilience to overcome these new challenges together.

----Ends---- 

References/notes to editors: 

[1] Gallina Sandra. Preparing Europe for future health threats and crises: the European Health Union. Euro Surveill. 2023;28(5):pii=2300066. https://doi.org/10.2807/1560-7917.ES.2023.28.5.2300066
[2] Cooke Emer. Preparing Europe for future health threats and crises ─ the European Medicines Agency; ensuring safe and effective medicines and medical devices. Euro Surveill. 2022;27(42):pii=2200798. https://doi.org/10.2807/1560-7917.ES.2022.27.42.2200798

[3] Kokki Maarit, Ammon Andrea. Preparing Europe for future health threats and crises – key elements of the European Centre for Disease Prevention and Control’s reinforced mandate. Euro Surveill. 2023;28(3):pii=2300033. https://doi.org/10.2807/1560-7917.ES.2023.28.3.2300033

[4] Delsaux Pierre. Preparing Europe for future health threats and crises – the European Health Emergency and Preparedness Authority; improving EU preparedness and response in the area of medical countermeasures. Euro Surveill. 2022;27(47):pii=2200893. https://doi.org/10.2807/1560-7917.ES.2022.27.47.2200893

JOURNAL

Eurosurveillance

DOI

10.2807/1560-7917.ES.2023.28.5.2300066 

METHOD OF RESEARCH

Commentary/editorial

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Preparing Europe for future health threats and crises: the European Health Union

ARTICLE PUBLICATION DATE

2-Feb-2023

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Evolution of wheat spikes since the Neolithic revolution

A cereal that changed human history

Peer-Reviewed Publication

UNIVERSITY OF BARCELONA

Around 12,000 years ago, the Neolithic revolution radically changed the economy, diet and structure of the first human societies in the Fertile Crescent of the Near East. With the beginning of the cultivation of cereals —such as wheat and barley— and the domestication of animals, the first cities emerged in a new social context marked by a productive economy. Now, a study published in the journal Trends in Plant Science and co-led by the University of Barcelona, the Agrotecnio centre and the University of Lleida, analyses the evolution of wheat spikes since its cultivation began by the inhabitants of ancient Mesopotamia —the cradle of agriculture in the world— between the Tigris and the Euphrates.

The authors of the study are Rut Sánchez-Bragado and Josep Lluís Araus-Ortega, from the UB Faculty of Biology and Agrotecnio-UdL; Gustavo A. Slafer, ICREA researcher at the UdL School of Agrifood and Forestry Science and Engineering, and Gemma Molero, from the International Maize and Wheat Improvement Center in Mexico, currently a researcher at KWS Seeds Inc.

A cereal that changed human history

The cultivation of wheat —a grass that became basic food— represented a turning point in the progress of human civilisation. Today it is the world's most important crop in terms of food security, but EU data warn that the impact of climate change could significantly increase its price and modify its production process in certain areas of the world.

Throughout the domestication process of wheat, the plant phenotype has undergone both rapid (within a few hundred years) and slow (thousands of years) changes, such as the weakening of the rachis, the increase in seed size, and the reduction or disappearance of the awns. In particular, awned and awnless wheat varieties are found all over the world, although the latter tend to be abundant in regions with arid climates, especially during the final stages of cultivation in late spring, a condition typical of Mediterranean environments.

"It is important to conduct studies that show which wheat varieties are best adapted to different environmental growing conditions, especially in a context of climate change. Studying the past retrospectively can give us an idea of the evolution of wheat cultivation over the millennia since agriculture appeared in ancient Mesopotamia", says Rut Sánchez-Bragado, first author of the study, who got a PhD at the UB.

"Awns are organs of the spike that have traditionally been associated with the plant's adaptations to drought conditions", says Josep Lluís Araus, professor at the Department of Evolutionary Biology, Ecology and Environmental Sciences of the Faculty of Biology.

"However, archaeological and historical records show that the wheat spike has existed predominantly with awns for more than ten millennia after the domestication of wheat. It is not until the last millennium that evidence shows in many cases the absence of awns, indicating a selection by farmers —probably in an undirected way— against this organ", stresses Araus, one of the most cited authors in the world according to Clarivate Analytics' Highly Cited Researchers (2022).

"The role of wheat awns in their performance remains controversial despite decades of studies", says researcher Gustavo A. Slafer, corresponding author of the study.

Spike awns: beneficial for the plant?

Is the presence of awns on the spike beneficial for the plant and the crops? Although there is no scientific consensus, "everything suggests that in conditions where the plant does not suffer from water stress, the extra photosynthetic capacity of the awns does not compensate for other potential negative effects (reduced susceptibility to fungal diseases, limitation in the total number of large ones that an ear supports, etc.)", says Araus.

"However, in wetter climates the awns accumulate moisture and can promote the spread of diseases", says Rut Sánchez-Bragado. "So, as the world's population is continuously growing, it is necessary to investigate the role of the awned spikes in the changing conditions of our climate in order to meet the world's demand for a primary food commodity such as wheat”.

In arid conditions, the spikes —including the awns— "have better physiological characteristics than the leaves. In addition, the awns allow the light captured by the crop to be more diffused, which facilitates a better distribution of light energy and allows the crop to photosynthesise more. Therefore, in arid conditions, the awns can still be beneficial for the crop, or at most, neutral", concludes Professor Josep Lluís Araus.

 

JOURNAL

Trends in Plant Science

DOI

10.1016/j.tplants.2022.10.010 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Awned versus awnless wheat spikes: does it matter?

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Increase in multidrug-resistant pathogens since Ukraine war

Medicine

Peer-Reviewed Publication

RUHR-UNIVERSITY BOCHUM

Team of authors 

IMAGE: MARTINA CREMADUS, HANS-JÖRG BERTHOLD AND NIELS PFENNIGWERTH (FROM LEFT) MONITOR THE OCCURRENCE OF MULTI-RESISTANT BACTERIA AT THE NATIONAL REFERENCE CENTRE FOR GRAM-NEGATIVE HOSPITAL PATHOGENS. view more 

CREDIT: © RUB, MARQUARD

Since the outbreak of the war in Ukraine, certain hospital pathogens that are resistant to many antibiotics have been detected with striking frequency in German hospitals. Due to a combination of two enzymes, some strains of the pathogen Klebsiella pneumoniae are resistant even to carbapenems, which are classified as antibiotics of last resort. In collaboration with the Robert Koch Institute (RKI), the National Reference Centre (NRC) for multidrug-resistant Gram-negative bacteria, based at Ruhr University Bochum, has proved that many of the reported cases are associated with patients from Ukraine. The researchers therefore recommend that this group should be screened prior to hospital admission. They published their findings in the journal Eurosurveillance on 15 December 2022.

Proof of a conspicuous connection

The isolates of the bacterium Klebsiella pneumoniae, which have been detected in large numbers in samples from German hospitals since the spring of 2022, produce a combination of two different so-called carbapenemases, NDM-1 and OXA-48, which are able to cleave carbapenem antibiotics. “We noticed that many of the respective samples had a connection to Ukraine, that the corresponding patients had fled from there, for example, or had been hospitalised in Germany as war casualties,” explains Dr. Niels Pfennigwerth from the NRC. Subsequent investigations proved that there was indeed a connection, which was also reflected in thesurveillance data collected by the Robert Koch Institute.

“Our analyses have shown that it is very likely that outbreaks with these bacterial strains have occurred in Germany as a result of the hospitalisation of Ukrainian patients,” says Niels Pfennigwerth. The NRZ and RKI team therefore recommend precautionary screening of persons with a connection to Ukraine when admitted to German hospitals. “If the screening confirms that the person is infected with the pathogen, they will be isolated in the hospital and very strict hygiene measures will be implemented,” points out the researcher.

People who are otherwise healthy often don’t notice that they have been exposed to such pathogens. In hospitals, however, the pathogens can be transmitted to people who are severely compromised due to illness or injury, especially via the hands of the medical personnel. In this case, Klebsiella pneumoniae can cause pneumonia, wound infections or urinary tract infections, to name but a few. Due to its resistance even to antibiotics of last resort, which are reserved exclusively for severe cases that need to be treated in hospital, treatment may no longer be possible at all in the worst case scenario.

National Reference Centre for multidrug-resistant gram-negative bacteria

Since 2009, the National Reference Centre (NRC) for multidrug-resistant Gram-negative bacteria at the Department of Medical Microbiology at Ruhr University Bochum has been collecting data throughout Germany on bacteria that are resistant to various antibiotics – this is referred to as multidrug-resistance. The centre collaborates closely with the Robert Koch Institute (RKI) and monitors the occurrence of these bacteria as a facility commissioned by the RKI.

JOURNAL

Eurosurveillance

DOI

10.2807/1560-7917.ES.2022.27.50.2200926 

ARTICLE TITLE

Increase in NDM-1 and NDM-1/OXA-48-producing Klebsiella pneumoniae in Germany associated with the war in Ukraine

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Reviewing the NIH-led research response to COVID-19

Reports and Proceedings

AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE (AAAS)

Though the COVID-19 pandemic isn’t over, “it is not too soon to consider the strengths and weaknesses of the research response and some of the lessons that can be learned,” say researchers including Francis Collins, the most recent director of the U.S. National Institutes of Health (NIH), in this Policy Forum. One of the major successes in this space was the development and emergency use authorization of two mRNA vaccines for the SARS-CoV-2 virus in just 11 months from the first identification of the pathogen; most other vaccines have taken at least a decade to develop. Further successes in the U.S.-led COVID-19 research effort included improving diversity in clinical trials and prioritizing the evaluation of therapeutic agents beyond vaccines, which enabled the rapid development of monoclonal antibodies and small-molecule antiviral drugs. Streamlining the development of diagnostic tests was also crucial; it led to the rapid development and roll-out of crucially needed COVID-19 tests to the public, which played a large role in understanding and mitigating SARS-CoV-2 transmission. In the Policy Forum, the authors also note continued and ongoing challenges, including a need to better understand “Long Covid.” They conclude by reflecting on how it takes more than individual ingenuity and hard work for biomedical research to respond swiftly and effectively to a rapidly emerging public health challenge. “Perhaps the most valuable lesson that COVID-19 has taught the research community – and hopefully society more broadly – is the importance of collective effort and continuous investment in basic and applied research,” write Collins et al.

JOURNAL

Science

DOI

10.1126/science.adf5167 

ARTICLE TITLE

The NIH-led research response to the COVID-19

ARTICLE PUBLICATION DATE

3-Feb-2023

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