POST MODERN ALCHEMY

Extracts from two wild plants inhibit COVID-19 virus, study finds

The first major screening of botanical extracts to search for potency against the SARS-CoV-2 virus

Peer-Reviewed Publication

EMORY UNIVERSITY

 

IMAGE: EMORY UNIVERSITY GRADUATE STUDENT CAITLIN RISENER, FIRST AUTHOR OF THE STUDY, GATHERS TALL GOLDENROD IN SOUTH GEORGIA. view more 

CREDIT: PHOTO BY THARANGA SAMARAKOON

Two common wild plants contain extracts that inhibit the ability of the virus that causes COVID-19 to infect living cells, an Emory University study finds. Scientific Reports published the results — the first major screening of botanical extracts to search for potency against the SARS-CoV-2 virus.

In laboratory dish tests, extracts from the flowers of tall goldenrod (Solidago altissima) and the rhizomes of the eagle fern (Pteridium aquilinum) each blocked SARS-CoV-2 from entering human cells.

The active compounds are only present in miniscule quantities in the plants. It would be ineffective, and potentially dangerous, for people to attempt to treat themselves with them, the researchers stress. In fact, the eagle fern is known to be toxic, they warn.

“It’s very early in the process, but we’re working to identify, isolate and scale up the molecules from the extracts that showed activity against the virus,” says Cassandra Quave, senior author of the study and associate professor in Emory School of Medicine’s Department of Dermatology and the Center for the Study of Human Health. “Once we have isolated the active ingredients, we plan to further test for their safety and for their long-range potential as medicines against COVID-19.”

Quave is an ethnobotanist, studying how traditional people have used plants for medicine to identify promising new candidates for modern-day drugs. Her lab curates the Quave Natural Product Library, which contains thousands of botanical and fungal natural products extracted from plants collected at sites around the world.

Caitlin Risener, a PhD candidate in Emory’s Molecular and Systems Pharmacology graduate program and the Center for the Study of Human Health, is first author of the current paper.

In previous research to identify potential molecules for the treatment of drug-resistant bacterial infections, the Quave lab focused on plants that traditional people had used to treat skin inflammation.

Given that COVID-19 is a newly emerged disease, the researchers took a broader approach. They devised a method to rapidly test more than 1,800 extracts and 18 compounds from the Quave Natural Product Library for activity against SARS-CoV-2.

“We’ve shown that our natural products library is a powerful tool to help search for potential therapeutics for an emerging disease,” Risener says. “Other researchers can adapt our screening method to search for other novel compounds within plants and fungi that may lead to new drugs to treat a range of pathogens.”

SARS-CoV-2 is an RNA virus with a spike protein that can bind to a protein called ACE2 on host cells. “The viral spike protein uses the ACE2 protein almost like a key going into a lock, enabling the virus to break into a cell and infect it,” Quave explains.

The researchers devised experiments with virus-like particles, or VLPs, of SARS-CoV-2, and cells programmed to overexpress ACE2 on their surface. The VLPs were stripped of the genetic information needed to cause a COVID-19 infection. Instead, if a VLP managed to bind to an ACE2 protein and enter a cell, it was programmed to hijack the cell’s machinery to activate a fluorescent green protein.

 

A plant extract was added to the cells in a petri dish before introducing the viral particles. By shining a fluorescent light on the dish, they could quickly determine whether the viral particles had managed to enter the cells and activate the green protein.   

The researchers identified a handful of hits for extracts that protected against viral entry and then homed in on the ones showing the strongest activity: Tall goldenrod and eagle fern. Both plant species are native to North America and are known for traditional medicinal uses by Native Americans.

Additional experiments showed that the protective power of the plant extracts worked across four variants of SARS-CoV-2: Alpha, theta, delta and gamma.

To further test these results, the Quave lab collaborated with co-author Raymond Schinazi, Emory professor of pediatrics, director of Emory’s Division of Laboratory of Biochemical Pharmacology and co-director of the HIV Cure Scientific Working Group within the NIH-sponsored Emory University Center for AIDS Research. A world leader in antiviral development, Schinazi is best known for his pioneering work on breakthrough HIV drugs.

The higher biosecurity rating of the Schinazi lab enabled the researchers to test the two plant extracts in experiments using infectious SARS-CoV-2 virus instead of VLPs. The results confirmed the ability of the tall goldenrod and eagle fern extracts to inhibit the ability of SARS-CoV-2 to bind to a living cell and infect it.

“Our results set the stage for the future use of natural product libraries to find new tools or therapies against infectious diseases," Quave says.

As a next step, the researchers are working to determine the exact mechanism that enables the two plant extracts to block binding to ACE2 proteins.

For Risener, one of the best parts about the project is that she collected samples of tall goldenrod and eagle fern herself. In addition to gathering medicinal plants from around the globe, the Quave lab also makes field trips to the forests of the Joseph W. Jones Research Center in South Georgia. The Woodruff Foundation established the center to help conserve one of the last remnants of the unique longleaf pine ecosystem that once dominated the southeastern United States.

“It’s awesome to go into nature to identify and dig up plants,” Risener says. “That’s something that few graduate students in pharmacology get to do. I’ll be covered in dirt from head to toe, kneeling on the ground and beaming with excitement and happiness.”

She also assists in preparing the plant extracts and mounting the specimens for the Emory Herbarium.

“When you collect a specimen yourself, and dry and preserve the samples, you get a personal connection,” she says. “It’s different from someone just handing you a vial of plant material in a lab and saying, ‘Analyze this.’”

After graduating, Risener hopes for a career in outreach and education for science policy surrounding research into natural compounds. A few of the more famous medicines derived from botanicals include aspirin (from the willow tree), penicillin (from fungi) and the cancer therapy Taxol (from the yew tree).

“Plants have such chemical complexity that humans probably couldn’t dream up all the botanical compounds that are waiting to be discovered,” Risener says. “The vast medicinal potential of plants highlights the importance of preserving ecosystems.”

Co-authors of the current paper include: Sumin Woo, Tharanga Samarakoon, Marco Caputo and Emily Edwards (the Quave lab and Emory’s Center for the Study of Human Health); Keivan Zandi, Shu Ling Goh and Jessica Downs-Bowen (the Schinazi lab); Kier Klepzig (Joseph W. Jones Research Center); and Wendy Applequist (Missouri Botanical Garden).

Funding for the paper was provided by the Marcus Foundation, the NIH-funded Center for AIDS Research and the NIH National Center for Complementary and Integrative Health.

Tall goldenrod (Solidago altissima)

CREDIT

Photo by Tharanga Samarakoon

JOURNAL

Scientific Reports

DOI

10.1038/s41598-023-28303-x 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Cells

ARTICLE TITLE

Botanical inhibitors of SARS-CoV-2 viral entry: a phylogenetic perspective

Cocaine use disorder alters gene networks of neuroinflammation and neurotransmission in humans

Peer-Reviewed Publication

THE MOUNT SINAI HOSPITAL / MOUNT SINAI SCHOOL OF MEDICINE

 

IMAGE: THE RESEARCH TEAM ANALYZED HOW COCAINE USE DISORDER IMPACTS GENE ACTIVITY IN THE STRIATUM, A BRAIN REGION INVOLVED IN MOTIVATION, REWARD, AND HABIT FORMATION. THEY FOUND THAT COCAINE USE ALTERS GENE NETWORKS THAT CONTROL NEUROTRANSMISSION IN TWO STRIATAL BRAIN REGIONS, THE NUCLEUS ACCUMBENS (NAC) AND THE CAUDATE NUCLEUS (CN). THE TEAM LIKEWISE ANALYZED GENE ACTIVITY IN MICE THAT SELF-ADMINISTERED COCAINE AND FOUND THAT MANY OF THE COCAINE-RELATED CHANGES SEEN IN HUMANS WERE ALSO PRESENT IN THESE MICE. THEIR ANALYSES REVEALED THAT HUMAN GENE MODULES GOVERNING BRAIN PLASTICITY ARE SIMILARLY ALTERED BY COCAINE IN A PARTICULAR SUBTYPE OF NEURON IN MICE THAT RESPOND TO DOPAMINE, THE D1 MEDIUM SPINY NEURONS (D1 MSNS). TOGETHER, THESE CONSERVED MOLECULAR SIGNATURES INDICATE THAT KEY GENE NETWORKS MAY BE CRITICAL TO THE DEVELOPMENT OF COCAINE USE DISORDER, AND THAT ANIMAL MODELS ARE VALUABLE IN STUDYING HOW COCAINE ALTERS THE HUMAN BRAIN view more 

CREDIT: ASHLEY M. CUNNINGHAM, MS

Individuals with cocaine use disorder exhibit gene expression changes in two brain regions: the nucleus accumbens, a region associated with reward, and the caudate nucleus, a region mediating habit formation, according to research conducted at the Icahn School of Medicine at Mount Sinai and published February 10 in Science Advances.

These changes, which contribute importantly to the persistent behavioral abnormalities seen in addiction to drugs, occur because cocaine use sets off a series of chemical reactions that lead to increases in the amount of messenger RNA being produced from some of the affected genes in these two brain regions, whereas the activity of other genes decreases. Changes in the amount of messenger RNA produced—a process also known as “expression” of the underlying genes—lead to changes in the amount of proteins that are produced and that subsequently carry out chemical reactions in the brain. The research team found a significant overlap between the RNAs expressed in these two brain regions, suggesting that these molecular changes may be key to the development and maintenance of cocaine use disorder.

Cocaine use disorder is a chronic, relapsing brain disorder for which there are currently no FDA-approved medication treatments. While it is hypothesized that regulation of gene expression in the brain’s reward and motivational centers plays a critical role in the persistent behavioral changes that define addiction, knowledge remains limited of the maladaptive gene activity that chronic cocaine use causes in these circuits in humans and that underlies cocaine use disorder.

To address the knowledge gap, the research team performed RNA sequencing in both the nucleus accumbens and caudate nucleus from the postmortem brain tissue of persons with cocaine use disorder and matched controls. Using the largest and most diverse cohort examined to date, they found that neuroinflammatory processes are suppressed and that synaptic transmembrane transporters and ionotropic receptors – proteins that control how nerve cells communicate with one another in the brain—are enriched in the striatum of people with cocaine use disorder.

Cocaine increases the amount of the neurotransmitter dopamine at synapses, or junctions between two brain cells where electrical signals are converted into chemical signals. By doing so, the research team found, cocaine sets off a cascade of events that activate a chemical messenger in the brain called cyclic AMP, which then triggers changes in gene expression.

“In addition to the new insights into the molecular changes that cocaine use confers, we found that people with cocaine use disorder have dysregulated genes associated with schizophrenia and major depressive disorder, which indicates that these disorders may share some underlying gene regulatory and neural circuit systems,” said Philipp Mews, PhD, Instructor of Neuroscience at Icahn Mount Sinai and first author of the paper together with Ashley M. Cunningham, a neuroscience PhD student. “Importantly, the transcriptional abnormalities—in particular, the neuroinflammatory responses that are suppressed in the nucleus accumbens of people with cocaine use disorder—are directionally opposite of the proinflammatory cascade responses conferred by opioid use disorder. The observation that there are distinct molecular changes conferred by each of the two substance use disorders could be valuable for the development of targeted, effective treatments specific to cocaine use disorder.”

Because it is difficult to directly study how drugs like cocaine affect the human brain, researchers often use animal models to study their effects. However, a key question is whether what they learn from these animal models is similar to what happens in the brains of humans who use cocaine.

“Our research team looked at studies performed in mice that were given the opportunity to self-administer cocaine and compared the resulting molecular changes to those seen in postmortem brain tissue of people with cocaine use disorder. Our analysis revealed strikingly similar changes in the brain’s gene expression profiles in both the mice and humans, validating the use of mouse models to study the pathophysiological basis of cocaine use disorder,” said Eric J. Nestler, MD, PhD, Nash Family Professor of Neuroscience, Director of The Friedman Brain Institute, Dean for Academic Affairs at Icahn Mount Sinai, Chief Scientific Officer of the Mount Sinai Health System, and senior author of the paper. “It is also important to emphasize that our human brain cohort includes a significant number of Black individuals, who have not been well represented in prior transcriptional studies of cocaine use disorder, despite longstanding evidence that the highest rate of overdose deaths involving cocaine is among Black individuals. Together, these findings represent a considerable advance in our understanding of the molecular abnormalities in cocaine use disorder and provide a highly valuable resource for future investigations.”

This study was funded by the National Institutes of Health, National Institute on Drug Abuse (P01DA047233, R01DA033684), the National Institute on Alcohol Abuse and Alcoholism (K99AA027839), and the Brain and Behavior Research Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About the Icahn School of Medicine at Mount Sinai
The Icahn School of Medicine at Mount Sinai is internationally renowned for its outstanding research, educational, and clinical care programs. It is the sole academic partner for the eight member hospitals* of the Mount Sinai Health System, one of the largest academic health systems in the United States, providing care to a large and diverse patient population. 

Ranked No. 14 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges, Icahn Mount Sinai has a talented, productive, and successful faculty. More than 3,000 full-time scientists, educators, and clinicians work within and across 34 academic departments and 44 multidisciplinary institutes, a structure that facilitates tremendous collaboration and synergy. Our emphasis on translational research and therapeutics is evident in such diverse areas as genomics/big data, virology, neuroscience, cardiology, geriatrics, and gastrointestinal and liver diseases.

Icahn Mount Sinai offers highly competitive MD, PhD, and master’s degree programs, with current enrollment of approximately 1,300 students. It has the largest graduate medical education program in the country, with more than 2,600 clinical residents and fellows training throughout the Health System. In addition, more than 535 postdoctoral research fellows are in training within the Health System.

A culture of innovation and discovery permeates every Icahn Mount Sinai program. Mount Sinai’s technology transfer office, one of the largest in the country, partners with faculty and trainees to pursue optimal commercialization of intellectual property to ensure that Mount Sinai discoveries and innovations translate into health care products and services that benefit the public.

Icahn Mount Sinai’s commitment to breakthrough science and clinical care is enhanced by academic affiliations that supplement and complement the School’s programs. Through Mount Sinai Innovation Partners (MSIP), the Health System facilitates the real-world application and commercialization of medical breakthroughs made at Mount Sinai. Additionally, MSIP develops research partnerships with industry leaders such as Merck & Co., AstraZeneca, Novo Nordisk, and others.

The Icahn School of Medicine at Mount Sinai is located in New York City on the border between the Upper East Side and East Harlem, and classroom teaching takes place on a campus facing Central Park. Icahn Mount Sinai’s location offers many opportunities to interact with and care for diverse communities. Learning extends well beyond the borders of our physical campus, to the eight hospitals of the Mount Sinai Health System, our academic affiliates, and globally.
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* Mount Sinai Health System member hospitals: The Mount Sinai Hospital; Mount Sinai Beth Israel; Mount Sinai Brooklyn; Mount Sinai Morningside; Mount Sinai Queens; Mount Sinai South Nassau; Mount Sinai West; and New York Eye and Ear Infirmary of Mount Sinai.

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JOURNAL

Science Advances

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Human tissue samples

ARTICLE TITLE

Convergent abnormalities in striatal gene networks in human cocaine use disorder and mouse cocaine administration models

ARTICLE PUBLICATION DATE

10-Feb-2023

https://archive.org/details/aleister-crowley-diary-of-a-drug-fiend

FOR PROFIT MEDICINE

Association of past and future paid medical malpractice claims

JAMA Health Forum

Peer-Reviewed Publication

JAMA NETWORK

About The Study: In this study of paid medical malpractice claims for all U.S. physicians at the time of the study, a single prior paid claim was associated with substantial, long-lived higher future claim risk, independent of whether a physician was practicing in a high- or low-risk specialty, or whether a state publicly disclosed paid claims. Timely, noncoercive intervention, including education, has the potential to reduce future claims. 

Authors: David A. Hyman, J.D., M.D., of the Georgetown University Law Center in Washington, D.C., is the corresponding author.

To access the embargoed study:

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

This link will be live at the embargo time https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2022.5436?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=021023

About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

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JOURNAL

JAMA Health Forum

BEWARE ANTI-FLOURIDE CAMPAIGNERS

School dental program prevents 80 percent of cavities with one-time, non-invasive treatment

Silver diamine fluoride, as well as sealants, protected against cavities in school-based program

Peer-Reviewed Publication

NEW YORK UNIVERSITY

 

IMAGE: A CAVITY PREVENTION PROGRAM IN BRONX ELEMENTARY SCHOOLS WAS FOUND TO PREVENT 80% OF CAVITIES. view more 

CREDIT: ©SOREL: COURTESY OF NYU PHOTO BUREAU

In a study of nearly 3,000 schoolchildren, silver diamine fluoride—a liquid that is brushed onto the surface of teeth to prevent cavities or keep them from worsening—was as effective against cavities as dental sealants, the standard of care. A single dose of either topical treatment given in elementary schools prevented roughly 80% of cavities and kept 50% of cavities from worsening when children were seen two years later.

 

The findings, published in JAMA Network Open, offer an efficient and cost-effective approach to improving children’s oral health through school-based care.

 

Dental cavities are the most common chronic disease in children, and kids from low-income families are twice as likely to have cavities as those from higher-income families. Without proper and timely intervention, cavities can lead to severe infections, reduce children’s quality of life, and are associated with lower student academic performance and school attendance. But getting kids to a dentist for the recommended twice-yearly visits can be challenging, especially when parents need to take time off of work.

 

To reduce the barriers to seeing a dentist, some basic dental services can be offered in schools, especially those serving children from low-income families. For example, the Centers for Disease Control and Prevention recommends and funds school sealant programs. In 2017, NYU College of Dentistry researchers received funding from the Patient-Centered Outcomes Research Institute (PCORI) to run the nation’s largest school-based cavity prevention study, which they named CariedAway.

 

CariedAway is a randomized trial comparing the effectiveness of two cavity-prevention techniques: a “simple” treatment using silver diamine fluoride (SDF) and fluoride varnish, and a “complex” treatment using traditional glass ionomer sealants and fluoride varnish. Both are non-invasive and applied to the surface of teeth to prevent and arrest cavities in children, but for the same time and cost, providers can treat more children with the simpler SDF therapy.

 

The study included 2,998 children in kindergarten through third grade at 47 New York City schools. The schools—which serve a racially diverse group of students, most of whom are from low-income families—were randomized to receive either the simple or complex treatment.

 

Upon visiting each school, the clinical research team—which included a supervising dentist, dental hygienists, registered nurses, and assistants—did baseline exams to measure any tooth decay, and then applied fluoride varnish and either sealants or SDF, depending on whether the school was assigned to receive the complex or simple treatment.

 

The initial visits took place in 2019 and early 2020, and were paused when the COVID-19 pandemic temporarily closed New York City schools and halted all school-based care. Two years later, schools allowed the clinical research team to resume, and they returned to each school for follow-up visits.

 

The researchers found that both the simple and complex treatments were successful: just one cavity prevention treatment prevented more than 80% of cavities (81% for SDF and 82% for sealants) and stopped half of cavities from progressing (56% for SDF and 46% for sealants).

 

“Without prevention, dental cavities grow continuously if not treated. One CariedAway cavity prevention treatment, provided just before schools closed during the pandemic, was remarkably effective over the following two-year period,” said Richard Niederman, DMD, professor in the Department of Epidemiology & Health Promotion at NYU College of Dentistry, co-principal investigator of CariedAway, and the study’s senior author. “I know of no other dental preventive intervention that had this great a beneficial impact across the pandemic.”

 

While the limited availability of trained dental professionals can pose challenges for school sealant programs, as sealants are applied by a dentist or dental hygienist, SDF may be an attractive alternative, as it can also be applied by nurses—a workforce already in place in many schools.

 

“Our results support the use of SDF for cavity prevention in school-based oral health programs and offer an opportunity for expanding access to critical oral health care,” said Ryan Richard Ruff, MPH, PhD, associate professor in the Department of Epidemiology & Health Promotion at NYU College of Dentistry, co-principal investigator of CariedAway and the study’s first author.

 

Tamarinda Barry-Godín, DDS, MPH, was a study co-author. This research was funded by the Patient-Centered Outcomes Research Institute (award PCS-1609-36824).

 

About NYU College of Dentistry

Founded in 1865, New York University College of Dentistry (NYU Dentistry) is the third oldest and the largest dental school in the US, educating nearly 10 percent of the nation’s dentists. NYU Dentistry has a significant global reach with a highly diverse student body. Visit dental.nyu.edu for more.

 

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2022.55458 

ARTICLE TITLE

Effect of Silver Diamine Fluoride on Caries Arrest and Prevention

ARTICLE PUBLICATION DATE

9-Feb-2023

JOHN BIRCH SOCIETY 1956

Single dose of common antibiotic reduces mothers’ risk of death during childbirth, study finds

Peer-Reviewed Publication

UNIVERSITY OF VIRGINIA HEALTH SYSTEM

A single dose of the antibiotic azithromycin can help protect mothers from dangerous sepsis infections and death during vaginal childbirth, a sweeping new international study from a UVA Health scientist and his collaborators has found.

Azithromycin, also known as Z-Pak, has already been shown to benefit women delivering by cesarean section. But the new findings reveal that the common antibiotic reduces mortality for women delivering vaginally and cuts their risk of developing sepsis, a potentially fatal full-body infection. 

Infections, particularly sepsis, are responsible for 10% of maternal deaths shortly before, during and after childbirth, putting such infections in the top five causes of maternal mortality worldwide.

“A single dose of the antibiotic azithromycin decreased sepsis and death by half in women in labor,” said researcher William A. Petri Jr., MD, PhD, of the University of Virginia School of Medicine’s Division of Infectious Diseases and International Health. “The simplicity of this intervention should allow its institution around the globe to protect mothers during childbirth.”

Safer Childbirth

Petri is part of the Azithromycin Prophylaxis in Labor Use Study (A-PLUS) Trial Group, an international coalition of researchers that set out to determine if giving the antibiotic during childbirth would benefit either mothers or their children. More than 29,000 women in low- and middle-income countries volunteered to take part in the randomized trial; half were given azithromycin and half were given a harmless placebo.

Among the 14,637 women who received the placebo, 2.4% developed sepsis or died within six weeks. That’s compared with only 1.6% of the 14,526 women who received azithromycin. The difference was clear enough that the researchers stopped the trial early. 

The antibiotic did not provide similar benefits for the babies, the researchers found. However, they say that benefits for the mothers, combined with the lack of harmful side effects, makes azithromycin an important new tool for keeping moms safe before, during and after delivery. (The antibiotic is already recommended for caesarian births in the United States and elsewhere.)

UVA is one of seven universities participating in the Global Network for Women's and Children's Health, which is supported by a grant from the National Institute of Child Health and Human Development. Network research supports and conducts clinical trials in resource-limited countries by pairing foreign and U.S. investigators, with the goal of evaluating low-cost, sustainable interventions to improve maternal and child health and simultaneously building local research capacity and infrastructure. 

The network team at UVA includes Petri, Drs. Chris Chisholm (Obstetrics/Gynecology), Rob Sinkin (Pediatrics), Chelsea Braun (Medicine/Infectious Diseases) and Program Manager Lauren Swindell and in Bangladesh Drs. Rashidul Haque and Masum Billah of the icddr,b research center and Ruth Lennox of the LAMB Hospital.

Petri noted that the findings result from an important collaboration of scientists around the world working together to improve care for pregnant women and help them deliver their babies more safely. 

“All of us engaged in the work of the network here in Charlottesville are enjoying the opportunity to collaborate across disciplines, each of us enriched by the perspectives of obstetricians, pediatricians and infectious-diseases specialists,” Petri said. “The network is open to all to propose new multi-site international studies in maternal and child health, and I hope that innovative ideas and ultimately clinical trials will originate here at UVA.”

Findings Published

The researchers have published their findings in the prestigious New England Journal of Medicine. A full list of the authors and their affiliations is included in the paper. 

The research was supported by The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Foundation for the National Institutes of Health through the Maternal, Newborn & Child Health Discovery & Tools initiative of the Bill and Melinda Gates Foundation. 

To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog at http://makingofmedicine.virginia.edu.

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JOURNAL

New England Journal of Medicine

DOI

10.1056/NEJMoa2212111 

RACIST MEDICINE U$A

Nearly half of children on Medicaid lack outpatient follow-up within a month after emergency care for mental health

Timely follow-up in Black children particularly low

Peer-Reviewed Publication

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

Only 56 percent of Medicaid-enrolled children received any outpatient follow-up within 30 days after discharge from the Emergency Department (ED) for a mental health concern, according to a large study published in the journal Pediatrics. Rates of timely follow-up among Black children were particularly low, with 10 percent fewer receiving an outpatient mental health appointment within 30 days compared to white children.

“Our results show the dire need to improve access to outpatient mental health services for children,” said lead author Jennifer Hoffmann, MD, MS, Emergency Medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “We especially need to remove barriers to mental health care for Black children. Strategies may include reducing stigma in seeking mental health care, improving diversity in the pediatric mental health workforce, and increasing availability of community and school-based mental health services.”

Follow-up within seven and 30 days of a mental health ED visit for children ages 6 to 17 years was added to the National Child Core Set of quality measures in 2022, and state Medicaid agencies will be mandated to report annual adherence rates starting in 2024.

“This work offers some critical insights into the challenges and inequities in mental healthcare for children and youth. These findings should spur efforts to strengthen systems to support mental health for children and youth and new initiatives to non-Hispanic Black children and youth to effective care,” said Dr. Sarah Hudson Scholle, Vice President for Research & Analysis at the National Committee for Quality Assurance (NCQA). NCQA evaluates evidence to select specific quality measures to be used to assess healthcare quality. Based on NCQA recommendations, the quality measure "follow-up within seven and 30 days after an emergency department visit for mental illness in children" was added to the National Child Core Set of quality measures in 2022.

To examine rates of mental health follow-up, Dr. Hoffmann and colleagues conducted a retrospective study of 28,551 children aged 6-17 years with mental health ED discharges from January 2018 to June 2019 using the IBM Watson MarketScan Medicaid database.

They found that after the initial ED discharge, less than one-third of children had mental health follow-up within seven days and just over half had follow-up within 30 days. Children without prior mental health outpatient care were at highest risk for poor access to follow-up care.

“Clearly we need to do better for children who come to the ED in a mental health crisis. Interventions to link to outpatient mental health care should prioritize follow-up within five days of a mental health ED discharge,” said Dr. Hoffmann, who also is the Children's Research Fund Junior Board Research Scholar. “To improve follow-up after mental health ED visits, we need to focus on children with new diagnoses who have not previously engaged in outpatient mental health care. Future research should assess specific strategies to promote outpatient follow-up, such as care coordination and use of telemedicine.”

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

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JOURNAL

PEDIATRICS

For children with cancer, different

neighborhoods may produce different

outcomes for different races

Peer-Reviewed Publication

RUTGERS UNIVERSITY

An analysis from Rutgers may help solve a mystery: Why do Black and Hispanic children suffer more life-threatening complications from cancer and cancer care than white children who get the same treatments at the same facilities?

Researchers combined health and location data and found that the neighborhoods where children live had a bigger impact on outcomes than race and ethnicity alone. Their findings were published in Cancer Nursing.

Correlation between neighborhoods and complications doesn’t prove neighborhoods cause complications, but the hypothesis was bolstered by a second observation. The tie between neighborhood and outcome increases with age.

Infants and toddlers who develop cancer fare about the same no matter where they live, the study data showed. Outcomes begin to diverge in grade school and keep on diverging into adolescence as children spend more time outside the house.

“There are many location-related factors that could be a causal factor for complications,” said Beth Savage, an assistant professor at the Rutgers School of Nursing and lead author of the study.

“To use one example, added Savage, who is also a member of the Cancer Health Equity Center of Excellence at Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health, "stress can damage health, and stressors like crime, air and noise pollution or poor-quality housing are more common in economically challenged neighborhoods than rich ones.”

“Neighborhood disadvantage is more common among Black and Hispanic persons. The neighborhood one lives in may also influence wellbeing and cancer outcomes through its impact on healthy behaviors and access to healthy foods and green space,” said Anita Kinney, director of the Cancer Health Equity Center of Excellence, associate director for Population Science and Community Outreach at Rutgers Cancer Institute and professor of biostatistics and epidemiology at Rutgers School of Public Health.

The researchers used 2018 medical data from the State Inpatient Databases (SID) of nine states — California, Florida, Maryland, Michigan, New Jersey, North Carolina, Rhode Island, Washington and Wisconsin — all of which included each patient’s home zip code. This allowed them to match racial demographics and health outcomes from 24,786 juvenile cancer patients with the Child Opportunity Index 2.0 (COI) rank of each child’s home neighborhood.

COI ranks are a composite of 29 measures of neighborhood quality in areas such as education, environment and socioeconomic resources. The average home zip code COI rank for children in the study was 60 for white children, 36 for Hispanic children and 33 for Black children.

Overall, the researchers found evidence of one or more potentially life-threatening complications on the hospital discharge records of 32 percent of white children, 36 percent of Hispanic children and 37 percent of Black children.

However, when researchers looked at how children of different races but similar neighborhoods fared, they found no significant differences between white and Hispanic children and the smallest possible significant difference between white and Black children.

Adjusting for age – and thus for exposure to the neighborhoods outside each child’s home – also reduced racial disparities in outcomes. Indeed, there were no significant racial differences in serious complications from cancer and cancer care among children under age 4.

The researchers hope to further this work by comparing health outcomes to individual census tracts, which are much smaller than zip code areas, and by finding other location data that might allow them to figure out what aspects of different neighborhoods might drive higher complication rates.

“The potential culprits are numerous,” Savage said. “Until we live in a more just America where all races live in high-opportunity neighborhoods, it is important to know what’s driving outcomes in lower-opportunity neighborhoods so we can at least ameliorate those dangers.”

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JOURNAL

Cancer Nursing

DOI

10.1097/NCC.0000000000001201 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Race, Neighborhood Opportunity, and Life-Threatening Complications in Children With Cancer