Happy worms have healthy eggs

Study hints that antidepressants could help slow reproductive aging

Peer-Reviewed Publication

NORTHWESTERN UNIVERSITY

 

IMAGE: PRECURSOR EGG CELLS (SHOWN IN BLUE) INSIDE A FEMALE ROUNDWORM'S GONAD. FLUOXETINE (PROZAC) INCREASES DIVISION OF GERMLINE PRECURSOR CELLS (SHOWN IN MAGENTA) IN WORMS. view more 

CREDIT: ILYA RUVINSKY/NORTHWESTERN UNIVERSITY

Worms might not be depressed, per se. But that doesn’t mean they can’t benefit from antidepressants.

In a new study, Northwestern University researchers exposed roundworms (a well-established model organism in biological research) to selective serotonin reuptake inhibitors (SSRIs), a class of drugs used for treating depression and anxiety. Surprisingly, this treatment improved the quality of aging females’ egg cells.

Not only did exposure to SSRIs decrease embryonic death by more than twofold, it also decreased chromosomal abnormalities in surviving offspring by more than twofold. Under the microscope, egg cells also looked younger and healthier, appearing round and plump rather than tiny and misshapen, which is common with aging.

Astounded by the results, the researchers replicated the experiment in fruit flies — another common model organism — and the SSRIs demonstrated the same effect.

Although much more work is needed, the researchers say these findings provide new opportunities to explore pharmacological interventions that might combat infertility issues in humans by improving egg quality and by delaying the onset of reproductive aging.

The study will be published on May 8 in the journal Developmental Biology. An early version of the paper is available here.

“There is still a great distance between this new finding and the fertility clinic,” said Northwestern’s Ilya Ruvinsky, who led the study. “But the more we study the reproductive system, the better we understand it and the more opportunities we have for developing practical interventions.”

Ruvinsky is an associate research professor at Northwestern’s Weinberg College of Arts and Sciences. Erin Aprison, a research associate in Ruvinsky’s laboratory, is the paper’s first author. Svetlana Dzitoyeva, a postdoctoral researcher in Ruvinsky’s laboratory, co-authored the paper.

Cutting out the middleman

Previously, Ruvinsky’s team discovered that male pheromones slowed the aging of females’ egg cells. Published in the Proceedings of the National Academy of Sciences in May 2022, the previous study exposed female roundworms to male pheromones, which resulted in healthier offspring.

When female roundworms sensed the male pheromones, they shifted their energy and resources away from their overall body health and toward increasing reproductive health. “The pheromone coaxes the female into sending help to her eggs and shortchanging the rest of her body,” Ruvinsky said. “It’s not all or nothing; it’s shifting the balance.”

In the new study, Ruvinsky and his team decided to remove male pheromones from the equation entirely.

“The neurons that signal the body to shift its resources rely on serotonin as the messenger,” he said. “We identified those neurons in previous work and wondered if we could tap directly into that system. Maybe we could stimulate the serotonin system with pharmaceuticals, bypassing the need for male pheromones. Lo and behold, we saw better eggs by every measure.”

Delaying decline

To conduct the study, the team added a low dose of SSRIs to aging roundworms’ food. The researchers primarily explored the effects of fluoxetine (Prozac) but also tested citalopram (Celexa) and zimelidine.

Researchers continuously exposed the aging worms to SSRIs at concentrations comparable to those used to treat anxiety and depression in humans. Although egg quality typically drops precipitously as the worms age, worms treated with fluoxetine managed to stave off the decline.

“When we only delivered a temporary regimen of the drug and then withdrew it, the egg quality stayed high for a while but then quickly decreased,” Ruvinsky said. “We think it’s because they need a continuous signal.”

Ruvinsky and his team also found that, when exposed to fluoxetine, roundworms produced more egg cell precursors. But, in a seemingly counterproductive twist, more of these cells died. However, this, too, is another advantage.

“How do you get the components to make higher-quality eggs? You take components from other eggs,” Ruvinsky explained. “Many eggs die and get sent to the ‘salvage yard.’ You break up the parts and use those for the few eggs that survive.”

Shared signaling

Wondering whether or not the finding was exclusive to worms, Ruvinsky’s team replicated the study in fruit flies. Yet again, exposure to fluoxetine improved the quality of eggs for older female flies.

Although worms, flies and humans might seem very different, they have more in common than most people realize.

“This neuronal system does more or less the same thing in various animals,” Ruvinsky said. “More serotonin in the brain causes animals to focus on food instead of exploring their surroundings. That’s true for mammals, flies and worms. We might not be able to widen the fertility window to 60 years. But even if we could add a year or two to a person’s fertility window, that would make a big difference.”

The study, “Serotonergic signaling plays a deeply conserved role in improving oocyte quality,” was supported by the National Institutes of Health (award number R01GM126125).

The larger spheres (two can be seen) are egg chambers. Each chamber contains a future egg and associated nurse cells (some of these can be seen as hazy out of focus outlines). The covering sheet is made of follicle cells (shown in blue). Fluoxetine (Prozac) increases division (in magenta) of follicle cells in flies.

CREDIT

Ilya Ruvinsky/Northwestern University

JOURNAL

Developmental Biology

DOI

10.1016/j.ydbio.2023.04.008 

ARTICLE TITLE

Serotonergic signaling plays a deeply conserved role in improving oocyte quality

ARTICLE PUBLICATION DATE

8-May-2023

A simple antibacterial treatment solves a severe skin problem caused by radiation therapy

Montefiore Einstein Cancer Center study shows that a low-cost antibacterial regimen can prevent acute radiation dermatitis

Peer-Reviewed Publication

ALBERT EINSTEIN COLLEGE OF MEDICINE

 

IMAGE: N/A view more 

CREDIT: N/A

BRONX, NY—May 4, 2023—Acute radiation dermatitis (ARD)—characterized by red, sore, itchy or peeling skin—affects up to 95% of people undergoing radiation treatment for cancer. Severe cases can cause significant swelling and painful skin ulcers that can severely impair quality of life, yet little is known about why this condition occurs and no standardized treatments for preventing severe ARD have been widely adapted.

Researchers at Montefiore Einstein Cancer Center (MECC) have found that many cases of ARD involve a common skin bacterium and that a simple, low-cost treatment can prevent severe cases, potentially setting a new standard of care for people undergoing radiation therapy. Their findings were reported in two papers published today in JAMA Oncology. Each year, 10 million people are treated with radiation therapy to reduce the size of their tumors.

”Until now, ARD was assumed to result simply from the skin being burned by the radiation, which meant that not much could be done to prevent it,” said Beth N. McLellan, M.D. director, supportive oncodermatology at Montefiore Einstein Cancer Center, chief of the division of dermatology at Montefiore Health System and Albert Einstein College of Medicine, and senior author of the two studies. “The readily available treatment we’ve developed and clinically tested could potentially save hundreds of thousands of people each year in the U.S. from severe ARD and its excruciating side effects.”

Identifying the Source
Staphylococcus aureus (SA) bacteria, often shortened to “staph,” typically live harmlessly on the skin, often in the nose and armpits. But, they can cause infections if the skin is broken by a cut,. Radiation weakens the skin’s structure at the treatment site and can result in infection by allowing SA to break through the skin’s outer layer. Courses of radiation therapy—routinely requiring daily treatments over several weeks—increase the risk for skin infection to occur.

Since SA is implicated in common skin disorders that lead to a breakdown in the skin such as eczema, Dr. McLellan and her colleagues reasoned that the bacteria might also play a role in ARD. In one of the JAMA Oncology studies, the MECC researchers enrolled 76 patients undergoing radiation therapy for cancer. Bacterial cultures were collected from patients before and after radiation treatment, from three different body sites: inside the nose, from skin in the radiated area, and from skin on the side of the body not exposed to radiation.

Before treatment, approximately 20% of patients tested positive for SA but did not have an active infection. Following treatment, 48% of those patients who developed severe ARD tested positive for the presence of SA, compared with only 17% of patients who developed the mildest form of the condition. Many patients with SA on their skin also tested positive for nasal SA, suggesting that SA from the nose might be infecting the skin.

“This study clearly showed that SA plays a major role in ARD,” said Dr. McLellan. “The good news is we have a lot of tools to fight this bacteria. In a second study, we tested a topical antibacterial drug combination we thought would be effective and easy for people to use.”

Preventing Severe ARD
The second study enrolled 77 patients undergoing radiation therapy, all but two of whom had breast cancer. Participants were randomized to receive either the standard of care at MECC (normal hygiene and moisturizing treatment such as Aquaphor), or the experimental antibacterial regimen. This treatment involved using the body cleanser chlorhexidine along with mupirocin 2% nasal ointment twice a day for five days, every other week, throughout their radiation treatment.

Although more than half the patients treated with the antibacterial regimen developed mild-to-moderate ARD, no patients developed moist desquamation—the most severe type of ARD that causes the skin to break down and develop sores—and no patients experienced adverse effects from the treatment. In contrast, severe ARD affected 23% of participants receiving the standard of care.

“Our regimen is simple, inexpensive, and easy so we believe it should be used for everyone undergoing radiation therapy, with no need to first test individuals for SA,” said Dr. McLellan. “I expect this will completely change protocols for people undergoing radiation therapy for breast cancer.”

Dr. McLellan also noted: “Like most of our trials at MECC, a majority of our participants were Black and Hispanic members of our community, meaning this protocol is generalizable and effective for people of different races and ethnicities. This is especially important because people with darker skin types are more likely to develop severe ARD.”  

The papers are titled “Association of Staphylococcus aureus Colonization With Severity of Acute Radiation Dermatitis in Patients With Breast or Head and Neck Cancer” and “Bacterial decolonization for prevention of radiation dermatitis: a randomized clinical trial.” Co-authors on both papers include: Yana Kost, B.A., Alana Deutsch, M.D., Nitin Ohri, M.D., M.S., H. Dean Hosgood, Ph.D., Johanna P. Daily, M.D., M.S. and Kosaku Shinoda, Ph.D. Additionally, Alexandra K. Rzepecki, M.D., and Mathew R. Birnbaum contributed to the S. aureus paper. Karolina Mieczkowska, M.D., Roya Nazarian, Ahava Muskat, B.S., Juan Lin, Ph.D., and Rafi Kabaritti, M.D., also contributed to the bacterial decolonization paper.

A new study in JAMA Oncology found that a simple antibacterial treatment prevents severe cases of radiation dermatitis (ARD): No patients in the treatment group developed severe ARD, while severe ARD affected 23% of patients treated with the current standard of care. (Mild to moderate ARD = Grade < 2; severe ARD = Grade > 2-MD)

Dr. Beth McLellan senior author of the two studies

CREDIT

Albert Einstein College of Medicine

About Montefiore Einstein Cancer Center
Montefiore Einstein Cancer Center (MECC) is a national leader in cancer research and clinical care located in the ethnically diverse and economically disadvantaged borough of the Bronx, N.Y. MECC combines the exceptional science of Albert Einstein College of Medicine with the multidisciplinary and team-based approach to cancer care of Montefiore Health System. Founded in 1971 and a National Cancer Institute (NCI)-designated Cancer Center since 1972, MECC is redefining excellence in cancer research, clinical care, education and training, and community outreach and engagement. Its mission is to reduce the burden of cancer for all, especially people from historically marginalized communities.

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JOURNAL

JAMA Oncology

The future of data storage lies in DNA microcapsules

DNA archival storage within reach thanks to new PCR technique

Peer-Reviewed Publication

EINDHOVEN UNIVERSITY OF TECHNOLOGY

 

IMAGE: TOM DE GREEF view more 

CREDIT: BART VAN OVERBEEKE / EINDHOVEN UNIVERSITY OF TECHNOLOGY (TU/E)

Storing data in DNA sounds like science fiction, yet it lies in the near future. Professor Tom de Greef expects the first DNA data center to be up and running within five to ten years. Data won’t be stored as zeros and ones in a hard drive but in the base pairs that make up DNA: AT and CG. Such a data center would take the form of a lab, many times smaller than the ones today. De Greef can already picture it all. In one part of the building, new files will be encoded via DNA synthesis. Another part will contain large fields of capsules, each capsule packed with a file. A robotic arm will remove a capsule, read its contents and place it back.

We’re talking about synthetic DNA. In the lab, bases are stuck together in a certain order to form synthetically produced strands of DNA. Files and photos that are currently stored in data centers can then be stored in DNA. For now, the technique is suitable only for archival storage. This is because the reading of stored data is very expensive, so you want to consult the DNA files as little as possible.

Large, energy-guzzling data centers made obsolete

Data storage in DNA offers many advantages. A DNA file can be stored much more compactly, for instance, and the lifespan of the data is also many times longer. But perhaps most importantly, this new technology renders large, energy-guzzling data centers obsolete. And this is desperately needed, warns De Greef, “because in three years, we will generate so much data worldwide that we won’t be able to store half of it.”

Together with PhD student Bas Bögels, Microsoft and a group of university partners, De Greef has developed a new technique to make the innovation of data storage with synthetic DNA scalable. The results have been published today in the journal Nature Nanotechnology. De Greef works at the Department of Biomedical Engineering and the Institute for Complex Molecular Systems (ICMS) at TU Eindhoven and serves as a visiting professor at Radboud University.

Scalable

The idea of using strands of DNA for data storage emerged in the 1980s but was far too difficult and expensive at the time. It became technically possible three decades later, when DNA synthesis started to take off. George Church, a geneticist at Harvard Medical School, elaborated on the idea in 2011. Since then, synthesis and the reading of data have become exponentially cheaper, finally bringing the technology to the market.

In recent years, De Greef and his group have looked mainly into reading the stored data. For the time being, this is the biggest problem facing this new technique. The PCR method currently used for this, called ‘random access’, is highly error-prone. You can therefore only read one file at a time and, in addition, the data quality deteriorates too much each time you read a file. Not exactly scalable.

Here’s how it works: PCR (Polymerase Chain Reaction) creates millions of copies of the piece of DNA that you need by adding a primer with the desired DNA code. Corona tests in the lab, for example, are based on this: even a minuscule amount of coronavirus material from your nose is detectable when copied so many times. But if you want to read multiple files simultaneously, you need multiple primer pairs doing their work at the same time. This creates many errors in the copying process.

Every capsule contains one file

This is where the capsules come into play. De Greef’s group developed a microcapsule of proteins and a polymer and then anchored one file per capsule. De Greef: “These capsules have thermal properties that we can use to our advantage.” Above 50 degrees Celsius, the capsules seal themselves, allowing the PCR process to take place separately in each capsule. Not much room for error then. De Greef calls this ‘thermo-confined PCR’. In the lab, it has so far managed to read 25 files simultaneously without significant error.

If you then lower the temperature again, the copies detach from the capsule and the anchored original remains, meaning that the quality of your original file does not deteriorate. De Greef: “We currently stand at a loss of 0.3 percent after three reads, compared to 35 percent with the existing method.”

Searchable with fluorescence

And that’s not all. De Greef has also made the data library even easier to search. Each file is given a fluorescent label and each capsule its own color. A device can then recognize the colors and separate them from one another. This brings us back to the imaginary robotic arm at the beginning of this story, which will neatly select the desired file from the pool of capsules in the future.

This solves the problem of reading the data. De Greef: “Now it’s just a matter of waiting until the costs of DNA synthesis fall further. The technique will then be ready for application.” As a result, he hopes that the Netherlands will soon be able to open its inaugural DNA data center – a world first.

This paper appeared in the journal Nature Nanotechnology under the title ‘DNA storage in thermoresponsive microcapsules for repeated random multiplexed data access’. DOI: 10.1038/s41565-023-01377-4. Industrial partners: Microsoft. University partners: University of Washington, Radboud University, University of Bristol, Shanghai Jiao Tong University. Partnerships: Center for Living Technologies, Eindhoven-Wageningen-Utrecht Alliance

Tom de Greef

CREDIT

Bart van Overbeeke / Eindhoven University of Technology (TU/e)

JOURNAL

Nature Nanotechnology

DOI

10.1038/s41565-023-01377-4 

ARTICLE TITLE

DNA storage in thermoresponsive microcapsules for repeated random multiplexed data access

ARTICLE PUBLICATION DATE

4-May-2023

Obesity as a risk factor for colorectal cancer underestimated so far

Weight loss before diagnosis obscures correlation

Peer-Reviewed Publication

GERMAN CANCER RESEARCH CENTER (DEUTSCHES KREBSFORSCHUNGSZENTRUM, DKFZ)

Obesity is a known risk factor for colorectal cancer. Scientists at the German Cancer Research Center (DKFZ) have now shown that this association has probably been significantly underestimated so far. The reason: many people unintentionally lose weight in the years before a colorectal cancer diagnosis. If studies only consider body weight at the time of diagnosis, this obscures the actual relationship between obesity and colorectal cancer risk. In addition, the current study shows that unintentional weight loss may be an early indicator of colorectal cancer.

Obesity is a risk factor for a whole range of cancers. This association is particularly clear, for example, in the case of endometrial cancer, kidney cancer and also colorectal cancer. According to previous estimates, obese people have a risk of developing colorectal cancer that is about one-third higher than that of normal weight individuals.

"However, these studies have so far not taken into account that many affected people lose weight in the years before their colorectal cancer diagnosis," says Hermann Brenner, epidemiologist and prevention expert at the German Cancer Research Center. "This has led to the risk contribution of obesity being significantly underestimated in many trials."

To assess the magnitude of this bias, Brenner's researchers evaluated data from the DACHS study*. The nearly 12,000 study participants included in the current evaluation had provided information on their body weight at the time of diagnosis and had also reported their weight in the years preceding diagnosis (measured at 10-year intervals).

On the basis of body weight at the time of diagnosis, no indication of a relationship between body weight and colorectal cancer risk could be established. The picture was quite different, however, when the researchers looked at the participants' earlier body weight: Here, a strong correlation between overweight and the probability of developing colorectal cancer was found, which was most pronounced 8 to 10 years before diagnosis. Study participants who were highly overweight - referred to as obese** - during this period were twice as likely as those of normal weight to develop colorectal cancer. "If we had only looked at weight at baseline, as has been done in many previous studies, we would have completely missed the link between obesity and increased risk of colorectal cancer," said Marko Mandic, the study's first author.

In their analyses, Brenner's team was able to identify another trend: A striking number of the study participants affected by colorectal cancer had unintentionally lost weight before diagnosis. An unintentional weight loss of two kilos or more within two years prior to diagnosis (or study entry) occurred 7.5 times more frequently in cancer-affected individuals than in those in the control group. "During this period, the cancer is already there, but not yet noticeable by symptoms. Doctors should therefore regularly ask their patients about unintentional weight loss," Brenner appeals, adding, "Unintentional weight loss could also be an early indication of other cancers or other diseases and should be carefully clarified."

 

Marko Mandic; Fatemeh Safizadeh; Tobias Niedermaier; Michael Hoffmeister, Hermann Brenner: Association of Overweight, Obesity, and Recent Weight Loss With Colorectal Cancer Risk.

JAMA Network Open. 2023, doi:10.1001/jamanetworkopen.2023.9556

 

* DACHS stands for: "Colorectal Cancer: Opportunities for Prevention through Screening" and is one of the world's largest case-control studies of colorectal cancer, which it has conducted at the German Cancer Research Center since 2003. Between 2003 and 2020, a total of 6,602 colorectal cancer sufferers and 7,950 people without colorectal cancer participated.

 

** Overweight above a body mass index of ≥30 kg/m2 is considered obesity.

 

 

The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) with its more than 3,000 employees is the largest biomedical research institution in Germany. More than 1,300 scientists at the DKFZ investigate how cancer develops, identify cancer risk factors and search for new strategies to prevent people from developing cancer. They are developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to all questions on cancer.

Jointly with partners from the university hospitals, the DKFZ operates the National Center for Tumor Diseases (NCT) in Heidelberg and Dresden, and the Hopp Children's Cancer Center KiTZ in Heidelberg. In the German Consortium for Translational Cancer Research (DKTK), one of the six German Centers for Health Research, the DKFZ maintains translational centers at seven university partner locations. NCT and DKTK sites combine excellent university medicine with the high-profile research of the DKFZ. They contribute to the endeavor of transferring promising approaches from cancer research to the clinic and thus improving the chances of cancer patients.

The DKFZ is 90 percent financed by the Federal Ministry of Education and Research and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.

 

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2023.9556 

Fred Hutch study highlights racial disparities in ovarian cancer risk for women

Researchers examined risks for Black and white women with endometriosis and fibroids to understand how common medical interventions for those conditions modified the outcomes

Peer-Reviewed Publication

FRED HUTCHINSON CANCER CENTER

SEATTLE, WA — May 4, 2023 — A new Fred Hutchinson Cancer Center study in the journal Obstetrics & Gynecology investigated how endometriosis, uterine leiomyomas (also known as fibroids) and a common intervention for these conditions—hysterectomy—changed ovarian cancer risk in Black and white women.

Scientists found fibroids were associated with an increased risk of ovarian cancer in both Black and white women, with hysterectomy modifying the risk of cancer in both groups. However, researchers also found that while Black and white women with endometriosis had a higher risk of ovarian cancer overall, hysterectomy only modified this risk of cancer for white women.

“Almost no research has been done examining the experiences of Black women with endometriosis, including how endometriosis can heighten the risk for ovarian cancer,” said Fred Hutch epidemiologist Dr. Holly Harris, who led the study. “We need to continue making more discoveries in this area and conduct further research into how variables such as medical interventions as well as access to care and treatment also impact the risk of ovarian cancer in all populations.”

The study’s primary goal was understanding how racial differences impacted ovarian cancer risk—an  under-studied area of research particularly impacting Black women. Data from the Ovarian Cancer in Women of African Ancestry Consortium (OCWAA) was utilized to compare outcomes from both Black and white women impacted by endometriosis and/or fibroids and the variety of medical interventions typically used to treat these conditions.

“Conditions such as endometriosis and fibroids can impact health and quality of life,” said Dr. Barbara Norquist, a Fred Hutch clinician focusing on gynecological oncology. “Medical interventions, such as hysterectomies, used to treat these conditions can have an impact on future health outcomes. This study is an important step toward understanding these outcomes and better understanding ovarian cancer risk.”

Nearly 5,500 women took part in the study. The study included 3,124 Black women of which 1,008 had ovarian cancer and 5,458 white women of which 2,237 had ovarian cancer. Of the study participants, 6.4% of Black women and 7% of white women experienced endometriosis and 43.2% of Black women and 21.5% of white women experiencing fibroids.

The National Cancer Institute, estimated 236,511 women in the U.S. were living with ovarian cancer in 2020, and the American Cancer Society notes that it is the fifth leading cause of cancer death in women.

“Like many other diseases of reproductive health, endometriosis and fibroids research is severely underfunded in proportion to their population burden,” said Dr. Elizabeth Swisher, who serves as a co-leader of Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium Breast and Ovarian Cancer Research Program. “Because of this, our knowledge of these diseases is severely limited, leaving patients with sub-par treatments and substantial impacts on their quality of life.”

Researchers hope to continue looking at how racial differences impact ovarian cancer risk, as well as the role that endometriosis and fibroids play.

“Despite the lower occurrence of ovarian cancer in Black women, this group has the highest mortality from ovarian cancer. Identifying how racial differences in access to care and treatment impact this disparity is critical to formulating risk reduction strategies,” said Dr. Harris.

Media Contact:
Kat Wynn
kwynn@fredhutch.org

# # #

About Fred Hutchinson Cancer Center

Fred Hutchinson Cancer Center unites individualized care and advanced research to provide the latest cancer treatment options while accelerating discoveries that prevent, treat and cure cancer and infectious diseases worldwide.

Based in Seattle, Fred Hutch is an independent, nonprofit organization and the only National Cancer Institute-designated cancer center in Washington. We have earned a global reputation for our track record of discoveries in cancer, infectious disease and basic research, including important advances in bone marrow transplantation, immunotherapy, HIV/AIDS prevention and COVID-19 vaccines. Fred Hutch operates eight clinical care sites that provide medical oncology, infusion, radiation, proton therapy and related services and has network affiliations with hospitals in four states. Fred Hutch also serves as UW Medicine’s cancer program.

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JOURNAL

Obstetrics and Gynecology

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE PUBLICATION DATE

4-May-2023

Inaugural maternal mental health state report cards released

The Policy Center for Maternal Mental Health, in collaboration with the George Washington University, are releasing the first-ever grading of state efforts in addressing maternal mental health; the results show 42 states receiving a D or below

Reports and Proceedings

GEORGE WASHINGTON UNIVERSITY

 

IMAGE: THE INAUGURAL MATERNAL MENTAL HEALTH REPORT CARD PROVIDES THE FIRST-EVER COMPREHENSIVE VIEW INTO THE STATE OF MATERNAL MENTAL HEALTH IN AMERICA. view more 

CREDIT: THE POLICY CENTER FOR MATERNAL MENTAL HEALTH

WASHINGTON (May 4, 2023)--Maternal Mental Health disorders like postpartum depression affect roughly 600,000 (20%) of U.S. mothers a year, with Black and other women of color experiencing substantial disparities in rates and access to care. It is estimated that up to 50% of mothers are not diagnosed by a health care professional, and that 75% of women never get the treatment they need and that is promised in health care coverage contracts.

When left untreated, these disorders can have lasting impacts on women’s wellbeing, family stability and children’s development. Untreated maternal mental health disorders are estimated to cost the U.S. $14.2 billion annually.

To address the gaps the Policy Center for Maternal Mental Health has, in collaboration with the George Washington University (GW), created a report card that scores each state's efforts. 

“Because in the United States health delivery is largely overseen by the states, we knew it was time to give states insight into how they are supporting maternal mental health.  With a standard set of measures, states can now benchmark their performance against other states and compare their own performance year over year,” Joy Burkhard, Executive Director of the Policy Center, said.

The report cards grades states in three key domains:

1. Providers and Programs
2. Screening Requirements and Reimbursements
3. Insurance Coverage and Payment

Up to three points are provided for each of the 17 measures within these domains.

“The results of this first ever grading system are not good – with 42 states receiving a D or below,” Caitlin Murphy, the research scientist at the GW Milken Institute School of Public Health, whose research supported the creation of the report cards, said.  “The highest grade any state received was a B-, and this was in just one state - California - where the Policy Center has indicated that significant recent philanthropic, legislative and advocacy efforts have occurred.”

Access the first maternal mental health state report cards here.

About The Policy Center for Maternal Mental Health

The Policy Center for Maternal Mental Health (the “Policy Center”) is working to prevent the suffering of mothers, babies, and families associated with untreated maternal mental health disorders, like postpartum depression. The Policy Center has driven the national conversation from one centered around raising awareness of one disorder, postpartum depression, to building a movement to address maternal mental health. The organization's work centers around closing gaps in the healthcare system by scaling change through the identification of evidence-based and emerging solutions, cross-sector collaboration, and advancing legislative and regulatory policy solutions. For more information, visit https://www.2020mom.org/and follow @PolicyCenterMMH on LinkedIn and Twitter.

 -GW-

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METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

Declines in racial disparities in COVID mortality in 2021 were largely driven by increases in white mortality and changing pandemic geography

Although national COVID mortality disparities declined in 2021, this decrease was largely explained by increases in mortality among White individuals and the shifting geography of the pandemic from urban to rural areas

Peer-Reviewed Publication

BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH

FOR IMMEDIATE RELEASE

Although national COVID mortality disparities declined in 2021, this decrease was largely explained by increases in mortality among White individuals and the shifting geography of the pandemic from urban to rural areas rather than decreases in mortality among non-Hispanic Black and Hispanic individuals. 

The racial disparities in COVID-19 deaths became a defining part of the first year of the pandemic in the United States, prompting national efforts to reduce this disproportionate toll among Black and Hispanic communities through vaccination drives and other outreach when COVID vaccines became available in 2021. Following these efforts, federal officials and the media touted major reductions in disparities in COVID mortality rates during the Delta and Omicron waves in the second year of the pandemic, but a new study led by Boston University School of Public Health (BUSPH) shows that the declines in these disparities do not reflect substantial improvements in population health to the extent previously thought.

Published in the journal JAMA Network Open, the study found that disparities in US COVID death rates between Black and White adults narrowed substantially from the first to the second year of the pandemic, from 339 deaths to 45 deaths per 100,000 people in 2021, after accounting for age. But this sharp decline mostly resulted from an increase in COVID deaths among White people, as well as a geographical shift in mortality from large, urban cities to rural and smaller metropolitan areas, rather than from decreases in deaths among the Black population.

Similarly, Hispanic-White disparities in deaths shrunk from 172 deaths to 12 deaths, and this decline was entirely due to increases in COVID deaths among White and rural populations.

Furthermore, while the findings showed that national COVID death rates for Black, Hispanic, and Asian populations did decrease by 2021, the death rates among these groups increased in rural areas in 2021 and exceeded White death rates.

This geographical shift in US COVID mortality and continued high death rates among racial and ethnic minority populations suggest that declarations of COVID-related racial equity achievements may be coming too soon. As the Biden administration prepares to lift the COVID public health emergency on May 11, much more work still needs to be done to address this burden among all populations. 

“Contrary to popular media narratives, our findings indicate that decreases in racial and ethnic disparities in COVID were mostly explained by increases in mortality for White adults and changes in pandemic geography rather than decreases in Black and Hispanic mortality,” says study corresponding author Dr. Andrew Stokes, assistant professor of global health at BUSPH. “This suggests that it may be premature to celebrate reductions in disparities because they did not largely represent reductions in mortality.”

For the study, Dr. Stokes and colleagues utilized national data to examine COVID-related deaths among nearly one million US adults 25 and older from the initial wave of the pandemic in March 2020 to the Delta and Omicron waves through February 2022. The team examined these deaths by race and ethnicity across metropolitan and nonmetropolitan areas and developed an innovative mathematical framework to identify the factors contributing to the decline in disparities.

Through this framework, the researchers estimated that the rise in COVID deaths in rural areas—which increased from five percent of all rural deaths in 2020 to about 22 percent of all rural deaths by March 2022—and the increase in mortality among the White population explained about 60 percent of the decline in disparities, and the remainder was due to the national decline in deaths among the Black population.

The team also observed concerning trends among the American Indian/Alaska Native (AIAN) population. COVID deaths for this group appeared to increase at the national level during the Delta and Omicron waves, in both urban and rural areas.

Several social, political, geographical, and structural factors may contribute to these shifts in COVID mortality rates. Vaccination and booster rates play a central role—the researchers say the politicized nature of vaccines likely led to lower uptake of the primary series among White and rural people, and Black, Hispanic, and AIAN people have received substantially fewer boosters than White people. Rural residents also experience greater rates of chronic diseases, a risk factor for severe COVID infection, as well as greater difficulty accessing care.

“The social and structural determinants of health that have contributed to the racial and ethnic disparities in mortality observed during the pandemic remain largely unaddressed,” says study first author Dielle Lundberg, research assistant at BUSPH and doctoral student at the University of Washington School of Public Health. “Ongoing work to address these determinants of health, along with increased efforts to ensure booster uptake in rural communities, especially among older adults, are still urgently needed.”

The researchers also urge community investments and policy changes that will remove social and economic barriers largely driven by structural racism, increase access to community resources, and close the racial health equity gap.

"These results underscore COVID's ongoing toll, even in the vaccinated era,” says study co-author Dr. Elizabeth Wrigley-Field, assistant professor of sociology at the University of Minnesota College of Liberal Arts. “Full protection can't rest only on vaccination or other choices that individuals can make -- it also means social policies like paid sick leave, new standards for indoor air quality in workplaces and schools, and expanding and diversifying the healthcare workforce, especially in rural areas."

The research team included additional researchers from BUSPH, Boston University College of Arts & Sciences, Boston University Center for Antiracist Research, The University of Pennsylvania, University of California, San Francisco and Santa Cruz; Stanford University, Massachusetts Institute of Technology, and The Robert Wood Johnson Foundation.

**

About Boston University School of Public Health

Founded in 1976, Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2023.11098 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022

ARTICLE PUBLICATION DATE

2-May-2023

COI STATEMENT

Dr. Nsoesie reported receiving personal fees from Novartis outside the submitted work and participating in the Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity Program team at the National Institutes of Health through the Intergovernmental Personnel Act Mobility Program. Dr Stokes reported receiving grants from Johnson & Johnson and Swiss Re outside the submitted work. No other disclosures were reported.

At start of COVID-19 pandemic, masking compliance of shoppers in Chinese store influenced their in-store behaviors

Compliant mask wearers spent 25% less time shopping than before pandemic

Peer-Reviewed Publication

CARNEGIE MELLON UNIVERSITY

As the coronavirus began to spread globally, face masks were recommended in public settings to protect against transmission, and compliance varied significantly. In a new study of people shopping in a large Chinese store in early 2020, researchers examined the motives behind customers’ compliance with mask recommendations and how their shopping behaviors changed with the onset of the pandemic. The study found that customers changed their in-store behaviors significantly based on their compliance with masking recommendations.

The study, by researchers at Carnegie Mellon University (CMU), Harvard University, and Renmin University, is published in Marketing Science.

“At the start of the COVID-19 pandemic, a variety of psychological factors drove individuals’ reactions to masking recommendations, making the pandemic a large-scale social experiment,” says Kannan Srinivasan, Professor of Management, Marketing, and Information Systems at Carnegie Mellon University's Tepper School of Business, who led the study.

Srinivasan and colleagues examined customers at a large store of a retail chain in China, using recordings from high-resolution cameras at entries, checkout counters, and other locations inside the store. Researchers collected videos from January 1-23, 2020 (which they classified as the pre-pandemic period) and from February 1 to May 31, 2020. The World Health Organization issued a statement about the outbreak of the novel coronavirus, and China presented evidence of human-to-human transmission on January 23. The store was closed from January 24-31, 2020.

Based on studies on social influence and mask wearing, researchers identified three types of customers: Fully compliant customers (54%) wore masks and seemed motivated primarily by concerns about their own health risk. Partially compliant customers (29%) also wore masks, but wore them improperly, and were motivated by the desire to comply with social norms. Non-compliant customers (17%) did not wear masks and were unmotivated by health concerns or social norms. To infer motives behind wearing masks, the researchers used advanced facial recognition mechanisms to detect whether a customer wore a mask and measured the mask fit (operationalized as the extent of mask coverage) for those who did. Fully compliant customers wore their masks over a larger area above the nose than partially compliant customers.

The researchers used the store videos to examine changes in individuals’ shopping behaviors at the onset of the pandemic, contrasting them with the individuals’ shopping behaviors before the pandemic. In particular, they looked at customers’ attempts to practice social distancing and the amount of time spent in the store, as well as at what kinds of masks customers wore.

Fully compliant mask wearers remained at a greater distance from cashiers when shopping during the pandemic than they did before the pandemic. They were five times more likely than other mask wearers to wear highly protective N95 masks while shopping and spent 25% less time shopping than they did before the pandemic. In contrast, partially compliant mask wearers did not distance themselves from cashiers, were less likely to wear high-quality masks, and shopped for the same duration of time as they did before the pandemic. Similarly, non-mask wearers did not distance themselves from cashiers and did not change the duration of their shopping time.

“Our findings have implications for businesses, health practitioners, and policymakers,” suggests Shunyuan Zhang, Assistant Professor of Marketing at Harvard Business School, who coauthored the study.

In particular:

• Retailers can target different customers in different ways: For example, for fully compliant customers, they can explain their efforts to reduce shopping time and mitigate store congestion, and for the partially compliant, they can emphasize the importance of social responsibility.
• Public-health practitioners can message more effectively when their efforts are customized to appeal to individual motives. For example, practitioners may benefit from applying the same principles to efforts involving vaccine compliance.
• In regions with large numbers of partially compliant or non-compliant individuals, policymakers can redouble educational efforts to encourage more masking.

The study was funded by the National Natural Science Foundation of China.

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JOURNAL

Marketing Science

DOI

10.1287/mksc.2022.1419 

ARTICLE TITLE

Frontiers: Unmasking Social Compliance Behavior During the Pandemic