Penn Medicine develops mRNA vaccine against Lyme disease-causing bacteria

Pre-clinical research indicates the experimental vaccine shows promise for reducing the cases of Lyme disease

Peer-Reviewed Publication

UNIVERSITY OF PENNSYLVANIA SCHOOL OF MEDICINE

PHILADELPHIA— An experimental mRNA vaccine provides protection in preclinical animal models against infection from Borrelia burgdorferi, the bacteria that causes Lyme disease, according to new research from the Perelman School of Medicine at the University of Pennsylvania. Results from these preclinical animal models suggest that the vaccine prevents the development of Lyme disease and may represent a powerful tool in reducing the number of Lyme disease cases.

The bacteria that causes Lyme disease is transmitted to humans through the bite of infected ticks, and can cause fever, headache, fatigue, and a skin rash. If left untreated, infection can spread to joints, the heart, and the nervous system. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics, but some individuals develop post-treatment Lyme disease syndrome (PTLDS), which can cause long-lasting symptoms like severe joint pain and neurocognitive issues. While there are existing vaccines against Lyme disease for dogs, there is not currently one approved for routine use in humans.

“Bacteria are more complex organisms than viruses, and therefore it can be more challenging to develop effective vaccines against them,” said senior author, Norbert Pardi, PhD, an assistant professor of Microbiology. “Here we were able to identify a target for a mRNA vaccine that shows promising results for preventing B. burgdorferi infection in animal models.”

The vaccine, described recently in Cell Press, uses the same messenger ribonucleic acid (mRNA) technology employed in the Pfizer and Moderna SARS-CoV-2 vaccines, which was pioneered at Penn. Along with mRNA vaccine pioneer Drew Weissman, MD, PhD, the Roberts Family Professor in Vaccine Research and director of Vaccine Research at Penn Medicine, Pardi and his laboratory identified one of the proteins in  B. burgdorferi that elicit a potent immune response, called outer surface protein A (OspA). OspA is a conserved protein in the multiple strains of B. burgdorferi, making it an ideal target for preventing an initial B. burgdorferi infection from progressing to Lyme disease.

Tests in animal models showed that the mRNA vaccine targeting OspA induced a strong antigen-specific antibody and T-cell response after a single vaccination that could protect from infection of B. burgdorferi. What’s more, the vaccine elicited a strong memory B cell response, which can be activated much later to help prevent infection by B. burgdorferi long after the vaccine is administered.

“Cases of Lyme disease have been rising sharply in the United States, underscoring the need for a vaccine to protect individuals from infection,” said Pardi. “The mRNA technology shows great promise for use in developing a vaccine that may prevent Lyme disease and subsequent development of the debilitating symptoms of PTLDS.”

This research was funded by the National Institute of Allergy and Infectious Diseases (R01AI146101, R01AI153064, AI126033, AI165499, AI138949, R01AI142572, R21AI137433, R01AI153064 and R01AI168312), the Steven and Alexandra Cohen Foundation, the Howard Hughes Medical Institute Emerging Pathogens Program, and the Burroughs Wellcome Fund (BWF1012376).

###

Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.

The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.

The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.

Penn Medicine is an $11.1 billion enterprise powered by more than 49,000 talented faculty and staff.

---

JOURNAL

Cell

DOI

10.1016/j.ymthe.2023.07.022 

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Development of an mRNA-lipid nanoparticle vaccine against Lyme disease

 

TEAM-UP together awards 62 scholarships to Black undergraduates in physics, astronomy

Scholarship program doubles recipients in second year, fostering culture of inclusion, support, and success for Black and African American undergraduate students in physics and astronomy

Grant and Award Announcement

AMERICAN INSTITUTE OF PHYSICS

 

IMAGE: TEAM-UP TOGETHER ENCOURAGES MORE YOUNG BLACK AND AFRICAN AMERICAN STUDENTS TO FOLLOW THEIR PASSION FOR SCIENCE. view more 

CREDIT: AIP

WASHINGTON, Sept. 20, 2023 – TEAM-UP Together is pleased to announce its second cohort of scholars: 62 students who will each receive $10,000 for the 2023-24 academic year. Among these high-achieving students, 15 are second-time award recipients. By offering financial support to promising undergraduates, TEAM-UP Together encourages more young Black and African American students to follow their passion for science.

“Because of [this scholarship], I can pursue my career in physics,” said TEAM-UP Together scholar Omokhuwele Umoru, a senior physics major at Texas Southern University. “It will help with my tuition, books, and conferences. As opposed to picking up shifts on campus, I’m able to work on research and finish my senior thesis.” 

Umoru spends much of her free time mentoring and tutoring other students to encourage them to stay in STEM.

“Mentorship is a passion of mine,” Umoru said. “When I came in as a freshman, I didn’t have much support. But then, when I found mentors like my advisor, I realized how much one person can make an impact on your journey and change the entire trajectory of your life for the better.”

The TEAM-UP Together awards are part of a multimillion-dollar scholarship program that provides direct funding and support to African American undergraduate students majoring in physics and astronomy. A collective action initiative, TEAM-UP Together is a partnership between the American Association of Physics Teachers, the American Astronomical Society, the American Institute of Physics, the American Physical Society, and the Society of Physics Students.

“I have always loved science,” said Nijai Dixon, a TEAM-UP Together scholar earning dual degrees in engineering and physics from Clark Atlanta University. “It was my favorite subject in grade school. Science is the base for everything around us, particularly physics.”

Dixon recognizes how physics informs our understanding of energy production and hopes to use this knowledge to advance a sustainable future, but her path to achieving higher education has been challenging.

“It is a heavy burden to be the sole contributor to my education,” Dixon said. “I knew this early on and have been proactive in seeking external funds to be able to afford it all. I found the TEAM-UP Together scholarship through a web page posting and applied immediately.

“Though I went through and over many hurdles to get to this place, I have remained in school and did everything to continue my education. I can proudly say that this is my last year as an undergraduate student, and it is solely due to programs like TEAM-UP Together.”

Scholarship awardees become members of the Society of Physics Students and will also gain access to professional development opportunities, mentoring, training, conference travel funding, and more through the TEAM-UP Together community. 

“TEAM-UP Together is a group effort, a collective action of AIP federation member organizations,” said Michael Moloney, CEO of AIP. “Through this collective action and connection, we are building clearer pathways to success so more Black undergraduates can thrive, earn their degrees, and become change-makers in our scientific enterprise.”

TEAM-UP Together has two overarching strategies to support the mission of cultivating a more inclusive, diverse field. The student program provides direct funding, professional development, and other support for Black and African American physics and astronomy undergraduate students. The departmental program provides funding for physics and astronomy departmental efforts and programs that drive systemic change and prioritize and support successful outcomes for Black and African American undergraduates.

“We take a multipronged, multilayered approach to achieving our mission,” said Arlene Modeste Knowles, TEAM-UP Together program manager. “Our programs empower stakeholders across the scientific ecosystem to catalyze systemic change and enhance the lived experiences of Black students in physics and astronomy.”

Applications for the Fall 2024 semester will be available Nov. 15, 2023, and must be submitted by March 8, 2024. Scholarship awardees are encouraged to reapply in subsequent years.

TEAM-UP Together is supported by the AIP Foundation, which raises philanthropic funds for the program. The AIP Foundation has secured major donations from the Simons Foundation/Simons Foundation International and the Heising-Simons Foundation for TEAM-UP Together.

“It’s exciting for this program to double its student reach in such a short amount of time and support so many deserving students,” added Knowles. “This was made possible due to the leadership and vision of our partner organizations and sponsors, all dedicated to creating impactful change.”

###

About TEAM-UP Together

TEAM-UP Together is a collective action initiative led by the American Association of Physics Teachers, American Astronomical Society, American Institute of Physics, American Physical Society, and Society of Physics Students to support the scientific community to take the next bold step in doubling the number of African American students earning physics and astronomy bachelor’s degrees annually by 2030. To learn more, check out teamuptogether.org. TEAM-UP Together is aligned with a number of changemaking initiatives being undertaken by these partners and other AIP Member Societies and AIP Affiliates to address underrepresentation and inequity in the physical sciences.

TEAM-UP Together has also been recognized by the White House as one of the commitments in the national strategy to drive transformative equitable change in the U.S. STEMM ecosystem. As a result, the AIP Federation was selected as a founding member of the U.S. STEMM Opportunity Alliance, which aims to bring together organizations and entities from across sectors and scientific communities that are committed to developing and advancing a national strategy for achieving shared goals for equity in STEMM.

###

 

Study: most people rely on parents for material support into adulthood

Peer-Reviewed Publication

NORTH CAROLINA STATE UNIVERSITY

A new study finds that only a third of adults in the United States did not rely on their parents for some form of material support between their late teens and early 40s. The study highlights the extent to which parents and adult children rely on each other for financial assistance or a place to live well into the children’s adult years, challenging popular conventions and expectations about adulthood.

“This work really challenges the notion that complete independence is a necessary marker of adulthood,” says Anna Manzoni, co-author of the study and an associate professor of sociology at North Carolina State University. “Instead, we see a pattern of interdependency that changes over time and appears to be influenced by race and educational background.”

For the study, researchers analyzed data on 14,675 U.S. adults who participated in the National Longitudinal Study of Adolescent to Adult Health, focusing on data collected from study participants between the ages of 18 and 43.

Specifically, the researchers looked at various ways in which these adults exchanged financial and residential support with their parents over time, as well as various social and demographic factors – such as gender, race/ethnicity, and parents’ educational background.

“We found that there is no single pathway that most people take regarding independence from their parents,” Manzoni says. “Instead, people tend to fall into one of six different categories.”

The researchers call these categories “pathways of intergenerational support”:

• Complete Independence (comprising 33.44% of survey respondents) refers to children who become financially and residentially independent in their late teens or early 20s and retain that independence;
• Independent with Transitional Support (20.14%) is similar to the “Complete Independence” group, but received some financial support from parents in their 20s or early 30s;
• Gradual Independence (15.07%) refers to children who lived at home into their 20s and received significant financial support, with that support declining very gradually over time;
• High to Low Support (14.63%) refers to children who lived at home into their 20s and received significant financial support, but that support declined rapidly as the children grow older;
• Extended Interdependence (10.22%) refers to children who lived at home for extended periods of time and who not only received financial support from parents but also provided financial support to parents; and
• Boomerang (6.51%) refers to children who moved out in their late teens or early 20s, moved back in with parents in their mid-20s to early 30s, and then moved out again in their 30s or early 40s.

“We also found that these pathways are not evenly distributed across the population,” Manzoni says. “For example, Complete Independence is least likely among Black families and most likely among white families, while Extended Interdependence is least likely among White families and most likely among Hispanic families.

“Educational background also appears to be a significant factor. For example, people whose parents completed less than a high school education are far more likely to experience the Extended Interdependence pathway, while people whose parents completed a graduate or professional degree are significantly more likely to experience the Complete Independence pathway.

“Ultimately, the work drives home the extent to which access to resources and structural restraints – such as access to education – influence which pathways to independence people have access to. It also makes clear that we need to reevaluate how we think of independence and adulthood, given that only a third of study participants were able to take the Complete Independence pathway that is often presented as being the norm.”

The paper, “Pathways of Intergenerational Support Between Parents and Children Throughout Adulthood,” is published in Sociological Perspectives. First author of the paper is Jane Lee, a research associate in the Center for Health Policy and Inequalities Research at Duke University.

---

JOURNAL

Sociological Perspectives

DOI

10.1177/07311214231193342 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Pathways of Intergenerational Support Between Parents and Children Throughout Adulthood

Why are the brain's nerve cells organized into modules?

Peer-Reviewed Publication

TOHOKU UNIVERSITY

 

IMAGE: A SCHEMATIC ILLUSTRATION OF THE EXPERIMENTAL SETUP. view more 

CREDIT: F. PAUL SPITZNER

Scientists have found that the outer cortex of the mammalian brain is able to maintain control over all the external inputs it receives because of how its nerve networks are organized into interconnected but independently functioning 'modules.' The finding was the result of a unique experimental system that grew neurons, the functional elements of the brain, on microfabricated glass surfaces. Computational models then described the experimental observations. The work, by an international team of researchers led by Hideaki Yamamoto from Tohoku University and Jordi Soriano from the University of Barcelona, was published in the journal Science Advances.

The cortex is the outer layer of the brain that contains a large number of neurons responsible for functions such as sensory perception, motor control, and higher-order computation. "Neuronal networks, like those in the mammalian cortex, need to be able to segregate inputs from specialised circuits, and to integrate inputs from multiple circuits," says Yamamoto. But it has not been clear how the cortex is able to support these two very different processing paradigms.

To study this, the researchers guided cortical neurons to form a network containing multiple sub-groups, or modules. The lab-grown neurons were engineered to express light-sensitive proteins so they could be stimulated using a specific wavelength of light.

The team found that the more well-formed modular networks had large responses to localised light stimulation, while those with less 'modularity' responded to all stimulus in an excessively synchronised way.

For this effect to happen, the applied light stimulation was delivered to different parts of the network at different times, to mimic the real-life inputs to the cortex from subcortical parts of the brain. However, when the overall excitability of the entire network was raised simultaneously, by increasing potassium concentration across the entire network, this did trigger a synchronous, coordinated activity response across the entirety of the networks.

"This balance between locally segregated activity and globally integrated activity is thought to be important for the brain to be able to expand its capacity for information representation with limited resources," explains Yamamoto.

The discovery not only helps scientists understand the interplay between structure and function of the mammalian brain but can also help improve the development of artificial neural networks for use in machine learning research.

---

JOURNAL

Science Advances

DOI

10.1126/sciadv.ade1755 

ARTICLE TITLE

Modular architecture facilitates noise-driven control of synchrony in neuronal networks

 

Exposure to plasticizers in pregnancy associated with smaller volumetric measures in the brain and lower IQ in children

A study published in Molecular Psychiatry provides new evidences on the possible effects of phthalates in brain development

Peer-Reviewed Publication

BARCELONA INSTITUTE FOR GLOBAL HEALTH (ISGLOBAL)

Children whose mothers had a higher exposure to certain phthalates during pregnancy tend to show smaller total gray matter in their brains at age 10. This is one of the main conclusions of a study led by the NYU Grossman School of Medicine and the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, and published in Molecular Psychiatry.

The study also found that maternal exposure to plasticizers during pregnancy is associated with lower child IQ at age 14, which confirmed the results of two previous study on the topic. Moreover, the research team observed that this relationship between exposure to certain phthalates and lower child IQ is partially influenced by total gray matter volumes. In other words: exposure to plasticizers before birth could lead to smaller total gray matter in childhood, which in turn could be related to a lower IQ.

Finally, the results showed an association between gestational exposure to plasticizers and smaller white matter volumes in girls.

Phthalates, a group of chemicals of concern

Phthalates are a group of chemicals which are ubiquitously used as plasticizers and solvents in a wide range of commercial products, such as personal care products, food packaging or vinyl flooring. Previous studies have shown that certain phthalates are associated with less optimal cognitive function, social development, and motor skills as well as behavioral problems in children.

In order to provide new evidences, the authors used data from 775 mother-child pairs from Generation R, a pediatric neuroimaging cohort based in Rotterdam (The Netherlands). Phthalate exposure of mothers was assessed using urine samples collected during pregnancy. Since phthalates are difficult to detect due to their rapid decay in the human body, the analysis of the samples focused on detecting phthalate metabolites, the breakdown products generated as the consequence of the presence phthalates.

Brain volumetric measures of children were taken using MRI scans at age 10. Lastly, children's IQ was assessed via standard tests performed when children were 14 years old.

Results

The statistical analysis revealed an association between higher gestational concentrations of monoethyl phthalate (mEP) and smaller total gray matter volumes in offspring at age 10. mEP is a metabolite, or breakdown product, of diethyl phthalate, a compound used to make plastics more flexible and in cosmetic products.

Higher maternal concentrations in urine during pregnancy of monoisobutyl phthalic acid (mIBP), a metabolite of diisobutyl phthalate (DIBP), were associated with smaller white matter only in girls. DIBP is also used as a plasticizer.

Gray matter is the tissue that contains most of the brain's neuronal cell bodies and help us process information and govern our muscles. This part of the brain is essential in our ability to learn and retain information, speak, move or process sensation and perceptions. 

In turn, white matter is a brain tissue that acts as a communication network between the different gray matter areas and between our brain and the rest of our body.

Lower IQ at age 14

In 2020 and 2021, the Generation R Study reported that maternal prenatal urinary concentrations of phthalates were associated with lower non-verbal IQ at age 6 years. After showing that the association persists at age 14, the authors state that "the impact of phthalate exposure on the brain and child cognition continues into adolescence".

The new study estimates that 18% of the total effect of phthalate exposure in pregnancy on children’s IQ could be explained by changes in gray matter volumes in both boys and girls. In girls, the association between gestational exposure to mIBP and lower IQ was found to be due to smaller cerebral white matter in a proportion of 76%.

Small differences at individual level

"Even though the observed differences in volumetric measures and IQ scores were small at individual level, it is the wide picture what shows reasons for concern because of the widespread exposure to phthalates and poor regulations, which lead to a high public health impact", says Mònica Guxens, ISGlobal researcher and last author of the study.

"In the light of scientific evidences on their health effects, countries such as the US or regions such as the EU have increased the regulations of this ubiquitous compounds. However, the use of new compounds to replace the regulated ones leads to a persistence of the global impact of prenatal exposure to phthalates", says Akhgar Ghassabian, researcher at the NYU School of Medicine.

 

 

Reference

Ghassabian A, van den Dries M, Trasande L, Lamballais S, Spaan S, Martinez-Moral MP, Kannan K, Jaddoe VWV, Engel SM, Pronk A, White T, Tiemeier H, Guxens M. Prenatal exposure to common plasticizers: a longitudinal study on phthalates, brain volumetric measures, and IQ in youth. Mol Psychiatry. 2023 Aug 29. doi: 10.1038/s41380-023-02225-6. Epub ahead of print. PMID: 37644173.  

---

JOURNAL

Molecular Psychiatry

DOI

10.1038/s41380-023-02225-6 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Prenatal exposure to common plasticizers: a longitudinal study on phthalates, brain volumetric measures, and IQ in youth

Cdc.gov

https://www.cdc.gov/biomonitoring/Phthalates_FactSheet.html

Phthalates Factsheet | National Biomonitoring Program - CDC 

Phthalates are a group of chemicals used to make plastics more durable. They are often called plasticizers. Some phthalates are used to help dissolve other ...

Ncbi.nlm.nih.gov

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157593

Phthalates and Their Impacts on Human Health - PMC - NCBI 

May 18, 2021 ... Phthalates are a series of widely used chemicals that demonstrate to be endocrine disruptors and are detrimental to human health.

Niehs.nih.gov

https://www.niehs.nih.gov/research/supported/assets/docs/j_q/phthalates_the_everywhere_chemical_handout_508.pdf

Phthalates: The Everywhere Chemical 

Which population of humans is at a greater health risk to phthalate exposure? Children under the age of three are more at risk from phthalates because of their ...

Hsph.harvard.edu

https://www.hsph.harvard.edu/news/features/the-big-3-why-phthalates-should-be-restricted-or-banned-from-consumer-products

Why phthalates should be banned in consumer products | News 

Mar 10, 2021 ... A: These chemicals—generally referred to as “phthalates”—are a family of compounds that has been widely used for well over 50 years. They have ...

Epa.gov

https://www.epa.gov/sites/default/files/2017-08/documents/phthalates_updates_live_file_508_0.pdf

Phthalates - EPA 

The indicators focus on three important phthalates: di-2-ethylhexyl phthalate (DEHP), dibutyl phthalate (DBP), and butyl benzyl phthalate (BBzP). These three ...

 

DGIST successfully concludes 2023 specialist training program in fragrance industry

Meeting Announcement

DGIST (DAEGU GYEONGBUK INSTITUTE OF SCIENCE AND TECHNOLOGY)

DGIST (President Kuk Young) celebrated the graduation of 23 outstanding local talents, poised for success in the global fragrance industry, during the "French Fragrance Industry Specialist Training Completion Ceremony" held on August 19.

 

□ As part of the "Southern District Total Beauty Manufacturing and Service Specialist Training and Youth Entrepreneurship Vitalization Program" and the "University-Centered Research Center Support Program," DGIST conducted a four-day "Fragrance Industry Specialist Training Program" from August 16 to nurture experts who can excel in the global fragrance industry.

 

□ The program was modeled after the globally renowned "Fragrance Industry Specialist Training Program" in France. It covered topics such as fragrance marketing, basic chemistry related to fragrant substances, and foundational neuroscience related to olfaction. To offer more specialized training, the course featured guest lectures by Professor Jeremy Tobin, the driving force behind the fragrance industry training program at the University of Nice Sophia Antipolis, and Dr. Jerome Golebiewski, a French fragrance industry expert, generating considerable interest among the participants.

 

□ During the completion ceremony on the 19th, the program attendees shared their thoughts and reflections, expressing their strong aspirations to continue their endeavors in the fragrance industry.

 

□ Moon Che-il, Director of the DGIST Convergence Research Advanced Centre for Olfaction, remarked, "We anticipate that young, aspiring entrepreneurs will gain hands-on experience through this training program, ranging from the basics of scent science to commercialization. We expect them to surmount technological barriers of advanced fragrance-producing countries and emerge as world-class talents. Alongside the development of this program into a top-tier curriculum, our center will actively aid in overcoming these technological barriers by regularly introducing technologies and mentoring local enterprises, thus contributing to youth employment in Daegu and strengthening the capabilities of local SMEs."

 

□ This program aimed to stimulate the local industry by equipping specialists in the “total beauty” industry, which fits seamlessly with the industrial landscape of Daegu. It was supported by Daegu City and the National Research Foundation of Korea.

 

Over 50s with ADHD ‘overlooked’ for diagnosis and treatment, say experts

Peer-Reviewed Publication

TAYLOR & FRANCIS GROUP

Doctors urgently need better international guidance on treating attention deficit hyperactivity disorder (ADHD) in the over 50s, conclude world-leading experts reviewing current research on this increasing issue globally.

Published in the peer-reviewed journal Expert Review of Neurotherapeutics, the team’s findings highlight a ‘striking’ gap in knowledge about older people as existing guidelines focus on children and young adults.

“Our analysis concludes that better approaches are urgently required to screen and diagnose people aged from around age 50 to 55,” says lead author Dr Maja Dobrosavljevic from the University of Orebro, in Sweden.

“As we gain deeper insights into the challenges faced by older adults living with ADHD, a comprehensive and tailored approach is crucial for their well-being.

“We therefore urge the medical community, researchers, and policymakers to collaborate in refining diagnostic criteria, treatment guidelines, and research initiatives that are inclusive of all age groups affected by ADHD.”

Estimated to affect around 2.5% of adults, ADHD runs in families.

Symptoms include being impulsive, hyperactive, and having poor focus, attention, and organisational skills. 

The neurodevelopmental disorder can persist throughout life and have a negative impact on education, job prospects and social interaction. Stimulants such as methylphenidate are the most commonly-used medication for ADHD. 

The team of authors includes Chair of the European ADHD Guidelines Group Samuele Cortese, who is a Professor of Child and Adolescent Psychiatry at the University of Southampton, and Henrik Larsson, a Professor of psychiatric epidemiology at Orebro Univeristy.

They reviewed almost 100 studies.
Of these, 44 were papers on the prevalence, health outcomes, diagnosis, and treatment efficacy/safety, as well as clinical guidelines/consensus statements providing recommendations on clinical diagnosis and treatment of ADHD in older adults.

The team then assessed the current diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the World Health Organisation’s International Classification of Diseases (ICD). Other aspects were also evaluated such as how useful current criteria are for diagnosing older adults.

“Our results show no studies have observed people over a long time period into older age. Research has instead focused on retrospective assessment of childhood symptoms, and this can be unreliable because of age-related memory issues,” says Professor Larsson, whose expertise lie in how genes and environment influence mental health problems across the life span.

“Essentially, this means that more trials are needed into the safety and efficacy of current ADHD medication, including the maximum recommended doses, used to treat this age group – who are at increased risk of other health conditions such as heart problems.”

Professor Larsson added: “Doctors should be assessing the physical health of an older person with ADHD before prescribing drug treatment.

“Diagnostic criteria have shifted towards a ‘wider inclusion’ of adults who previously would have remained undiagnosed.

“Yet, still, there is no specific consideration of how ADHD presents in older adults. 

“Another issue is that screening tools validated for ADHD in older adults are not specific enough to recognize the condition in the over 50s. Only those with the most severe ADHD would be picked up.”

The team’s analysis also adds further weight to conclusions that ADHD is linked with mental health issues, increased death rates, and illness such as cardiovascular disease and dementia. 

However, diagnosis remains an issue for this age group.

The research concludes that one of the main challenges for clinicians is that some medical conditions among older adults have similar clinical presentations as ADHD such as menopause-related memory decline.

On this basis, the researchers recommend that doctors take into account distinctive clues to distinguish ADHD from age-related mild cognitive impairment (MCI). People with ADHD typically report childhood symptoms whereas MCI has a more abrupt onset, they point out.

The authors do concede that future editions of the DSM and ICD are expected to address current gaps in the definition of ADHD for older adults, and that more data will become available.

They suggest that classification for older adults should include diagnoses that differentiate between ADHD and conditions with similar symptoms.

---

JOURNAL

Expert Review of Neurotherapeutics

DOI

10.1080/14737175.2023.2250913 

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

The diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) in older adults

ARTICLE PUBLICATION DATE

20-Sep-2023

 

A new regulatory model which supports and encourages needed to help organizations comply with equalities legislation, study says

Peer-Reviewed Publication

UNIVERSITY OF EXETER

A new type of regulation is needed to support and encourage organisations to comply with equality and human rights law because enforcement alone is ineffective, a new study says.

The introduction of the Public Sector Equality Duty and the Human Rights Act were intended to establish an equality and human rights culture within public authorities. The research highlights how this culture has failed to take hold.

An alternative is needed to the current model of regulation (the enforcement pyramid) under which penalties increasingly progress until noncompliers comply. The study says the current model cannot recognise innovation, good practice or the reasons why organisations struggle to comply. Some organisations may lack confidence or feel overwhelmed rather than intentionally choosing not to follow the rules.

Dr David Barrett, from the University of Exeter Law School, analysed original empirical data and interviewed individuals within regulators and inspectorates and ombudsmen. He found firms are implementing the duty in three ways: strong implementation (where individuals make the most of the resources they have and drive ever deeper implementation), mixed implementation (where individuals oscillate between deeper and perfunctory implementation), and weak implementation (where individuals avoid taking meaningful action due to feeling overwhelmed and in need of rescue).

Dr Barrett said: “Equality and human rights laws require organisations to adjust and reconfigure themselves to mainstream the values of equality and human rights. This requires a model of enforcement that assists organisations, builds capabilities and ultimately sanctions organisations if they fail to comply.

“Ever severe punishment is unlikely to secure meaningful mainstreaming and instead is likely to result in minimal and perfunctory performance. What is needed is encouragement and support, but this cannot be adequately provided by the current enforcement pyramid.”

The study recommends there should be a “strength-based” pyramid, which would work alongside the enforcement based pyramid. This would involve increasing incentives in the form of education and persuasion, validation and encouragement, grants and awards, that would hopefully work to incentivise individuals and their organisations to embed equality and human rights ever deeper into the organisation.

Dr Barrett found a significant barrier to implementation is the finite number of resources - including money, staff and time. Even where staff had more interest in equality and human rights, time was still a significant constraint. Most staff have knowledge of the sector that they oversee rather than equality and human rights, meaning that it is difficult to integrate these norms into the work of the organisation.

Confidence was an important issue in relation to staff and often deterred staff from taking action. The majority of interviewees operated outside the top leadership of the organisation, and many spoke of the challenges imposed by the senior leadership.

The study recommends, as part of a strength-based system, organisations could apply either singularly or collectively (for example a network) for grants to further the implementation of equality and human rights. Eligibility requirements could be established to incentivise moving up the pyramid.

Organisations that had particularly excelled in equality and human rights could apply to be accredited. Awards could also be given to individual implementers to recognise and encourage innovation.

---

JOURNAL

Industrial Law Journal

DOI

10.1093/indlaw/dwad020 

ARTICLE TITLE

Implementation Behaviours and a Strength-Based Approach to Equality and Human Rights Implementation

ARTICLE PUBLICATION DATE

19-Sep-2023