Overdose deaths increased in pregnant and postpartum women from early 2018 to late 2021

Among those aged 35 to 44, overdose mortality more than tripled during this period, NIH study reports

Peer-Reviewed Publication

NIH/NATIONAL INSTITUTE ON DRUG ABUSE

Drug overdose deaths rose markedly between January to June 2018 and July to December 2021 among 10- to 44-year-old girls and women who were pregnant or pregnant within the previous 12 months, according to a new study by researchers at National Institute on Drug Abuse (NIDA) at the National Institutes of Health. Overdose mortality more than tripled among those aged 35 to 44 during the study period, from 4.9 deaths per 100,000 mothers aged 35 to 44 with a live birth in the 2018 period to 15.8 in the 2021 period. Over 60% of these pregnancy-associated overdose deaths occurred outside healthcare settings, though often in counties with available healthcare resources, such as emergency and obstetric care. Published today in JAMA Psychiatry, the findings suggest that, while treatment is available to pregnant women with substance use disorders, significant barriers – such as penalization, stigma, discrimination, and limited socioeconomic resources – may obstruct the path to care, the authors note.

“The stigma and punitive policies that burden pregnant women with substance use disorder increase overdose risk by making it harder to access life-saving treatment and resources,” said Nora Volkow, M.D., NIDA Director and senior author on the study. “Reducing barriers and the stigma that surrounds addiction can open the door for pregnant individuals to seek and receive evidence-based treatment and social support to sustain their health as well as their child’s health.”

While it’s well documented that overdose mortality rose sharply in association with the COVID-19 pandemic, little is known about the specifics of pregnancy-associated overdose mortality during this time. Moreover, the differences in the characteristics of pregnant and postpartum women who died from a drug overdose and those who died of childbirth-related, or obstetric, causes are unknown.

To fill these knowledge gaps, NIDA scientists analyzed U.S. data on multiple cause of death, county-level area health resources, county health rankings, and U.S. births before and during the COVID-19 pandemic – January to June 2018 and July to December 2021. This study focused on individuals aged 10 to 44 belonging to three groups: 1,457 at the pregnant and postpartum stage who died from a drug overdose involving the most common drugs of misuse, excluding alcohol and antidepressants; 4,796 who died of obstetric causes; and 11,205 who died from a drug overdose and were not pregnant in the past 12 months. The study assessed trends in “pregnancy-associated mortality ratios,” which were defined as the number of deaths during or within one year of the end of pregnancy per 100,000 mothers with a live birth.

The researchers found that overdose mortality ratios increased substantially for women who were pregnant or postpartum during the study period, across almost all examined age, racial/ethnic, educational, and marital status groups. The largest increase was observed in pregnant and postpartum women aged 35 to 44, for whom overdose mortality ratios tripled—from 4.9 in the 2018 period to 15.8 in 2021 period. Among those aged 10 to 44 who died between 43 days and one year after pregnancy, overdose mortality ratios almost doubled from 3.1 in the 2018 period to 6.1 in the 2021 period.

Girls and women who died from a drug overdose during pregnancy, compared to those who died from obstetric causes, were more likely to be aged 10 to 34 (75.4% compared with 59.5%), be non-college graduates (72.1% versus 59.4%), be unmarried (88.0% vs. 62.1%), and die in “non-home, non-healthcare settings” (25.9% vs. 4.5%). Unlike most individuals who died from obstetric causes and in a hospital inpatient setting, 60% to 73% of pregnant and postpartum women who died from an overdose were either at home or other non-healthcare places.

Overdose deaths among pregnant and postpartum women also often occurred in areas where there were medical services available, but potentially not accessed. Pregnant and postpartum women who died from an overdose, compared to those who died from obstetric causes, were more likely to reside in counties with doctors practicing obstetrics and gynecology ranking within the 48 to 75th percentile among U.S. counties (32.9% vs. 25.5%). Roughly 51% to 53% of pregnant and postpartum women who died from overdoses resided in counties with at least two general hospitals ranked at the 95th percentile for obstetric care among U.S. counties, and 58% to 67% resided in counties with numbers of practicing psychiatrists per 100,000 county residents ranking over the 75th percentile among U.S. counties.

“These results reflect the persistent national overdose crisis and demonstrate that pregnancy is an urgent time for interventions that can reduce the risk of overdose,” said Emily Einstein, Ph.D., NIDA Science Policy Branch Chief and study co-author. “Stigmatizing and penalizing women with substance use disorders makes it very hard for them to seek help for drug use and receive routine prenatal care. Effective treatments and medical services exist – unfettered access is needed to help mothers and children survive.”

Previous research has shown that pregnant women are less likely to receive an appointment to an addiction treatment center; have difficulties obtaining child care at treatment facilities; and in many states, face punitive policies for their substance use, including fines, loss of custody of their children, involuntary commitment, and incarceration. In states with punitive policies, pregnant women who use drugs have a lower likelihood of receiving timely or quality care. These policies can result in adverse outcomes for their families as well, as children in states with these punitive policies are less likely to be reunited with their parents than those in other states – a system that disproportionately affects Black and American Indian/Alaska Native children.

Future studies are needed to better understand and address these disparities, and to build upon accumulating evidence on the association of overdose mortality in pregnant and postpartum women with poverty and lack of adequate healthcare. More research is also needed on the risk and protective factors of pregnancy-associated mortality among people with and without drug use.

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For more information on substance and mental health treatment programs in your area, call the free and confidential National Helpline 1-800-662-HELP (4357) or visit www.FindTreatment.gov. 

Reference: B Han, et al. Pregnancy and postpartum drug overdose deaths in the US before and during the COVID-19 Pandemic.  JAMA Psychiatry. DOI: 10.1001/jamapsychiatry.2023.4523 (2023)

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About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2022, nearly 49 million people in the United States had at least one substance use disorder. Substance use disorders are defined in part by continued use of substances despite negative consequences. They are also relapsing conditions, in which periods of abstinence (not using substances) can be followed by a return to use. Stigma can make individuals with substance use disorders less likely to seek treatment. Using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide. 

 

NIH…Turning Discovery Into Health®

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JOURNAL

JAMA Psychiatry

DOI

10.1001/jamapsychiatry.2023.4523 

ARTICLE TITLE

Pregnancy and postpartum drug overdose deaths in the US before and during the COVID-19 Pandemic

 

Nutrient found in beef and dairy improves immune response to cancer

Scientists at UChicago discover that trans-vaccenic acid (TVA), a fatty acid found in beef, lamb, and dairy products, improves the ability of immune cells to fight tumors

Peer-Reviewed Publication

UNIVERSITY OF CHICAGO

Trans-vaccenic acid (TVA), a long-chain fatty acid found in meat and dairy products from grazing animals such as cows and sheep, improves the ability of CD8+ T cells to infiltrate tumors and kill cancer cells, according to a new study by researchers from the University of Chicago.

The research, published this week in Nature, also shows that patients with higher levels of TVA circulating in the blood responded better to immunotherapy, suggesting that it could have potential as a nutritional supplement to complement clinical treatments for cancer.

“There are many studies trying to decipher the link between diet and human health, and it’s very difficult to understand the underlying mechanisms because of the wide variety of foods people eat. But if we focus on just the nutrients and metabolites derived from food, we begin to see how they influence physiology and pathology,” said Jing Chen, PhD, the Janet Davison Rowley Distinguished Service Professor of Medicine at UChicago and one of the senior authors of the new study. “By focusing on nutrients that can activate T cell responses, we found one that actually enhances anti-tumor immunity by activating an important immune pathway.”

Finding nutrients that activate immune cells

Chen’s lab focuses on understanding how metabolites, nutrients and other molecules circulating in the blood influence the development of cancer and response to cancer treatments. For the new study, two postdoctoral fellows, Hao Fan, PhD and Siyuan Xia, PhD, both co-first authors, started with a database of around 700 known metabolites that come from food and assembled a “blood nutrient” compound library consisting of 235 bioactive molecules derived from nutrients. They screened the compounds in this new library for their ability to influence anti-tumor immunity by activating CD8+ T cells, a group of immune cells critical for killing cancerous or virally infected cells.

After the scientists evaluated the top six candidates in both human and mouse cells, they saw that TVA performed the best. TVA is the most abundant trans fatty acid present in human milk, but the body cannot produce it on its own. Only about 20% of TVA is broken down into other byproducts, leaving 80% circulating in the blood. “That means there must be something else it does, so we started working on it more,” Chen said.

The researchers then conducted a series of experiments with cells and mouse models of diverse tumor types. Feeding mice a diet enriched with TVA significantly reduced the tumor growth potential of melanoma and colon cancer cells compared to mice fed a control diet. The TVA diet also enhanced the ability of CD8+ T cells to infiltrate tumors.

The team also performed a series of molecular and genetic analyses to understand how TVA was affecting the T cells. These included a new technique for monitoring transcription of single-stranded DNA called kethoxal-assisted single-stranded DNA sequencing, or KAS-seq, developed by Chuan He, PhD, the John T. Wilson Distinguished Service Professor of Chemistry at UChicago and another senior author of the study. These additional assays, done by both the Chen and He labs, showed that TVA inactivates a receptor on the cell surface called GPR43 which is usually activated by short-chain fatty acids often produced by gut microbiota. TVA overpowers these short-chain fatty acids and activates a cellular signaling process known as the CREB pathway, which is involved in a variety of functions including cellular growth, survival, and differentiation. The team also showed that mouse models where the GPR43 receptor was exclusively removed from CD8+ T cells also lacked their improved tumor fighting ability.

Finally, the team also worked with Justin Kline, MD, Professor of Medicine at UChicago, to analyze blood samples taken from patients undergoing CAR-T cell immunotherapy treatment for lymphoma. They saw that patients with higher levels of TVA tended to respond to treatment better than those with lower levels. They also tested cell lines from leukemia by working with Wendy Stock, MD, the Anjuli Seth Nayak Professor of Medicine, and saw that TVA enhanced the ability of an immunotherapy drug to kill leukemia cells.

Focus on the nutrients, not the food

The study suggests that TVA could be used as a dietary supplement to help various T cell-based cancer treatments, although Chen points out that it is important to determine the optimized amount of the nutrient itself, not the food source. There is a growing body of evidence about the detrimental health effects of consuming too much red meat and dairy, so this study shouldn’t be taken as an excuse to eat more cheeseburgers and pizza; rather, it indicates that nutrient supplements such as TVA could be used to promote T cell activity. Chen thinks there may be other nutrients that can do the same.

“There is early data showing that other fatty acids from plants signal through a similar receptor, so we believe there is a high possibility that nutrients from plants can do the same thing by activating the CREB pathway as well,” he said.

The new research also highlights the promise of this “metabolomic” approach to understanding how the building blocks of diet affect our health. Chen said his team hopes to build a comprehensive library of nutrients circulating in the blood to understand their impact on immunity and other biological processes like aging.

“After millions of years of evolution, there are only a couple hundred metabolites derived from food that end up circulating in the blood, so that means they could have some importance in our biology,” Chen said. “To see that a single nutrient like TVA has a very targeted mechanism on a targeted immune cell type, with a very profound physiological response at the whole organism level—I find that really amazing and intriguing.”

The study, “Trans-vaccenic acid reprograms CD8+ T cells and anti-tumor immunity,” was supported by the National Institutes of Health (grants CA140515, CA174786, CA276568, 1375 HG006827, K99ES034084), a UChicago Biological Sciences Division Pilot Project Award, the Ludwig Center at UChicago, the Sigal Fellowship in Immuno-oncology, the Margaret E. Early Medical Research Trust, the AASLD Foundation a Harborview Foundation Gift Fund, and the Howard Hughes Medical Institute.

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JOURNAL

Nature

DOI

10.1038/s41586-023-06749-3 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Trans-vaccenic acid reprograms CD8+ T cells and anti-tumor immunity

 

Your eyes talk to your ears. Scientists know what they’re saying.

Eye movements can be decoded by the sounds they generate in the ear, meaning your hearing may be affected by vision.

Peer-Reviewed Publication

DUKE UNIVERSITY

 

IMAGE: 

PARTICIPANTS TRACKED A GREEN DOT ON THE SCREEN WHILE RESEARCHERS LISTENED TO THE SOUNDS MADE IN THEIR EAR CANALS USING MICROPHONE-EMBEDDED EARBUDS.

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CREDIT: MEREDITH SCHMEHL/DUKE UNIVERSITY

DURHAM, NC – Scientists can now pinpoint where someone’s eyes are looking just by listening to their ears.

“You can actually estimate the movement of the eyes, the position of the target that the eyes are going to look at, just from recordings made with a microphone in the ear canal,” said Jennifer Groh, Ph.D., senior author of the new report, and a professor in the departments of psychology & neuroscience as well as neurobiology at Duke University.

In 2018, Groh’s team discovered that the ears make a subtle, imperceptible noise when the eyes move. In a new report appearing the week of November 20 in the journal Proceedings of the National Academy of Sciences, the Duke team now shows that these sounds can reveal where your eyes are looking.

It also works the other way around. Just by knowing where someone is looking, Groh and her team were able to predict what the waveform of the subtle ear sound would look like.

These sounds, Groh believes, may be caused when eye movements stimulate the brain to contract either middle ear muscles, which typically help dampen loud sounds, or the hair cells that help amplify quiet sounds.

The exact purpose of these ear squeaks is unclear, but Groh’s initial hunch is that it might help sharpen people’s perception.

“We think this is part of a system for allowing the brain to match up where sights and sounds are located, even though our eyes can move when our head and ears do not,” Groh said.

Understanding the relationship between subtle ear sounds and vision might lead to the development of new clinical tests for hearing.

“If each part of the ear contributes individual rules for the eardrum signal, then they could be used as a type of clinical tool to assess which part of the anatomy in the ear is malfunctioning,” said Stephanie Lovich, one of the lead authors of the paper and a graduate student in psychology & neuroscience at Duke.

Just as the eye’s pupils constrict or dilate like a camera’s aperture to adjust how much light gets in, the ears too have their own way to regulate hearing. Scientists long thought that these sound-regulating mechanisms only helped to amplify soft sounds or dampen loud ones. But in 2018, Groh and her team discovered that these same sound-regulating mechanisms were also activated by eye movements, suggesting that the brain informs the ears about the eye’s movements.

In their latest study, the research team followed up on their initial discovery and investigated whether the faint auditory signals contained detailed information about the eye movements. 

To decode people’s ear sounds, Groh’s team at Duke and Professor Christopher Shera, Ph.D. from the University of Southern California, recruited 16 adults with unimpaired vision and hearing to Groh’s lab in Durham to take a fairly simple eye test.

Participants looked at a static green dot on a computer screen, then, without moving their heads, tracked the dot with their eyes as it disappeared and then reappeared either up, down, left, right, or diagonal from the starting point. This gave Groh’s team a wide-range of auditory signals generated as the eyes moved horizontally, vertically, or diagonally.

An eye tracker recorded where participant’s pupils were darting to compare against the ear sounds, which were captured using a microphone-embedded pair of earbuds.

The research team analyzed the ear sounds and found unique signatures for different directions of movement. This enabled them to crack the ear sound’s code and calculate where people were looking just by scrutinizing a soundwave.

“Since a diagonal eye movement is just a horizontal component and vertical component, my labmate and co-author David Murphy realized you can take those two components and guess what they would be if you put them together,” Lovich said. “Then you can go in the opposite direction and look at an oscillation to predict that someone was looking 30 degrees to the left.”

Groh is now starting to examine whether these ear sounds play a role in perception.

One set of projects is focused on how eye-movement ear sounds may be different in people with hearing or vision loss.

Groh is also testing whether people who don’t have hearing or vision loss will generate ear signals that can predict how well they do on a sound localization task, like spotting where an ambulance is while driving, which relies on mapping auditory information onto a visual scene.

“Some folks have a really reproducible signal day-to-day, and you can measure it quickly,” Groh said. “You might expect those folks to be really good at a visual-auditory task compared to other folks, where it's more variable.”

Groh’s research was supported by a grant from the National Institutes of Health (NIDCD DC017532).

CITATION: “Parametric Information About Eye Movements is Sent to the Ears,” Stephanie N. Lovich, Cynthia D. King, David L.K. Murphy, Rachel Landrum, Christopher A. Shera, Jennifer M. Groh. Proceedings of the National Academy of Sciences, Nov. 2023.

Online: https://www.pnas.org/doi/10.1073/pnas.2303562120

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JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2303562120 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Parametric Information About Eye Movements is Sent to the Ears

 

Northumbria University announces £50M space skills, research and development centre set to transform the UK space industry

Grant and Award Announcement

NORTHUMBRIA UNIVERSITY

 

IMAGE: 

AN INITIAL ARTIST'S IMPRESSION OF THE NORTH EAST SPACE SKILLS AND TECHNOLOGY CENTRE BUILDING AT NORTHUMBRIA UNIVERSITY.

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CREDIT: NORTHUMBRIA UNIVERSITY

Investments from Lockheed Martin, the UK Space Agency and Northumbria University forge pathway for NESST’s global prominence

Northumbria University, Newcastle has secured a total of £50 million in funding to create a world-leading space skills, research and technology centre in the North East of England.

Major funding awards that were confirmed today from the UK Space Agency and global aerospace giant, Lockheed Martin have been match-funded by the University itself to create the North East Space Skills and Technology Centre.

The centre, which will be known as NESST, will be a “game-changer” for the UK space economy. NESST is expected to directly support the creation of over 350 jobs and inject over £260 million into the North East economy over the next 30 years, playing a critical role in the government’s levelling-up agenda and immediately becoming a catalyst for the wider development of the UK space sector in the North East region.

Announced today during the UK Space Conference, the UK Space Agency has awarded £10 million to Northumbria University to support the development of NESST. In addition to this, Lockheed Martin committed a further £15 million investment in NESST to work with Northumbria’s experts on collaborative research, technology development, in-demand skills provision and STEM engagement activities over a 10-year period. 

Through this strategic agreement, Lockheed Martin will become the first anchor tenant in NESST, creating unprecedented links for UK companies to access the global space market.

In recognition of the University’s excellence in all aspects of space research, and the transformative impact of NESST on the North East region and beyond, Northumbria University confirmed it would match-fund the UK Space Agency and Lockheed Martin awards with a further £25 million, bringing the overall total investment in NESST to £50 million.

Located in the heart of Northumbria University's Newcastle city campus, NESST will be a new national space asset that brings together industry and academic to collaborate on internationally significant space research and technological developments.

NESST will put the UK at the forefront of research and innovation in areas including optical satellite communications, space weather and space-based energy, and will lead the way in providing specialist education and training to ensure the UK space sector has the highly skilled workers it needs in the future.

Lockheed Martin and Northumbria University first joined forces in 2022 to support the development of skills, research and technology in the space sector. Lockheed Martin has previously invested £630,000 into collaborations with the University on a number of trailblazing projects, including working together to create machine learning algorithms to detect and record nanojets, as well as joining forces to accelerate the use of space-based solar power. Its award of £15 million will be split evenly across capital equipment to be used in the centre and research and development work.

The UK Space Agency award to Northumbria was the largest of all the projects funded and the maximum amount that could be granted under the organisation’s new Space Clusters Infrastructure Fund (SCIF) - an initiative aimed at increasing the capability, capacity, and connectivity of the UK’s space research and development infrastructure - and is a clear sign of the UK Space Agency’s confidence in the University’s ambitions.

The University's Wynne Jones building, which overlooks Newcastle's central motorway, will be transformed into a prominent, iconic home for NESST. The building, which is due to re-open in 2025, will feature world-class laboratory, testing, teaching, collaboration and office spaces, and the surrounding public spaces will be extensively regenerated to create an attractive new environment.

A major stimulus to the thriving local space cluster ecosystem, NESST will be home to some of the University’s key existing partnerships with local, national and international organisations and will also be open to businesses of all sizes working in the space sector.

Northumbria University is one of the UK’s leading universities in solar and space physics, receiving a number of significant funding awards in recent months including £5 million from the UK Space Agency to take forward work to build a new laser-based satellite communications system and awards totalling £2.6 million from the Science and Technology Facilities Council to fund studies into the Sun’s activity and its impact on Earth and to create a new Centre for Doctoral Training in the field of data intensive science.

The flagship NESST development marks a further step-change for Northumbria’s reputation as one of the UK’s leading universities for research and teaching, following its success in the latest Research Excellence Framework and being named Times Higher Education’s University of the Year 2022.

Professor Andy Long, Vice-Chancellor and Chief Executive of Northumbria University, said: “This is a pivotal moment, not just for Northumbria University, but for the wider North East region and indeed, for the UK space sector as a whole.

“This catalytic funding from both the UK Space Agency and Lockheed Martin recognises the world-leading excellence in all aspects of space research at Northumbria University. Quite simply, NESST will be a game-changer for the whole of the North East, ensuring the region becomes a major hub for innovation in the global space economy.”

 

Nik Smith, Regional Director for UK and Europe, Lockheed Martin, said: “NESST is one part of Lockheed Martin’s investment plans for our space business in the UK and will provide early prototyping and test facilities for new capabilities that could eventually be manufactured onshore. It will also be a reskilling hub, providing the pipeline of talent we will need to deliver national and even global programmes. With this investment, Lockheed Martin is thrilled to further our collaboration with Northumbria University and the UK Space Agency, and be a part of such significant initiatives for the region and the entire UK space sector.”

 

Andrew Griffith MP, Minister of State at the Department for Science, Innovation and Technology, said: “Making Britain a space superpower means backing brilliant ideas up and down the land and harnessing the full potential of talent in our growing sector – from Dundee to Newcastle, Cornwall to Snowdonia. 

“By investing with the private sector in research and facilities across the UK, we are ensuring they become home to global industries that support the growth of our £17.5 billion space sector, create hundreds of new jobs and build dynamic businesses across the UK.” 

 

Dr Paul Bate, Chief Executive of the UK Space Agency, said: “Our space sector has been concentrated in London and the South East, but in recent years we’ve seen the emergence of vibrant clusters across the whole of the country and significant investments from world-leading companies such as Lockheed Martin. This is a fantastic opportunity for Northumbria University to further propel the UK to the forefront of world-class research and innovation with the North East Space Skills and Technology Centre (NESST), helping us lead the way in optical satellite communications, space weather and energy research, education and training.

“It’s a brilliant example of the potential of our thriving space sector across the length and breadth of the UK to develop innovative infrastructure that helps us deliver increasingly ambitious missions and capabilities. The Space Clusters Infrastructure Fund highlights the government’s commitment to space and will help deliver the goal set out in the National Space Strategy to build one of the most innovative and attractive space economies in the world, developing new skills and creating jobs.”

 

Cllr Nick Kemp, Leader of Newcastle City Council, said: “The North East Space Skills and Technology Centre is an incredibly exciting development for our city and the wider region.

“This is an opportunity to make Newcastle a major player in the UK space industry while providing a significant boost to the local economy and providing hundreds of new opportunities for people.

“We are very fortunate in Newcastle to have the world-leading academic institutions that we do, and securing the funding for this landmark project is an outstanding achievement for Northumbria University, and is testament to the excellence of the research it undertakes.

 

Colorectal cancer in sub-Saharan Africa: Lack of basic care is costing lives

Peer-Reviewed Publication

MARTIN-LUTHER-UNIVERSITÄT HALLE-WITTENBERG

Most people with colorectal cancer in sub-Saharan Africa receive no treatment or only inadequate treatment, despite the disease being potentially curable. The life expectancy of many of those affected can be significantly improved through simple measures. These were the findings of a new study published in JNCCN—Journal of the National Comprehensive Cancer Network. The study was conducted by University Medicine Halle along with the American Cancer Society and various international institutes. The team analyzed the data of 653 people diagnosed with colorectal cancer. In light of the rising number of cases and low survival rates in the region, the authors underscore the need to improve diagnosis and treatment options.

“Our study aimed at establishing the amount of basic care that colorectal cancer patients are receiving in sub-Saharan Africa and how impactful the treatment is in terms of survival rates,” explains Lucia Hämmerl, lead author of the new study and research associate in the Global Health working group at University Medicine Halle. Guidelines are used to make appropriate treatment decisions and options depend on the availability of personnel and the infrastructure and vary widely around the world. “Our focus was on harmonized colorectal cancer guidelines that take into account the circumstances in sub-Saharan Africa,” explains Hämmerl.

The study looked at 653 people who had been diagnosed with colorectal cancer. The data was taken from eleven population-based cancer registries. Additional medical information was available in 356 cases (55%). Of these, non-metastatic colorectal cancer (stage I-III) was documented in 262 people and metastatic colorectal cancer (stage IV) in 94 people. Only eight people (3%) with non-metastatic and potentially curable disease received guideline-compliant treatment; over half received treatment with deviations and more than a third received no treatment at all. This resulted in a mortality rate that was up to 3.5-times higher in the regions studied. “Most of the patients with incomplete medical records presumably did not receive adequate treatment and that was why no clinical data was collected. In the remaining patients, the survival rate was significantly higher when the treatment was guideline-concordant or slightly deviated from the guideline. However, this occurred in less than one in twenty cases, even though adequate basic care can be provided without high-tech or costly solutions,” says Hämmerl.

Inequalities were also found when the data was compared globally. This was done using the Human Development Index (HDI), which takes life expectancy, education and income into account. The mortality rate of colorectal cancer patients in countries with low HDI scores, such as Ethiopia, Mali and the Congo, is two thirds higher than in countries with medium HDI scores, like Namibia and Kenya. “We saw an alarming gap between the recommendations of the harmonized guidelines and the treatment that was actually being provided, especially in patients with potentially curable disease. In light of the aging population in sub-Saharan Africa and the rising incidence of colorectal cancer, a great deal of suffering could be avoided through simple measures. The necessary strategies are available,” explains Professor Eva Kantelhardt, co-author of the study and head of the Global Health working group at University Medicine Halle.

“It is crucial that surgeons in particular are trained to perform radical cancer surgery. German hospitals can contribute by working in partnership to train specialists from African countries. In the case of gynecological oncology, where a similar problem exists, many colleagues from Ethiopia have already received further surgical training at University Medicine Halle,” says the expert on global health. As part of the BMBF-funded NORA research network, the study will be repeated and compared with the previous data.

Study: Hämmerl L. et al. Treatment and Survival Among Patients With Colorectal Cancer in Sub-Saharan Africa: A Multicentric Population-Based Follow-Up Study. JNCCN—Journal of the National Comprehensive Cancer Network. (2023) doi: 10.6004/jnccn.2023.7041

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JOURNAL

Journal of the National Comprehensive Cancer Network

DOI

10.6004/jnccn.2023.7041 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Treatment and Survival Among Patients With Colorectal Cancer in Sub-Saharan Africa: A Multicentric Population-Based Follow-Up Study

 

Canadians’ feelings about the causes of obesity are often harmful to self-esteem, new Concordia study shows

Vida Forouhar’s research reveals that negative thoughts about body weight are found among Canadians of all sizes

Peer-Reviewed Publication

CONCORDIA UNIVERSITY

 

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VIDA FOROUHAR: “THIS STUDY LOOKS AT HOW THE AVERAGE PERSON IN CANADA VIEWS NOT ONLY OBESITY AND PEOPLE WITH OBESITY, BUT ALSO THE VIEWS THEY HAVE ABOUT THEMSELVES WHEN THEY ARE SELF-DIRECTED.”

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CREDIT: VIDA FOROUHAR

The causes behind weight gain and obesity are complex, but many Canadians still hold negative attitudes and beliefs towards individuals who live with overweight and obesity.

Those attitudes are often held by people living with overweight and obesity themselves. These individuals have often internalized those feelings and blame their own behaviour for their size — an experience called weight bias internalization (WBI).

According to a new Concordia-led study, these feelings are present in individuals across the weight spectrum. However, they are more pronounced in people with higher body mass index (BMI) scores. And females are more likely to report WBI than males.

Writing in the journal BMC Public Health, the authors note that “44 percent of Canadians believe behavioural causes are very or extremely important in causing obesity, 38% for environmental causes, 28% for physiological and 27% for psychosocial causes.”

Those individuals who are more likely to believe in behavioural causes were also more likely to hold negative attitudes towards people with overweight or obesity. These negative attitudes are a concept known as explicit weight bias.

“This study looks at how the average person in Canada views not only obesity and people with obesity, but also the views they have about themselves when they view themselves negatively,” says lead author Vida Forouhar (MSc 22).

“Looking at this from a public health perspective helps us to better understand these attitudes to inform advocacy initiatives and weight bias reduction interventions.”

Internal and external biases

The researchers used data that was previously collected from a 2018 study. The study involved 942 demographically representative English-speaking Canadian adults who completed questionnaires about attitudes towards weight-related issues.

Their secondary analysis looked at answers from three specific questionnaires that measured respondents’ internalization of negative attitudes about weight, their beliefs about the different causes of obesity and their explicit weight bias.

Among their findings, the researchers noted that internalization of WBI — the extent to which a person self-stigmatizes their own weight and applies negative attitudes towards themselves — was present in every BMI category (normal/underweight, overweight, obesity).

High WBI rates were reported in 20 percent of those who were normal/underweight, in 29 percent who were overweight and in 51 percent in the group of people who had obesity.

Respondents most commonly endorsed overeating as a cause of obesity (71 percent of the sample), followed by physical inactivity (67 percent) and high fat diets (59 percent) — all behavioural causes.

Among the least endorsed were endocrine disorders (35 percent), repeated dieting (38 percent) and metabolic factors (41 percent), which are physiological and psychosocial causes.

Beliefs in behavioural causes of obesity were directly associated with explicit weight bias, while beliefs in physiological and psychosocial causes were negatively associated.

“You tend to have more negative attitudes towards people with obesity if you really believe that obesity is mostly a behavioural issue,” Forouhar says.

Forouhar works as a research coordinator in the Montreal Interdisciplinary Laboratory on Obesity and Health. Her co-author Angela Alberga, an associate professor and research chair in the Department of Health, Kinesiology and Applied Physiology, is the lab’s director.

She adds that WBI has been linked to increased symptoms of depression, anxiety, psychological distress, eating disorders and exercise avoidance in many other studies.

“Our study reflects that weight bias is prevalent everywhere and among everyone, regardless of body shape and size,” she says.

“It does not only affect people with obesity. We should be addressing weight bias more systematically rather than simply from a clinical perspective.”

Iyoma Y. Edache (Concordia MSc 2019 alumna and current PhD student at the University of British Columbia) and Ximena Ramos Salas of Replica Communications also contributed to this study.

Les Fonds de Recherche du Québec-Santé provided funding.

Read the cited paper: “Weight bias internalization and beliefs about the causes of obesity among the Canadian public.”

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JOURNAL

BMC Public Health

DOI

10.1186/s12889-023-16454-5 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Weight bias internalization and beliefs about the causes of obesity among the Canadian public

COI STATEMENT

VF, IYE, and ASA authors declare that they have no competing interests. XRS is an independent research consultant. She owns a private research consulting agency in Sweden. XRS provides research consulting services to Obesity Canada, the European Association for the Study of Obesity, and the World Health Organization.

 

A new diagnostic tool to identify and treat pathological social withdrawal, Hikikomori

Researchers develop the Hikikomori Diagnostic Evaluation, or HiDE, as a diagnostic tool to better identify the pathology of extended social withdrawal, known as Hikikomori

Peer-Reviewed Publication

KYUSHU UNIVERSITY

 

IMAGE: 

HIKIKOMORI WAS FIRST RECOGNIZED IN JAPAN IN 1998. IT IS A PATHOLOGY CHARACTERIZED BY SUSTAINED PHYSICAL ISOLATION OR SOCIAL WITHDRAWAL FOR A PERIOD EXCEEDING SIX MONTHS, AND WHILE INITIALLY CONSIDERED A CULTURE-BOUND SYNDROME, RECENT EVIDENCE HAS SHOWN A MARKED GROWTH OF IT WORLDWIDE.

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CREDIT: KYUSHU UNIVERSITY/KATO LAB

Fukuoka, Japan—Researchers at Kyushu University have developed a new tool to help clinicians and researchers assess individuals for pathological social withdrawal, known as Hikikomori. The tool, called Hikikomori Diagnostic Evaluation, or HiDE, can be a practical guide on collecting information on this globally growing pathology.

Hikikomori is a condition characterized by sustained physical isolation or social withdrawal for a period exceeding six months. It was first defined in Japan in 1998, and while thought to be a Japan specific ‘culture-bound’ syndrome, recent evidence has shown a marked growth of it worldwide. Researchers and medical professionals also fear that the recent COVID-19 pandemic has compounded the increase of hikikomori patients across the globe.

However, there is yet to be a standardized tool to identify the hikikomori pathology. The new HiDE assessment tool, developed by Associate Professor Takahiro A. Kato of the Graduate School of Medical Sciences published in World Psychiatry, is intended to be the next step in a transcultural tool to help identify and assess hikikomori individuals.

In 2013, the Kyushu University hospital established the world's first outpatient clinic for hikikomori in the hopes to research the pathology and find better methods of treatment. Over the years, Kato and his team have developed different methods for early detection of hikikomori and has even been investigating possible biomarkers of the pathology.

"HiDE is a questionnaire we've been developing at our clinic at the University Hospital. We've refined it over the years, and today it takes roughly 5-20 minutes to complete depending on the answers," explains Kato. "It's primarily divided into two sections. The first section looks at the features of the patient's behavior to see if they exhibit hikikomori. The second section is used to help us gain context to the patient’s extent of social withdrawal."

The team has also added a screening form to the HiDE in case clinicians lack the time to administer the entire tool. They suggest that the full questionnaire be administered to patients who respond that they 'spend one hour or less per day out of their home, at least three days a week' and that 'their family, others, or are personally bothered by this.'

"The HiDE has proven to be an indispensable tool for the structured assessment of pathological social withdrawal in our clinical practice and research. But more empirical studies must be done to assess its validity beyond our practice," concludes Kato. "We would like to see this used by our colleagues around the world, so we can work to refine the tool. Hikikomori is becoming a global phenomenon, and a collective effort in recognizing and treating hikikomori is going to be vital."

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For more information about this research, see "The Hikikomori Diagnostic Evaluation (HiDE): a proposal for a structured assessment of pathological social withdrawal," Alan R. Teo, Kazumasa Horie, Keita Kurahara, and Takahiro A. Kato World Psychiatry, https://doi.org/10.1002/wps.21123

About Kyushu University 
Kyushu University is one of Japan's leading research-oriented institutes of higher education since its founding in 1911. Home to around 19,000 students and 8,000 faculty and staff, Kyushu U's world-class research centers cover a wide range of study areas and research fields, from the humanities and arts to engineering and medical sciences. Its multiple campuses—including one of the largest in Japan—are located around Fukuoka City, a coastal metropolis on the southwestern Japanese island of Kyushu that is frequently ranked among the world's most livable cities and historically known as Japan's gateway to Asia. Through its Vision 2030, Kyushu U will 'Drive Social Change with Integrative Knowledge.' Its synergistic application of knowledge will encompass all of academia and solve issues in society while innovating new systems for a better future.

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JOURNAL

World Psychiatry

DOI

10.1002/wps.21123 

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

The Hikikomori Diagnostic Evaluation (HiDE): a proposal for a structured assessment of pathological social withdrawal