‘Maintain Asian forest diversity to avoid climate change impact’

Study shows SE Asian forests resisted ‘savannisation’ in Last Glacial Maximum

Peer-Reviewed Publication

UNIVERSITY OF SYDNEY

 

IMAGE: 

OUR RESEARCH SUGGESTS THAT MOSAICS OF OPEN (ALTERNATE IMAGE) AND CLOSED (THIS IMAGE) SEASONALLY DRY TROPICAL FOREST EXPANDED ACROSS TROPICAL ASIA’S LOWLANDS DURING THE LAST GLACIAL MAXIMUM. THESE FORESTS COULD BE CRITICAL FOR SUPPORTING THE RESILIENCE OF ASIA’S RAINFORESTS TO FUTURE CLIMATE CHANGE IN THE REGION.

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CREDIT: DR REBECCA HAMILTON/THE UNIVERSITY OF SYDNEY

A team of international scientists led by Dr Rebecca Hamilton at the University of Sydney has found that rather than dry savannah in South East Asia dominating during the Last Glacial Maximum more than 19,000 years ago, there was a mosaic of diverse closed and open forest types, upending previous scientific consensus.

The findings suggest Asia’s tropical forests could be more resilient to climate change than previously thought, provided a diversity of landscape is maintained. They further show that humans and animals migrating across the region would have had a more diverse resource base than previously understood.

The research is published in the Proceedings of the National Academy of Sciences of the United States of America.

Dr Hamilton, from the School of Geosciences at the University of Sydney, said that with climate change accelerating, scientists and ecologists have been concerned about what impact this will have on tropical rainforests in regions like South East Asia.

“Maintaining forest types that facilitate resilience should be a conservation objective for the region. Our work suggests that prioritising protection of forests above 1000 metres (‘montane forest’) alongside seasonally dry forest types could be important for preventing future ‘savannisation’ of Asia’s rainforests,” she said.

Savannisation refers to the metamorphosis of a landscape, typically a forested area, into a savannah ecosystem, which typically involves open wooded plains. The change is typically induced by climate variations, human interventions or natural ecological dynamics.

The researchers analysed records from 59 paleoenvironmental sites across tropical SE Asia to test the so-called savannah model, which assumed a large, uniform grassland expanded across the region during the Last Glacial Maximum.

They found that records from pollen grains preserved in lakes show forests persisted during this period alongside an expansion of grasslands, indicated by other biochemical signatures.

Dr Hamilton said: “We put forward the idea that these seeming discrepancies can be reconciled if, during the cool and seasonal climate of the Last Glacial Maximum, montane forests (above 1000m) persisted and expanded in high-elevation regions, while lowlands experienced a shift to seasonally dry forests, which have a naturally grassy understorey.”

The team also included scientists from the Max Planck Institute of Geoanthropology in Jena, Germany; Flinders University; Purdue University in the USA; University of the Philippines; and the Australian National University.

Researchers said they expect the statistical methods developed to cross-compare the many paleoecological records will be useful for regional testing of other past ecological change.

Our research suggests that mosaics of open (this image) and closed (alternate image) seasonally dry tropical forest expanded across tropical Asia’s lowlands during the Last Glacial Maximum. These forests could be critical for supporting the resilience of Asia’s rainforests to future climate change in the region.

CREDIT

Dr Rebecca Hamilton/The University of Sydney

DOWNLOAD a photo of Dr Rebecca Hamilton and a copy of the paper at this link.

INTERVIEWS

Dr Rebecca Hamilton | rebecca.hamilton@sydney.edu.au | +61 420 843 242
School of Geosciences, The University of Sydney

DECLARATION

The authors declare no conflicts of interest. Research was funded by the European Research Council; the Max Planck Society; the Australian Research Council.

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JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2311280120 

METHOD OF RESEARCH

Experimental study

ARTICLE TITLE

Forest mosaics, not savanna corridors, dominated in Southeast Asia during the Last Glacial Maximum

ARTICLE PUBLICATION DATE

25-Dec-2023

COI STATEMENT

The authors declare no conflicts of interest. Research was funded by the European Research Council; the Max Planck Society; the Australian Research Council.

American College of Physicians says barriers to participating in the electoral process must be removed

Peer-Reviewed Publication

AMERICAN COLLEGE OF PHYSICIANS

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.  
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1. ACP says barriers to participating in the electoral process must be removed

Full text: https://www.acpjournals.org/doi/10.7326/M23-2293

Voting in U.S. elections and health are directly connected and ensuring equitable access to the electoral process would advance health equity, says the American College of Physicians (ACP) in a new policy brief published today in the Annals of Internal Medicine. In the paper, ACP makes recommendations about what needs to be done to inform physicians, medical students, and other health care professionals on the links between electoral processes and health, encourage civic participation, and offers policy recommendations to support safe and equitable access to electoral participation to advance health equity for both patients and health care professionals.

Low voter turnout rates and inequitable electoral structures, such as gerrymandered districts, can skew policy decisions toward the preferences of a smaller group and further exclude individuals and communities who have been historically marginalized and excluded from decision making processes. Civic participation connects individuals to their community and empowers them with agency in decision making.

The paper states that ACP recognizes that voting impacts health and health care and supports policies that ensure safe and equitable access to voting, opposing the institution of barriers to both the process of voter registration and the act of casting a vote.

Additionally, ACP supports the drawing of fair, representative, and non-partisan electoral districts and recognizes that partisan gerrymandering may exacerbate health inequities through the disenfranchisement of vulnerable communities and supports efforts to end the practice of partisan gerrymandering.

ACP encourages medical students, residents, physicians, and other health care professionals to vote, supports efforts to eliminate barriers to their participation in the electoral process, and encourages non-partisan health care-sponsored voter engagement as a strategy to increase health equity for patients and health care professionals.

   

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2. ACP Underscores the Importance of Physician-Led Team-Based Care in New Policy

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2260

URL goes live when the embargo lifts   

Team-based care is associated with better patient outcomes and lower burnout for physicians, but despite these benefits barriers remain to its adoption, says the American College of Physicians (ACP) in a new policy paper. In the paper, ACP makes recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams. The policy is published in Annals of Internal Medicine.

 

ACP recommends that physicians should be the primary leaders for health care professionals working together in a multidisciplinary team-based care model. Physicians have extensive education, skills, and training that make them most qualified to exercise advanced clinical responsibilities within teams and they are not interchangeable with other health care professionals. The paper goes on to recommend that clinical and coordination responsibilities within the team be determined based on what is in the best interest of the patient, with patients being made aware of the unique qualifications of all of the team members.

 

The paper affirms that the purpose of licensure must be to ensure public health and safety; and state licensing bodies need to recognize the different skills, training, clinical experience, and demonstrated competencies of health care professionals and should only allow the independent practice of medicine to be performed by physicians.  Lastly, the paper states that in order to promote team-based care, payment and delivery models need to be redesigned and continued research must be done to achieve the best outcomes for patients.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.

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3. Black internal medicine residents continue to face knowledge assessment bias

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1588  

Editorial: https://www.acpjournals.org/doi/10.7326/M23-3141

URL goes live when the embargo lifts   

U.S.-born Black residents in internal medicine programs continue to face knowledge assessment bias according to an analysis published in Annals of Internal Medicine. Black residents were rated lower on performance assessments by their residency program leadership before and after adoption of the Milestone rating system, an assessment tool developed in 2014 to address deficiency in the previous ratings system. After implementation of Milestone, biases against all underrepresented groups and Asian residents were reduced. Despite this decline, substantial bias persisted for US-born Black residents and US-born Asian residents in terms of receiving a top score.

 

In 2014, the Accreditation Council for Graduate Medical Education, in collaboration with the American Board of Internal Medicine (ABIM), replaced the Resident Annual Evaluation Summary (RAES) rating system with the Milestone rating system to address several shortcomings in existing residency assessment and feedback methods. Although past research indicates that these types of changes have the potential to reduce evaluation bias, studies examining changes in bias across rating systems are sparse.

 

Researchers from ABIM compared evaluation medical knowledge ratings for 59,835 U.S.-born and non-U.S.-born Black, Latino, and Asian internal medicine residents during the pre-Milestone (2008 to 2013) and post-Milestone (2015 to 2020) periods, using U.S.-born non-Latino White residents as the comparison group. The authors found that controlling for initial ABIM certification exam score, a standardized and blinded, unbiased measure of knowledge ratings biases against these minoritized groups were large and decreased significantly for both U.S.-born and non-U.S.-born Asian and Latino residents. However, this decrease was much less substantial for U.S.-born Black residents where substantial bias persisted. The authors state that this finding is particularly concerning given the already low representation of Black residents in clinical care and the history of bias against Black Americans. They also point out that, only 6 percent of the residents identified as Black, and 34 percent of Black residents were U.S.-born in contrast to 90 percent of the U.S. Black population being born domestically.

 

In an accompanying editorial, authors from the George Washington University School of Medicine and Health Sciences suggest that the current study is an important step in unraveling and combating the persistent nature of bias in the evaluation of internal medicine residents of color. Considering the study findings, specialty societies should continue to raise awareness of the potential for bias in resident evaluations and provide training and tools, and training programs should ensure that trainees are assessed with intentionally designed systems that provide accurate, competency-based information and behavior-based narratives based on observations from multiple trained assessors.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Bradley M. Gray, PhD, please contact John Held at JHeld@ABIM.ORG.

 

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JOURNAL

Annals of Internal Medicine

DOI

10.7326/M23-2293 

METHOD OF RESEARCH

News article

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Ensuring Equitable Access to Participation in the Electoral Process: A Policy Brief From the American College of Physicians

ARTICLE PUBLICATION DATE

26-Dec-2023

Quality of care declines after 

private equity takes over hospitals

Patient falls, infections, other measures of safety worsen after buyouts

Peer-Reviewed Publication

HARVARD MEDICAL SCHOOL

At a glance:

• National study of quality of care in hospitals acquired by private equity shows worsening of fall and infection risk, other measures of quality and safety.

• Some post-procedure adverse events increased even though private equity hospitals performed fewer procedures among younger and less disadvantaged patients.

• The new findings amplify existing economic concerns about the growth of this for-profit ownership model.

Patients are more likely to fall, get new infections, or experience other forms of harm during their stay in a hospital after it is acquired by a private equity firm, according to a new study led by researchers at Harvard Medical School.

The research, published Dec. 26 in JAMA, is among a handful of recent nationwide analyses of how private equity takeovers affect the quality of patient care in hospitals. The increases are seen in conditions or outcomes deemed preventable and are key measures of hospital safety and quality.

The findings come amid growing concerns about private equity’s increasing role in U.S. health care, with $1 trillion invested in the past decade.

“We had previously found that private equity acquisitions led to higher charges, prices, and societal spending,” said Zirui Song, associate professor of health care policy and medicine in the Blavatnik Institute and director of research in the Center for Primary Care at HMS. “Now, we’re learning that there are also downstream concerns for the clinical quality of care delivered to hospital patients.”

The researchers said the findings are alarming because they may reflect bottom-line incentives overshadowing patient care and safety.

“Hospital success is measured not only in dollars or the number of patients who pass through the doors, but also in lives saved, complication rates, patient satisfaction, and a number of other quality and safety metrics,” said HMS research fellow Sneha Kannan, a physician in the Division of Pulmonary and Critical Care at Massachusetts General Hospital. “We need to make sure we fully understand the costs and benefits of this prominent new force in health care.”

The economic repercussions of private equity acquisitions are not a new concern. Previous studies by Song and co-author Joseph Dov Bruch of the University of Chicago indicate that this high-debt, for-profit financial model of hospital ownership may also lead to increased spending and other economic implications. Many have expressed concerns about hospital bankruptcies under private equity ownership that often leave underserved populations with limited access to care. But up until now, the effects of private equity deals on patient health and quality of care have remained understudied and poorly understood.

Why private equity is different

“When health systems buy hospitals, they generally do not use borrowed money,” said Song, who is also an internal medicine physician at Mass General. “In contrast, the classic private equity buyout uses a small amount of cash, but a large amount of debt.”

A private equity firm raises some capital from investors and borrows the rest, putting debt on the acquired hospital with its physical assets, such as land and buildings, as collateral for the loan. The acquired hospital must then generate revenue to pay down that debt.

Private equity generates revenue by charging management fees to its investors — commonly, pension funds, endowments, and other institutions or individuals — as well as by focusing on high-revenue procedures, cost-cutting, reorganization, and financial engineering. One argument in favor of private equity investments is that many struggling hospitals need capital and management expertise. However, most private equity buyouts are of successful operations. Private equity firms want to buy going concerns that are able to take on debt and generate revenue in the short run. These financial pressures can create perverse incentives favoring profit over patients, the researchers say.

Private equity and quality of care

For this study, the researchers examined insurance claims data for all fee-for-service Medicare hospitalizations from 2009 to 2019, totaling more than 600,000 hospitalizations at 51 private equity hospitals and more than 4 million hospitalizations at 259 similar hospitals not acquired by private equity. The hospitals not acquired by private equity served as the control group to control for other factors that may have affected outcomes.

The researchers compared how often patients experienced certain outcomes before and after the hospital was acquired by private equity. For example, they looked at how often patients fell while in the hospital or how often they developed an infection after a procedure or a surgery. The team also analyzed the makeup of the patient populations and various other outcomes such as  how often patients died, how long they stayed at the hospital, and how often they ended up readmitted after leaving the hospital.

After a hospital was acquired by private equity, admitted Medicare patients had a 25 percent increase in hospital-acquired complications, compared with patients admitted before acquisition. Patients also had 27 percent more falls and 38 percent more bloodstream infections caused by central lines, which are temporary surgically inserted ports that allow easy intravenous access for patients receiving repeated drug infusions or other treatments.

The increase was seen despite private equity hospitals’ placing 16 percent fewer central lines than before the buyout. All of these results were calculated while taking into account changes, trends, and patterns over the same period of time at peer hospitals not owned by private equity to isolate the differences that were due to the change in ownership.

Curiously, the study found a small drop in hospital deaths at private equity hospitals. This, the researchers said, may be due to social and demographic factors — private equity patients were younger and less disadvantaged than those at peer hospitals not owned by private equity. It may also be due to patients getting transferred more often out of private equity hospitals. When the researchers followed patients longer after discharge, the small decrease in deaths dissipated within a month after leaving the hospital.

Framework for policy solutions

Policymakers, insurance companies, and public sector bodies have grown increasingly concerned about protecting patients and societal resources from the effects of private equity transactions.

Earlier this year, Song and Christopher Cai, a HMS clinical fellow in medicine at Brigham and Women’s Hospital, outlined such a policy framework in a JAMA viewpoint article, which included regulating fraud and abuse, increasing antitrust oversight, reducing moral hazard (such as by lowering the debt used in acquisitions), protecting against inflated prices, and transparency in reporting of private equity acquisitions.

Currently, only private equity acquisitions over $111.4 million must be reported. This threshold may capture many hospital acquisitions but leaves out most acquisitions of physician practices.

“Private equity firms have historically operated in the shadows in health care,” Kannan said. “Going forward, it’s important to lift the veil and increase transparency.”

And both researchers and policymakers should be rigorous in their efforts to understand how private equity changes health care operations and the downstream consequences, the authors cautioned.

“Patients and providers, investors and taxpayers, employers and insurers, all have a stake in this,” Song said. “Understanding what the corporatization of health care delivery means is a goal shared by many across society.”

Authorship, funding, disclosures

The current work was supported by a grant from the National Heart, Lung, and Blood Institute (T32HL15502-03). It was also supported by grants from the National Institute on Aging (3P01AG032952-14S1) and Arnold Ventures (20-04402).

 

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JOURNAL

JAMA

DOI

10.1001/jama.2023.23147 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Changes in Hospital Adverse Events and Patient Outcomes Associated with Private Equity Acquisition

ARTICLE PUBLICATION DATE

26-Dec-2023

Virtual care works best when patients see their own family doctor, study finds

Peer-Reviewed Publication

INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES

 

IMAGE: 

KEY INSIGHTS

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CREDIT: UNIVERSITY HEALTH NETWORK (UHN)

Toronto, ON, December 27, 2023 – Compared to patients who had a virtual visit with their own family doctor, those who received virtual care from a doctor outside of their family care team were 66 percent more likely to visit the emergency department within seven days, according to new research.

The study, led by researchers at the University Health Network (UHN), Unity Health Toronto, and ICES, also showed that patients receiving virtual care outside of an existing family doctor-patient relationship were 25 percent more likely to have an in-person visit and 88 percent more likely to have another virtual visit within seven days.

“This study sheds light on how different types of virtual care impact downstream healthcare use—our findings show that the relationship between a patient and their virtual care doctor makes a difference,” says lead author Dr. Lauren Lapointe-Shaw, Adjunct Scientist with ICES, General Internal Medicine physician, and Scientist at UHN, and Innovation Fellow at the Women’s College Hospital Institute for Health System Solutions and Virtual Care.

"Within an existing and ongoing relationship with a physician, patients are less likely to go elsewhere for further care," adds Dr. Lapointe-Shaw.

Published in the journal JAMA Network Open, the study included over 5 million Ontario residents who had a family doctor and had a virtual visit between April 2021 and March 2022, and methods were used to match 4.1 million patients whose virtual visit was with their own physician, and 1 million patients whose visit was with an outside physician.

In a secondary analysis, the researchers found that patients using “direct-to-consumer" telemedicine clinics were three times more likely to visit the emergency department within seven days, compared to patients seeing their own family doctor. “Direct-to-consumer" clinics are virtual-only walk-in clinics, and they offer on-demand virtual care without an in-person exam.  

More than 6.5 million people in Canada don’t have a family physician, and virtual care is believed to be an important access point for patients.

“Virtual care done right can improve timely access to care—both for people who do and don’t have a family doctor,” says co-author Dr. Tara Kiran, Adjunct Scientist at ICES and a family physician at St. Michael’s Hospital of Unity Health Toronto. “But if it’s not integrated with in-person care, or delivered by someone who has access to your health history, there is a risk that we’re adding more churn to the system.”

The data used for this study cannot tell us why patients with their own family doctor chose to have a virtual visit with an outside physician. This decision could relate to access challenges, convenience, or other factors, and further research is warranted. 

Nonetheless, these findings support the use of primary care virtual services within an existing physician-patient relationship.

The study, “Virtual visits with own family physician versus an outside family physician and emergency department use” was published in JAMA Network Open.

Authors: Lapointe-Shaw L, Salahub C, Bird C, Bhatia RS, Desveaux L, Glazier RH, Hedden L, Ivers NM, Martin D, Na Y, Spithoff S, Tadrous M, Kiran T.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on X, formerly known as Twitter: @ICESOntario

About University Health Network

University Health Network consists of Toronto General and Toronto Western Hospitals, the Princess Margaret Cancer Centre, Toronto Rehabilitation Institute, and The Michener Institute of Education at UHN. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, arthritis, vision, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto. For more information: www.uhn.ca

About St. Michael's

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.

FOR FURTHER INFORMATION PLEASE CONTACT:

From December 21-22 and December 27:
Catherine Danko
Public Affairs Associate, UHN
647-408-5617
Catherine.Danko@uhn.ca

From December 23-26:

Dr. Lauren Lapointe-Shaw
Lead author on the study
Lauren.Lapointe-Shaw@uhn.ca

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2023.49452 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use

ARTICLE PUBLICATION DATE

27-Dec-2023

 JAMA NETWORK

Comparison of capture rates of the National Cancer Database across race and ethnicity

JAMA Network Open

Peer-Reviewed Publication

About The Study: In this study of individuals diagnosed with cancer in the National Cancer Database (NCDB), Hispanic and American Indian or Alaska Native individuals diagnosed with breast, colorectal, lung, and prostate cancer were undercaptured in the NCDB, but their representation improved over time. Increased study is needed to determine where these populations predominantly seek cancer care. 

Authors: Juan Javier-DesLoges, M.D., M.S., of the University of California, San Diego, is the corresponding author. 

doi:10.1001/jamanetworkopen.2023.50237

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

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http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.50237?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=122723

Low-carbohydrate diet macronutrient quality and weight change

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: In this study using data from three large prospective cohort studies among 123,000 individuals, low-carbohydrate diets that emphasized high-quality proteins, fats and carbohydrates from whole grains and other healthy plant-based foods were significantly associated with slower weight gain in the long term. In contrast, low-carbohydrate diets emphasizing animal-sourced proteins and fats or refined carbohydrates were associated with faster weight gain.

Authors: Qi Sun, M.D., Sc.D., of the Harvard T.H. Chan School of Public Health in Boston, is the corresponding author. 

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamanetworkopen.2023.49552)

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

#  #  #

Embed this link to provide your readers free access to the full-text article 

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Consistency and accuracy of AI for providing nutritional information

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: The results of this study suggest that artificial intelligence (AI) can be a useful and convenient tool for people who want to know the energy and macronutrient information of their foods. Although AI chatbots cannot replace nutritionists, they may provide real-time analysis of foods, and the capacity to harness AI technology in a supportive role may fundamentally transform the way nutritionists communicate with patients. 

Authors: Jung-Su Chang, Ph.D., of Taipei Medical University in Taipei, Taiwan, is the corresponding author. 

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamanetworkopen.2023.50367)

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

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

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JOURNAL

JAMA Network Open

 

Benzodiazepine use during pregnancy and risk of miscarriage

JAMA Psychiatry

Peer-Reviewed Publication

JAMA NETWORK

About The Study: This nationwide case-time-control study revealed an increased risk of miscarriage associated with benzodiazepine use during pregnancy after accounting for measurable confounders, and results were unlikely to be due to unmeasured confounding. These findings underscore the necessity for health care professionals to meticulously balance the risk-benefit ratio when considering the use of benzodiazepines to treat psychiatric and sleep disorders during pregnancy. 

Authors: Fei-Yuan Hsiao, Ph.D., of National Taiwan University in Taipei, Taiwan, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(10.1001/jamapsychiatry.2023.4912)

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

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JOURNAL

JAMA Psychiatry

 

Risk of young-onset dementia could be reduced through targeting health and lifestyle factors - study

Researchers have identified a wide range of risk factors for young-onset dementia. The findings challenge the notion that genetics are the sole cause of the condition, laying the groundwork for new prevention strategies.

Peer-Reviewed Publication

UNIVERSITY OF EXETER

December 21 Peer reviewed /observational study / in people*

Researchers have identified a wide range of risk factors for young-onset dementia. The findings challenge the notion that genetics are the sole cause of the condition, laying the groundwork for new prevention strategies.

The largescale study identified 15 risk factors, which are similar to those for late-onset dementia. For the first time, they indicate that it may be possible to reduce the risk of young-onset dementia by targeting health and lifestyle factors.

Relatively little research has been done on young-onset dementia, though globally there are around 370,000 new cases of young-onset dementia each year.

Published in JAMA Neurology, the new research by the University of Exeter and Maastricht University followed more than 350,000 participants younger than 65 across the United Kingdom from the UK Biobank study. The team evaluated a broad array of risk factors ranging from genetic predispositions to lifestyle and environmental influences. The study revealed that lower formal education, lower socioeconomic status, genetic variation, lifestyle factors such as alcohol use disorder and social isolation, and health issues including vitamin D deficiency, depression, stroke, hearing impairment and heart disease significantly elevate risk of young-onset dementia

Professor David Llewellyn of the University of Exeter emphasized the importance of the findings: "This breakthrough study illustrates the crucial role of international collaboration and big data in advancing our understanding of dementia. There's still much to learn in our ongoing mission to prevent, identify, and treat dementia in all its forms in a more targeted way. This is the largest and most robust study of its kind ever conducted. Excitingly, for the first time it reveals that we may be able to take action to reduce risk of this debilitating condition, through targeting a range of different factors.

Dr Stevie Hendriks, Researcher at Maastricht University, said: “Young-onset dementia has a very serious impact, because the people affected usually still have a job, children, and a busy life. The cause is often assumed to be genetic, but for many people we don’t actually know exactly what the cause is. This is why we also wanted to investigate other risk factors in this study.”

Sebastian Köhler, Professor of Neuroepidemiology at Maastricht University, said: “We already knew from research on people who develop dementia at older age that there are a series of modifiable risk factors. In addition to physical factors, mental health also plays an important role, including avoiding chronic stress, loneliness and depression. The fact that this is also evident in young-onset dementia came as a surprise to me, and it may offer opportunities to reduce risk in this group too.”

The study's support was supported by Alzheimer’s Research UK, The Alan Turing Institute/Engineering and Physical Sciences Research Council, Alzheimer Nederland, Gieskes Strijbis Fonds, the Medical Research Council, the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South West Peninsula (PenARC), the National Health and Medical Research Council, the National Institute on Aging, and Alzheimer Netherlands.

Dr Janice Ranson, Senior Research Fellow at the University of Exeter, said: “Our research breaks new ground in identifying that the risk of young-onset dementia can be reduced. We think this could herald a new era in interventions to reduce new cases of this condition.”

 

Dr Leah Mursaleen, Head of Clinical Research at Alzheimer’s Research UK, which co-funded the study, said: “We’re witnessing a transformation in understanding of dementia risk and, potentially, how to reduce it on both an individual and societal level. In recent years, there’s been a growing consensus that dementia is linked to 12 specific modifiable risk factors such as smoking, blood pressure and hearing loss . It’s now accepted that up to four in 10 dementia cases worldwide are linked to these factors.

“This pioneering study shines important and much-needed light on factors that can influence the risk of young-onset dementia. This starts to fill in an important gap in our knowledge. It will be important to build on these findings in broader studies.’

The full study is entitled ‘Risk factors for young-onset dementia in the UK Biobank: A prospective population-based study’, published in JAMA Neurology.

ENDS

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JOURNAL

JAMA Neurology

DOI

10.1001/jamaneurol.2023.4929 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Risk Factors for Young-Onset Dementia in the UK Biobank

ARTICLE PUBLICATION DATE

26-Dec-2023