Head impacts and abnormal imaging findings in youth football players over consecutive seasons

JOURNAL OF NEUROSURGERY PUBLISHING GROUP

Research News

 

IMAGE: IMAGING DATA FROM TWO FOOTBALL ATHLETE SUBJECTS SHOWING A COMPARISON BETWEEN ABNORMAL VOXELS FROM THE SEASON WITH THE HIGHER 50TH PERCENTILE NUMBER OF IMPACTS PER PRACTICE SESSION AND ABNORMAL VOXELS FROM... view more 

CREDIT: COPYRIGHT 2021 AANS.

CHARLOTTESVILLE, VA (JUNE 15, 2021). In this longitudinal study, researchers from Wake Forest School of Medicine and the University of Texas Southwestern in Dallas, Texas, examined the frequency and severity of head impacts experienced by youth football players and how exposure to head impacts changes from one year to the next in returning players. The researchers then compared the resulting data with findings on neuroimaging studies obtained over consecutive years in the same athletes. The comparison demonstrated a significant positive association between changes in head impact exposure (HIE) metrics and changes in abnormal findings on brain imaging studies. Full details of this study can be found in the article "Analysis of longitudinal head impact exposure and white matter integrity in returning youth football players" by Mireille E. Kelley, PhD, and colleagues, published today in the Journal of Neurosurgery: Pediatrics.

Illustrating the considerable variability in head impacts among football players, Kelley et al. inform us that in one football season, youth football players (10-13 years of age) can sustain between 26 and 1003 head impacts, and high school players can sustain between 129 and 1258 head impacts. Fortunately, most of these impacts do not result in concussions. In fact, most of these subconcussive impacts do not produce any acute signs or symptoms attributed to concussions.

Nevertheless, there is concern that, over time, repetitive subconcussive impacts may cause damage to contact-sport athletes' brains. This is particularly of concern when we are speaking of young athletes, who have many years ahead of them in their sport and in their lives.

To examine changes in head impact exposure (HIE) from year to year, the researchers focused on a group of 47 athletes who participated in youth football for two or more consecutive years sometime between 2012 and 2017. The athletes played on a variety of teams. All wore football helmets outfitted with the Riddell Head Impact Telemetry System™, which measures linear and rotational head accelerations that occur during a head impact. The outfitted helmets were worn during all football sessions--both practices and games. Biomechanical data on head impacts were transmitted in real time via radio waves to a sideline data collection field unit for later analysis. Altogether, the data covered 109 football athlete-seasons with 41,148 head impacts. Despite the large number of head impacts, none of the 47 youth athletes sustained a clinically diagnosed concussion during the study period.

Kelley et al. examined a variety of HIE metrics: number of head impacts, 50th percentile of impacts per football session (game, practice, and both); 95th percentile peak linear and rotational accelerations measured by the Head Impact Telemetry System System™; and risk-weighted cumulative exposure, a metric summarizing the frequency and magnitude of head impacts experienced by the athlete over a single season. The researchers found that variations in HIE metrics differed from year to year and between athletes. For example, in an examination of data from three consecutive seasons, some youths experienced more impacts in their second year of play than in their first, while other youths experienced fewer impacts in later years of play.

Although trends in increasing mean number of game impacts, mean 50th percentile of impacts per football session, and mean 50th percentile of impacts per game session were identified over three seasons, the differences between the means were not statistically significant. The researchers did note "significant variability in several HIE metrics among teams," but this was not the focus of this study.

In 19 of the 47 youth football athletes, brain images were obtained pre- and post-season for two consecutive football seasons. This was done using diffusion tensor imaging (DTI), a type of magnetic resonance imaging that can be used to assess the integrity of the brain's white matter, indicating possible sites of injury. Using this technique, the researchers evaluated changes in the following scalar metrics: fractional anisotropy; mean diffusivity; and linear, planar, and spherical anisotropy coefficients.

A group of 16 youth athletes who participated in non-contact sports (for example, swimming, tennis, track) underwent DTI two times (baseline and follow-up studies, four months apart) and served as a control group. Abnormal white matter voxels (small three-dimensional areas) on youth football players' brain images were defined as voxels in which DTI scalar values increased or decreased throughout the football season significantly (two standard deviations above or below those of mean values in the control group).

Similar to the pattern of HIE, the researchers found "both increases and decreases in the number of abnormal voxels between season 1 and season 2" in the youth football athletes.

Linear regression analyses were performed to assess relationships between changes in HIE metrics and changes in DTI scalar metrics from one year to the next. There was a significant positive correlation between changes in the number of head impacts per practice session and every DTI scalar metric. In addition, significant positive correlations were determined between changes in both the 50th percentile impacts per practice sessions and the 50th percentile impacts per football sessions (including both practice and game sessions) and the various DTI scalar metrics.

In summary, the major findings of this longitudinal study include the following:

• HIE varied among individual athletes from one season to the next. Increases and decreases in HIE across three consecutive seasons in individual youth football players were observed; the changes were not significant from one season to the next.
• Trends in DTI imaging changes varied among individual athletes from one season to the next. Increases and decreases in the number of abnormal voxels on DTI from the first to second season were identified in individual players.
• The amount of HIE an athlete experienced in football, particularly in practice, was associated with the amount of change in neuroimaging metrics. Positive associations between changes in abnormal voxels on DTI and the number of head impacts per practice session, 50th percentile impacts per practice session, and 50th percentile impacts per session overall (including both practice and game sessions) between consecutive seasons (seasons 1 and 2) were found.

Because of the significant positive correlations between changes in HIE metrics and changes in the number of abnormal voxels on DTI between consecutive seasons, the authors support efforts to reduce the number and frequency of head impacts, particularly those occurring during practice sessions, when the majority of head impacts occur. They believe this action may reduce the number of abnormal imaging findings in youth football athletes from one football season to the next.

When asked about the findings of the study, Dr. Jillian Urban, Assistant Professor at Wake Forest School of Medicine, responded, "Our findings further support ongoing efforts to reduce the number of head impacts in football practices. In an upcoming study, we plan to engage stakeholders in the youth football community to develop and test practical solutions informed by the biomechanical data we collect on field to reduce head impacts in practice."

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Article: Kelley, ME, Urban JE, Jones DA, Davenport EM, Miller LE, Snively BM, Powers AK, Whitlow CT, Maldjian JA, Stitzel JD: Analysis of longitudinal head impact exposure and white matter integrity in returning youth football players. Journal of Neurosurgery: Pediatrics, published online, ahead of print, June 15, 2021; DOI: 10.3171/2021.1.PEDS20586.

Drs. Kelley, Urban, Jones, Miller, and Stitzel are affiliated with both Wake Forest School of Medicine and Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences in Winston-Salem, North Carolina. Drs. Snively, Powers, and Whitlow are affiliated with Wake Forest School of Medicine. Drs. Davenport and Maldjian are affiliated with the University of Texas Southwestern in Dallas, Texas.

Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Grant Support: Three grants from the National Institutes of Health, namely National Institute of Neurological Disorders and Stroke grants R01NS094410 and R01NS082453, and National Center for Advancing Translational Sciences grant KL2TR001421.

For additional information, please contact: Ms. Jo Ann M. Eliason, Communications Manager, Journal of Neurosurgery Publishing Group, One Morton Drive, Suite 200, Charlottesville, VA 22903. Email: joanneliason@thejns.org Phone: 434-982-1209

The Journal of Neurosurgery: Pediatrics is a monthly peer-reviewed journal focused on diseases and disorders of the central nervous system and spine in children. This journal contains a variety of articles, including descriptions of preclinical and clinical research as well as technical notes. The Journal of Neurosurgery: Pediatrics is one of six journals published by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons. Other peer-reviewed journals published by the JNS Publishing Group include the Journal of Neurosurgery, Journal of Neurosurgery: Spine, Neurosurgical Focus, Neurosurgical Focus: Video, and Case Lessons. All six journals can be accessed at http://www.thejns.org.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada, or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, and peripheral nerves. For more information, visit http://www.AANS.org.

Young adults' alcohol use increases when casually dating

WASHINGTON STATE UNIVERSITY

Research News

 

IMAGE: JENNIFER DUCKWORTH view more 

CREDIT: WASHINGTON STATE UNIVERSITY

When young adults are more interested in socializing and casually dating, they tend to drink more alcohol, according to a new paper led by a Washington State University professor.

On the other hand, scientists found that when young adults are in serious relationships, are not interested in dating or place less importance on friendship, their alcohol use was significantly lower.

Published June 15 in the journal Substance Use & Misuse, the study included more than 700 people in the Seattle area aged 18-25 who filled out surveys every month for two years. The study used a community sample that was not limited to college students.

"Young adults shift so much in terms of social relationships that having this monthly data really allowed us to hone in on nuances and see these changes in alcohol use depending on social situations," said Jennifer Duckworth, the lead author on the paper. "The idea is to understand whether young adults may be viewing alcohol as a way to facilitate relationships. They may think of alcohol as a way to make hanging out easier or more fun."

Being able to look at young adult behavior over a longer period allowed the research team to see how alcohol use was related to socializing and relationships.

"If a college student has mid-terms, they may have less interest in spending time with friends," said Duckworth, an assistant professor in WSU's Department of Human Development. "But if it's spring break, they may place more importance on those friendships. And when friendships become more important, we found alcohol use tends to be higher."

For relationships, Duckworth and her co-authors separated single young adults into two groups: casually dating and not interesting in dating. That distinction showed a significant difference in alcohol use. Since the survey tracked people every month, they could study changes as participants moved in and out of different relationship statuses.

"For instance, one month, someone may not be interested in dating and their alcohol use tended to be lower," Duckworth said. "Then, if they start dating, alcohol use tended to be higher."

Previous research has shown that young adults in relationships tend to drink less than single people, but those studies didn't separate the term single into two separate groups based on whether or not the young adults were interested in dating.

Young adults have more high-risk alcohol use than any other age group, she said. The overall goal of this research is to understand the context for greater alcohol use by young adults.

"Understanding what's going on in their lives across time is very useful if we want to mitigate high-risk use of alcohol," Duckworth said. "We can focus on interventions that help educate young adults on what is motivating their behaviors. We're bridging alcohol use with development research in a meaningful way that can really help people."

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The young adults in the study filled out confidential monthly online surveys and received a stipend at the end of the two-year study. That combination of confidentiality, financial incentive and ease of use led to a very high retention rate, Duckworth said.

Co-authors on the paper were principal investigator Christine M. Lee, Isaac Rhew, and Anne Fairlie at the University of Washington, Megan Patrick and John Schulenberg at the University of Michigan and Jennifer L. Maggs at Pennsylvania State University.

The National Institute on Alcohol Abuse and Alcoholism (R01AA022087) provided funding for the study.

Teenagers at greatest risk of self-harming could be identified almost a decade earlier

UNIVERSITY OF CAMBRIDGE

Research News

 

Researchers have identified two subgroups of adolescents who self-harm and have shown that it is possible to predict those individuals at greatest risk almost a decade before they begin self-harming.

The team, based at the MRC Cognition and Brain Sciences Unit, University of Cambridge, found that while sleep problems and low self-esteem were common risk factors, there were two distinct profiles of young people who self-harm - one with emotional and behavioural difficulties and a second group without those difficulties, but with different risk factors.

Between one in five and one in seven adolescents in England self-harms, for example by deliberately cutting themselves. While self-harm is a significant risk factor for subsequent suicide attempts, many do not intend suicide but face other harmful outcomes, including repeatedly self-harming, poor mental health, and risky behaviours like substance abuse. Despite its prevalence and lifelong consequences, there has been little progress in the accurate prediction of self-harm.

The Cambridge team identified adolescents who reported self-harm at age 14, from a nationally representative UK birth cohort of approximately 11,000 individuals. They then used a machine learning analysis to identify whether there were distinct profiles of young people who self-harm, with different emotional and behavioural characteristics. They used this information to identify risk factors from early and middle childhood. The results are published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Because the data tracked the participants over time, the researchers were able to distinguish factors that appear alongside reported self-harm behaviour, such as low self-esteem, from those that precede it, such as bullying.

The team identified two distinct subgroups among young people who self-harm, with significant risk factors present as early as age five, nearly a decade before they reported self-harming. While both groups were likely to experience sleep difficulties and low self-esteem reported at age 14, other risk factors differed between the two groups.

The first group showed a long history of poor mental health, as well as bullying before they self-harmed. Their caregivers were more likely to have mental health issues of their own.

For the second group, however, their self-harming behaviour was harder to predict early in childhood. One of the key signs was a greater willingness to take part in risk-taking behaviour, which is linked to impulsivity. Other research suggests these tendencies may predispose the individual towards spending less time to consider alternate coping methods and the consequences of self-harm. Factors related to their relationships with their peers were also important for this subgroup, including feeling less secure with friends and family at age 14 and a greater concern about the feelings of others as a risk factor at age 11.

Stepheni Uh, a Gates Cambridge Scholar and first author of the study, said: "Self-harm is a significant problem among adolescents, so it's vital that we understand the nuanced nature of self-harm, especially in terms of the different profiles of young people who self-harm and their potentially different risk factors.

"We found two distinct subgroups of young people who self-harm. The first was much as expected - young people who experience symptoms of depression and low self-esteem, face problems with their families and friends, and are bullied. The second, much larger group was much more surprising as they don't show the usual traits that are associated with those who self-harm."

The researchers say that their findings suggest that it may be possible to predict which individuals are most at risk of self-harm up to a decade ahead of time, providing a window to intervene.

Dr Duncan Astle said: "The current approach to supporting mental health in young people is to wait until problems escalate. Instead, we need a much better evidence base so we can identify who is at most risk of mental health difficulties in the future, and why. This offers us the opportunity to be proactive, and minimise difficulties before they start.

"Our results suggest that boosting younger children's self-esteem, making sure that schools implement anti-bullying measures, and providing advice on sleep training, could all help 

 

Teens experienced helplessness when exposed to secondhand racism

Activism might help

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

Research News

 

This past year has been transformational in terms of not only a global pandemic but a sustained focus on racism and systemic injustice. There has been a widespread circulation of images and videos in the news and online. Just like adults, adolescents are exposed to these images with important consequences for their emotional health and coping. However, few studies have sought to understand the influence of racism experienced online.

According to a qualitative study published in JAMA Network Open adolescents expressed feelings of helplessness when exposed to secondhand racism online. Specifically, adolescents described helplessness stemming from the pervasiveness of racism in our society. This was illustrated by quotes, such as "[racist events are] just another day in the life" referring to racism as a constant force and unmovable by saying, "there's nothing I can do." However, many adolescents emphasized activism as a way to cope with the vicarious racism they experience. One adolescent stated, "Yeah, and then sometimes my response is it's something I can do something about, like right now..." Further, participation in activism may help mitigate negative feelings.

Lead study author, Dr. Nia Heard-Garris, MD, MSc is a pediatrician and physician-investigator at the Ann & Robert H. Lurie Children's Hospital of Chicago and an Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. The study team conducted 4 focus groups of 18 adolescents across the Chicagoland area between November 2018-April 2019. Dr. Heard-Garris noted that teens felt that adults underestimated how much they witness discrimination around them. One adolescent said, "It's funny because a lot of people think that teenagers are not socially aware, but I think the friends I keep around me, once we start talking about something, it goes on and on and on and on..."

It is important to note that this study, that took place prior to the wave of racialized violence of Black Americans publicized in the summer of 2020, however, it emphasizes the need to study how adolescents respond to witnessing these events. Dr. Nia Heard-Garris states, "Investigating adolescents' exposure and response to racism online proves critical because of the negative changes in emotional state and potential adverse physical and mental health across the life course." The researchers of this study also highlight that "this study aligns with previous studies that demonstrate social cohesion or connectedness can buffer the negative influence racism has on health generally, and the benefits of activism may be because adolescents can connect to a larger social network to draw support and participate in collective action."

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Research at Ann & Robert H. Lurie Children's Hospital of Chicago is conducted through the Stanley Manne Children's Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children's is ranked as one of the nation's top children's hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 212,000 children from 49 states and 51 countries.

Original Investigation 

Public Health

June 15, 2021

Adolescents’ Experiences, Emotions, and Coping Strategies Associated With Exposure to Media-Based Vicarious Racism

Nia Heard-Garris, MD, MSc^1,2,3; Patricia O. Ekwueme, MD, MPH³; Shawnese Gilpin, MD, MPH⁴; et alKaitlyn Ann Sacotte, MD³; Leishla Perez-Cardona, MPHe²; Megan Wong, BA³; Alyssa Cohen, MD^1,3

Author Affiliations Article Information

JAMA Netw Open. 2021;4(6):e2113522. doi:10.1001/jamanetworkopen.2021.13522

Adolescents’ Experiences, Emotions, and Coping Strategies Associated With Exposure to Media-Based Vicarious Racism | Adolescent Medicine | JAMA Network Open | JAMA Network

Key Points

Question  How do adolescents respond to media-based vicarious racism, and do these responses affect adolescent emotional health and well-being?

Findings  This qualitative focus group–based study with 18 participants found that adolescents experienced helplessness after exposure to media-based vicarious racism and that activism was used as a positive coping strategy.

Meaning  The findings suggest that activism may serve as a powerful coping mechanism, potentially reducing negative emotions for adolescents exposed to media-based vicarious racism; thus, activism may have implications for improving mental health outcomes and advancing societal changes.

Abstract

Importance  Adolescents frequently encounter racism vicariously through online news and social media and may experience negative emotional responses due to these exposures. To mitigate potential adverse health impacts, including negative emotional health, it is important to understand how adolescents cope with these exposures.

Objectives  To examine adolescents’ responses to online and media-based vicarious racism exposure and to explore coping strategies, particularly positive coping strategies, that may be used to combat negative emotions.

Design, Setting, and Participants  This qualitative study rooted in phenomenological research methods conducted 4 semistructured focus groups, with 3 to 6 English-speaking adolescents (aged 13-19 years) in each group, between November 2018 and April 2019. Focus groups were facilitated by 2 research team members. The study was conducted at community sites and youth organizations in the greater Chicago, Illinois, area. Interview transcripts were analyzed thematically.

Exposures  Lived experiences of media-based vicarious racism.

Main Outcomes and Measures  Focus group participants shared their experiences with media-based vicarious racism online, including their responses to exposure and the coping strategies used.

Results  Four focus group sessions were conducted with a total of 18 adolescents. Participants had a mean (SD) age of 16.4 (1.6) years. Overall, 7 participants (39%) self-identified as Black/African American, 8 (44%) as Hispanic/Latinx, and 3 (17%) as White individuals; 7 (39%) were in grades 7 to 9, 8 (44%) in grades 10 to 12 grade, and 3 (17%) at the college or university level. Central themes emerged related to adolescents’ experiences, including their emotional and coping responses to media-based vicarious racism. Many participants reported helplessness as a major negative emotion associated with these exposures. Activism was endorsed as a key positive coping strategy that participants used, including online and in-person modalities.

Conclusions and Relevance  The findings from this qualitative study suggest adolescents may experience helplessness as a primary negative emotion after exposure to media-based vicarious racism and activism may serve as a coping mechanism. Activism may represent an important and constructive means by which adolescents cope with and combat structural racism, mitigate negative emotions, and potentially prevent adverse health effects.

Introduction

Racism is entrenched in US institutions, with well-documented impacts on physical and mental health and well-being, even if experienced secondhand.^1-4 Institutions such as health care, government, carceral systems as well as news and media are inextricable from the pervasive nature of racism. News and online platforms, such as social media, can be an important conduit for vicarious racism at the population level and may also affect health. Vicarious racism is the secondhand exposure to racism directed at another individual and occurs irrespective of the race of the unintended target; however, that unintended target or bystander must identify the event as racism.⁴ Recently, the disproportionate murders of members of racial/ethnic minority groups by police has been a type of structural vicarious racism within the public discourse and has been associated with negative repercussions for health.⁵

Adolescents consume news of racialized violence and other racially charged events that are disseminated through traditional and online media as well as social media outlets.⁶ Scholarship on media-based vicarious racism exposures is emerging, and qualitative studies have begun to describe negative emotions after media-based vicarious racism exposure in adolescents.^4,7,8 Given the ubiquity of these stories and ease of internet access, adolescents may have more exposure to structural racism experienced vicariously than previous contemporary periods. Thus, youth may have an increased need for positive coping mechanisms to mitigate adverse health outcomes from this exposure.

Although structural racism may require intervention at the societal level, adolescents may not have traditional access to positions of authority or policy making. However, in today’s technology-driven and highly interconnected world, adolescents may seek out unique strategies to prevent and cope with racism. Given the nascent literature, studies have not yet explored how adolescents navigate media-based vicarious racism or identified the coping strategies that adolescents use following vicarious racism exposure.

Using an adolescent-centered, qualitative approach, we sought to (1) examine how adolescents respond to media-based vicarious racism and (2) to explore coping strategies adolescents use to mitigate negative emotions and structural racism, vicariously experienced in the media. We hypothesized that adolescents use a variety of coping skills after exposure to media-based vicarious racism. We also anticipated that adolescents would openly discuss the impact of vicarious racism on their health. Finally, structural racism and the resultant adverse health outcomes and disparities will require societal, institutional, and individual transformation. However, by focusing on individual-level experiences and strategies, adolescents may be able to actively lessen the negative consequences of racism on their own health and well-being.

 

Anti-inflammatory effects of omega-3 fatty acids could help reduce depression

Omega-3 polyunsaturated fatty acids (PUFAs) are metabolised into molecules called lipid mediators and the levels of these in the blood are linked to an improvement in depressive symptoms

KING'S COLLEGE LONDON

Research News

 

The omega-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are found in oily fish. Researchers from the National Institute of Health Research (NIHR) Maudsley Biomedical Research Centre assessed the effects of high doses of EPA and DHA in lab-grown neurones and then in patients to help clarify how they reduce inflammation and depression. This novel approach allowed the scientists to identify an important molecular mechanism which can help inform the development of potential new treatments involving omega-3 fatty acids for patients with depression.

Lead author Dr Alessandra Borsini, NIHR Maudsley BRC Senior Postdoctoral Neuroscientist at King's College London, said: "Using a combination of laboratory and patient research our study has provided exciting new insight into how omega-3 fatty acids bring about anti-inflammatory effects that improve depression. For some time we have known that omega-3 PUFA can induce anti-depressant and anti-inflammatory effects but, without further understanding of how this happens in the human brain, it has been difficult to develop treatments. Our study has helped shine a light on the molecular mechanisms involved in this relationship which can inform the development of potential new treatments for depression using omega-3 PUFA."

Previous research has shown that people with major depressive disorder have higher levels of inflammation in their bodies than those without the disorder. There are currently no proven anti-inflammatory treatment strategies for depression and, although two important omega-3 PUFAs, EPA and DHA, have been shown to provide anti-inflammatory and antidepressant effects, the precise mechanism by which they do this is unknown.

Depression in a dish The study set out to test the theory that when omega-3 fatty acids are utilised and processed in the body, some of their metabolites (known as lipid mediators) are able to protect the brain from the harmful effects of inflammation. Researchers used a validated in vitro human cell model known as 'depression in a dish' that was developed at the NIHR Maudsley Biomedical Research Centre and which uses cells from the hippocampus, a part of the brain fundamental in many cognitive, memory and learning areas thought to be important in depression. Hippocampal cells play an important role in the production of new neurones - neurogenesis.

The study showed that treating human hippocampal cells with EPA or DHA before being exposed to chemical messengers involved in inflammation called cytokines, prevented increased cell death and decreased neurogenesis. Both these impacts had been previously observed in cells exposed to cytokines alone. Further investigation confirmed these effects were mediated by the formation of several key lipid mediators produced by EPA and DHA, namely hydroxyeicosapentaenoic acid (HEPE), hydroxydocosahexaenoic acid (HDHA), epoxyeicosatetraenoic acid (EpETE) and epoxydocosapentaenoic acid (EpDPA), and these were detected for the first time in human hippocampal neurones. Further investigation showed that treatment with an enzyme inhibitor increased the availability of two of these metabolites (EpETE and EpDPA) suggesting a possible way by which future treatments could be optimised.

Professor Anna Nicolaou, professor of Biological Chemistry at the Faculty of Medical and Human Sciences, The University of Manchester, who led the team that measured the lipid mediators using mass spectrometry said: "The lipid mediators that our research identified are broken down in the body relatively quickly, which means they may only be available for a relatively short time. By testing the effect of inhibitors of the enzymes involved in the metabolism of omega-3 PUFA we showed that we can greatly improve how long they can have an effect in the body and ultimately, increase their efficacy. This is very important for the development of new treatments and means that patients could be given higher doses of EPA and DHA together with these enzyme inhibitors to increase the amount of these important compounds in their blood over time."

Omega-3 metabolites in patients

The study assessed twenty-two patients with major depression who were given either 3 grams of EPA or 1.4 grams of DHA daily for twelve weeks. The lipid metabolites of EPA and DHA were measured in their blood before and after the omega-3 PUFA treatment, along with a score of their depressive symptoms. In both groups of patients, EPA or DHA treatment was associated with an increase in their respective metabolites and a significant improvement in depressive symptoms - an average reduction in symptom scores of 64% and 71% in the EPA and DHA groups respectively. In addition, higher levels of the same metabolites identified in the in vitro experiments were correlated with lower levels of depressive symptoms.

The levels of EPA and DHA used in this study are concentrations that most likely cannot be achieved with dietary consumption of oily fish, a rich source of omega-3 PUFAs, but require therapeutic supplements.

Future Research

The results of the study indicate that the bioactive lipid mediators produced by the breakdown of EPA and DHA in the body could be targeted as a mechanism to reduce depression and inflammation but there is a need to ensure that their effects are prolonged in order for this approach to be successful. Previous research indicates a key enzyme in the omega-3 fatty acid metabolism could be a valid option for drug repurposing and could be used for other inflammation-associated brain disorders, including depression, where at least a sub-group of patients often have chronic levels of inflammation.

Senior author of the paper, Professor Carmine Pariante, NIHR Maudsley BRC Affective Disorders Interface with Medicine Theme Lead said: "There is ever growing interest in the links between the immune system, inflammation and depression but in order to develop new treatments in this area we need to better understand the mechanisms behind these relationships. Our study has provided important insight into how known anti-inflammatory compounds - the omega-3 PUFA - help reduce depression. By identifying and measuring the exact lipid mediators that are involved, identifying the enzyme that prolongs their effects and finding the same lipid mediators in depressed patients treated with omega-3 PUFA and demonstrating improvements in symptoms, we have provided vital information to help shape clinical trials for future therapeutic approaches with omega-3 fatty acids.

"It is important to highlight that our research has not shown that by simply increasing omega-3 fatty acids in our diets or through taking nutritional supplements we can reduce inflammation or depression. The mechanisms behind the associations between depression and omega-3 PUFA are complicated and require further research and clinical trials to fully understand how they work and inform future therapeutic approaches."

The study was a collaboration between researchers from King's College London, The University of Manchester and China Medical University.

The paper Omega-3 polyunsaturated fatty acids protect against inflammation through production of LOX and CYP450 lipid mediators: relevance for major depression and for human hippocampal neurogenesis was published today (Wednesday 16 June) in Molecular Psychiatry.

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Notes to Editors

For more information and for a copy of the paper under strict embargo until 01:00 am Wednesday 16 June 2021 please contact: Franca Davenport, Communications and Engagement Manager, NIHR Maudsley Biomedical Research Centre, franca.davenport@kcl.ac.uk or Serena Rianjongdee, Communications and Engagement Officer, NIHR Maudsley Biomedical Research Centre, serena.rianjongdee@kcl.ac.uk

The paper will be available after the embargo lifts on: https://www.nature.com/articles/s41380-021-01160-8

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if

About King's College London and the Institute of Psychiatry, Psychology & Neuroscience

King's College London is one of the top 10 UK universities in the world (QS World University Rankings, 2020) and among the oldest in England. King's has more than 31,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff. The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London is the premier centre for mental health and related neurosciences research in Europe. It produces more highly cited outputs (top 1% citations) on mental health than any other centre (SciVal 2019) and on this metric we have risen from 16th (2014) to 4th (2019) in the world for highly cited neuroscience outputs. World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness and other conditions that affect the brain. http://www.kcl.ac.uk/ioppn @KingsIoPPN

The National Institute for Health Research (NIHR)

The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

• Funding high quality, timely research that benefits the NHS, public health and social care;
• Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
• Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
• Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
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The University of Manchester, a member of the prestigious Russell Group, is one of the UK's largest single-site university with more than 40,000 students - including more than 10,000 from overseas. It is consistently ranked among the world's elite for graduate employability. The University is also one of the country's major research institutions, rated fifth in the UK in terms of 'research power' (REF 2014). World-class research is carried out across a diverse range of fields including cancer, advanced materials, global inequalities, energy and industrial biotechnology.

Job-related stress threatens the teacher supply - RAND survey

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Nearly one in four teachers may leave their job by the end of the current (2020-'21) school year, compared with one in six who were likely to leave prior to the pandemic, according to a new RAND Corporation survey. Teachers who identified as Black or African American were particularly likely to consider leaving.

U.S. public-school teachers surveyed in January and February 2021 reported they are almost twice as likely to experience frequent job-related stress as the general employed adult population and almost three times as likely to experience depressive symptoms as the general adult population.

These results suggest potential immediate and long-term threats to the teacher supply.

"Teacher stress was a concern prior to the pandemic and may have only become worse. The experiences of teachers who were considering leaving at the time of our survey were similar in many ways to those of teachers who left the profession because of the pandemic," said Elizabeth Steiner, lead author of the report and a policy researcher at RAND, a nonprofit, nonpartisan research organization. "This raises the concern that more teachers may decide to quit this year than in past years if nothing is done to address challenging working conditions and support teacher well-being."

Stressful working conditions included a mismatch between actual and preferred mode of instruction, lack of administrator and technical support, frequent technical issues with remote teaching, and lack of implementation of COVID-19 safety measures. Stressors relating to mode of instruction and health were ranked most highly by teachers surveyed.

About a third of teachers were responsible for the care and learning support of their own children while teaching. These stressful working conditions were even more prevalent among teachers who were likely to quit after the onset of the pandemic, but not before.

"Given that some pandemic-era stressors, such as remote teaching, might be here to stay, we think district and school leaders can support teachers' well-being by understanding current working conditions and their need for a more supportive and flexible work environment," said Ashley Woo, coauthor and an assistant policy researcher at RAND.

The report recommends schools implement COVID-19 mitigation measures in a way that allows teachers to focus on instruction and offset worries about their health. Schools and districts should consider systematically collecting data about the mental health and well-being needs of teachers to understand the sources of teacher distress in their school communities while also working together to design and implement mental health and wellness supports. Helping teachers access childcare could go a long way to alleviating stress and promoting teacher retention, as would developing clear policies for remote teaching and adopting technology standards for remote teaching equipment.

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The survey was conducted using the RAND American Educator Panels, nationally representative samples of educators who provide their feedback on important issues of educational policy and practice.

"Job-Related Stress Threatens the Teacher Supply: Key Findings from the 2021 State of the U.S. Teacher Survey" was supported by the National Education Association and the American Federation of Teachers.

RAND Education and Labor, a division of RAND, is dedicated to improving education and expanding economic opportunities for all through research and analysis. Its researchers address key policy issues in U.S. and international education systems and labor markets, from pre-kindergarten to retirement planning.

Academic Medicine Faculty Perceptions of Work-Life Balance Before and Since the COVID-19 Pandemic

 

Original Investigation 

Medical Education

June 15, 2021

Susan A. Matulevicius, MD, MSCS^1,2; Kimberly A. Kho, MD, MPH, MSCS³; Joan Reisch, PhD⁴; et alHelen Yin, PhD^1,5

Author Affiliations Article Information

JAMA Netw Open. 2021;4(6):e2113539. doi:10.1001/jamanetworkopen.2021.13539

Key Points

Question  How is the COVID-19 pandemic associated with academic medicine faculty perceptions of work-life integration?

Findings  In this survey of 1186 medical, graduate, and health professional school faculty, more faculty considered leaving since the COVID-19 pandemic than before. Faculty with children, particularly female faculty with children, were more likely to consider leaving since the pandemic.

Meaning  These findings suggest that the stressors of integrating work and life are higher in female faculty than male faculty, highest in women with children, and may have been heightened by the COVID-19 pandemic.

Abstract

Importance  How the COVID-19 pandemic has affected academic medicine faculty's work-life balance is unknown.

Objective  To assess the association of perceived work-life conflict with academic medicine faculty intention to leave, reducing employment to part time, or declining leadership opportunities before and since the COVID-19 pandemic.

Design, Settings, and Participants  An anonymous online survey of medical, graduate, and health professions school faculty was conducted at a single large, urban academic medical center between September 1 and September 25, 2020.

Main Outcomes and Measures  Self-assessed intention to leave, reducing employment to part time, or turning down leadership opportunities because of work-life conflict before and since the COVID-19 pandemic.

Results  Of the 1186 of 3088 (38%) of faculty members who answered the survey, 649 (55%) were women and 682 (58%) were White individuals. Respondents were representative of the overall faculty demographic characteristics except for an overrepresentation of female faculty respondents and underrepresentation of Asian faculty respondents compared with all faculty (female faculty: 649 [55%] vs 1368 [44%]; Asian faculty: 259 [22%] vs 963 [31%]). After the start of the COVID-19 pandemic, faculty were more likely to consider leaving or reducing employment to part time compared with before the pandemic (leaving: 225 [23%] vs 133 [14%]; P < .001; reduce hours: 281 [29%] vs 206 [22%]; P < .001). Women were more likely than men to reduce employment to part time before the COVID-19 pandemic (153 [28%] vs 44 [12%]; P < .001) and to consider both leaving or reducing employment to part time since the COVID-19 pandemic (leaving: 154 [28%] vs 56 [15%]; P < .001; reduce employment: 215 [40%] vs 49 [13%]; P < .001). Faculty with children were more likely to consider leaving and reducing employment since the COVID-19 pandemic compared with before the pandemic (leaving: 159 [29%] vs 93 [17%]; P < .001; reduce employment: 213 [40%] vs 130 [24%]; P < .001). Women with children compared with women without children were also more likely to consider leaving since the COVID-19 pandemic than before (113 [35%] vs 39 [17%]; P < .001). Working parent faculty and women were more likely to decline leadership opportunities both before (faculty with children vs without children: 297 [32%] vs 84 [9%]; P < .001; women vs men: 206 [29%] vs 47 [13%]; P < .001) and since the COVID-19 pandemic (faculty with children vs faculty without children: 316 [34%] vs 93 [10 %]; P < .001; women vs men: 148 [28%] vs 51 [14%]; P < .001).

Conclusions and Relevance  In this survey study, the perceived stressors associated with work-life integration were higher in women than men, were highest in women with children, and have been exacerbated by the COVID-19 pandemic. The association of both gender and parenting with increased perceived work-life stress may disproportionately decrease the long-term retention and promotion of junior and midcareer women faculty.

Introduction

The COVID-19 pandemic has altered the ways we live and work with far-reaching impacts on all sectors of society. In the United States, 9.8 million jobs were lost between February and December 2020.¹ This job loss has disproportionately affected women, who accounted for 46% of the prepandemic workforce but have experienced 54% of pandemic-related job losses.² Structural inequalities further affect parents who have significantly increased their time spent on household and childcare duties by an additional 27 hours per week.¹ This change has disproportionately affected mothers of young children, who have experienced a 4- to 5-fold decrease in work hours than working fathers since the pandemic.³

The COVID-19 pandemic has not spared the field of medicine, magnifying both the unique and universal stressors faced by physicians and medical scientists. Even before the pandemic, the US health care system had put a great deal of stress on health care workers through systems of high workload, high administrative burdens, inefficiency, emphasis on high productivity, and a culture of constant availability.^4,5 Gender differences in pay parity, promotion, and work distribution have unevenly affected female physicians, leading more female physicians to reduce their working hours to part time or leave the field of medicine entirely.⁶ In academic medicine, women were already underrepresented in senior leadership positions before the pandemic. Although women make up 41% of all full-time academic medical school faculty, they account for 18% of academic chairs, 18% of deans, and 25% of full professors.⁷ The COVID-19 pandemic threatens to cause a regressive effect on the positive trends in gender equity and success in academic medicine unless action is taken.

To better understand how the COVID-19 pandemic is associated with faculty work-life conflict within our large urban academic medical institution, we conducted a campus-wide faculty survey to evaluate the perceived stress of the pandemic and maintaining work-life balance has affected faculty intention to leave, consideration of reducing their employment to part time and turning down leadership opportunities.

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Academic Medicine Faculty Perceptions of Work-Life Balance Before and Since the COVID-19 Pandemic | Coronavirus (COVID-19) | JAMA Network Open | JAMA Network