Researchers uncover new information on the effects of antidepressants

The drugs bind directly to a brain-derived neurotrophic factor receptor without help from serotonin

UNIVERSITY OF HELSINKI

Research News

 

The effects of selective serotonin reuptake inhibitors (SSRIs) and other conventional antidepressants are believed to be based on their increasing the levels of serotonin and noradrenalin in synapses, while ketamine, a new rapid-acting antidepressant, is thought to function by inhibiting receptors for the neurotransmitter glutamate.

Neurotrophic factors regulate the development and plasticity of the nervous system. While all antidepressants increase the quantity and signalling of brain-derived neurotrophic factor (BDNF) in the brain, the drugs have so far been thought to act on BDNF indirectly, through serotonin or glutamate receptors.

A new study published this week in Cell demonstrates, however, that antidepressants bind directly to a BDNF receptor known as TrkB. This finding challenges the primary role of serotonin or glutamate receptors in the effects of antidepressants.

The international study, which was collaboratively led by the Neuroscience Center and the Department of Physics at the University of Helsinki, investigated the binding of antidepressants from different drug classes to the TrkB receptor. All the antidepressants examined, including fluoxetine (an SSRI), imipramine (a tricyclic antidepressant) and the rapid-acting ketamine interacted with TrkB.

"We found that all antidepressants boost BDNF signalling by binding to its TrkB receptor. This signalling is necessary for the cellular and behavioural effects of antidepressants in our experimental models. The effects of antidepressant on plasticity do not therefore require increases in the serotonin levels or the inhibition of glutamate receptors, as previously thought," says Professor Eero Castrén, the principal investigator of the study.

Molecular modelling helped to locate the binding site of antidepressants

The binding site of antidepressants in the transmembrane region of TrkB was identified through molecular modelling, performed in Professor Ilpo Vattulainen's research group at the Department of Physics, University of Helsinki. Biochemical binding studies and mutations introduced in the TrkB receptor verified the site.

Molecular modelling also demonstrated that the structure of TrkB is sensitive to the cholesterol concentration of the cell membrane. TrkB is displaced in cholesterol-rich membrane compartments, such as synaptic membranes.

"The drug binding stabilises dimers, structures composed of two TrkB receptors, inhibiting the displacement of the TrkB receptors and increasing their quantity in synaptic cell membranes, which boosts the effects of BDNF. That is to say that the drugs do not directly activate TrkB. Instead, they sensitise the receptor to the effects of BDNF," Castrén explains.

In addition to findings pertaining to the effects of antidepressants, the study produced a substantial amount of new information on the structure and function of the growth factor receptor.

Why does ketamine have such a rapid effect?

Ketamine, which has been used as an anaesthetic, is becoming increasingly utilized as an antidepressant. The researchers were surprised to find that both slow-acting SSRIs and rapid-acting ketamine act by binding to the same site in TrkB.

SSRI drugs bind to the serotonin transporter protein much more avidly than to TrkB, but the binding of ketamine to the glutamate receptor and TrkB occurs at similar drug concentrations.

"Previous studies have shown that in SSRI therapy, drugs gradually reach the high brain concentration needed for binding to the TrkB receptor, whereas intravenously administered ketamine and esketamine as a nasal spray reach the level needed for binding quickly, in a matter of minutes. The difference in the onset of action for SSRIs and ketamine may be caused by their different capacity to reach in the brain the concentration needed for binding with TrkB receptors," Castrén says.

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Which suicide prevention strategies work?

COLUMBIA UNIVERSITY IRVING MEDICAL CENTER

Research News

 

NEW YORK, NY (Feb. 18, 2021)--A new study from Columbia University Vagelos College of Physicians and Surgeons has found that suicide mortality can be reduced by a Federally coordinated approach employing scientifically proven options.

Columbia researchers J. John Mann, MD, Christina A. Michel, MA, and Randy P. Auerbach, PhD, conducted a systematic review, determining which suicide prevention strategies work and are scalable to national levels.

The study, "Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review," was published online in the American Journal of Psychiatry.

The researchers found that screening school children or the general population for those at risk for suicide--the tenth leading cause of death in the U.S. with 48,344 suicide deaths in 2018--have generally not reduced suicide rates.

The outstanding exception is training primary care physicians in depression recognition and medication treatment. That approach prevents suicide, often halving the risk.

While educating the public about depression and suicidal behavior has not been shown to prevent suicidal behavior in adults, educating high school students prevents suicidal behavior, though educating their teachers or parents does not.

"Timing is everything," said Dr. Mann. "Active outreach to psychiatric patients after discharge or following a suicidal crisis both prevent suicidal behavior."

Although medication treatment of depression is subject to a black box warning by the FDA, meta-analyses of FDA and NIMH-funded study data find antidepressants prevent suicide attempts. But standard antidepressants take weeks to work, which has led to increased interest in intravenously administered ketamine, a promising treatment to reduce suicidal ideation in hours that is untested for suicidal behavior prevention.

The study found that the final line of defense in suicide prevention is reducing access to the most lethal methods for suicide. Half of all suicides in the United States involve a firearm that was mostly purchased years earlier, suggesting that improved gun safety in the home should be a national priority.

Combinations of these approaches in health care systems show promise in reducing suicide rates in the U.K., Denmark, and even parts of the U.S.

"It is time to use this knowledge and implement a national suicide prevention plan, " said Dr. Mann.

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The Columbia University Department of Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Irving Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at the Columbia University Vagelos College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cuimc.columbia.edu or columbiadoctors.org.

Disclaimer: AAAS and EurekAlert! are not responsi

 

The messenger matters in safe gun storage, suicide prevention education

Firearm owners listen most to law enforcement and military members, Rutgers study finds

RUTGERS UNIVERSITY

Research News

 

Law enforcement and those in the military, rather than doctors and celebrities, are the most preferred messengers on firearm safety, a Rutgers study found.

The findings, published in the journal Preventive Medicine, can help communicate the importance of safe firearm storage and reduce the rate of suicides, Rutgers researchers say.

"We know that safe firearm storage is a key component to suicide prevention, but that belief is not widespread among firearm owners," said lead author Michael Anestis, executive director of the New Jersey Gun Violence Research Center and an associate professor of Urban-Global Public Health at Rutgers School of Public Health. "No matter how clear the message is, if it is being delivered by the wrong person, it is not going to have the desired effect."

Although "means safety," which emphasizes storing firearms so they are not readily available, has been shown to decrease suicide rates, researchers say the message will only take hold when clearly conveyed by a trusted source.

In the Rutgers study, 6,200 firearm owners in the United States were asked to rank 14 groups -- which included firearm dealers, firearm show managers, the National Rifle Association, family, friends and co-workers -- as trusted sources for messages about safe firearm storage.

They found that while law enforcement and military personnel ranked at the top, physicians and celebrities were the least-preferred messengers. Although both white and Black firearm owners had similar rankings for messengers overall, white firearm owners more strongly preferred law enforcement, military veterans, current military personnel and the National Rifle Association than did Black firearm owners, who preferred casual acquaintances, friends or co-workers, gun show managers, medical professionals and celebrities more than White firearm owners did.

"Our results show that certain groups like service members and veterans may be the best choices to voice the messages on safe storage, but they also show that not every community will view the same messenger the same way," Anestis said.

Abstract: https://www.sciencedirect.com/science/article/abs/pii/S0091743521000360?dgcid=author

First report on mass shootings from Columbia University database

COLUMBIA UNIVERSITY IRVING MEDICAL CENTER

Research News

NEW YORK, NY (Feb. 18, 2021)--A research team at the Center of Prevention and Evaluation (COPE) at Columbia University Irving Medical Center and the New York State Psychiatric Institute, led by Drs. Gary Brucato and Ragy R. Girgis, found that, contrary to popular belief, serious mental illness was present in only 11% of all mass murderers and in only 8% of mass shooters.

The study--the first published report on mass shootings from the Columbia Mass Murder Database--appeared online Feb. 17th in Psychological Medicine.

The investigators sought to gain much-needed insight into the relationship between serious mental illness and mass shootings. Creating the database involved extensive review of 14,785 murders publicly described in English in print or online, occurring worldwide between 1900 and 2019.

In the study, the investigators analyzed 1,315 mass murders of all types, from all over the world, to better understand mass shooting events.

People who committed mass murder by other means, such as fire, explosives, poison, stabbing, bludgeoning, or driving vehicles into crowds, had a prevalence of serious mental illness of 18%. Although almost two-thirds of all mass murders were committed with firearms, non-firearm means resulted in significantly more casualties per event.

Examining a wide array of demographic, psychological and other background features of mass murderers available in multiple public reports, the researchers also found that U.S.-based mass shooters were more likely to have legal histories, use recreational drugs or misuse alcohol, or have histories of non-psychotic psychiatric or neurologic symptoms."

They also reported that non-automatic firearms are the weapon of choice of most mass shooters. Furthermore, the investigators found that, among mass shooters in the U.S., the only distinguishing factor between those who used non-automatic vs. semi-automatic weapons is that individuals with any psychiatric or neurologic condition were more likely to use semi-automatic weapons. These findings may have key implications for the way background checks preceding weapon purchases should be conducted.

The authors also found that since 1970 the rate of mass shootings has been far greater than the rate of non-firearm mass murder, with the vast majority of mass shootings occurring in the United States.

Dr. Brucato remarked, "The findings from this potentially definitive study suggest that emphasis on serious mental illness, such as schizophrenia or psychotic mood disorders, as a risk factor for mass shootings is given undue emphasis, leading to public fear and stigmatization."

Coauthor Dr. Paul S. Appelbaum, known for his work on violence in psychiatric samples, noted, "These data suggest that other difficulties, such as legal problems, substance and alcohol use, and difficulty coping with life events seem more useful foci for prevention and policy than an emphasis on serious mental illness."

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The study is titled, "Psychotic Symptoms in Mass Shootings vs. Mass Murders Not Involving Firearms: Findings from the Columbia Mass Murder Database. "

Authors: Gary Brucato Ph.D., Paul S. Appelbaum M.D., Hannah Hesson B.A., Eileen A. Shea M.P.H., Gabriella Dishy M.A., Kathryn Lee M.A., Tyler Pia M.A., Faizan Syed M.D., Alexandra Villalobos M.A., Melanie M. Wall Ph.D., Jeffrey A. Lieberman M.D., Ragy R. Girgis M.D.

The Columbia University Department of Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Irving Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at the Columbia University Vagelos College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cuimc.columbia.edu or columbiadoctors.org.

Liberal government's 'empty shell' firearms bill unlikely to curb violence, gun control advocate warns
Jesse Snyder 


OTTAWA — Gun control advocates are blasting Ottawa’s “empty shell” firearms legislation, saying its primary function is to provide Liberal talking points rather than curb gun violence through sensible reforms.

© Provided by National Post Ecole Polytechnique shooting survivor Heidi Rathjen: “The point of banning assault weapons is to say that these are guns that are too dangerous to leave in the hands of ordinary Canadians.”

Prime Minister Justin Trudeau has drawn fierce criticism from both sides of the firearms debate with the tabling of Bill C-21, which extends some penalties for firearms-related offences. Many gun owners say the legislation arbitrarily targets law-abiding citizens, while gun control advocates say it fails to get guns out of the hands of potential risks to the public.

Perhaps most notably, the legislation does not enforce the Liberal government’s promised buyback program, instead allowing Canadians to keep their newly prohibited rifles but not use them.

“I don’t understand the political calculation, and it’s all the more baffling that the bill is an empty shell,” said Heidi Rathjen, who survived the 1989 mass shooting at Ecole Polytechnique in Montreal. The decision by the Liberal government to stop short of its mandatory buyback is evidence of a contradictory position by Ottawa, Rathjen said, who has repeatedly said prohibited firearms cannot be left in the possession of civilians.

“The point of banning assault weapons is to say that these are guns that are too dangerous to leave in the hands of ordinary Canadians,” said Rathjen, who founded Poly Remembers, a gun control advocacy group.

The firearms buyback program came as part of an order in council issued by the Trudeau government on May 1, which immediately outlawed 11 semi-automatic rifle styles, including well over 1,500 firearm variants. 

Ottawa had said it would buy back “all” citizen-owned firearms included under the order, following a two-year amnesty. The government has so far struggled to secure private-sector bidders to design the buyback, which some experts estimate could cost well over $1 billion.

Bill C-21 modestly expands a number of existing laws, like lengthened prison sentences for people who smuggle firearms or who manipulate gun magazines beyond their legal limit. Changes to “red flag” laws grant expanded powers to courts to search and seize the possessions of gun owners.

But most of the changes amount only to half measures, Rathjen said. A recommendation by Poly Remembers to ban the sale of any magazine that can be manipulated, for example, was dismissed by Ottawa, who instead introduced increased penalties that are unlikely to prevent would-be killers from using higher capacity clips.

“There’s so many of these little things that once you scratch the surface under the talking points, there’s not much underneath,” Rathjen said.

“Everything that we see is window dressing.”

Her comments were echoed by other gun control advocates, who say the Trudeau government used their talking points in the lead-up to the May 1 ban, only to disregard those policies in C-21.

Trudeau in October 2019 tweeted that Liberal gun control measures were the “strongest of all the parties,” quoting a Poly Remembers press release. However, Rathjen said, that was awarded strictly on the basis that the Liberals had promised to introduce an entirely mandatory buyback program.

“This is a total betrayal,” said Suzanne Laplante-Edward, whose daughter Anne-Marie Edward was one of 14 women killed in the 1989 shooting.

“They lied. They lied to us. They lied to Canadians,” she said in a statement Tuesday.

Trudeau on Tuesday said the Liberal ban was introduced explicitly to prevent shootings of the sort that took place in Montreal. “I remember where I was when I was 17 and heard the news of a massacre at the École Polytechnique. I’ve sat down with first responders, doctors and nurses who see every day the cost of gun violence,” he said.

Representatives of gun retailers and private gun owners, meanwhile, have likewise said that Liberal talking points are contradictory and unfounded, especially claims that so-called “military style” rifles are comparable to those used by the military.

Assault rifles have never been legal in Canada, and the firearms included under the Liberal ban are far from military grade. For years, sport shooters in Canada have instead used semi-automatic rifles that mimic the look of military firearms, but can carry a maximum of five rounds in their magazines.

The rifles included under the Liberal ban have been restricted in Canada since 1977, meaning they could only be shot at designated ranges, could only be transported directly to and from designated ranges, and required the owner to secure additional safety training before purchase.

Liberal ministers nonetheless claimed that their new legislation would outlaw military-grade firearms from public use.

Joël Lightbound, Liberal MP for the Quebec riding of Louis-Hébert, said the Liberals had outlawed “powerful and dangerous” rifles that “were designed to be used on a battlefield in the time of war.”

The current standard issue rifle used by the Canadian military is the Canada Colt C7, a variant of the M16 that fires at a rate of up to 900 rounds per minute from a 30-round magazine. Semi-automatic ARs of the type previously used by Canada citizens, by comparison, fire at roughly 100-120 rounds per minute, and carry a maximum of five rounds.

Repeating previous talking points, Finance Minister Chrystia Freeland on Tuesday also said firearms included under the government’s ban were “designed for just one purpose: to kill people and to look like they can kill people.”

The federal union representing the Royal Canadian Mounted Police has itself opposed Ottawa’s gun ban, saying it does little to address gang violence and gun smuggling at the Canada-U.S. border, which accounts for the majority of firearm-related violence.

Statistics Canada says the country had 678 homicides in 2019, of which 38 per cent were committed using firearms. Of those homicides, 60 per cent were committed using a handgun rather than a rifle. The majority of those homicides were a result of gang violence, which has increased 10 per cent since 2015, the RCMP bargaining group said in a press release last year.

Rich nations see virus rates fall quicker -- study

Research finds economic performance directly related to number of cases

ANGLIA RUSKIN UNIVERSITY

Research News

 

Richer countries were more likely to see rates of COVID-19 fall faster during the first wave of the pandemic, according to new research published in the journal Frontiers in Public Health.

The study by Anglia Ruskin University (ARU) professors Shahina Pardhan and Nick Drydakis examined economic indicators in 38 European countries, such as Gross Domestic Product (GDP) per capita, life expectancy, and public spending, and the number of new coronavirus cases per million of the population between 1 April and 31 May 2020, using data from Our World in Data based on the seven-day rolling average of new cases for each country.

A significant negative correlation was found between number of cases and GDP per capita across the two months. The study found that the country with the highest GDP per capita in Europe (Luxembourg) experienced the biggest fall in cases (271 per million of the population). The opposite was found for countries with lower GDP per capita, such as Ukraine (fell by one case per million) and Romania (fell by seven cases per million).

Researchers concluded that countries with higher GDP per capita were able to spend more on test and trace solutions, public health messaging and had economies that better facilitated home working than poorer nations. The UK recorded a reduction from 3,706 new cases on 1 April to 1,500 new cases on 31 May, a reduction of 20 cases per million of the population during this time.

Lead author Professor Shahina Pardhan, of ARU's School of Medicine, said: "Our study found a strong negative correlation between number of cases and GDP per capita. This is not only potentially down to the ability of wealthier nations to spend more on healthcare and prevention, but it is possible that suppressing the spread through lockdowns is more difficult to implement in poorer countries where there are a greater number of people working in sectors where manual labour is needed.

"COVID-19 is a global issue and has spread rapidly from country to country. It does not discriminate, and it is in everybody's best interests to ensure that poorer countries are given the assistance they need to fight this virus during this second wave and beyond."

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ABIONIC HYDROCARBONS

Fuel for earliest life forms: Organic molecules found in 3.5 billion-year-old rocks

UNIVERSITY OF COLOGNE

Research News

 

IMAGE: 3.5 BILLION-YEAR-OLD BARITE (BOTTOM) WITH FOSSILIZED MICROBIAL MAT (TOP). THIS BARITE IS PART OF THE DRESSER FORMATION IN NW AUSTRALIA. view more 

CREDIT: HELGE MISSBACH

A research team including the geobiologist Dr. Helge Missbach from the University of Cologne has detected organic molecules and gases trapped in 3.5 billion-year-old rocks. A widely accepted hypothesis says that the earliest life forms used small organic molecules as building materials and energy sources. However, the existence of such components in early habitats on Earth was as yet unproven. The current study, published in the journal 'Nature Communications', now shows that solutions from archaic hydrothermal vents contained essential components that formed a basis for the earliest life on our planet.

Specifically, the scientists examined about 3.5 billion-year-old barites from the Dresser Formation in Western Australia. The barite thus dates from a time when early life developed on Earth. 'In the field, the barites are directly associated with fossilized microbial mats, and they smell like rotten eggs when freshly scratched. Thus, we suspected that they contained organic material that might have served as nutrients for early microbial life,' said Dr. Helge Missbach of the Institute of Geology and Mineralogy and lead author of the study.

In the fluid inclusions, the team identified organic compounds such as acetic acid and methanethiol, in addition to gases such as carbon dioxide and hydrogen sulfide. These compounds may have been important substrates for metabolic processes of early microbial life. Furthermore, they are discussed as putative key agents in the origin of life on Earth. 'The immediate connection between primordial molecules emerging from the subsurface and the microbial organisms - 3.5 billion years ago - somehow surprised us. This finding contributes decisively to our understanding of the still unclear earliest evolutionary history of life on Earth,' Missbach concluded.

Shale gas development in PA increases exposure of some to air pollutants

Current setback policy not most effective approach to protect people from exposure

PENN STATE

Research News

 

IMAGE: A MARCELLUS SHALE WELL SITE IN PENNSYLVANIA view more 

CREDIT: PENN STATE

Air pollution levels may have exceeded air quality standards during the development of some Marcellus Shale natural gas wells in Pennsylvania, potentially impacting more than 36,000 people in one year alone during the drilling boom, according to Penn State scientists.

"The construction and drilling of these wells are a relatively short-term thing, and assessment of the impact on air quality is something that often falls through the cracks," said Jeremy Gernand, associate professor of industrial health and safety at Penn State. "But there are thousands and thousands of wells drilled depending on the year, and we wanted to see what the impact would be if we added it all up."

More than 20,000 unconventional Marcellus Shale gas wells have been drilled since Pennsylvania's boom began around 2005. Large diesel-powered equipment and gas turbines used during the drilling and hydraulic fracturing stages of shale gas development emit air pollution, and these emissions can affect air quality within the vicinity of shale well sites and farther downwind, the scientists said.

The scientists found emissions at some of the sites could have impacted air quality for people who live beyond the 500-foot setbacks required by state regulations.

"We found in one year alone, 36,000 people, or about 1% of the population of Pennsylvania's Marcellus Shale region, could have been exposed to pollution levels exceeding air quality standards," Gernand said. "However, we found doubling the required setback distance reduced that number by about half."

The scientists developed a dispersion model to estimate concentrations of fine particulate matter (PM 2.5) resulting from well development. One form of air pollution created by the burning of fossil fuels, PM 2.5 are tiny particles that can be inhaled and cause lung damage, according to the scientists.

"Very few studies have investigated local residents' exposure to PM 2.5 emissions from shale gas development, specifically in the Marcellus region of Pennsylvania," Gernand said.

The model considered meteorological conditions during well development, indicating how factors like wind carried emissions from individual well sites, the scientists said. The team then used census data to estimate how many people were in the areas affected by higher levels of air pollution.

Their findings, published in Energy Policy, showed a small number of wells near populated areas contributed to most of the exposures to elevated levels of air pollution.

"I think the main message is that a one-size-fits-all policy to constrain the impacts of industry probably isn't the most effective approach," Gernand said. "In this case, there are real benefits to making some alterations to setback regulations. We only need to push certain sites back farther from inhabited areas to see a big reduction in the number of people whose air quality is affected by this."

Setback policy is shown to be an effective method to reduce exposure exceedances, but the scientists said their results indicate the policies should consider the number of wells per well pad and local conditions to further limit air quality impacts.

The scientists said drilling activity has moved closer to populated areas as Marcellus development progressed in Pennsylvania. And while the construction, drilling and fracking stages are relatively short, sites now often have multiple wells so development can extend for months.

"Staying back 500 feet was probably fine when we drilled one well per pad and moved on, but under the current conditions that's not really sufficient anymore," Gernand said. "We really need to take into consideration things like how much construction and drilling activity will take place and for how long and population density in the area and use those things in some kind of decision framework."

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Zoya Banan, an air quality specialist with South Coast Air Quality Management District, also conducted this research while a doctoral student at Penn State.

New report calls for universal coverage of long-term care for older adults in U.S.

COVID-19 pandemic exposes flaws in American system for older adults in need in long-term services and supports

OREGON HEALTH & SCIENCE UNIVERSITY

Research News

 

The COVID-19 pandemic's heavy toll on older Americans highlights the need to strengthen the nation's safety net for people in need of long-term services and supports, an Oregon Health & Science University researcher and co-authors argue in a new report published by Milbank Quarterly.

The report proposes a system of universal coverage to support the long-term care of all older Americans.

"This approach would protect against financial catastrophe and end the current system that is based on the need to be financially destitute in order to access coverage via Medicaid," the authors write. "Such an approach would benefit both individuals and families and would also create a far more stable and more generous funding stream to providers."

Walt Dawson, D.Phil., assistant professor of neurology in the OHSU School of Medicine, said he believes the pandemic could be an inflection point to improve the U.S. system of long-term services and support.

Dawson, also a senior Atlantic Fellow of Equity in Brain Health with the Global Brain Health Institute, studies the public policy implications of Alzheimer's disease and other dementias - including the financial impact on families and the public programs that finance care.

The report lays out a series recommendations to repair what it characterized as a fragmented and patchwork system of long-term services and supports for older Americans living with physical and cognitive impairments.

Long-term recommendations

• Universal coverage: The report calls for establishing universal coverage for all Americans' long-term care needs through Medicare. "Universal coverage is essential to achieving greater equity in access and coverage, but it is also essential to the fiscal viability of the financing mechanism (e.g., everyone pays into the system)," the authors write.

• Creating an age-friendly health system: The report calls for better collaboration between public health, health care systems and long-term care to safeguard the health and safety of older adults.

Near-term recommendations

• Improved reporting of COVID-19 infections: The report calls for improving a "lack of publicly available information" nationally about COVID-19 infections among people receiving long-term services and supports and the workforce caring for them.

• Support for unpaid caregivers: Family caregivers could be identified through Medicare and compensated at the rate of home health aides. In addition, the report calls for improved lines of communication between acute care facilities and other forms of long-term services and support.

• Equitable treatment: The Medicaid reimbursement system should provide resources to support independent long-term care and home care providers who often care for the most vulnerable and medically fragile older adults.

"Although these are not new problems, the pandemic has exacerbated and amplified their impact to a point that they are impossible to ignore," the report concludes. "The opportunity for reform is now."

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In addition to Dawson, co-authors included Nathan Boucher, Dr.PH., assistant research professor in the Sanford School of Public Policy at Duke University; Robyn Stone, Ph.D., senior vice president of the LeadingAge LTSS Center at the University of Massachusetts Boston; and, Courtney Van Houtven, Ph.D., professor of population health science in the Duke University School of Medicine.

Scientists probe Antarctic waters to see effect of massive iceberg breakup

Duration: 01:30 1 day ago

 cbc.ca

British scientists have launched submersible gliders near a massive iceberg breakup in the far southern Atlantic Ocean to see what effect the melting freshwater has on the surrounding salty sea.