Tuesday, September 19, 2023

 

Recent advances in bread research

Peer-Reviewed Publication

AMERICAN CHEMICAL SOCIETY




Whether light and fluffy or thin and flexible, bread holds an important place in many cultures and cuisines. And despite millennia of baking experience, scientists are still striving to improve this staple food. Below are some recent papers published in ACS journals that report insights into the quality, healthfulness and preparation of bread. Reporters can request free access to these papers by emailing newsroom@acs.org.

“Unraveling the Influence of Wheat Bran Chemical Composition, Lipolytic Enzyme Activities, and Phenolic Components on the Bread-Making Properties of Reconstituted Whole Wheat Flours”
ACS Food Science & Technology
Sept. 13, 2023
Whole-wheat bread contains more dietary fiber than its white bread counterpart because it contains wheat bran and germ, but those components also cause baked goods to be flatter and denser. Now, researchers have shown that the enzyme lipoxygenase could be contributing to this phenomenon. In tests, the team combined white flour and separate brans from 10 different wheat genotypes. The brans with greater lipoxygenase activity produced flatter loafs. Future studies are needed to determine how lipoxygenase influences the quality of whole-wheat products, the researchers say.

“Proteomic Characterization of Wheat Protein Fractions Taken at Different Baking Conditions”
Journal of Agricultural and Food Chemistry
Aug.15, 2023
Here, researchers prepared three wheat flour-based baked goods: a thin crispbread, a shaped loaf and pretzel rolls. Then, they analyzed the products’ crumb and crust, and found that the abundances of 82 gluten proteins were affected by the dough’s processing conditions. Interestingly, most of the protein changes could be attributed to the high heat of baking. The results could be used to help guide wheat breeding and improve future bread products.

“Microcrystalline Cellulose Isolation and Impregnation with Sappan Wood Extracts as Antioxidant Dietary Fiber for Bread Preparation”
ACS Omega
Aug. 14, 2023
Plant cellulose is an edible fiber, and the microcrystalline form can stabilize and thicken foods, making it a promising ingredient in baked goods. And adding phenolic compounds, such as those extracted from wood, to dietary fibers could impart extra nutritional benefits. Now, scientists have soaked microcrystalline cellulose in extracts from sappan wood and then used various amounts of the powder to bake bread. Test results indicated that a small amount of the cellulose-based additive could enhance a bakery product’s antioxidant activity and phenolic content with minimal impacts on the overall color or texture.

The American Chemical Society (ACS) is a nonprofit organization chartered by the U.S. Congress. ACS’ mission is to advance the broader chemistry enterprise and its practitioners for the benefit of Earth and all its people. The Society is a global leader in promoting excellence in science education and providing access to chemistry-related information and research through its multiple research solutions, peer-reviewed journals, scientific conferences, eBooks and weekly news periodical Chemical & Engineering News. ACS journals are among the most cited, most trusted and most read within the scientific literature; however, ACS itself does not conduct chemical research. As a leader in scientific information solutions, its CAS division partners with global innovators to accelerate breakthroughs by curating, connecting and analyzing the world’s scientific knowledge. ACS’ main offices are in Washington, D.C., and Columbus, Ohio.


RADICAL MEDICINE

Anesthesia & Analgesia devotes special issue to diversity, equity, and inclusion


Papers promote solution-based approaches at the individual, hospital, and policy levels


WOLTERS KLUWER HEALTH




September 19, 2023 — Reflecting the need in anesthesiology to address diversity, equity, and inclusion (DEI), Anesthesia & Analgesia has devoted its entire October 2023 issue to these topics. This official journal of the International Anesthesia Research Society is published in the Lippincott portfolio by Wolters Kluwer. 

"The mission of Anesthesia & Analgesia states that the Journal exists for the benefit of current and future patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology," Paloma Toledo, MD, MPH, professor in the Department of Anesthesiology, Perioperative Medicine and Pain Management at the University of Miami, Florida, and colleagues note in an introductory editorial. "We as a specialty cannot escape the reality that to fulfill this mission, we must also address DEI." 

Furthering DEI work is part of the effort to eliminate healthcare disparities 

The manuscripts selected for the special issue span a gamut. Some are descriptive, some identify potential solutions, and others describe what the authors are doing at their institutions or within a medical society to achieve meaningful change and progress in DEI. A sampling of topics: 

  • Marching towards Utopia: Mentor–mentee relationship devoid of race or gender considerations 

  • The Women in Cardiothoracic Anesthesiology (WICTA) special interest group: What can the lessons of one anesthesiology affinity group tell us about how to build impactful professional communities? 

  • Leading change and managing resistance for equity, diversity, and inclusivity in anesthesiology departments 

  • Assuring the groundwork for success: mentorship, sponsorship, and allyship for practicing anesthesiologists 

  • Perspectives on ethnic and language diversity and perioperative neurocognitive disorders 

  • Championing the mom: the role of a mothers' support group in academic anesthesia practice 

  • The anesthesiology physician–scientist pipeline: current status and recommendations for future growth—an initiative of the Anesthesia Research Council 

  • So, you want to DEI? Ten practical tips for establishing sustainable change 

  • Pro–con debate: Consideration of race, ethnicity, and gender is detrimental to successful mentorship 

  • Systematic efforts to recruit diversity in a residency program and the impact on representation over 3 years 

The themed edition is just one of several Anesthesia & Analgesia initiatives related to DEI 

In a related effort, the staff and editorial board of Anesthesia & Analgesia recently evaluated the composition of the journal's editorial board. Befitting an international journal, nearly half the editors were born outside the United States. Editors' ages are equally distributed across early-, mid-, and late-career, and 28% are women, comparable to the percentage of women in anesthesiology. 

Anesthesia & Analgesia intends to keep striving to ensure a diversity of perspectives and fair editorial and manuscript review processes, regardless of an author's gender, race, ethnicity, or country of origin. In keeping with that goal, at the 2023 annual meeting of the International Anesthesia Research Society the journal hosted its first peer review workshop, to train a greater range of anesthesiologists in the fundamentals of manuscript review. That effort is also expected to improve the diversity of the editorial board, because excellent peer reviewers are often invited to join the board. 

The editorialists add, "Anesthesia & Analgesia will continue to publish articles related to DEI and conduct journal-sponsored programming to further our understanding of how DEI impacts the care we give, and the outcomes our patients experience." 

Link to Article [ Diversity, Equity, and Inclusion: More Than Words ] 

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth

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About Anesthesia & Analgesia 

Anesthesia & Analgesia is "The Global Standard in Anesthesiology" and provides the practice-oriented, clinical research needed to keep current and provide optimal care to patients. Each monthly issue includes peer-reviewed articles on the latest advances in drugs, preoperative preparation, patient monitoring, pain management, pathophysiology, and many other timely topics. 

About the International Anesthesia Research Society 

The International Anesthesia Research Society (IARS) is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through research. The IARS contributes more than $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of physicians, health professionals in anesthesia-related practice, and physician residents and others with doctoral degrees; and sponsors the SmartTots initiative. 

About Wolters Kluwer 

Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.  

Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,900 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. 

 

RNA for the first time recovered from an extinct species


Peer-Reviewed Publication

STOCKHOLM UNIVERSITY

Tasmanian tiger specimen 

IMAGE: TASMANIAN TIGER SPECIMEN USED IN THE STUDY AND PRESERVED IN DESICCATION AT ROOM TEMPERATURE IN THE SWEDISH NATIONAL HISTORY MUSEUM IN STOCKHOLM". PHOTO: EMILIO MÁRMOL SÁNCHEZ (PHOTOGRAPH) AND PANAGIOTIS KALOGEROPOULOS (EDITING). view more 

CREDIT: PHOTO: EMILIO MÁRMOL SÁNCHEZ (PHOTOGRAPH) AND PANAGIOTIS KALOGEROPOULOS (EDITING).




A new study shows the isolation and sequencing of more than a century-old RNA molecules from a Tasmanian tiger specimen preserved at room temperature in a museum collection. This resulted in the reconstruction of skin and skeletal muscle transcriptomes from an extinct species for the first time. The researchers note that their findings have relevant implications for international efforts to resurrect extinct species, including both the Tasmanian tiger and the woolly mammoth, as well as for studying pandemic RNA viruses.

The Tasmanian tiger, also known as the thylacine, was a remarkable apex carnivorous marsupial that was once distributed all across the Australian continent and the island of Tasmania. This extraordinary species found its final demise after European colonization, when it was declared as an agricultural pest and a bounty of £1 per each full-grown animal killed was set by 1888. The last known living Tasmanian tiger died in captivity in 1936 at the Beaumaris Zoo in Hobart, Tasmania.

Recent efforts in de-extinction have focused on the Tasmanian tiger, as its natural habitat in Tasmania is still mostly preserved, and its reintroduction could help recovering past ecosystem equilibriums lost after its final disappearance. However, reconstructing a functional living Tasmanian tiger not only requires a comprehensive knowledge of its genome (DNA) but also of tissue-specific gene expression dynamics and how gene regulation worked, which are only attainable by studying its transcriptome (RNA).

“Resurrecting the Tasmanian tiger or the woolly mammoth is not a trivial task, and will require a deep knowledge of both the genome and transcriptome regulation of such renowned species, something that only now is starting to be revealed”, says Emilio Mármol, the lead author of a study recently published in the Genome Research journal by researchers at SciLifeLab in collaboration with the Centre for Palaeogenetics*, a joint venture between the Swedish Museum of Natural History and Stockholm University.

RNA molecules recovered from the Tasmanian tiger

The researchers behind this study have sequenced, for the first time, the transcriptome of the skin and skeletal muscle tissues from a 130-year-old desiccated Tasmanian tiger specimen preserved at room temperature in the Swedish Museum of Natural History in Stockholm. This led to the identification of tissue-specific gene expression signatures that resemble those from living extant marsupial and placental mammals.

The recovered transcriptomes were of such good quality that it was possible to identify muscle- and skin-specific protein coding RNAs, and led to the annotation of missing ribosomal RNA and microRNA genes, the later following MirGeneDB recommendations.

“This is the first time that we have had a glimpse into the existence of thylacine-specific regulatory genes, such as microRNAs, that got extinct more than one century ago”, says Marc R. Friedländer, Associate Professor at the Department of Molecular Biosciences, The Wenner-Gren Institute at Stockholm University and SciLifeLab.

This pioneering study opens up new exciting opportunities and implications for exploring the vast collections of specimens and tissues stored at museums across the globe, where RNA molecules might await to be uncovered and sequenced.

“In the future, we may be able to recover RNA not only from extinct animals, but also RNA virus genomes such as SARS-CoV2 and their evolutionary precursors from the skins of bats and other host organisms held in museum collections”, says Love Dalén, Professor of evolutionary genomics at Stockholm University and the Centre for Palaeogenetics.

The authors of the study say they are excited for future holistic research developments integrating both genomics and transcriptomics towards a new era in palaeogenetics beyond DNA.

Read article in Genome Research

 

The Centre for Palaeogenetics (CPG) is a joint venture between the Swedish Museum of Natural History and  Stockholm University. The overall objective of the centre is to bring researchers from different disciplines, such as biology, archaeology and geology, together into a state-of-the-art research environment dedicated to ancient DNA analyses.
Read more about CPG

 

New book examines benefits, harms and ethics of online crowdfunding


Book Announcement

SIMON FRASER UNIVERSITY




Would you help a complete stranger in desperate need of money, based solely on their social media posts? Simon Fraser University professor and bioethicist Jeremy Snyder examines the complex dimensions of this question in his new book, Appealing to the Crowd: The Ethical, Political, and Practical Dimensions of Donation-Based Crowdfunding (Oxford University Press, 2023) which highlights how online crowdfunding – while helping to meet immediate needs – also impacts privacy and dignity, worsens inequalities, doesn’t solve systemic issues and most often, falls short of its goals.

In recent years, millions of people have given to family, friends, and complete strangers via donation-based crowdfunding, a process where online platforms and social networks are leveraged to raise money for individuals asking for support. Some of the requests are for fundamentals, such as food, housing or education. Some requests are urgent calls for aid from desperate persons living through financially catastrophic events such as unplanned medical procedures, or climate-disasters – such as floods and wildfires – that have destroyed homes and/or livelihoods. 

While it can feel gratifying to help others, Snyder has concerns about how crowdfunding campaigns could undermine the privacy and dignity of individuals in need. “To succeed in crowdfunding, you must convince potential donors that you are deserving of help. [Often,] this means providing a great deal of information including your financial history, medical diagnoses, family dynamics.” 

Many campaigners will upload photos and video, and provide regular updates in an effort to prove their worthiness for support. Some are asked by platforms to supply banking information and other details, which may be difficult to supply in situations where documentation isn’t accessible or has been destroyed. “Privacy and grieving outside of the public eye are not options for people who want to take advantage of the benefits of crowdfunding.”

Despite the increased use of crowdfunding platforms, many people fail to secure the aid they need. A 2021 University of Washington study found that only 12 per cent of campaigns hosted between 2016 to 2020 met their fundraising goals, while 16 per cent received no donations whatsoever.

Snyder observes that factors such as small social networks, limited access to internet, or inability to tell a compelling narrative – due to limited computer or language literacy, or stigma – negatively impact campaigns. “People living at the margins of society and with less ability to get noticed online are at a disadvantage. These biases [within the crowdfunding environment] reflect and exacerbate existing social inequities.” 

Snyder additionally points out that the individualistic nature of crowdfunding – while potentially helpful for meeting some people’s immediate needs – cannot adequately address systemic issues. For example, community rebuilding efforts after large scale wildfires or severe earthquakes involve multiple people, agencies and organizations, and are frequently too large in scope to benefit from crowdfunding. 

“Local community and national organizations may be better suited to rebuilding community housing, providing equitable economic opportunities, and addressing climate change,” observes Snyder. 

Appealing to the Crowd also explores crowdfunding within the historical context of philanthropy and identifies new problems being created by this practice, such as fraud and use of the platforms to spread mis- and dis-information. Snyder presents nine values in the book that can be used to guide donors, campaigners, recipients, platforms and policy makers in their giving so that they can preserve the good that results from crowdfunding while addressing some of its many negative aspects.

“Helping strangers is important and, in many cases, a moral imperative. Crowdfunding, however, is an ethically inferior way to go about it.”

Appealing to the Crowd is an open access title that is free to read through Oxford University Press and select open access portals.  

 

Ponds release more greenhouse gas than they store


Peer-Reviewed Publication

CORNELL UNIVERSITY





ITHACA, N.Y.- Though human-made ponds both sequester and release greenhouse gases, when added up, they may be net emitters, according to two related studies by Cornell University researchers.

The studies begin to quantify the significant effects that both human-made and natural ponds have on the global greenhouse gas budget, measurements that aren’t well understood.

“Global climate models and predictions rely on accurate accounting of greenhouse gas emissions and carbon storage,” said Meredith Holgerson, assistant professor of ecology and evolutionary biology at Cornell and senior author of the studies. Nicholas Ray, a postdoctoral researcher in Holgerson’s lab, is a co-author of both papers.

Holgerson and colleagues have previously estimated that ponds ­– defined as 5 hectares (12 acres) or less and of which there could be 1 billion on Earth – may contribute 5% of the global methane emissions to the atmosphere. But without accurate measurements across many water bodies, the true number could be as little as half or as much as twice that percentage. At the same time, very few estimates of carbon burial rates in ponds exist.  

One paper, “High Rates of Carbon Burial Linked to Autochthonous Production in Artificial Ponds,” published Aug. 18 in the journal Limnology and Oceanography Letters, examines how much carbon is sequestered in 22 Cornell Experimental Ponds. The identical ponds – there are 50 – constructed in 1964, provided highly controlled environments, with detailed records from previous studies. The data allowed Holgerson and Ray to evaluate how management activities contributed to carbon storage.

In the study, the researchers examined the past management activities, while also taking sediment cores and measurements of sediment thickness for each of the 22 study ponds. They measured the amount of carbon in the sediment, extrapolated those measurements to the overall pond, and divided that number by the age of the pond to arrive at the amount of carbon sequestered annually per square meter, a number on the same order of magnitude as wetlands and mangroves, and more than lakes.

They also found that carbon burial rates were influenced by aquatic plants (those large enough to be seen), fish and additions of high nitrogen levels relative to phosphorus, nutrients that may not get renewed in a static pond and become limited. The right kinds and ratios of added nutrients promote plant growth, which use carbon for cells, and are deposited on the pond floor when plants die.

Though data of organic carbon sequestration in natural ponds is lacking, the researchers extrapolated their findings to estimate the total carbon burial rate in natural and artificial ponds globally. They  concluded that natural and artificial ponds sequester 65% to 87% of the total amount estimated to be stored by all lakes, which indicated that scientists are globally underestimating carbon sequestration in ponds and lakes.

The second study, “High Intra-Seasonal Variability in Greenhouse Gas Emissions From Temperate Constructed Ponds,” published Sept. 19 in the journal Geophysical Research Letters, examined seasonal emissions of greenhouse gases (mainly carbon dioxide and methane) from four of the Cornell Experimental Ponds.

In the study, the researchers measured gas emissions from the ponds approximately every two weeks over the course of ice-free period in 2021.

“Global estimates of greenhouse gas budgets from ponds are highly uncertain, in part due to lack of temporal measurements,” said Ray, who is lead author of the study. The researchers found that methane – a greenhouse gas 25 times more potent than carbon dioxide – accounted for most of the gas emitted annually, and carbon dioxide and methane emissions varied greatly by season.

Ponds absorbed carbon dioxide during early summer months when plants were growing, and emitted it later in the year, when plants decomposed. Methane was emitted throughout warm months, but week-to-week shifts in emissions were high, pointing to the need for frequent sampling for accurate accounting.

The researchers found that when water was stratified (a layer of warm water sitting on top of cold bottom waters), methane built up and led to overall higher emissions than when water was mixed by wind or sudden cooling. That’s because micro-organisms on the pond bed that produce methane require low-oxygen conditions that is disrupted by mixing.

When the results from the two papers are considered together, ponds are net emitters of greenhouse gases, due to methane release overwhelming the amount of carbon stored in the sediments. But the findings also offer the possibility of reducing methane emissions with bubblers or underwater circulators.

“If we could reduce that methane number, we could potentially flip these ponds from being net emitters to net sinks, but we have to get a handle on that methane,” Holgerson said.

The research was funded by the New York State Water Resources Institute.

 

Study shows life near the golf course isn't easy for alligators


Peer-Reviewed Publication

UNIVERSITY OF NORTH FLORIDA




Is it an eagle? A birdie? No, it’s a gator. 

The Rosenblatt Lab at the University of North Florida has recently published a study finding that living on a golf course dramatically changes alligator feeding habits. 

The study suggests that land use changes can significantly alter the feeding habits of large predators. Changes in habitat and prey availability caused gators living on golf courses to have different dietary patterns and access to different prey communities compared to those living in natural habitats. As a result, the health and behaviors of the animals could be impacted by various conditions including exposure to human-made chemicals.   

The researchers conducted their study on two neighboring islands located along the southeast coast of Georgia, focusing on the feeding habits of young gators from Jekyll Island, which has several golf courses and a significant amount of human activity, and Sapelo Island, which has no golf courses and much less human activity. In addition to shifting their feeding patterns, the Jekyll Island gators ate some unusual things, like canned corn, a cat, a fishing lure and a cheeseburger with fries. 

Field assistants and UNF students worked with the Jekyll Island Authority (JIA) to help collect the data. The study was led by Dr. Adam Rosenblatt, UNF biology assistant professor, with assistance from Robert Greco and Eli Beal, UNF graduate students; Yank Moore, JIA director of conservation; Joseph Colbert, JIA wildlife biologist; Victoria Baglin, UNF Research Experiences for Undergraduates (REU) intern; and Dr. James Nifong, an alligator expert.   

Read “Golf course living leads to a diet shift for American alligators” in Ecology and Evolution

 

Behavior is the secret to success for a range expansion


Researchers find that behavioral flexibility and persistence help species, like the great-tailed grackle, expand their range and adapt to new habitats


Peer-Reviewed Publication

MAX PLANCK INSTITUTE FOR EVOLUTIONARY ANTHROPOLOGY

Great-tailed grackles 

IMAGE: AN ADULT MALE GREAT-TAILED GRACKLE (RIGHT) WATCHES AS CUERVO (A JUVENILE MALE, LEFT) EXTRACTS FOOD FROM ITS CONTAINER AT A SHOPPING MALL PARKING LOT IN SACRAMENTO, CALIFORNIA. view more 

CREDIT: © CORINA LOGAN




One explanation for why some species decline is that human modifications make existing habitat unsuitable for them. For other species, these modifications are advantageous and make the habitat available for them to expand into.

Researchers from the Max Planck Institute of Evolutionary Anthropology in Germany, and the University of California Santa Barbara and the University of Rochester in the USA investigated the role that increased habitat availability might have played. They compared the rapidly expanding great-tailed grackle with their closest relative, the boat-tailed grackle, who are not rapidly expanding their range.

Based on citizen science observations of bird occurrences, the researchers found that, between 1979 and 2019, great-tails did not just move into new available habitats that matched their earlier requirements, but they increased their habitat breadth to move into more urban, arid environments. In contrast, boat-tails only moved their range slightly northwards in response to climate change making these habitats suitable for them.

Behavior facilitates rapid range expansions into new habitats

This means that the great-tails are not simply expanding their range because more habitat is available to them. “These results support the possibility that their behavior played a role in the great-tailed grackle’s ability to increase habitat breadth,” says Corina Logan, a research group leader in the Department of Human Behavior, Ecology and Culture at the Max Planck Institute of Evolutionary Anthropology, and Gates Cambridge Scholar.

The likely role of behavior in taking advantage of new habitats led researchers to investigate behavior in two great-tailed grackle populations: a recently established population on the northern edge of the range, and an older population closer to the center of the range.

The researchers found that the edge population had a wider range of flexibility and was more persistent than the non-edge population. “We know that this is a highly flexible species and that they are rapidly expanding their geographic range. What surprised us was that it ended up being persistence, and not a higher average flexibility, that stood out as the behavior associated with the range expansion,” says Logan.

Flexibility and persistence

Being persistent might allow individuals to accidentally find solutions to the challenges they face in their new environments, for example by exposing new food sources. Having more variability of flexibility within a population means that there is a higher chance that at least some individuals in the population will be highly flexible and that other individuals could learn from them, thus facilitating that population’s expansion.

Previous research by the grackle team discovered that great-tailed grackles (including individuals who were not on the range edge) have higher average flexibility than most other species. This indicates that flexibility might interact with other abilities to shape the behavior necessary to move into new areas. For example, grackles on the edge might be successful because they keep trying new solutions, rather than giving up quickly or persisting in trying the same solution over and over again.

The grackle team is continuing their work over the past 10 years on this species to untangle these mysteries and provide robust findings that can bear on the broader question of which behavioral traits are associated with a rapid geographic range expansion. “Discovering how great-tailed grackles solve challenges differently from boat-tailed grackles and other species could reveal ways to help declining species adapt to the changes in their environment,” says Logan.

A female (left) and male (right) great-tailed grackle hang out in their usual habitat: an outdoor cafe in Sacramento, California.

A female great-tailed grackle foraging in a parking lot in Sacramento, California.

CREDIT

© Corina Logan

Certain community health care worker programs often exploit volunteers, Mount Sinai researchers report


Peer-Reviewed Publication

THE MOUNT SINAI HOSPITAL / MOUNT SINAI SCHOOL OF MEDICINE

More than half of volunteer community health care workers in 19 countries experience labor exploitation, including sub-minimum-wage pay and excess work hours, Mount Sinai researchers report in the first systematic review of the subject.

The researchers focused on two-tiered or dual-cadre programs, in which salaried community health workers work alongside a volunteer group of community health workers. The study, published in Lancet Global Health on September 19, provides a global estimate of the presence, prevalence, and magnitude of labor exploitation among volunteer community health care workers.

The review also underscores the need for immediate attention to public policies that ensure fair compensation and safe working conditions for all community health care workers, which will subsequently improve the quality of care and overall health outcomes.

The study found that about 59 percent of unsalaried community health care workers in programs with both salaried and volunteer employees experienced labor exploitation, which is defined as pay below the country’s minimum wage coupled with excessive work hours or complex tasks. A significant percentage of unsalaried community health care workers, or about 17 percent of volunteers in dual-cadre programs, would need to work 40 hours per week to fulfill their responsibilities. Therefore, a full work load on a voluntary basis, which may include complex tasks beyond the original role—known as “task shifting”—could result in workers experiencing distress from these working conditions, the researchers said.

“Volunteering is wonderful and should be encouraged, but volunteers should not bear the responsibility for delivering essential health services,” said senior author Madeleine Ballard, PhD, Assistant Professor of Global Health and Health System Design at the Arnhold Institute for Global Health, part of the Icahn School of Medicine at Mount Sinai. “It’s fundamentally exploitative to expect the poor to volunteer as a condition to guarantee their own right to health.”

Amidst the worldwide shortage of health care workers, dual-cadre community health worker programs are increasingly common, especially in low- or middle-income countries. Health care delivered by community health workers—a majority-female labor force—can improve health outcomes and equity, providing a return on investment of up to 10 to 1, according to a United Nations study. However, this review found that two-tiered community health worker programs can result in health care of subpar quality.

The team completed a systematic review of 117 peer-reviewed reports on unsalaried community health workers in 19 countries in the Pacific, sub-Saharan Africa, south Asia, and east Asia that were published between 1988 and 2021. They extracted data on salaries, workload, task complexity, and self-reported experiences. Work hours of 10 hours or more per week for unsalaried community health workers, and 48 hours or more per week for salaried community health workers, met the threshold for exploitation in the review.

The researchers concluded that labor laws should be upheld and fair contracts prioritized, while volunteers should not bear the majority of the responsibilities for delivering essential health services and should be able to contribute to policy decisions. The Mount Sinai team said future patient care strategies should focus on optimizing the roles and responsibilities of community health care workers to ensure they can deliver effective services without being overburdened.

Community Health Impact Coalition, a nonprofit directed by Ballard, co-led this study.

About the Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals” and by U.S. News & World Report’s® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report’s® “Best Hospitals” Honor Roll for 2023-2024.

For more information, visit https://www.mountsinai.org or find Mount Sinai on FacebookTwitter and YouTube.