A few hundred dollars makes a difference in use of long-lasting birth control

LARC use by women in high-deductible health plans rose faster than use by other women after Affordable Care Act cut cost

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

Research News

 

IMAGE: ILLUSTRATION OF AN INTRAUTERINE DEVICE OR IUD, A FORM OF LONG-ACTING REVERSIBLE CONTRACEPTION view more 

CREDIT: UNIVERSITY OF MICHIGAN

Getting a birth control implant used to cost some women hundreds of dollars, if they were among the nearly half of privately insured Americans covered by a health plan with a high deductible that they were responsible for paying.

But a new study in the April issue of Health Affairs shows that after the Affordable Care Act's no-cost birth control provision took effect in 2013, women in these high-deductible health plans (HDHPs) opted for long-acting contraception even more than women with other types of health plans.

The study's findings have important policy implications, because employers now have the ability to opt out of the birth control portion of the ACA, following a Supreme Court case decided in 2020. Many employers have shifted to HDHPs to hold down their overall health benefit costs.

The new data show that between 2013 and 2017, the use of long-acting reversible contraception devices (LARCs) increased 35% more among women in HDHPs than it did among women enrolled in other plans, the study finds.

This difference was on top of an already growing trend. Women with both types of coverage opted for LARCs more and more each year from 2010 to 2017, choosing to receive an intrauterine device or an implant placed beneath their skin and avoid having to remember to take birth control pills. The rate of the yearly increase in LARC use accelerated in both groups after the ACA made all forms of birth control available without out-of-pocket cost in 2013.

The study's authors, led by Nora Becker, M.D., Ph.D., of the University of Michigan, show that before the ACA provision took effect, women in HDHPs paid anywhere between $119 and $580 for a LARC, though the amount depended on whether or not they had met their plan's yearly deductible with other types of health spending. By contrast, women with other private plans paid between $53 and $122 for a LARC. After 2013, both groups received their LARC with an average cost of about $25, to cover aspects of LARC placement not covered by the ACA.

"Our results highlight how much a women's choice of birth control is affected by the out-of-pocket cost of birth control," says Becker, an assistant professor of in the Division of General Medicine at the U-M Medical School's Department of Internal Medicine. "The women who faced the highest costs before the ACA mandate increased their use of LARC methods the most. If many employers now choose to opt out of the mandate going forward, women in high-deductible plans will be the most affected."

She continues, "Our results also have implications for the possible negative consequences of enrolling patients in high-deductible health plans in the first place. In this case, the high out-of-pocket cost of LARC methods before the mandate severely inhibited women from using them, despite the fact that we know these methods have tremendous health and economic benefits for women."

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In addition to Becker, the study's authors are Nancy L. Keating and Lydia E. Pace of Harvard Medical School and Brigham and Women's Hospital.

ACA Mandate Led To Substantial Increase In Contraceptive Use Among Women Enrolled In High-Deductible Health Plans, Health Affairs, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.01710 

 

How many mothers have lost a child: A global comparison

The first systematic comparison of 170 countries reveals large global inequalities in the number of mothers who have experienced the death of a child

UNIVERSITY OF SOUTHERN CALIFORNIA

Research News

 

IMAGE: CUMULATIVE PREVALENCE OF MOTHERS (45-49-YEARS-OLD) BEREAVED BY CHILD DEATH, EXPRESSED PER 1,000 MOTHERS view more 

CREDIT: USC DORNSIFE COLLEGE OF LETTERS, ARTS AND SCIENCES

The inequality is enormous: Mothers in select African countries are more than 100 times more likely to have had a child die than mothers in high-income countries.

This is what Diego Alburez-Gutierrez (Researcher at the Max Planck Institute for Demographic Research (MPIDR) in Rostock, Germany), Emily Smith-Greenaway (Researcher at the USC Dornsife College of Letters, Arts and Sciences in Los Angeles and Guest Researcher at MPIDR), and co-authors found in their recent paper published in BMJ Global Health.

"We offer the first global estimates of the cumulative number of child deaths experienced by mothers between the ages of 20 and 49, in 170 countries," said Smith-Greenaway.

Initially, she and her collaborators did so by drawing from the wealth of publicly available survey data, collected between 2010 and 2018, to calculate the proportion of mothers who have ever lost an offspring in 89 countries.

A new indirect approach to estimate the prevalence of bereaved mothers

"The innovation of our study lies in the fact that we expanded beyond these 89 countries and provided estimates for those lacking recent, nationally representative survey data by leveraging a novel indirect approach that combines formal kinship models and life-table methods," says Alburez-Gutierrez. "That has allowed us to offer a comprehensive look at bereavement worldwide." The estimates generated for these additional 81 countries are interpretable, just as the survey estimates.

International inequalities in mothers' experiences of the death of a child will linger beyond the initial improvement in infant and child mortality conditions, given the varied demographic history of populations. In the seven least affected countries, which includes Japan, Finland, and Spain, fewer than 5 per 1,000 mothers who are between 20 and 44 years old have ever lost an offspring younger than one year old. In Germany, only 6 out of 1,000 mothers have ever lost an infant.

In 34 countries, mostly in Africa, more than 150 per 1,000 mothers have experienced the death of an infant. That means mothers in these countries are more than 30 times as likely to have had a child die than mothers in the seven countries with the lowest numbers. Moreover, in as many as 16 countries--all located in sub-Saharan Africa and the Middle East--more than 200 per 1,000 mothers have lost an infant.

It is concerning that the very parts of the world where the cumulative burden of child death is heaviest for mothers are also the settings where the least is known about the social, economic, relational, and health implications of child death for mothers. "We hope that this work will emphasize that further efforts to lower child deaths will not only improve the quality and length of life for children across the globe, but will also fundamentally improve the lives of parents," said Smith-Greenaway.

 

The Lancet Psychiatry: Largest study to date suggests link between COVID-19 infection and subsequent mental health and neurological conditions

THE LANCET

Research News

Study using electronic health records of 236,379 COVID-19 patients mostly from the USA estimates that one in three COVID-19 survivors (34%) were diagnosed with a neurological or psychiatric condition within six months of infection.

• Anxiety (17%) and mood disorders (14%) were the most common. Neurological diagnoses such as stroke and dementia were rarer, but not uncommon in those who had been seriously ill during COVID-19 infection. For example, of those who had been admitted to intensive care, 7% had a stroke and almost 2% were diagnosed with dementia.
• These diagnoses were more common in COVID-19 patients than in flu or respiratory tract infection patients over the same time period, suggesting a specific impact of COVID-19.
• Authors say their findings should aid service planning and highlight need for ongoing research.

One in three COVID-19 survivors received a neurological or psychiatric diagnosis within six months of infection with the SARS-CoV-2 virus, an observational study of more than 230,000 patient health records published in The Lancet Psychiatry journal estimates. The study looked at 14 neurological and mental health disorders [1].

Professor Paul Harrison, lead author of the study, from the University of Oxford, UK, said: "These are real-world data from a large number of patients. They confirm the high rates of psychiatric diagnoses after COVID-19, and show that serious disorders affecting the nervous system (such as stroke and dementia) occur too. While the latter are much rarer, they are significant, especially in those who had severe COVID-19." [2]

"Although the individual risks for most disorders are small, the effect across the whole population may be substantial for health and social care systems due to the scale of the pandemic and that many of these conditions are chronic. As a result, health care systems need to be resourced to deal with the anticipated need, both within primary and secondary care services." [2]

Since the COVID-19 pandemic began, there has been growing concern that survivors might be at increased risk of neurological disorders. A previous observational study by the same research group reported that COVID-19 survivors are at increased risk of mood and anxiety disorders in the first three months after infection [3]. However, until now, there have been no large-scale data examining the risks of neurological as well as psychiatric diagnoses in the six months after COVID-19 infection.

This latest study analysed data from the electronic health records of 236,379 COVID-19 patients from the US-based TriNetX network, which includes more than 81 million people. Patients who were older than 10 years and who became infected with the SARS-CoV-2 virus after 20 January 2020, and were still alive on 13 December 2020, were included in the analysis. This group was compared with 105,579 patients diagnosed with influenza and 236,038 patients diagnosed with any respiratory tract infection (including influenza).

Overall, the estimated incidence of being diagnosed with a neurological or mental health disorder following COVID-19 infection was 34%. For 13% of these people it was their first recorded neurological or psychiatric diagnosis.

The most common diagnoses after COVID-19 were anxiety disorders (occurring in 17% of patients), mood disorders (14%), substance misuse disorders (7%), and insomnia (5%). The incidence of neurological outcomes was lower, including 0.6% for brain haemorrhage, 2.1% for ischaemic stroke, and 0.7% for dementia (see table 2).

Risks of a neurological or psychiatric diagnosis were greatest in, but not limited to, patients who had severe COVID-19. Compared to the overall 34% incidence, a neurological or psychiatric diagnosis occurred in 38% of those who had been admitted to hospital, 46% of those in intensive care, and 62% in those who had delirium (encephalopathy) during their COVID-19 infection. This gradient of risk applied to individual disorders too. For example, 2.7% of people needing intensive care and 3.6% of people with encephalopathy had a brain haemorrhage (compared to 0.3% in people without hospitalisation); 6.9% and 9.4% had ischaemic stroke (compared to 1.3% without hospitalisation); 1.7% and 4.7% developed dementia (0.4% without hospitalisation); and 2.8% and 7% were diagnosed with a psychotic disorder (0.9% without hospitalisation) (see table 2).

The authors also looked at people who experienced flu and other respiratory tract infections over the same time frame to help understand whether these neurological and mental health complications were linked specifically to COVID-19. After taking into account underlying health characteristics, such as age, sex, ethnicity, and existing health conditions, there was overall a 44% greater risk of neurological and mental health diagnoses after COVID-19 than after flu, and a 16% greater risk after COVID-19 than with respiratory tract infections. As a result, the authors say that COVID-19 does lead to a greater risk of neurological and psychiatric disorders than these other health conditions. However, this was not seen for all conditions; there was no clear evidence that COVID-19 led to an increased risk of parkinsonism or and Guillain-Barré syndrome.

Dr Max Taquet, a co-author of the study, from the University of Oxford, UK, said: "Our results indicate that brain diseases and psychiatric disorders are more common after COVID-19 than after flu or other respiratory infections, even when patients are matched for other risk factors. We now need to see what happens beyond six months. The study cannot reveal the mechanisms involved, but does point to the need for urgent research to identify these, with a view to preventing or treating them." [2]

The authors note several limitations to their study. Firstly, the completeness and accuracy of the electronic health records is not known. Secondly, many people with COVID-19 have mild or no symptoms and do not present for health care, therefore, the people studied here are likely to have been more severely affected than in the general population. Thirdly, the severity and course of the neurological and psychiatric disorders is not known.

Writing in a linked Comment article, Dr Jonathan Rogers, who was not involved in the study, from University College London (UCL), UK, said: "[this] study points us towards the future, both in its methods and implications. Researchers need to be able to observe and anticipate the neurological and psychiatric outcomes of future emerging health threats by use of massive, international, real-world clinical data. Selection biases will remain an issue, not necessarily mitigated by sample size,10 and thus the onus should be on countries with public health-care systems to enable truly comprehensive national data to be available for research. Sadly, many of the disorders identified in this study tend to be chronic or recurrent, so we can anticipate that the impact of COVID-19 could be with us for many years."

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Peer reviewed / Observational / People

NOTES TO EDITORS

The study was funded by the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre. It was conducted by researchers from the University of Oxford (UK), and TriNetX (USA).

[1] Full list of neurological and psychiatric outcomes assessed: intracranial haemorrhage; ischaemic stroke; parkinsonism; Guillain-Barre syndrome; nerve, nerve root and plexus disorders; myoneural junction and muscle disease; encephalitis; dementia; psychotic, mood and anxiety disorders (grouped and separately); substance misuse; and insomnia.

[2] Quote direct from author and cannot be found in the text of the Article.

[3] See: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30462-4/fulltext

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 you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com

IF YOU WISH TO PROVIDE A LINK FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext

Study links prenatal phthalate exposure to altered information processing in infants

UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN, NEWS BUREAU

Research News

 

IMAGE: AN INFANT IN THE PROGRAM SEATED ON HER MOTHER'S LAP. THE INFANT HAS A STICKER ON HER FOREHEAD THAT ALLOWS AN EYE-TRACKING INSTRUMENT TO ORIENT TO HER EYES. view more 

CREDIT: PHOTO BY STEVE DRAKE

CHAMPAIGN, Ill. -- Exposure to phthalates, a class of chemicals widely used in packaging and consumer products, is known to interfere with normal hormone function and development in human and animal studies. Now researchers have found evidence linking pregnant women's exposure to phthalates to altered cognitive outcomes in their infants.

Most of the findings involved slower information processing among infants with higher phthalate exposure levels, with males more likely to be affected depending on the chemical involved and the order of information presented to the infants.

Reported in the journal Neurotoxicology, the study is part of the Illinois Kids Development Study, which tracks the effects of hormone-disrupting chemicals on children's physical and behavioral development from birth to middle childhood. Now in its seventh year, IKIDS has enrolled hundreds of participants and is tracking chemical exposures in pregnant women and developmental outcomes in their children. Susan Schantz, a neurotoxicologist and professor emerita of comparative biosciences at the University of Illinois Urbana-Champaign, is the principal investigator of the study. She is a faculty member in the Beckman Institute for Advanced Science and Technology, which houses the IKIDS program at Illinois.

"IKIDS is part of a larger initiative funded by the National Institutes of Health, the Environmental Influences on Child Health Outcomes program. It is tracking the impact of prenatal chemical exposures and maternal psychosocial stress on children's growth and development over time," Schantz said. "We measure numerous birth outcomes, including birth weight and gestational age. We also assess infants' cognition by studying their looking behavior. This allows us to get measures of working memory, attention and information-processing speed."

The researchers analyzed metabolites of three commonly occurring phthalates in urine samples regularly collected from the pregnant women in the study. The chemical exposure data were used in combination with assessments of the women's infants when the children were 7.5 months old.

The researchers used a well-established method that gives insight into the reasoning of children too young to express themselves verbally: Infants typically look longer at unfamiliar or unexpected images or events.

The team used an infrared eye-tracker to follow each infant's gaze during several laboratory trials. With the infant sitting on a caregiver's lap, researchers first familiarized the child with two identical images of a face. After the infant learned to recognize the face, the researchers showed that same face paired with an unfamiliar one.

"In repeated trials, half of the 244 infants tested saw one set of faces as familiar, and half learned to recognize a different set of faces as familiar," Schantz said. "By analyzing the time spent looking at the faces, we could determine both the speed with which the infants processed new information and assess their ability to pay attention."

The assessment linked pregnant women's exposure to most of the phthalates that were assessed with slower information processing in their infants, but the outcome depended on the specific chemical, the sex of the infant and which set of faces the infant viewed as familiar. Male infants, in particular, tended to process information more slowly if their mothers had been exposed to higher concentrations of phthalates known to interfere with androgenic hormones.

The specific characteristics of faces presented to the infants in the familiarization trials also appeared to play a role in the outcome, the researchers reported. Phthalate-exposed children who were first familiarized with faces from Set 2 were more likely to experience slower processing speed than those familiarized with faces from Set 1. The finding is perplexing, Schantz said, but is likely related to differences in the infants' preferences for the faces in the two sets. It also may be an indication that familiarization with the Set 2 faces is a more sensitive detector of changes in processing speed related to phthalate exposure.

"Most previous studies of the relationship between prenatal exposure to phthalates and cognition have focused on early and middle childhood," Schantz said. "This new work suggests that some of these associations can be detected much earlier in a child's life."

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The U.S. Environmental Protection Agency, the National Institute of Environmental Health Sciences, the National Institutes of Health ECHO Program supported this research.

Editor's notes:

IKIDS is a research partnership with Carle Foundation Hospital, Christie Clinic, OSF HealthCare, the U. of I., and Brigham and Women's Hospital/Harvard Medical School.

To reach Susan Schantz, email schantz@illinois.edu.

The paper "Associations of prenatal exposure to phthalates with measures of cognition in 7.5-month-old infants" is available online and from the U. of I. News Bureau

For breastfeeding moms, COVID-19 vaccinations may also protect babies

Major boost in COVID-19 antibodies seen in breast milk after vaccination

WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

Research News

 

Nursing mothers who receive a COVID-19 vaccine may pass protective antibodies to their babies through breast milk for at least 80 days following vaccination, suggests new research from Washington University School of Medicine in St. Louis.

"Our study showed a huge boost in antibodies against the COVID-19 virus in breast milk starting two weeks after the first shot, and this response was sustained for the course of our study, which was almost three months long," said first author Jeannie Kelly, MD, assistant professor of obstetrics and gynecology. "The antibodies levels were still high at the end of our study, so the protection likely extends even longer."

Based on the small study, involving five mothers who provided frozen breast milk samples after receiving the two-dose Pfizer-BioNTech coronavirus vaccine, the research provides some of the first peer-reviewed evidence that breastfeeding confers a long-lasting immune response in the nursing infants and toddlers of vaccinated mothers.

"There is so much vaccine misinformation out there right now - really scary, misleading posts on social media that are designed to scare moms - so we felt like we needed to look at the science," Kelly said. "We know that these types of antibodies coat babies mouths and throats and protect against disease when a baby is drinking breast milk. So, getting vaccinated while breastfeeding not only protects mom, but also could protect the baby, too, and for months."

Published March 30 in the American Journal of Obstetrics and Gynecology, the study tracked levels of COVID-19 antibodies in breast milk from a baseline before the mothers' first vaccinations and on a weekly basis for 80 days after those initial vaccinations.

While other recent research has shown that COVID-19 vaccines generate antibodies that are passed to nursing infants through breast milk, this is thought to be the first study to track specific levels of these antibodies in breast milk over an extended time period.

The babies of women included in the study ranged in age from one month to 24 months old. To gauge immune response in the breast milk, researchers monitored levels of the immunoglobulins IgA and IgG, which are antibodies deployed by the immune system to fight infections in babies.

Findings confirm that breast milk contains elevated levels of the IgA and IgG antibodies immediately following the first dose of vaccination, with both antibodies reaching immune-significant levels within 14 to 20 days of first vaccination in all participants.

"Our study is limited by a small number of participants, but the findings provide encouraging news about the potential immune benefit to breast-feeding infants after vaccination," said study senior author Misty Good, MD, an assistant professor of pediatrics, also at Washington University. "Our paper is the first that has shown COVID-19 antibodies persist in breast milk for months following the mother's vaccination."

The Washington University findings are similar to prior studies on maternal vaccination, which have shown high levels of antibodies in breast milk for up to six months following vaccination for influenza and whooping cough.

While further studies of maternal COVID-19 vaccination are needed to characterize the length of antibody production in breast milk and the effect on infant infection rates, recent research continues to confirm that the COVID-19 vaccine offers real benefits for protecting both mother and child.

"We do know that COVID-19 infection is more severe during pregnancy and the main benefit of vaccination is to provide protection for moms before they become really sick, which can also be dangerous to their fetus," Kelly said. "There have now been almost 70,000 pregnant people vaccinated against COVID 19 with no evidence of harm."

"We're now seeing a cascade of new data that indicate maternal vaccines are also going to help protect babies -- both through transfer of antibodies through the placenta during pregnancy and through the breast milk during lactation," Kelly said. "This is information we didn't have a few months ago and it's really helping us better counsel our patients who are considering getting the vaccine. I'm telling my pregnant and breastfeeding moms that I strongly recommend that they get vaccinated as soon as possible."

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Kelly JC, Carter EB, Raghuraman N, Nolan LS, Gong Q, Lewis AN, Good M. Anti-SARS-CoV-2 antibodies induced in breast milk after Pfizer-BioNTech/BNT162b2 vaccination. American Journal of Obstetrics and Gynecology. March 30, 2021. DOI: https://doi.org/10.1016/j.ajog.2021.03.031

This research is supported, in part, by the Washington University Institute of Clinical and Translational Sciences which is, in part, supported by the NIH/National Center for Advancing Translational Sciences (NCATS) grant number UL1TR002345; the Foundation for Barnes-Jewish Hospital; The PEW Charitable Trusts Community Opioid Response and Evaluation (CORE); the National Institutes of Health (NIH) grant numbers 5T32HD043010 and R01DK118568; an American Academy of Pediatrics Marshall Klaus Award; the St. Louis Children's Hospital Foundation; the Children's Discovery Institute of Washington University and St. Louis Children's Hospital; and the Department of Pediatrics at Washington University School of Medicine.

Washington University School of Medicine's 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is a leader in medical research, teaching and patient care, consistently ranking among the top medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

#STFU

Americans are super-spreaders of COVID-19 misinformation

The US 'infodemic' has spread to Canada, fueled by social media

MCGILL UNIVERSITY

Research News

Misinformation about COVID-19 is spreading from the United States into Canada, undermining efforts to mitigate the pandemic. A study led by McGill University shows that Canadians who use social media are more likely to consume this misinformation, embrace false beliefs about COVID-19, and subsequently spread them.

Many Canadians believe conspiracy theories, poorly-sourced medical advice, and information trivializing the virus--even though news outlets and political leaders in the country have generally focused on providing reliable scientific information. How then, is misinformation spreading so rapidly?

"A lot of Canadians are struggling to understand COVID-19 denialism and anti-vaccination attitudes among their loved ones," says lead author Aengus Bridgman, a PhD Candidate in Political Science at McGill University under the supervision of Dietlind Stolle. According to the study, published in Frontiers in Political Science, these attitudes are partially the result of massive Canadian consumption of information from the United States.

The researchers analyzed the behaviours of the 200,000 most active Canadian Twitter users and conducted surveys on news consumption habits and COVID-19 beliefs of Canadians. They found that those who use social media are relatively more exposed to US-based information than domestic sources of information, and that exposure to US news outlets was associated with misperceptions about COVID-19.

They also found that most of the misinformation circulating on Twitter shared by Canadians was retweeted from US sources. Canadians who followed more American users were more likely to post misinformation.

Canada is not immune to the American infodemic

While there has been a Canadian cross-partisan consensus on battling COVID-19, the political climate in the United States is very different. South of the border there is intense polarization over the severity of the pandemic, with misinformation being reinforced by American media and political figures alike.

Information circulating in the United States also deeply impacts Canadians, for better or worse. This is especially true in social media spaces, where Canadians are among the heaviest users - one out of two are on Instagram, five out of six are on Facebook, and two out of five are on Twitter. Moreover, Canadians pay special attention to American media. "On average, they follow three times as many Americans as they do Canadians on Twitter, and retweet them eight times more often," says co-author Taylor Owen, an Associate Professor at the Max Bell School of Public Policy at McGill University.

According to the researchers, this influence produces a troubling vulnerability for Canada during the pandemic. "It's hard for Canadian journalists, scientists and public health experts to be heard by the average Canadian, given all the noise generated by American sources," says Bridgman. "Countries with journalists and political leaders that don't indulge conspiracy theories or profess anti-science views are simply not immune to dangerous infodemics."

Finding a cure

Although many Canadians choose to consume news from the US, social media platforms likely play a key role in deepening this interest, say the researchers.

Not only do their algorithms saturate information streams with American news, they also propagate false news much faster than factual news. By privileging content that draws emotional responses from users, the algorithms help spread misinformation like wildfire.

Governments wishing to limit the spread of infodemics should consider the ways that social media platforms push out-of-country information to the top of news feeds. "This infodemic has the capacity to change important attitudes and behaviours that influence transmission patterns of COVID-19. Ultimately, it can change the scale and lethality of a pandemic," says Owen.

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About this study

"Infodemic pathways: Evaluating the role that traditional and social media play in cross-national information transfer" by Aengus Bridgman, Eric Merkley, Oleg Zhilin, Peter John Loewen, Taylor Owen, and Derek Ruths was published in Frontiers in Political Science.

DOI: http://doi.org/10.3389/fpos.2021.648646

About McGill University

Founded in Montreal, Quebec, in 1821, McGill University is Canada's top ranked medical doctoral university. McGill is consistently ranked as one of the top universities, both nationally and internationally. It is a world-renowned institution of higher learning with research activities spanning two campuses, 11 faculties, 13 professional schools, 300 programs of study and over 40,000 students, including more than 10,200 graduate students. McGill attracts students from over 150 countries around the world, its 12,800 international students making up 31% of the student body. Over half of McGill students claim a first language other than English, including approximately 19% of our students who say French is their mother tongue.

https://www.mcgill.ca/newsroom/

Black women are dying of COVID-19 at rates higher than men in other racial/ethnic groups

GenderSci Lab publishes first analysis of sex-disparity in COVID-19 mortality across racial groups, emphasizing the specific vulnerability of Black women.

HARVARD UNIVERSITY

Research News

 

IMAGE: AGE-STANDARDIZED COVID-19 MORTALITY RATE PER 100,000 view more 

CREDIT: GENDERSCI LAB AT HARVARD UNIVERSITY

A new paper in the Journal of General Internal Medicine published by the GenderSci Lab at Harvard University shows that Black women are dying at significantly higher rates than white men, and that disparities in mortality rates among women of all races are greater than those between white women and white men.

The study is the first to quantify the inequities in COVID-19 mortality looking at both race and sex group.

"This analysis complicates the simple narrative that men are dying at greater rates of COVID-19 than women," said lead author Tamara Rushovich, Harvard Ph.D. candidate in population health sciences and lab member at the GenderSci Lab.

Results show that the common belief that men with COVID-19 fare more poorly than women varies in magnitude across social groups defined by race/ethnicity.

Key findings of the study include:

• Black women have COVID-19 mortality rates that are almost 4 times higher than that of white men and 3 times higher than that of Asian men, as well as higher than white and Asian women.
• Black men have far higher mortality rates than any other sex and racial group, including over 6 times higher than the rate among white men.
• The disparity in mortality rates between Black women and white women is over 3 times the disparity between white men and white women.
• The disparity between Black men and Black women is larger than the disparity between white men and white women.

It is well understood that racism and social inequities, not genetics, are responsible for racial disparities in COVID-19 mortality. However, many researchers focus on differences in biology to explain the sex disparity in COVID-19 mortality. This paper's findings challenge the sole focus on biology as an explanation for sex differences in COVID-19 mortality and argue that societal factors related to gender in combination with racism and socioeconomic stratification are important explanatory factors.

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This study used census data and publicly available data from Michigan and Georgia, the only two states reporting data disaggregated by age, race, and sex, to calculate and compare COVID-19 mortality rates.

 

COVID-19: Tsunami of chronic health conditions expected, research & health care disrupted

Circulation Journal reports

AMERICAN HEART ASSOCIATION

Research News

 

DALLAS, April 6, 2021 -- A tsunami of chronic health conditions as a result of the SARS-CoV-2 pandemic, especially cardiometabolic disease, may produce an enormous wave of death and disability that demands immediate, comprehensive strategies. In addition, COVID-19 has disrupted cardiovascular science and medicine, yet it presents opportunities to transform and create novel approaches that can yield new successes. These are the opinions of two esteemed leaders in cardiovascular disease care, research and strategy, detailed in two new Frame of Reference articles published today in the American Heart Association's flagship journal Circulation.

While COVID-19 has severely impacted everyone's daily lives, its societal and economic impact will be present for generations. It has prompted urgent responses in many sectors that could be models for rapidly developing real-world solutions that can improve efforts focused on prevention of chronic health conditions. Dramatic transformation in health care research is needed to align with the disruption of cardiovascular care and heart health caused by the COVID-19 pandemic.

The first article, "Avoiding the Coming Tsunami of Common, Chronic Disease: What the Lessons of the COVID-19 Pandemic Can Teach Us," is authored by Robert M. Califf, M.D. He is the head of clinical policy and strategy at Verily Life Sciences and Google Health, a former commissioner of the U.S. Food and Drug Administration, former vice chancellor for health data science at Duke University School of Medicine and the founding director of the Duke Clinical Research Institute.

In his article, Califf urges swift and comprehensive action to avoid the dramatic rise in chronic health conditions, particularly cardiometabolic disease, that are to be expected as a result of COVID-19. Three of the top 10 leading causes of death in the U.S., cardiovascular disease, stroke and type 2 diabetes, are linked to cardiometabolic disease.

He calls for critical shifts in the U.S. health care system to include universal health care, public health and research strategies that incorporate "big data," and improved health data sharing that can inform more effective and efficient prevention and treatment protocols and programs across society."

Califf also notes the impacts of structural racism and that social determinants of health must be incorporated at all levels of research, clinical care and within communities and society at large for equitable, systemic improvement in health outcomes to be realized. He advocates for universal access to broadband internet that could increase access to medical information, digital support programs and telehealth appointments with health care professionals.

He recommends more real time, in-depth tracking of chronic health conditions similar to the rapid data dashboards that were implemented to track COVID-19 cases, hospitalizations and deaths. With better information accessible more quickly, strategies to prevent and treat chronic health conditions can be measured and adapted accordingly.

Califf also proposes a new effort called "Operation Warp Evidence," modeled after the rapid COVID vaccine effort "Operation Warp Speed," to be a speedy, prioritized clinical trial infrastructure that assesses the risks and benefits of new therapies compared to existing therapies for chronic health conditions. This would allow the vast pool of clinical trials to be more focused on immediate interventions that can improve prevention, care and outcomes.

A number of Califf's comments align with the American Heart Association's November 2020 Presidential Advisory, "Call to Action: Structural Racism is a Fundamental Driver of Health Disparities," in which the Association outlined an aggressive and meaningful plan to address structural inequity to eliminate disparities, remove barriers and increase diversity, equity, access and inclusion for all. They also echo the Association's findings in the recent Heart Disease and Stroke Statistics - 2021, showing that COVID-19 will likely influence cardiovascular health and mortality rates for years to come.

The second article, titled "Incremental Change versus Disruptive Transformation: COVID-19 and the Cardiovascular Community," is from Nanette K. Wenger, M.D., FAHA, professor of medicine in the division of cardiology at Emory University School of Medicine, consultant to the Emory Heart and Vascular Center, founding consultant to the Emory Women's Heart Center and director of the Cardiac Clinics and Ambulatory Electrocardiographic Laboratory at Grady Memorial Hospital in Atlanta.

Wenger has been at the forefront of advancing patient care for the last 60-plus years, and she was among the first physicians to focus on coronary heart disease in women and to evaluate the different cardiovascular risk factors, symptoms and conditions for women compared to men. She was one of the first women to graduate from Harvard Medical School and has received numerous accolades throughout her distinguished career for her pioneering work on cardiovascular disease in women. Notably, she was an author of the Association's 2007 Guidelines for Cardiovascular Disease in Women, and she has received multiple awards from the Association including the Gold Heart Award, the Lifetime Achievement Award and, most recently, the 2020 Eugene Braunwald Academic Mentorship Award.

Wenger's article documents her perspective that the U.S. has been experiencing three simultaneous pandemics: COVID-19, economic disruption and social injustice. The COVID-19 pandemic magnified societal and health care disparities; millions of people lost jobs; numerous industries and small businesses have been financially decimated; and every aspect of scientific research and medicine has been altered - education, research and clinical care. Yet, she acknowledges there were numerous successes and critical shifts, such as the quick adoption of telemedicine, that can lead to broad transformation in health care delivery and potentially improve access to care for more patients.

Disparities were revealed to include patient hesitancy to receive care. Many improvements achieved over the past five decades in acute coronary and stroke care were compromised because patients self-quarantined to avoid the emergency room and exposure to COVID-19.

While COVID-19 drove research urgency to understand the disease, its course, treatments and vaccines, it opened the door for successful new public-private partnerships that realized rapid results. Wenger asks, "Could these be a model for future advancements?"

Academic education moved to virtual settings, many labs were closed and some programs fast-tracked students to join the pool of professionals providing emergency patient care. Career opportunities for medical students and professionals shifted in unexpected ways, and women scientists have been disproportionately affected by quarantines because of historic childcare responsibilities. "What will the long-term effects be on science and discovery?" Wenger noted.

In scientific publishing, COVID-19 research was accelerated through the peer-review process to meet the pressures and yielded an effective model for greater efficiencies that should be continued. Health registries that were implemented quickly to track COVID-19 patients could be expanded to include cardiovascular disease measures, treatment and outcomes, particularly since there are still so many unknowns about long-haul COVID and lasting cardiovascular effects.

The recognition of social injustice and its correlation to poorer health outcomes were unmasked by the disproportionate COVID-19 deaths in African American, Hispanic/Latino, American Indian/Alaska Native and Pacific Islander communities this past year. COVID-19 magnified these disparities and has catalyzed critical commitments to dismantle structural racism, as addressed in the previously mentioned AHA 2020 Presidential Advisory.

Wenger concludes, "The convergence of all of these issues, their impact on cardiovascular disease and care, presents unique opportunities for transformation in cardiovascular medicine, clinical care and research. We must remain focused and flexible during this unprecedented time to maximize innovation and achieve equity for all."

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The Association has made significant strides in a number of important areas noted by Wenger. Within weeks after the pandemic began, the Association established the COVID-19 CVD Registry Powered by Get With The Guidelines® to capture data on patient clinical characteristics, medications, treatments, labs, vitals, biomarkers and outcomes for adult patients hospitalized with COVID-19 including patients without a history of cardiovascular disease or stroke. Through January 2021, more than 37,000 deidentified patient records and over 135,000 lab reports from more than 160 hospital sites across the U.S. are available in the registry. The Registry will continue to be modified and strengthened and is a powerful repository to guide advancements.

As early pandemic data emerged and confirmed fewer patients seen in emergency rooms for heart attacks and strokes, the Association launched the Don't Die of Doubt public awareness campaign in July 2020. Available in both English and Spanish, the campaign focused on reminding Americans that even during the pandemic, the hospital is still the safest place to be if experiencing symptoms of a heart attack or stroke.

Last month, the editors of Circulation: Cardiovascular Quality and Outcomes, an Association journal, published a statement detailing specific instructions for scientific authors to guide consistent framing, terminology and methods aligned with established best practices for scientific research on racial and ethnic disparities in health. The guidance is under review for adoption by the editorial teams of the Association's portfolio of 11 additional scientific journals: Circulation; Stroke; Hypertension; Journal of the American Heart Association; Arteriosclerosis, Thrombosis, and Vascular Biology; Circulation Research; Circulation: Arrhythmia and Electrophysiology; Circulation: Genomic and Precision Medicine; Circulation: Heart Failure; Circulation: Cardiovascular Imaging; and Circulation: Cardiovascular Interventions.

The Association is about to launch a new campaign, Doctor, It's Been Too Long, to encourage everyone to return to their doctors and health care professionals for routine care during the pandemic.

Additional Resources:

Available multimedia is on right column of release link -
https://newsroom.heart.org/news/covid-19-tsunami-of-chronic-health-conditions-expected-research-health-care-disrupted?preview=4394d57a6064c78eb1a7e077b7f2a8b7

After April 6, 2021, view the manuscripts online:
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.053461 and https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.053860

COVID-19 CVD registry details disparities among patients hospitalized with COVID
American Heart Association coronavirus (COVID-19) resources for the public
American Heart Association coronavirus (COVID-19) resources for health care professionals
American Heart Association announces COVID-19 patient data registry

More than $230 million committed to support equitable health for all people
New guidance addresses structural racism in racial and ethnic disparities research
Don't Die of Doubt
Doctor, It's Been Too Long

American Heart Association COVID-19 Newsroom
Follow AHA/ASA news on Twitter @HeartNews
Follow news from the AHA's flagship journal Circulation @CircAHA

Statements and conclusions of studies published in the American Heart Association's scientific journals are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org , Facebook , Twitter or by calling 1-800-AHA-USA1.

 

Curbing coronavirus spread in enclosed spaces means better masks, adequate ventilation

Findings show leakage of airborne droplets escaping from masks even when just breathing

AMERICAN INSTITUTE OF PHYSICS

Research News 

IMAGE: ILLUSTRATION SHOWS THE REACH OF BREATH WITHOUT A MASK AND DURING VARIOUS MASK AND FACE SHIELD EVALUATIONS. view more 

CREDIT: VENUGOPAL ARUMURU/INDIAN INSTITUTE OF TECHNOLOGY BHUBANESWAR

WASHINGTON, April 6, 2021 -- With research increasingly showing the COVID-19 virus is transmissible via smaller droplets suspended in air, there is a growing concern current public health guidelines of mask wearing and social distancing are insufficient in combating its spread in indoor environments, like prisons, hospitals, and meatpacking plants, where people tend to be in close quarters.

Most research has focused on coughing and sneezing. But studies on how simply breathing might contribute to airborne spread of the virus are rare.

In AIP Advances, by AIP Publishing, researchers at the Indian Institute of Technology Bhubaneswar show social distancing is equally important as mask wearing when people indoors are just breathing or participating in normal conversation, even when there is no risk of coughing or sneezing. They also found mask leakage in the same scenario presents a notable challenge in preventing the virus's spread.

"Our findings show the need for good ventilation systems that take into account the 5 to 10% of aerosolized particle leakage that occurs in each breathing cycle as a way to reduce droplet concentration in enclosed spaces," author Venugopal Arumuru said. "There also is a need for mask design innovation to reduce side and bottom droplet leakage while providing adequate face comfort."

In an experimental setup, a mechanical breathing simulator was connected to a mannequin standing at 5 feet 8 inches tall to simulate regular breath and slightly longer breath typical of healthy adults standing still or involved in moderate activity, like walking, talking, or participating in assembly work. The researchers evaluated the efficacy of various mask types, mask-shield combinations, and only face shield use.

A fog generator was filled with a mixture of water and glycerin to emulate the consistency of saliva droplets in the diameter range of 1-10 micrometers to reflect airborne transmissibility. Droplet exposure was illuminated and captured by video camera.

The researchers found that with no face covering, droplets from breathing can travel up to 4 feet in five seconds. A commercial five-layered mask was found to provide the best protection, with full front-of-face protection and minimal leakage below the chin. A commercial N-95 mask impedes droplet leakage in front, but leakage in gaps between the mask and nose was significant.

Leakage from the front of the surgical mask was evident, although adding a face shield increased droplet restriction.

"However, the noticeable droplets settling below the shield is concerning, and pairing surgical masks with shields is not adequate in hospitals and other places where strict social distancing guidelines are difficult to follow," Arumuru said.

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The article "Breathing, virus transmission and social distancing - An experimental visualization study" is authored by Venugopal Arumuru, Jangyadatta Pasa, Sidhartha Sankar Samantaray, and Vaibhavsingh Surendrasingh Varma. The article will appear in AIP Advances on April 6, 2021 (DOI: 10.1063/5.0045582). After that date, it can be accessed at https://aip.scitation.org/doi/10.1063/5.0045582.

ABOUT THE JOURNAL

AIP Advances is an open access journal publishing in all areas of physical sciences--applied, theoretical, and experimental. The inclusive scope of AIP Advances makes it an essential outlet for scientists across the physical sciences. See https://aip.scitation.org/journal/adv.