Product label changes do not prevent accidental acetaminophen overdoses

Peer-Reviewed Publication

CANADIAN MEDICAL ASSOCIATION JOURNAL

Changes to acetaminophen product labels did not decrease rates of hospitalization for accidental acetaminophen overdoses, according to a new Canadian study in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.210842.

"We found that changes to acetaminophen labels that communicated the risks of overdose and the presence of acetaminophen in over-the-counter products did not affect rates of hospital admission for accidental acetaminophen overdose, ICU admission for accidental acetaminophen overdose and admission for acetaminophen overdoses involving opioids," writes Dr. Tony Antoniou, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, with coauthors.

Acetaminophen is a medication commonly used by millions of people worldwide for pain relief, and although it is generally safe if taken correctly, accidental overdoses can occur because the drug is found in many over-the-counter products for treating pain and the common cold. In Canada, the percent of acetaminophen-related injuries related to accidental overdose in Canada increased from 27% in 2006 to 45% in 2011.

To increase awareness of potential harm, product label changes were made in Canada in October 2009 to warn of the risk of possible liver damage. In 2016, they were updated with additional labelling for safe dosing and to identify products containing acetaminophen.

However, in this study of more than 12 000 hospital admissions for accidental acetaminophen overdose in 9 provinces and 3 territories in Canada between 2004 and 2020, researchers found there was no impact from the updated labeling on admissions.

The authors suggest these findings have several implications for public health.

"Because of the human and economic burden imparted by accidental acetaminophen overdoses, additional measures for preventing these episodes are required, beyond those that attempt to inform consumers about the potential risks of acetaminophen through product labels and package inserts. This is especially important when considered in light of previous research that showed that fewer than 50% of patients regularly read labelled instructions for use of over-the counter analgesics, and only 26% read the active ingredients before first use."

As well, 4.5% to 6% of patients exceed the maximum daily dosage, perhaps because acetaminophen is found in other cough and cold medications, according to studies from the United Kingdom and the United States.

Suggestions for preventing accidental acetaminophen overdoses include removal of acetaminophen from other nonanalgesic over-the-counter medications, discontinuing opioid–acetaminophen combination products and restricting maximum doses of 325 mg per unit.

A Practice article https://www.cmaj.ca/lookup/doi/10.1503/cmaj.210703  about treating acetaminophen overdose provides easy-to-follow guidance for health care providers on treatment for this potentially life-threatening condition. Most deaths occur after deliberate overdose or from excessive dosing for fever or pain over several days.

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JOURNAL

Canadian Medical Association Journal

DOI

10.1503/cmaj.210842 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Impact of acetaminophen product labelling changes in Canada on hospital admissions for accidental acetaminophen overdose: a population-based study

ARTICLE PUBLICATION DATE

19-Apr-2022

About 30% of COVID patients develop “Long COVID,” UCLA research finds

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES

 

IMAGE: COVID-19 view more 

CREDIT: PIXABAY

FINDINGS

New UCLA research finds that 30% of people treated for COVID-19 developed Post Acute Sequelae of COVID-19 (PASC), most commonly known as “Long COVID.” People with a history of hospitalization, diabetes, and higher body mass index were most likely to develop the condition, while those covered by Medicaid, as opposed to commercial health insurance, or had undergone an organ transplant were less likely to develop it. Surprisingly, ethnicity, older age, and socioeconomic status were not associated with the syndrome even though those characteristics have been linked with severe illness and greater risk of death from COVID-19.

Of the 309 people with long COVID studied, the most persistent symptoms were fatigue and shortness of breath (31% and 15%, respectively) in hospitalized persons, and loss of sense of smell (16%) in outpatients.

BACKGROUND

The incidence and risk factors of Long COVID, and even how to define the syndrome, have remained unclear throughout the pandemic. The researchers sought evaluate its association with demographics and clinical characteristics in order to devise the most effective treatments.

METHOD

The UCLA researchers studied 1,038 people who were enrolled in the UCLA COVID Ambulatory Program between April 2020 and February 2021. Of those, 309 developed Long COVID. A person was determined to have the syndrome if they reported persistent symptoms on questionnaires 60 or 90 days after infection or hospitalization.

Potential weaknesses in the study include the subjective nature of how patients rated their symptoms, the limited number of symptoms the researchers evaluated, and limited information about patients’ pre-existing conditions.

IMPACT

“This study illustrates the need to follow diverse patient populations longitudinally to understand the Long COVID disease trajectory and evaluate how individual factors such as pre-existing co-morbidities, sociodemographic factors, vaccination status and virus variant type affect type and persistence of Long COVID symptoms,” said Dr Sun Yoo, health sciences assistant clinical professor at David Geffen School of Medicine at UCLA and medical director of the Extensivist Program.  “Studying outcomes in a single health system can minimize variation in quality of medical care. Our study also raises questions such as: Why were patients with commercial insurance twice as likely to develop Long COVID than patients insured through Medicaid? Because persistent symptoms can be subjective in nature, we need better tools to accurately diagnose Long COVID and to differentiate it from exacerbations of other emerging or chronic conditions. Finally, we need to ensure equitable access to outpatient Long COVID care.”

AUTHORS

Additional study authors are Dr. Teresa Liu, Yash Motwani, Myung Sim, Dr. Nisha Viswanathan, Dr. Nathan Samras, Dr. Felicia Hsu, and Dr. Neil Wenger of UCLA.

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JOURNAL

Journal of General Internal Medicine

DOI

10.1007/s11606-022-07523-3 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Factors associated with post-acute sequelae of SARS-CoV-2 (PASC) after diagnosis of symptomatic COVID-19 in the inpatient and outpatient setting in a diverse cohort

Personalized feedback can reduce opioid prescribing rates, new study shows

Peer-Reviewed Publication

AMERICAN COLLEGE OF EMERGENCY PHYSICIANS

WASHINGTON, D.C.—While drug overdose deaths reached an all-time high in 2021, opioid prescribing by physicians and clinicians dropped significantly in emergency departments that prioritized personalized feedback between peers, according to a new analysis in Annals of Emergency Medicine.

From January 2019 to July 2021, opioid prescribing dropped 35% among physicians and 41% among nurse practitioners and physician assistants, according to the analysis of care teams from one physician group spanning 102 emergency departments in 17 states.

“The impact of peer-to-peer feedback on opioid prescribing was immediate and profound,” said Jesse Pines, MD, MBA, FACEP, national director of clinical innovation at US Acute Care Solutions, professor of emergency medicine at Drexel University and the study’s senior author. “Emergency physicians are leading efforts to evolve the culture of prescribing. Sometimes, all it takes to bring about meaningful change is a data-driven conversation that details the evidence behind the many non-opioid options that can achieve similar or even better pain control.”

The study, “Opioid Prescription Reduction After Implementation of a Feedback Program in a National Subset of Emergency Departments,” appearing in the May edition of Annals of Emergency Medicine is the largest known analysis of emergency clinician prescribing interventions to date. The authors assessed the impact of conversations between clinicians and site directors about prescribing rationale and patterns, education on using alternatives to opioids whenever feasible, and the use of a prescription drug management program. Each conversation was personalized and informed by national data gathered by the participating clinicians’ staffing group.  

Decreases in opioid prescribing were evident across the most common diagnoses, according to the study. Opioid prescribing for injury or poisoning decreased 15% while prescribing for symptoms of illness dropped 25%, as did prescribing for respiratory disease (40%), infection or parasite (54%), blood circulation issues (36%), and endocrine or nutritional issues (28%).

Although emergency departments are not a significant source of opioid prescriptions overall, emergency physicians continue to lead programs that reduce opioid prescribing and can be adapted by other health care professionals.

“This research gives clinicians and administrators a promising model for limiting opioid prescribing in a variety of different ED settings,” said the study’s lead author Jonathan Oskvarek, MD, MBA, emergency physician and innovation fellow at US Acute Care Solutions. “Emergency physicians are setting a strong example for prescribers by prioritizing alternatives to opioids when appropriate, a choice that goes a long way toward preventing opioid overdoses.” 

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Annals of Emergency Medicine is one of the peer-reviewed scientific journals for the American College of Emergency Physicians (ACEP), the national medical society representing emergency medicine. Annals of Emergency Medicine is the largest and most frequently cited circulation peer-reviewed journal in emergency medicine and publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine.

For further information: Steve Arnoff | sarnoff@acep.org | Twitter: @EmergencyDocs

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JOURNAL

Annals of Emergency Medicine

DOI

10.1016/j.annemergmed.2021.12.009 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Opioid prescription reduction after implementation of a feedback program in a national emergency department group

ARTICLE PUBLICATION DATE

1-May-2022

Fruit snack or edible? Study finds some cannabis products look like popular snacks

Copycat edibles increase risk for accidental ingestion by children, include high THC content

Peer-Reviewed Publication

NEW YORK UNIVERSITY

 

IMAGE: "COPYCAT" EDIBLES LOOK REMARKABLY LIKE POPULAR SNACK FOODS. view more 

CREDIT: OMPAD/NYU

Some cannabis edibles look remarkably like popular snack foods and may be easily confused for them, finds a new study led by researchers at NYU School of Global Public Health published in Drug and Alcohol Dependence.

These “copycat” edibles also have levels of tetrahydrocannabinol or THC—the main psychoactive compound in cannabis—that far exceed the limits set by state cannabis regulations.

“At first glance, most of the packages look almost exactly like familiar snacks. If these copycat cannabis products are not stored safely, there is the potential for accidental ingestion by children or adults,” said Danielle Ompad, associate professor of epidemiology at NYU School of Global Public Health and the study’s lead author.

Edibles are a popular and growing segment of the cannabis market. In states where cannabis use is legal, more than half (56%) of people who use cannabis consume edibles, with younger people more likely to do so.

Recent news reports have drawn attention to edibles that use similar branding and imagery to mimic popular snack foods. These copycat cannabis products are a public health concern given that people—including children—could mistake them for snacks and accidentally consume them. From 2017 to 2019, U.S. Poison Control Centers handled nearly 2,000 cases of young children ages 0 to 9 consuming edibles.

To gain a deeper understanding of copycat edibles, the researchers collected hundreds of photos of cannabis products and analyzed their packaging, including branding, names, imagery, and THC content. They focused on photos for 267 edibles and found that 8% (22 photos) closely resembled 13 different snack products.

Twelve of the products were candies or sweet snacks (fruit chews, fruit snacks, rice and marshmallow treats, and gummies) and one was a salty snack (chips). Eight of the 13 packages used the exact brand or product name of the original product; the remaining five used names that were similar (for instance, “Stoner Patch Dummies” instead of “Sour Patch Kids”). Seven of the packages used the same cartoon or brand character as the original product.

Most states that have legalized cannabis limit the amount of THC in edibles—typically 5 mg or 10 mg of THC per dose and 100 mg per package. According to information listed on the packaging of the lookalike products, these edibles contained an average of 459 mg of THC and a range of 300 to 600 mg per package, greatly exceeding the maximum limits.

“While each package is likely intended to include multiple doses, few packages indicate the serving size or number of servings,” said Ompad, who is also the deputy director of the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU School of Global Public Health. “Moreover, if we’re considering 10 mg a standard dose, these products could contain an alarming 30 to 60 doses per package.”

The findings highlight the risk that these copycat products could be attractive to children, given the colorful packaging and use of familiar branding and characters.

“Policies to prevent cannabis packaging from appealing to children haven’t stopped copycat products from entering the market—nor have food brands taking legal action against cannabis companies for copyright infringement,” said Ompad. “People who purchase edibles that look like snack foods should store them separately from regular snacks and out of reach of children.”

In addition to Ompad, study authors include Kyle Snyder, Simon Sandh, Daniel Hagen, Emily Goldmann, and Melody Goodman of NYU School of Global Public Health; Kewanda Collier of Morgan State University; and Andy Tan of the University of Pennsylvania. The research was supported by the National Institute on Drug Abuse (P30DA011041, R21DA052421, and R01DA054236) and National Cancer Institute (R01CA237670).

About the NYU School of Global Public Health

At the NYU School of Global Public Health (NYU GPH), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen, and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, interdisciplinary model, NYU GPH aims to improve health worldwide through a unique blend of global public health studies, research, and practice. The School is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching. For more, visit: http://publichealth.nyu.edu/

About CDUHR

The mission of the Center for Drug Use and HIV/HCV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national, and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041).  It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the NYU School of Global Public Health. For more information, visit www.cduhr.org.

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JOURNAL

Drug and Alcohol Dependence

DOI

10.1016/j.drugalcdep.2022.109409 

ARTICLE TITLE

Copycat and lookalike edible cannabis product packaging in the United States

ARTICLE PUBLICATION DATE

19-Apr-2022

A better way to reduce child maltreatment

Program results in 17% reduction in foster care use, study finds

Peer-Reviewed Publication

OHIO STATE UNIVERSITY

COLUMBUS, Ohio – A first-of-its-kind national study has found that a special program adopted in many states to help some families at risk of child maltreatment has been surprisingly successful.

The study found that states with what is called “differential response” (DR) programs had about 19% fewer substantiated reports of child maltreatment, 25% fewer substantiated reports of neglect and a 17% reduction in using foster care services when compared to states without DR programs.

The success of DR in reducing the number of children sent to foster care is especially important, said Michelle Johnson-Motoyama, lead author of the study and associate professor of social work at The Ohio State University.

“In certain situations, foster care is necessary to protect children from harm. However, it is also costly from human and societal perspectives and some states have been creative in finding ways to keep families together,” Johnson-Motoyama said.

“We found differential response programs may be getting families the resources they need to prevent foster care entry.”

The study was published recently in the journal Child Maltreatment.

Normally, when a state’s Child Protective Services (CPS) agency learns about children who may be in danger, it triggers investigations that can lead to court orders and a more legalistic path, Johnson-Motoyama said.

Differential response was developed as an alternative pathway for CPS workers to help families who came to their attention but were at lower risk of child maltreatment.

“These families have an opportunity to receive voluntary services and to receive referrals to community agencies that may be able to provide assistance,” she said.

The assistance could be in the form of links to organizations that help with housing, food, teaching parenting skills and other resources.

When the researchers started this work, they weren’t planning to focus on differential response programs.  They originally were analyzing the effect of social safety net policies in the United States and their impact on preventing child maltreatment.

But when they took differential response programs into account as they analyzed their data, the impact of the programs stood out, Johnson-Motoyama said.

“What was surprising to us was that these programs emerged as really important protective factors for children in all our analyses.  We decided we had to take a closer look,” she said.

The researchers analyzed data from the National Child Abuse and Neglect Data System from 2004 to 2017. They harnessed variations in when states implemented differential response programs to compare substantiated reports of maltreatment and neglect and foster care placements in states with and without DR programs.

Over the study period, 24 states and the District of Columbia used DR at some point in time.

The positive findings regarding the success of differential response programs stood out even after the researchers took into account a wide variety of other factors that could have been related, including whether states that had DR programs also had more generous social safety net programs.

Johnson-Motoyama said the data didn’t allow the researchers to determine exactly why differential response programs were so successful.  But they do have some ideas about what might be happening.

She noted that most of the families who encounter Child Protective Services are poor and may face problems with housing, food, child care and mental health, among other issues.

In the traditional pathway, families may face court orders to participate in various services if they want to keep their children out of foster care.

“Sometimes these court-ordered services can set families up to fail.  They mean well, but they may not be feasible to complete on the timelines of the child welfare system given a family’s limited resources,” she said.

“Some parents can end up losing their child, simply because they couldn’t fulfill the court-ordered plan.”

In contrast, under differential response programs, CPS employees work with families to develop voluntary plans that help them meet their needs and keep their children.

“Typically, these services are tailored to fit the family’s needs. This contrasts with court-ordered services, which may be one size fits all depending on the jurisdiction,” Johnson-Motoyama said.

The results show, she said, that differential response is worth investigating further as states consider ways of reducing foster care entry.

The study was supported by the Centers for Disease Control and Prevention.

Other authors were Rebecca Phillips and Oliver Beer of Ohio State, Donna Ginther of the University of Kansas and Lisa Merkel-Holguin and John Fluke of the University of Colorado Anschutz Medical Campus.

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JOURNAL

Child Maltreatment

DOI

10.1177/10775595211065761 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Differential Response and the Reduction of Child Maltreatment and Foster Care Services Utilization in the U.S. From 2004 to 2017

Cross-racial study of 1.87m vets shows wide disparities in dementia

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - SAN FRANCISCO

In what is believed to be the largest study to date on race and dementia, researchers from UCSF and the San Francisco Veterans Affairs Health Care System tracked health and demographic data from close to two million veterans. It compared rates of dementia across five racial groups and showed significant race-based variations in the incidence of the condition.

This study is also believed to be the first to report the rate of dementia in Native Americans using a nationwide sample, the researchers stated in their paper, publishing in JAMA on April 19, 2022.

Of the 1.87 million veterans, whose average age was 69, 88.6% were white, 9.5% were Black, 1% Hispanic, 0.5% Asian and 0.4% Native American. Just 2.3% were female, consistent with the gender distribution of the older veteran population. All received their health care at medical centers of the Veterans Health Administration (VHA) located throughout the continental United States. 

Among the 13% of participants who were diagnosed with dementia over the course of the 10-year study, the researchers found that rates were markedly higher for Hispanic and Black veterans than they were for whites: 99% and 55% respectively. These results reinforce previous research that showed elevated rates for both groups.

Rates for Asian veterans have not been as widely documented and in this study were 24% higher than for whites. Among Native Americans, the rate was 8% higher than for whites, a finding that enhances prior research that has focused on smaller, geographically limited populations and has shown conflicting results, according to the researchers. 

When adjusting for sex, education, and underlying medical and psychiatric conditions, differences in dementia rates for all four groups were narrowed slightly in relation to whites: 92% higher for Hispanics, 54% for Blacks, 20% for Asians and 5% for Native Americans. This finding  for Native Americans shows no significant difference with whites, the researchers noted. 

Senior author Kristine Yaffe, MD, of the UCSF Departments of Psychiatry and Behavioral Sciences, Neurology, Epidemiology and the San Francisco Veterans Affairs Health Care System, said she had been surprised by the relatively low risk for Native Americans. “There may be genetic or resilience factors that we just don’t know about yet,” she said, “or maybe even a survival bias. Those who are old enough to get dementia may have a survival advantage.”

Vets at Higher Risk for Dementia, Due to TBI, PTSD, Poor Cardiovascular Health

Yaffe said the study was unique in that it evaluated racial differences among five groups, versus two or three in previous studies, and that the cohort received their health care at the VHA, the largest integrated care system in the United States.

“U.S. veterans are at high risk of dementia because of exposure to military-related risk factors, like traumatic brain injury and post-traumatic stress disorder, and high prevalence of cardiovascular and other non-military risk factors,” she said. 

As expected, health and education disparities associated with dementia were more apparent in some groups. Native Americans were least likely to live in zip codes where more than 25% of residents were college-educated (26.9%), and had the highest rate of obesity (16.4%), post-traumatic stress disorder (11.2%) and alcohol use disorder (9.1%). Hispanics had the highest rate of diabetes (36.1%) and stroke (8.2%), and Blacks had the highest rate of hypertension (73.7%).

The researchers found regional variations in dementia incidence, but Black and Hispanic veterans were consistently identified as having higher risk than the other groups. 

These racial and ethnic differences are concerning, said first author Erica Kornblith, PhD, of the UCSF Department of Psychiatry and Behavioral Sciences, and the San Francisco Veterans Affairs Health Care System, “but they underscore the need to explore the cause of these differences with the ultimate goal of ameliorating them.” 

Differences in Dementia Diagnosis May Reflect Biases of Doctors 

Differences in dementia diagnosis may also reflect “the biases of doctors who make the diagnosis or biases in our cognitive tests, as well as the impact of education, and medical and psychiatric variables,” Kornblith said. 

Since most veterans serve as young adults and remain eligible for health care for the rest of their lives, it is likely that the participants had more equitable access than that of the general population, the researchers noted.

“This implies other mechanisms may be at play, such as early life circumstances, or that there were differences in quality of health care, despite better access,” said Yaffe, who is also affiliated with the UCSF Weill Institute for Neurosciences and the Northern California Institute for Research and Education. “In future studies, we hope to have a better understanding of the mechanisms that are driving the differences in dementia incidence across these five groups,” she said.

Co-Authors: Amber Bahorik, PhD, of UCSF and Northern California Institute for Research and Education; Feng Xia, MPH, of San Francisco VA Health Care System and Northern California Institute for Research and Education; Deborah E. Barnes, PhD, MPH, and W. John Boscardin, PhD, of San Francisco VA Health Care System and UCSF. 

Funding: This study was supported by Department of Veterans Affairs Rehabilitation Research and Development Career Development Award (CDA-2) 1 IK2 RX003073-01A2 (Kornblith) and NIA grant K24 AG031155, R35 AG071916 (Yaffe).

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. Learn more at https://www.ucsf.edu, or see our Fact Sheet.

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Follow UCSF
ucsf.edu | Facebook.com/ucsf | YouTube.com/ucsf

 

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JOURNAL

JAMA

Sending out bacteria-carrying mosquitos to protect people from dengue

Identifying vulnerable geographic areas so Wolbachia-carrying mosquitos can protect as many people as possible

Peer-Reviewed Publication

AMERICAN INSTITUTE OF PHYSICS

 

IMAGE: THE MAP REPRESENTS THE CITY OF SANTIAGO DE CALI AS A NETWORK IN WHICH NODES REPRESENT ITS DISTRICTS. THE SIZES OF THE NODES ARE PROPORTIONAL TO THE HUMAN POPULATION IN EACH DISTRICT, WHILE THE NODES ARE COLORED ACCORDING TO THEIR IMPORTANCE FOR THE RELEASE OF WOLBACHIA-CARRYING MOSQUITOES. THE LINKS IN THE NETWORK REPRESENT MOBILITY FLOWS BETWEEN CALI'S DISTRICTS. view more 

CREDIT: ADRIANA REYNA-LARA

WASHINGTON, April 19, 2022 – Dengue is the most widespread mosquito-borne disease in the world, and to date, there are no medical treatments for people suffering from this disease. The virus causes symptoms ranging from high fevers to severe bleeding and shock, can be life-threatening, and presents an enormous burden on health systems.

In Chaos, by AIP Publishing, researchers from Spain, Portugal, and Colombia developed a model the virus. In 2009, researchers discovered mosquitoes carrying Wolbachia bacteria lessen the chances for the dengue virus to impact humans.

Mosquitoes do not acquire Wolbachia bacteria in their natural environment, however. This bacterium must be introduced in vitro in mosquitoes' eggs, which are later released in areas affected by dengue transmission. Mosquitoes infected with Wolbachia naturally take over the local mosquito population.

The researchers use real data on human and vector activity in a framework that can be analyzed from a mathematical point of view, allowing them to re-create and understand the epidemiological situation. In this way, they can identify those geographical areas with the greatest vulnerability, creating a ranking of areas that prioritizes those where Wolbachia-carrying mosquitoes can have the strongest and most beneficial impact on the spread of the dengue virus.

"One might think that the most populated areas are those in which Wolbachia release would be most beneficial. However, this is not always true," said co-author Jesus Gomez-Gardenes, from Universidad del Valle in Colombia.

The authors found once they immunize the most vulnerable geographical area, the ranking of the remaining areas is affected, giving rise to a new scenario that tells them where they should concentrate resources in the second instance and beyond.

The findings from this research will be beneficial to many groups, such as the World Mosquito Program, which is currently releasing Wolbachia-infected mosquitoes to protect the global community from diseases such as dengue, chikungunya, yellow fever, and Zika.

In these kinds of initiatives, the information about the most vulnerable areas within cities or regions proved the researchers' model could complement field studies to find targets that maximize the benefit for the whole community.

"Data-driven models have also proven useful to tackle the evolution and mitigation of other diseases such as COVID-19," said Gomez-Gardenes. "Hopefully, the framework developed for dengue can be further generalized for tackling the control of other vector-borne diseases."

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The article "A metapopulation approach to identify targets for Wolbachia-based dengue control" is authored by Adriana Reyna-Lara, David Soriano Panos, Juddy Heliana Arias-Castro, Hector J. Martínez, and Jesus Gomez-Gardenes. The article will appear in Chaos on April 19, 2022 (DOI: 10.1063/5.0087435). After that date, it can be accessed at https://aip.scitation.org/doi/full/10.1063/5.0087435.

ABOUT THE JOURNAL

Chaos is devoted to increasing the understanding of nonlinear phenomena in all areas of science and engineering and describing their manifestations in a manner comprehensible to researchers from a broad spectrum of disciplines. See https://aip.scitation.org/journal/cha.

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JOURNAL

Chaos An Interdisciplinary Journal of Nonlinear Science

DOI

10.1063/5.0087435 

ARTICLE TITLE

A metapopulation approach to identify targets for Wolbachia-based dengue control

ARTICLE PUBLICATION DATE

19-Apr-2022

A new understanding of how the immune system deals with malaria

Peer-Reviewed Publication

KAROLINSKA INSTITUTET

By analysing samples from patients who have been treated for malaria in Sweden, researchers at Karolinska Institutet can now describe how the immune system acts to protect the body after a malaria infection. The results, published in the journal Cell Reports, provide knowledge that can aid in the development of more effective vaccines against the disease. 

“Our results contribute to a better understanding of how humans fight this serious disease and may help in the development of better vaccines," says Christopher Sundling, principal researcher at the Department of Medicine, Solna, at Karolinska Institutet, and last author of the study. “This sheds new light on the question of how the body's immunse system deals with malaria." 

Malaria is caused by parasites that are spread to humans by mosquitoes. The disease caused more than 600,000 deaths in 2020, mainly among young children in sub-Saharan Africa.  

People who contract malaria repeatedly may gradually become immune to the disease. But even before that, the body can build up a so-called tolerance, which provides protection against severe disease. 

To find out more about how disease tolerance develops, KI researchers have investigated immune cells and proteins in blood samples from patients who have been treated for acute malaria infection at Karolinska University Hospital in Solna, Sweden and have recovered.  

This patient group was monitored by being tested on six occasions during one year following the onset of the disease. A total of 53 patients were included, 17 of whom had contracted malaria for the first time, while 36 had grown up in malaria endemic areas, had had malaria many times before and now contracted the disease again after travel. 

“Since we have followed the patients here in Sweden, we can study the natural course of the immune response after a malaria infection, without the risk of a new infection interfering with the results. This cohort has proved to be very valuable for studying the immunology of malaria," says Anna Färnert, Professor of Infectious Diseases at the Department of Medicine, Solna, Karolinska Institutet and Senior infectious diseases physician at Karolinska University Hospital, Sweden in whose research group the study was conducted.  

Within this cohort, the researchers recently described the kinetics of antibody responses after infection. 

In the case of malaria, the disease itself is partly a result of the inflammation created in the body by the immune system's reaction to the infection. In their comparisons, the researchers noted a strong inflammatory response from the so-called innate immune system in people who were infected for the first time. In contrast, the people who were re-infected had an ability to suppress the inflammation, Christopher Sundling explains. 

“In those who have had malaria before, we saw that the early presence of parasite-specific antibodies interrupt the first stages of the inflammation and prevent a certain type of inflammatory T-cell from expanding," Sundling continues. 

In October 2021, the World Health Organization recommended the use of the world's first, and so far, only vaccine against malaria, Mosquirix. However, Mosquirix targets only one form of the malaria parasite – the form the parasite has when it first moves from the mosquito into the liver. Once it enters the bloodstream and gives symptoms, the pathogen is at a different stage against which the vaccine does not work. 

“This is a weakness of the current vaccine. Understanding how tolerance develops and what happens in the blood stage can help us develop other types of vaccines, which may not fully protect against infection but will lessen the chances of becoming seriously ill. If such a vaccine can enable people to survive the first infections that kill so many, we could save many lives," says Sundling. 

Over the last decades, the incidence of malaria decreased globally. Efforts to distribute mosquito nets, spray insecticides indoors, as well as diagnostics and new treatments are believed to have contributed to the positive trend, Anna Färnert notes. But in recent years, the rate of decline has levelled off and in 2020 the covid pandemic contributed to increased mortality. 

“We now need to continue to ensure that people are protected from being bitten by infected mosquitoes and have access to rapid and effective treatment. But to further reduce the burden of disease and eventually eradicate malaria, new tools are required. An effective vaccine is really needed; that is how we have been able to manage other infections, also in poor countries," says Anna Färnert. 

The research has been funded by the Swedish Research Council, Magnus Bergvall Foundation, the Åke Wiberg Foundation, Region Stockholm, and the Marianne and Marcus Wallenberg Foundation, as well as doctoral grants from Karolinska Institutet. The researchers declare that there are no conflicts of interest. 

Publication: ”Systems analysis shows a role of cytophilic antibodies in shaping innate tolerance to malaria.” Maximilian Julius Lautenbach, Victor Yman, Carolina Sousa Silva, Nadir Kadri, Ioanna Broumou, Sherwin Chan, Sina Angenendt, Klara Sondén, David Fernando Plaza, Anna Färnert, Christopher Sundling. Cell Reports, online 19 April 2022, doi: 10.1016/j.celrep.2022.110709. 

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JOURNAL

Cell Reports

DOI

10.1016/j.celrep.2022.110709 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

”Systems analysis shows a role of cytophilic antibodies in shaping innate tolerance to malaria”

ARTICLE PUBLICATION DATE

19-Apr-2022

Health risk factors, outcomes among transgender, gender-questioning high school students

JAMA

Peer-Reviewed Publication

JAMA NETWORK

What The Study Did: This survey study found that transgender and gender-questioning high school students reported increased risk factors and worse outcomes, compared with cisgender youths, in bullying, sexual and dating violence, mental health and suicidality, and sexual risk behaviors and substance use.

Authors: Gilbert Gonzales, Ph.D., M.H.A., of Vanderbilt University in Nashville, Tennessee, is the corresponding author.

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

(doi:10.1001/jama.2022.3087)

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

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Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2022.3087?guestAccessKey=5c3c2798-6164-4aaf-a4c6-35afbc191546&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=041922

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JOURNAL

JAMA