GEROTOLOGICAL MENTAL HEALTH

Weight training improves symptoms of anxiety and depression in old people, study confirms

Brazilian researchers analyzed more than 200 articles on the subject and identified the types of training most indicated for these cases. Their findings are reported in the journal Psychiatry Research

FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO

Weight training can help reduce body fat and increase muscle strength and mass in older people, contributing to functional autonomy and avoidance of falls and injury. Furthermore, recent studies have shown that it can also benefit the mental health of older people, especially those who suffer from anxiety and depression.

These benefits were confirmed by a study reported in the journal Psychiatry Research. The study involved a systematic review and meta-analysis of more than 200 articles on the subject. The analysis was conducted by Paolo Cunha, a postdoctoral fellow with a scholarship from FAPESP at the Albert Einstein Jewish-Brazilian Institute of Education and Research (IIEPAE) in São Paulo, Brazil. 

“Resistance training has been shown to be one of the most effective non-pharmacological strategies for healthy aging. It promotes countless health benefits, including improvements to mental health,” Cunha said.

The findings of the study are highly promising, he continued. Besides improvements to symptoms of anxiety and depression in the general population, weight training appears to have a more significant effect on people with a confirmed diagnosis of anxiety or depression disorder.

“Epidemiological studies have shown that the decrease in muscle strength and mass that occurs naturally as we age may be associated with an increase in mental health problems, given the existence of various physiological mechanisms that bring about functional and structural changes and that are controlled by the brain,” Cunha said.

Another important mental health benefit, he added, is that when weight training is done in a group, it contributes to more social interaction among those involved.

Recommended exercises

The investigation also pointed to the best ways of structuring one’s training to improve mental health. “How the training is done appears to influence the results achieved. The information obtained so far suggests that older people should ideally do weight training exercises three times a week, with three sets of each exercise and sessions that are not too long – six exercises would seem to be sufficient. Do less, but do it well: a short set produces better results. This is meaningful information, as we lack guidelines with specific recommendations for resistance training that focuses on mental health parameters,” Cunha said.

While there are many possible ways to prescribe resistance training programs designed to improve the health, autonomy and quality of life for older people, most result directly or indirectly in improvements to symptoms of anxiety and depression, regardless of the intensity and volume of the exercises involved, according to Edilson Cyrino, last author of the article and principal investigator for the study. He is a professor at the State University of Londrina (UEL) and coordinates the Active Aging Longitudinal Study, a project begun in 2012 to analyze the impact of resistance training on parameters relating to the health of older women.

Another point observed by the researchers was that the use of training machines and free weights appears to be more beneficial for mental health than exercises that involve elastic bands or calisthenics (using the weight of the person’s body), for example. 

“We don’t have statistics comparing the two kinds of training, but the analysis showed that resistance training with weights and other gear is more effective in terms of improving the mental health of older people, largely because the intensity and volume of the exercises can be more precisely controlled,” Cunha explained.

In the article, the researchers note that despite the incontestable mental health benefits of weight training, important gaps remain and should be filled by further studies. “Generally speaking, most studies have involved a small number of volunteers, which hinders an understanding of how the phenomenon occurs and the main mechanisms that explain it. This research field has expanded in recent years and has ample room for more advances,” Cunha said.

Cunha is currently conducting a project in partnership with the Research Group on Clinical Intervention and Cardiovascular Disease (GEPICARDIO) at the Albert Einstein Jewish Brazilian Hospital (HIAE) to analyze the impact of long periods of sedentarism on vascular and cognitive functions in older people.

About São Paulo Research Foundation (FAPESP)

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit FAPESP news agency at www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe.

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JOURNAL

Psychiatry Research

DOI

10.1016/j.psychres.2024.115746 

ARTICLE TITLE

Can resistance training improve mental health outcomes in older adults? A systematic review and meta-analysis of randomized controlled trials

Improving dementia care in nursing homes: Learning from the pandemic years

REGENSTRIEF INSTITUTE

INDIANAPOLIS – No one associated with nursing homes – as residents or their families, friends, staff or administrators – is unaware of the massive impact of the pandemic on these facilities which provide essential services to a growing number of older adults, many living with cognitive impairment.

In “Learning from the experience of dementia care for nursing home residents during the pandemic,” an editorial published in the Journal of the American Geriatrics Society, Regenstrief Institute and Indiana University School of Medicine researcher-clinician Kathleen Unroe, M.D., MHA, M.S., and University of Utah College of Nursing faculty member Gail Towsley, PhD, NHA, focus on the continual need to integrate quality dementia-specific care into nursing homes.

“Nursing home leaders [during the pandemic] had to balance competing demands including pressures to off-load hospitals by admitting new patients, as well as responsibilities to protect staff and established residents. The constant assessment of risks versus benefits often resulted in trade-offs between safety (or at least, what was believed at the time provided safety) and quality of life,” the editorial notes.

The authors highlight the uncertainties and stressors faced by extended care providers and those for whom they care, focusing on challenges including resident social isolation, staff recruitment, training and retention as well as the troublesome conflict between best practice infection control and best practice dementia care.

“A majority of people who receive care in nursing homes have cognitive impairment,” said Dr. Unroe. “High-quality care for people with cognitive impairment, including people with a diagnosis of dementia, should be person-centered, which requires knowing a person's goals for their care and their treatment preferences and making sure that those goals and preferences are documented and then met, including for those with limited ability or even no ability to participate in these discussions anymore.

“People in nursing homes are, by the nature of living in a nursing home, often isolated from their community, their prior neighborhoods and contacts as well as their families,” she added. “We need to take extra steps to make sure that we maintain these important connections, making it as easy as possible for people to come and participate in life in the nursing home and for people to be able to leave the facility and participate in life in their neighborhoods and with their families.”

According to Dr. Unroe, the pandemic highlighted:

• Need for dementia care specific staff training
• Value of telehealth communication
• Importance of expansion of family’s role in nursing home care

In 2022, the National Academies of Sciences, Engineering and Medicine issued “The National Imperative to Improve Nursing Home Quality,” which noted “the devastating impact of the COVID-19 pandemic on nursing home residents and staff has renewed attention to the long-standing weaknesses that impede the provision of high-quality nursing home care.” The report calls for the Centers for Medicare and Medicaid Services (CMS) and states to improve oversight of nursing homes to avoid a repeat of failures that occurred during the COVID-19 pandemic.

Highlighting the importance of exploration of opportunities to “coalesce around solutions” to solve persistent challenges in nursing home settings, Drs. Unroe and Towsley conclude, “While the pandemic included lessons we wish we did not have to experience, we have an opportunity to shift our practices and re-focus on high quality dementia care.”

Kathleen Unroe, M.D., MHA, M.S. 

In addition to being a research scientist with the Indiana University Center for Aging Research at Regenstrief Institute, Kathleen Unroe, M.D., MHA, M.S., is an associate professor of medicine at Indiana University School of Medicine and a practicing geriatrician. Dr. Unroe is the founder and an executive officer of Probari, a healthcare start-up supporting nursing home care.

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JOURNAL

Journal of the American Geriatrics Society

DOI

10.1111/jgs.18771 

ARTICLE TITLE

Learning from the experience of dementia care for nursing home residents during the pandemic

Brain stimulation treatment may improve depression, anxiety in older adults

UNIVERSITY OF FLORIDA

A noninvasive brain stimulation treatment improved depression and anxiety symptoms among older adults in a new University of Florida-led study.

Improvements in depression and anxiety symptoms were greatest among patients who reported higher symptom levels before treatment. Among participants who experienced moderate to severe state anxiety — or anxiety associated with stressful situations or events — the treatment benefits persisted at a one-year followup.

The findings, published in the journal Brain Stimulation, suggest the treatment, known as transcranial direct current stimulation, or tDCS, holds promise as a noninvasive, drug-free option to treat depression and anxiety symptoms, which affect 1 in 4 older adults.

“Depression and anxiety can impact our overall mental health, cognitive function and ability to function independently as we age,” said the study’s senior author Adam Woods, Ph.D., the associate dean for research and a professor of clinical and health psychology at the UF College of Public Health and Health Professions and co-director of UF’s Center for Cognitive Aging and Memory Clinical Translational Research. “Often, front-line treatments involve medication and/or therapy, which can both be effective. However, there is also a pressing need for accessible and noninvasive options that can be deployed in people who are either nonresponsive to pharmaceutical treatment, unable to access or participate in clinic-based intensive treatment programs, or for a variety of other reasons.”

Treatment benefits in the UF-led study were seen among participants with subclinical depression and anxiety, meaning their symptoms may not meet the criteria for diagnosis. Yet, even subclinical depression and anxiety can be associated with cognitive decline in older adults, the researchers say. 

The tDCS treatment is delivered by a safe and weak electrical current passed through electrodes placed on a person’s head. Researchers targeted the prefrontal cortex, an area of the brain associated with cognition and emotion regulation.

The new study was conducted as part of the National Institute on Aging-funded Augmenting Clinical Training in Older Adults Study, the largest study of its kind with older adults participating at UF and University of Arizona study sites. Nearly 400 older adults were randomly assigned to one of two groups: 12 weeks of tDCS paired with cognitive training designed to improve working memory and processing speed, or 12 weeks of cognitive training paired with a placebo version of tDCS.

Investigators also collected a wealth of data from cognitive, functional and neuroimaging tests as well as self-report measures of psychological symptoms, including depression and anxiety.

After controlling for factors such as prescription drugs that may impact depression and anxiety symptoms, the study team found that participants who received the tDCS treatment had significant improvements in mild depression and moderate to severe state anxiety, compared with the group that did not receive tDCS.

“Extensive research has demonstrated the efficacy of active stimulation to this area of the brain in reducing psychological symptoms in individuals with diagnosed psychiatric disorders,” said Hanna Hausman, the study’s lead author and a UF PHHP clinical psychology Ph.D. student in neuropsychology. “It was an unexpected yet welcome surprise to witness similar effects in our sample of older adults without significant psychiatric histories, especially on a large scale. Demonstrating this therapeutic effect is important because even subclinical depression and anxiety symptoms in older adults are associated with adverse outcomes.”

Next steps for this research should include a phase 3 randomized clinical trial designed to assess the effect of tDCS and cognitive training on anxiety among a large and diverse group of older adults, the investigators say. The Korea Food and Drug Administration has approved tDCS as an at-home treatment for depression for adults in South Korea, and with additional study, it could become an accessible and easy-to-use treatment in the U.S. once sufficient evidence is available for U.S. Food and Drug Administration approval.

“tDCS treatment is cost-effective, portable and can be seamlessly integrated with existing mental health therapies or used as a standalone intervention,” Hausman said. “Its potential for at-home self-administration would further expand accessibility and reduce personnel costs, making it a promising intervention for individuals who may experience barriers accessing face-to-face clinical care.”

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JOURNAL

Brain Stimulation

DOI

10.1016/j.brs.2024.02.021 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

tDCS reduces depression and state anxiety symptoms in older adults from the augmenting cognitive training in older adults study (ACT)

U$A

UH College of Pharmacy researcher examines trends in rising cost of medicine

Diabetic medications most expensive, fastest rise in price

UNIVERSITY OF HOUSTON

 

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TYLER VARISCO, ASSISTANT PROFESSOR OF PHARMACEUTICAL HEALTH OUTCOMES AND POLICY AND ASSISTANT DIRECTOR OF THE PRESCRIPTION DRUG MISUSE EDUCATION AND RESEARCH CENTER AT THE UNIVERSITY OF HOUSTON, HAS PUBLISHED NEW RESEARCH ABOUT THE SOARING COST OF DIABETES MEDICATIONS.

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CREDIT: UNIVERSITY OF HOUSTON

Newly published research from the University of Houston College of Pharmacy reveals an alarming trend in diabetic medication expenditures. While pharmaceutical spending in the U.S. has long been recognized as higher than in other affluent nations, diabetic medications, including insulin, are now at the forefront of this surge in prescription drug costs. 

From 2011 to 2020, total annual prescription medication expenditures rose from $341.49 to $473.12 billion per year with metabolic agents being the costliest category. Among the metabolic agents, antidiabetic agents were the most expensive therapeutic area, with an increasing trend observed from $27.15 to $89.17 billion over the same period.   

“Despite observed trends in medication expenditures, very little effort has been made to understand how those trends vary by therapeutic class,” reports Tyler Varisco, assistant professor of Pharmaceutical Health Outcomes and Policy and assistant director of the Prescription Drug Misuse Education and Research Center in the journal Research in Social and Administrative Pharmacy. Varisco and Whanhui Chi, a second-year doctoral student in Pharmaceutical Outcomes and Policy, conducted a cross-sectional analysis to identify determinants of increasing medicine expenditures in the U.S. between 2011 and 2020. 

Varisco used prescription medication expenditures from the Medical Expenditures Panel Survey to calculate total annual medication expenditures  by payer categories (Out-of-pocket, Medicare, Medicaid, TRICARE/Veterans Administration/CHAMPVA (TVAC), Other Government Sources, Private Insurance, and Other Sources). 

Spending by Medicare ($38.23 billion) and Medicaid ($8.68 billion) accounted for almost half of all U.S. spending on metabolic agents in 2020. 

Varisco also found the growth in prescription drug expenditures in the U.S. can be ascribed to several different factors such as population demographics, changes in technology and healthcare practice. For example, total Medicare enrollment was found to be 48,892,758 in 2011, which later reached 62,840,267 in 2020. 

“In light of these developments, research is needed to substantiate concerns that trends in the cost of care are outpacing patients’ ability to pay,” Varisco said. “Continuing analysis is needed to help policymakers and other key stakeholders understand how changes in practice, policy, and drug marketing converge to impact total market expenditures.” 

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JOURNAL

Research in Social and Administrative Pharmacy

ARTICLE TITLE

Why the increase? Examining the rise in prescription medication expenditures in the United States between 2011 and 2020

 

On the way to a complete seafloor map

GEOMAR and Seabed 2030 sign Memorandum of Understanding in Barcelona

HELMHOLTZ CENTRE FOR OCEAN RESEARCH KIEL (GEOMAR)

 Joint press release of the GEOMAR Helmholtz Centre for Ocean Research Kiel and GEBCO Seabed 2030 –

At least twice in the last 20 years, nuclear submarines have collided with previously unknown underwater mountains called seamounts. The reason: they were not on any nautical charts. Just last year, a study discovered 19,000 new, previously unknown seamounts. There are now around 43,000 known seamounts over 1,000 metres high. But most of them have never been mapped.

Mapping the topographic shape of the seafloor is called bathymetry (from the Greek words bathýs deep and métron measure). And there are still many gaps in the bathymetric maps of the world's oceans. The example above dramatically illustrates the need for accurate underwater maps. But it is also essential for understanding ocean circulation and climate models, for assessing geohazards such as submarine slides on oceanic island flanks, for exploring seabed resources, and for marine spatial planning, including the delineation of marine protected areas.

Only about 25% of the seafloor has been mapped using ship-borne echosounders, which is the only method capable of producing high-resolution (10m) seafloor maps. Another survey method is satellite altimetry, which infers seafloor topography from satellite measurements of deviations in the sea surface. This provides global coverage, but with a much lower resolution of several kilometres, allowing only large-scale structures to be identified. As Professor Dr Lars Rüpke, head of the Seafloor Modeling Group at the GEOMAR Helmholtz Centre for Ocean Research Kiel, explains, “ship-based echosounder surveys remain indispensable” for more detailed seafloor mapping. Currently the group is campaigning for a closer integration of underway data with urgent research questions. Rüpke: “For example, data collected during transits by German research vessels can be used to systematically map seamounts.”

“Our vision is to have a complete and freely accessible map of the entire seafloor," says Dr Rüpke. "We share this vision with the many researchers from all over the world who are involved in the Seabed 2030 project". As part of the United Nations Conference on the Decade of the Ocean, which starts today in Barcelona, GEOMAR and Seabed 2030 have now signed a Memorandum of Understanding (MoU) to work together to improve seabed mapping.

Professor Dr Katja Matthes, Director of GEOMAR: “The international availability of collected data is the basis for successful cooperation and a decisive step towards a global map of the seafloor. The signing of this Memorandum of Understanding with Seabed 2030 shows the enormous potential to jointly pursue the goal of the UN Decade of the Oceans ‘to protect and sustainably use the oceans and marine resources for sustainable development’. The international networking of GEOMAR's expertise with the global Seabed 2030 initiative is a further milestone in international marine research.”

Jamie McMichael-Phillips, Director of Seabed 2030 stated: “I am absolutely delighted that we have partnered with GEOMAR, a world leading institution in marine research. Our MoU reinforces the strong links with their extensive science team and the combined GEOMAR/German research fleet which has global reach. This will undoubtedly strengthen the SB2030 global ocean mapping community, driving us forward in supporting the GEBCO mission.”

 

About Seabed 2030:

Seabed 2030 is a joint project of GEBCO and the Nippon Foundation, launched at the 2017 UN Ocean Conference in support of UN Sustainable Development Goal 14, which aims to conserve the oceans and marine resources for sustainable use. At that time, only about six per cent of the seabed had been mapped with sufficient accuracy. By 2030, all available information on the seabed is to be collected and integrated into a seamless digital map of the world's oceans. To do this, Seabed 2030 brings together a global community of marine cartographers, hydrographers and other researchers, as well as industry and the public. Governments, organisations and individuals around the world are invited to join this common mission for the global seabed by the end of the decade.

About GEOMAR:

GEOMAR Helmholtz Centre for Ocean Research Kiel is one of the world's leading marine research institutions. GEOMAR investigates the global ocean from the seafloor to the atmosphere, covering a unique spectrum of physical, chemical, biological and geological processes in the ocean. Since last year, the new Seafloor Morphology working group at GEOMAR combines expertise in seafloor mapping and geological research based on bathymetric observations. The group investigates the processes that shape the seafloor and the role its morphology plays in the ocean system. It uses data from expeditions as well as ocean observations, rock analysis, modelling and data science.

About “Underway” Research Data

As part of the EU AtlantOS project, GEOMAR started systematically mapping the seafloor along the transit routes of large German research vessels in international waters in 2015. Since 2019, this new approach has been continued in Germany as part of the research data project “Underway” of the German Marine Research Alliance (DAM). GEOMAR has a coordinating role in this project. The data will be made available internationally according to the FAIR principles.

 

Aston University to help Saudi Arabia turn waste into energy

ASTON UNIVERSITY

 

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KEW TECHNOLOGY’S SUSTAINABLE ENERGY CENTRE IN WEDNESBURY, UK

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CREDIT: ASTON UNIVERSITY

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• Energy will help power new cities in the desert
• Aston University is in talks about converting waste products into vital energy
• Its Energy and Bioproducts Institute is experienced in the waste-to-energy sector through global collaborations.

Aston University researchers are to help turn waste into energy to power new cities in the desert.

The University has started talks with experts from Saudi Arabia, including those who are building two sustainable cities in the desert, called NEOM and The Line.

They are to collaborate with Aston University and its Energy and Bioproducts Research Institute (EBRI) to explore how they can convert waste products into vital energy. 

The scientists and engineers are to apply their expertise to help Saudi Arabia create technology to convert discarded matter into a source of energy and other innovations such as using date palm waste to transform desert sand to allow it to retain water and grow crops.

Aston University also hosted a two-day conference in March to discuss how to develop and apply the technology.
The event is a key element of the UK-KSA Waste2Energy project supported by the Foreign, Commonwealth and Development Office under the Gulf Strategy Fund (GSF) programme and is led by senior lecturer in mechanical, biomedical and design engineering Dr Muhammad Imran.  

More than 70 delegates attended the conference, including representatives from King Abdulaziz City for Science and Technology (KACST), King AbdulAziz University, The National Research and Development Center for Sustainable Agriculture and the Saudi Investment Recycling Company (SIRC).

Professor Patricia Thornley, director of Energy & Bioproducts Research Institute, said: “The delegation chose to collaborate with and visit EBRI because we have common research goals, but some complementarity facilities and skills. We are looking forward to working together to develop some the shared priorities we have identified.”

Tim Miller, EBRI director of engagement, added: “Aston University has extensive engagement in the waste-to-energy sector through substantial industrial and academic collaborations globally. Advancements made by institutes like EBRI in waste-to-energy technologies are continually contributing to sustainable energy development.”

“The meeting provided an insightful overview of the project, emphasising the significant opportunities it offers to UK industries and academia for funding, collaboration and PhD opportunities.

“Our special appreciation is extended to Naif Makki from the Ministry of Energy, Saudi Arabia and his colleagues for their valuable participation.”

The event ended with a tour of the EBRI lab and biochar demonstrator plant and a visit to Kew Technology’s Sustainable Energy Centre in Wednesbury.

 

Air pollution data could be used to plan better transit routes

Researchers from the University of São Paulo are producing maps that show areas of the city of São Paulo with the highest concentration of air pollutants; the results of the studies were presented in the United States during FAPESP Week Illinois

FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO

 

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TERESA CÓRDOVA, MARIANA GIANNOTTI AND THIAGO NOGUEIRA. RESERCHERS ARE PRODUCING MAPS THAT SHOW THE AREAS OF THE CITY WITH THE HIGHEST POLLUTION LEVELS AND THE PERIODS OF PEAK EMISSIONS.

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CREDIT: ELTON ALISSON

 In addition to traffic information, in the not-too-distant future it will be possible to decide the best route and time to travel by car in cities like São Paulo – the capital of the state of the same name and Brazil’s largest metropolis – based on air quality data. Through studies supported by FAPESP, researchers from the Institute of Astronomy, Geophysics and Atmospheric Sciences (IAG) and the School of Public Health (FSP) of the University of São Paulo (USP) are producing maps that show the areas of the city with the highest pollution levels and the periods of peak emissions.

Some of the results of the projects were presented during a panel discussion on opportunities for studies on smart cities, held on April 9th at the opening of FAPESP Week Illinois, in Chicago (United States).

Organized by FAPESP in partnership with the University of Illinois System (UIS) – composed of the universities of Illinois in Chicago, Urbana-Champaign and Springfield – at the headquarters of the Discovery Partners Institute in Chicago, the meeting aims to create opportunities for scientific and technological cooperation between researchers from the state of São Paulo and the Midwest of the United States.

The event brings together researchers from universities and research institutions in the state of São Paulo, from the UIS, from the Great Lakes region of North America – located on the border between the United States and Canada – and from partner institutions in Canada and Mexico.

Participants’ areas of expertise include health and medicine, smart agriculture, climate, bioenergy, investing in democratic institutions, and smart cities.

“Smart cities use innovative information technologies to collect data that are used to build and operate interconnected urban systems to improve efficiency and enhance sustainability and resilience,” said Teresa Córdova, director of the Great Cities Institute of the University of Illinois in Chicago.

According to the researcher, some key technologies that are driving the development of solutions to make cities in different parts of the world smarter are fiber optics, radio signal sensors, and cell phone frequencies.

In São Paulo, for example, researchers from IAG and FSP-USP are using portable equipment such as laser particle counters and GPS devices installed in cars to measure and obtain geo-referenced data on the concentration of particulate matter to which drivers and passengers are exposed in the city on different routes and at different times of day.

"Based on the data collected during these studies, we were able to make maps and identify which regions of the city have the highest concentration of pollutants," Thiago Nogueira, professor at FSP-USP, told Agência FAPESP.

The researchers conducted a study assessing exposure to air pollutants during commutes by different modes of transportation in São Paulo – including car, bus, subway and bicycle – and in different regions of the city. The results showed that residents in the western region of the capital are exposed to higher concentrations of an air pollutant called black carbon. The regions with the best air quality were those with the highest concentration of green spaces. On the other hand, the regions with intermediate air quality had more high-rise buildings.

“We’ve seen that high-rise buildings have a negative effect on the dispersion of air pollution,” said Nogueira.

As part of an international project, the researchers also measured the levels of exposure to particulate matter in ten cities around the world, including São Paulo. The results of the study showed that off-peak exposure was 40% lower in the morning and 91% lower at night. The highest levels of exposure to high-concentrated particulate matter were recorded in situations where the car windows were open.

Another finding of the study was that bus drivers and passengers in São Paulo are exposed to higher levels of air pollutants than car and subway users. However, the levels of atmospheric exposure in São Paulo’s transport system were lower than those recorded in the other nine participating cities, located in Africa, Asia and South America.

“Despite the culture that São Paulo is a very polluted city, in comparison with other countries we observed that the levels of exposure to particulate matter in the capital are lower,” said Nogueira.

Some of the reasons for this difference are that the fuels used to power vehicles in Brazil are cleaner than those used in the countries of the other nine participating cities. In addition, Brazil’s energy matrix has a larger share of renewable sources, Nogueira explained.

“In Brazil, we also have Proconve [Health Program for the Control of Air Pollution from Motor Vehicles], which at every stage has established the requirement to use cleaner fuels and more efficient engines in the country,” Nogueira said.

Unequal access

Currently, 70% of the world’s greenhouse gas (GHG) emissions come from cities, almost half of which come from urban transportation, mostly from private cars, said Mariana Giannotti, professor at the Polytechnic School of USP (POLI-USP) and technology transfer coordinator at the Center for Metropolitan Studies (CEM) – a FAPESP Research, Innovation and Dissemination Center (RIDC). “In this sense, public transport represents an excellent strategy to address issues related to sustainability,” said the researcher during a lecture at the event.

Through a study conducted within the framework of the CEM, the researcher and collaborators compared access to public transport in São Paulo, New York, and London, based on users’ travel time and ticket costs. The results show that New York has a public transport integration policy that is fair and helps to reduce inequality in access to public transport. The situation in São Paulo is different, according to Giannotti.

“In São Paulo, inequality is being exacerbated by the way public transport users are charged. Normally, people in the city spend on average between 20% and 40% of their income on it, while New Yorkers spend between 5% and 10%,” she compared.

The biggest users of buses in São Paulo are people from lower economic classes, especially blacks, the researcher said.

“Rich people, who live in the best places in São Paulo, have access to better quality public transportation and are paying less,” she compared.

 

Industry gifts may influence which cardiac device is used in common lifesaving procedure

UNIVERSITY OF PITTSBURGH

PITTSBURGH, April 10, 2024 — Physicians who received payments from the manufacturer of a specific set of cardiac devices are more likely to use those devices, often during a common procedure to unblock coronary arteries, according to a research letter published today in JAMA authored by researchers from the University of Pittsburgh, University of California, San Francisco, Yale University and the University of Connecticut.

The devices, known as the intravascular microaxial left ventricular assist devices (LVADs), were developed to provide cardiac support, often during percutaneous coronary intervention (PCI) procedures, and have been scrutinized in recent years for concerns about the evidence supporting their safety and effectiveness. The Food and Drug Administration issued a correction on instructions for LVADs last month. The research letter raises questions about how industry payments influence the use of medical devices, which can include high-risk procedures as well as high costs.

Using the national disclosure program Open Payments, the authors examined marketing-related payments from the LVAD manufacturer to cardiologists from 2016 to 2018, then linked these data to Medicare claims to determine which devices were subsequently used in beneficiaries. The team found that physicians who received payments from the manufacturer of LVADs were approximately twice as likely to use the device that year as well as in the following year, suggesting a lasting effect.

Senior author Timothy Anderson, M.D., M.A.S., a primary care physician, health services researcher and assistant professor of medicine at Pitt, explained that their findings align with previous studies showing that even small marketing payments may influence clinical care, but that most prior studies focus on prescription drugs. This study is one of the first to expand to medical devices and raises concern given that intravascular microaxial LVADs are more expensive but not shown to be more safe or effective than alternatives.

“These marketing relationships are very different from research partnerships between academia and industry, which are often beneficial in developing new innovations,” said Anderson. “If free meals and gifts to doctors might influence what device is used during a cardiac emergency, it is time to rethink whether these relationships are acceptable.”

Other authors on the study were Sanket Dhruva, M.D., M.H.S., of UCSF, Joseph S. Ross, M.D., M.H.S., of Yale; Michael Steinman, M.D., and Siqi Gan, M.P.H., of UCSF; and Sruthi Muluk, M.D., of University of Connecticut.

This research was supported by Veterans Affairs Health Services Research & Development (#1IK2HX003357) and National Institutes of Health/National Institute on Aging (#K76AG074878, #2K24AG049057, #P30 AG044281).

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About the University of Pittsburgh School of Medicine

As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top recipients of funding from the National Institutes of Health since 1998. In rankings released by the National Science Foundation, Pitt is in the upper echelon of all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see www.medschool.pitt.edu.

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JOURNAL

JAMA

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Intravascular Microaxial Left Ventricular Assist Device Manufacturer Payments to Cardiologists and Use of Devices

ARTICLE PUBLICATION DATE

10-Apr-2024

COI STATEMENT

Disclosures: Dr. Dhruva currently receives research funding from the Department of Veterans Affairs and Arnold Ventures and reports serving as a member of the Institute for Clinical and Economic Review California Technology Assessment Forum. Drs. Dhruva and Ross report serving on the Medicare Evidence Development and Coverage Advisory Committee. Dr. Ross currently receives research support through Yale University from Johnson and Johnson to develop methods of clinical trial data sharing, from the Food and Drug Administration for the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation (CERSI) program (U01FD005938), from the Agency for Healthcare Research and Quality (R01HS022882), and from Arnold Ventures; formerly received research support from the Medical Device Innovation Consortium as part of the National Evaluation System for Health Technology (NEST) and from the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH) (R01HS025164, R01HL144644); and in addition, Dr. Ross was an expert witness at the request of Relator’s attorneys, the Greene Law Firm, in a qui tam suit alleging violations of the False Claims Act and Anti-Kickback Statute against Biogen Inc. that was settled September 2022. Dr. Anderson reports grant support from the American College of Cardiology, American Heart Association, and US Deprescribing Research Network outside of the submitted work. Dr. Anderson also reports consulting fees from the American Medical Student Association and personal fees from the American Medical Association. Dr. Steinman reports grant support from the National Institute on Aging and receives royalties from UpToDate and honoraria from the American Geriatrics Society.

 

Researchers discover how we perceive bitter taste

UNIVERSITY OF NORTH CAROLINA HEALTH CARE

 

IMAGE: 

REPRESENTATIVE CRYO-EM MAPS (LEFT) AND MODELS (RIGHT) FOR TAS2R14-GGUST-SCFV16, COLORED ACCORDING TO
EACH SUBUNIT, TAS2R14; GREEN, GΑI1; PURPLE, GΑGUST; PINK, GΒ1; SKY BLUE, GΓ2;YELLOW, SCFV16; GRAY.

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CREDIT: KIM ET AL (2024)

CHAPEL HILL, N.C. – Humans can sense five different tastes: sour, sweet, umami, bitter, and salty, using specialized sensors on our tongues called taste receptors. Other than allowing us to enjoy delicious foods, the sensation of taste allows us to determine the chemical makeup of food and prevents us from consuming toxic substances.

Researchers at the UNC School of Medicine, including Bryan Roth, MD, PhD, the Michael Hooker Distinguished Professor of Pharmacology, and Yoojoong Kim, PhD, a postdoctoral researcher in the Roth Lab, recently set out to address one very basic question: "How exactly do we perceive bitter taste?”

A new study, published in Nature, reveals the detailed protein structure of the TAS2R14 bitter taste receptor. In addition to solving the structure of this taste receptor, the researchers were also able to determine where bitter-tasting substances bind to TAS2R14 and how they activate them, allowing us to taste bitter substances.

“Scientists know very little about the structural make up of sweet, bitter, and umami taste receptors,” said Kim. “Using a combination of biochemical and computational methods, we now know the structure of the bitter taste receptor TAS2R14 and the mechanisms that initializes the sensation of bitter taste in our tongues.”

This detailed information is important for discovering and designing drug candidates that can directly regulate taste receptors, with the potential to treat metabolic diseases such as obesity and diabetes.

From Chemicals to Electricity to Sensation

TAS2R14s are members of the G protein-coupled receptor (GPCR) family of bitter taste receptors. The receptors are attached to a protein known as a G protein. TAS2R14 stands out from the others in its family because it can identify more than 100 distinct substances known as bitter tastants.

Researchers found that when bitter tastants come into contact with TAS2R14 receptors, the chemicals wedge themselves into to a specific spot on the receptor called an allosteric site, this causes the protein to change its shape, activating the attached G protein.

This triggers a series of biochemical reactions within the taste receptor cell, leading to activation of the receptor, which can then send signals to tiny nerve fibers – through the cranial nerves in the face – to an area of the brain called the gustatory cortex. It is here where the brain processes and perceives the signals as bitterness. And of course, this complex signaling system occurs almost instantaneously.

Cholesterol’s Role in Bitter Taste Reception

While working to define its structure, researchers found another unique feature of TAS2R14 – that cholesterol is giving it a helping hand in its activation.

“Cholesterol was residing in another binding site called the orthosteric pocket in TAS2R14, while the bitter tastant binds to the allosteric site,” said Kim. “Through molecular dynamics simulations, we also found that the cholesterol puts the receptor in a semi-active state, so it can be easily activated by the bitter tastant.”

Bile acids, which are created in the liver, have similar chemical structures with cholesterol. Previous studies have suggested that bile acids can bind and activate TAS2R14, but little is known about how and where they bind in the receptor.

Using their newfound structure, researchers found that bile acids might be binding to the same orthosteric pocket as cholesterol. While the exact role of bile acid or cholesterol in TAS2R14 remains unknown, it may play a role in the metabolism of these substances or in relation to metabolic disorders such as obesity or diabetes.

How This Can Help Drug Development

The discovery of this novel allosteric binding site for bitter tasting substances is unique.

The allosteric binding region is located between TAS2R14 and its coupled G protein is called G-protein alpha. This region is critical to form a signaling complex, which helps to transfer the signal from the taste receptor to the G-protein to the taste receptor cells.

“In the future, this structure will be key to discovering and designing drug candidates that can directly regulate G proteins through the allosteric sites,” said Kim. “We also have the ability to affect specific G-protein subtypes, like G-protein alpha or G-protein beta, rather than other G-protein pathways that we don't want to cause any other side effects.”

Roth and Kim have made a number of new discoveries, but some leave more questions than answers. While running a genomics study, they found that the TAS2R14 protein in complex with the GI is expressed outside the tongue, especially in the cerebellum in the brain, the thyroid, and the pancreas. Researchers are planning future studies to elucidate the function these proteins may have outside of the mouth.

This work was supported by the NIH Illuminating the Druggable Genome Initiative.

About UNC School of Medicine

The UNC School of Medicine (SOM) is the state’s largest medical school, graduating more than 180 new physicians each year. It is consistently ranked among the top medical schools in the US, including 5th overall for primary care by US News & World Report, and 6th for research among public universities. More than half of the school’s 1,700 faculty members served as principal investigators on active research awards in 2021. Two UNC SOM faculty members have earned Nobel Prize awards.

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JOURNAL

Nature

DOI

10.1038/s41586-019-0000-0 

ARTICLE TITLE

Bitter taste receptor activation by cholesterol and an intracellular tastant

ARTICLE PUBLICATION DATE

10-Apr-2024