Neandertals have adopted male sex chromosome from modern humans
WAIT! WHAT? HAVE IS PRESENT TENSE THAT MEANS

NEANDERTALS ARE STILL AROUND

by Max Planck Society

Matthias Meyer at work in the clean laboratory at the Max Planck Institute for Evolutionary Anthropology. Credit: MPI f. Evolutionary Anthropology

In 1997, the very first Neandertal DNA sequence—just a small part of the mitochondrial genome—was determined from an individual discovered in the Neander Valley, Germany, in 1856. Since then, improvements in molecular techniques have enabled scientists at the Max Planck Institute for Evolutionary Anthropology to determine high quality sequences of the autosomal genomes of several Neandertals, and led to the discovery of an entirely new group of extinct humans, the Denisovans, who were relatives of the Neandertals in Asia.

However, because all specimens well-preserved enough to yield sufficient amounts of DNA have been from female individuals, comprehensive studies of the Y chromosomes of Neandertals and Denisovans have not yet been possible. Unlike the rest of the autosomal genome, which represents a rich tapestry of thousands of genealogies of any individual's ancestors, Y chromosomes have a peculiar mode of inheritance—they are passed exclusively from father to son. Y chromosomes, and also the maternally-inherited mitochondrial DNA, have been extremely valuable for studying human history.

New method to identify Y chromosome molecules

In this study, the researchers identified three male Neandertals and two Denisovans that were potentially suitable for DNA analysis, and developed an approach to fish out human Y chromosome molecules from the large amounts of microbial DNA that typically contaminate ancient bones and teeth. This allowed them to reconstruct the Y chromosome sequences of these individuals, which would not have been possible using conventional approaches.

By comparing the archaic human Y chromosomes to each other and to the Y chromosomes of people living today, the team found that Neandertal and modern human Y chromosomes are more similar to one another than they are to Denisovan Y chromosomes. "This was quite a surprise to us. We know from studying their autosomal DNA that Neandertals and Denisovans were closely related and that humans living today are their more distant evolutionary cousins. Before we first looked at the data, we expected that their Y chromosomes would show a similar picture," says Martin Petr, the lead author of the study. The researchers also calculated that the most recent common ancestor of Neandertal and modern human Y chromosomes lived around 370,000 years ago, much more recently than previously thought.

Upper molar of a male Neandertal (Spy 94a) from Spy, Belgium. Credit: I. Crevecoeur

It is by now well established that all people with non-African ancestry carry a small amount of Neandertal DNA as a result of interbreeding between Neandertals and modern humans approximately 50,000-70,000 years ago, quite shortly after modern humans migrated out of Africa and started spreading around the world. However, whether Neandertals might also carry some modern human DNA has been a matter of some debate.


These Y chromosome sequences now provide new evidence that Neandertals and early modern humans met and exchanged genes before the major out of Africa migration—potentially as early as 370,000 years ago and certainly more than 100,000 years ago. This implies that some population closely related to early modern humans must already have been in Eurasia at that time. Surprisingly, this interbreeding resulted in the replacement of the original Neandertal Y chromosomes with those of early modern humans, a pattern similar to what has been seen for Neandertal mitochondrial DNA in an earlier study.

Selection for Y chromosomes from early modern humans

At first, the complete replacement of both Y chromosomes and mtDNA of early Neandertals was puzzling, as such replacement events are quite unlikely to occur by chance alone. However, the researchers used computer simulations to show that the known small size of Neandertal populations may have led to an accumulation of deleterious mutations in their Y chromosomes which would reduce their evolutionary fitness. This is quite similar to situations where extremely small population sizes and inbreeding can sometimes increase the incidence of some diseases. "We speculate that given the important role of the Y chromosome in reproduction and fertility, the lower evolutionary fitness of Neandertal Y chromosomes might have caused natural selection to favor the Y chromosomes from early modern humans, eventually leading to their replacement," says Martin Petr.

Janet Kelso, the senior author of the study, is optimistic that this replacement hypothesis could be tested in the near future: "If we can retrieve Y chromosome sequences from Neandertals that lived prior to this hypothesized early introgression event, such as the 430,000 year old Neandertals from Sima de los Huesos in Spain, we predict that they would still have the original Neandertal Y chromosome and will therefore be more similar to Denisovans than to modern humans."


Explore further Neandertals had older mothers and younger fathers

More information: Martin Petr et al, The evolutionary history of Neanderthal and Denisovan Y chromosomes", Science; September 25th, 2020, science.sciencemag.org/cgi/doi … 1126/science.abb6460

Journal information: Science

Provided by Max Planck Society

#KINKY

Talc and petroleum jelly among the best lubricants for people wearing PPE
GOOD NEWS FOR CANADIANS TOLD TO WEAR MASKS DURING SEX BY HEALTH CANADA
by Imperial College London

Credit: Unsplash/CC0 Public Domain

For frontline healthcare workers during the COVID-19 pandemic, wearing personal protective equipment (PPE) like face visors, googles, and respiratory protective equipment is an essential part of working life. More workers are wearing facial PPE now than ever before, often for extended periods of time, to protect them against the SARS-CoV-2 virus.


However, extended PPE use, particularly on the delicate skin of the face, can cause friction and shear injuries like skin tears, blistering, ulcers, and hives.

The effects of friction and shear can be reduced by lubricants, which workers are advised to apply every half hour. Half-hourly applications can be impractical during shift work and may expose workers to the virus, and many typical moisturisers don't last long as they are designed to be absorbed into the skin for a 'non-greasy feel'.

Now, researchers from Imperial College London have investigated which products create the longest-lasting protective layer between PPE and skin. They hope their findings will help healthcare workers and other long-term PPE users like those in hospitality to prevent skin injury and deformity.

They found that the best lubricants to use are those that don't absorb into the skin, creating a long-lasting layer of protection between skin and PPE. They say that non-absorptive creams like coconut oil-cocoa butter beeswax mixtures, and powders like talcum powder, are most likely to provide PPE wearers with long-lasting skin protection.

The findings are published today in PLOS ONE.

Lead author Dr. Marc Masen, of Imperial's Department of Mechanical Engineering, said: "We think of moisturisers as good for our skin, but commercial skin creams are often designed to absorb into the skin without leaving any residue. While this is fine for everyday moisturising, our study shows that a greasy residue is precisely what's needed to protect skin from PPE friction."

To identify the best-performing lubricants, the researchers custom-built a tribometer—an instrument that assesses friction between two surfaces—and used it to test the friction between skin and polydimethylsiloxane (PDMS), which is a common component of PPE.

They used the tribometer to test commercially available products to measure how they changed the friction between PDMS and the inner forearm skin of a healthy 44-year-old male participant. They tested friction upon application, and then one, two, and four hours after application.

They found that while most products initially reduced friction by 20 percent, some silicone-based and water-and-glycerin based lubricants increased friction levels over time by up to 29 percent compared to dry skin.

However, two products reduced friction as time went on. Talcum powder reduced friction by 49 percent on application and 59 percent at four hours, and a commercially available product comprising coconut oil, cocoa butter and beeswax reduced friction by 31 percent on application and 53 percent at four hours. A mixture of petrolatum and lanolin reduced friction by 30 percent throughout testing.

When testing commercial moisturisers, they found that friction on application was low, but increased drastically within ten minutes of application. The researchers say this is because the active ingredients, known as humectants, attract water like magnets from the lower layers of skin to the upper ones, leaving it soft, unlubricated, and breakable.

Co-author Dr. Zhengchu Tan, also of the Department of Mechanical Engineering, said: "The products that don't absorb easily into the skin are the ones that provide a protective layer. In fact, for PPE wearers, it's best to actively avoid creams and moisturisers which advertise a 'non-greasy feel'."

Dr. Masen said: "Friction can be incredibly damaging for the skin, particularly when applied for an extended period. We hope our study will save healthcare workers and other frontline PPE wearers from suffering with the painful and damaging effects of skin friction."

The researchers say that while their study signposts PPE wearers to the best skin-saving products, they are looking to perform further studies using facial skin and more participants. Due to COVID-19 restrictions during lockdown, they were only able to test the products on one study participant, and used his inner forearm as a surrogate for facial skin.


Explore further Advice to health staff suffering skin damage from face masks

More information: "Evaluating lubricant performance to reduce COVID-19 PPE-related skin injury" by Marc Masen et al, published 24 September 2020 in PLOS ONE. journals.plos.org/plosone/arti … journal.pone.0239363

Journal information: PLoS ONE


Provided by Imperial College London

BOY'S IN THE BAND REDUX

LBG individuals use stimulants at higher rates than heterosexuals

by Columbia University's Mailman School of Public Health


Lesbian, gay and bisexual (LGB) individuals report higher rates of medical, non-medical, and illegal stimulant use compared to heterosexuals, mirroring patterns seen in other substance use. The study by Columbia University Mailman School of Public Health researchers provides the most detailed picture to date on stimulant use by LGB subgroups and gender. Findings are published in the American Journal of Preventive Medicine.

The researchers analyzed data from the 2015-2017 National Survey on Drug Use and Health to examine associations between sexual identity and past-year use of medical and non-medical stimulants (i.e., Adderall, Ritalin) and illegal stimulants (i.e., cocaine, crack, methamphetamine). They found that bisexual women's illegal stimulant use in the past year was fivefold that of heterosexual women (7.8% vs. 1.5%), while gay men's use was threefold that of heterosexual men (9.2% vs. 3.2%). Non-medical use of prescription stimulants was higher among gay and bisexual men than heterosexual men (5.4% and 6.6% vs. 2.4%) and among gay/lesbian and bisexual women versus heterosexual women (3.3% and 6.8% vs. 1.6%). Past-year medical use of prescription stimulants was higher among gay men than heterosexual men (6.6% vs. 4.1%) and bisexual women than heterosexual women (7.9% vs. 4.9%). There were no differences between bisexual men and women compared to their gay/lesbian counterparts.

Potential consequences of stimulant include substance use disorder and overdose, particularly given increases in fentanyl contamination in illegally produced pills and cocaine and methamphetamine. As many as half of LGB individuals who reported nonmedical and illegal stimulant use also reported nonmedical prescription opioid use.

"This study highlights the need for future interventions to target stimulant use among LGB populations, with a particular focus on harm reduction approaches," says first author Morgan Philbin, Ph.D., assistant professor of sociomedical sciences. "The findings have important implications across sexual identities, and demonstrate the need to disaggregate stimulant use by subgroup and gender, particularly related to polysubstance use."

Higher drug use among LGB individuals is likely a result of minority stress—that is, the fact that exposure to stigma and discrimination based on sexual orientation results in health disparities. Structural stigma (e.g., employment or housing discrimination) drives psychological and physical health morbidities among LGB populations, and perceived stigma is associated with cocaine use. Bisexuals can also experience "double discrimination" from heterosexuals and lesbian and gay communities, which the researchers say may account for the particularly high substance use among bisexual individuals.

The paper outlines several avenues to address stimulant use, including by educating healthcare providers who focus on LGB communities to screen for and discuss substance use, including stimulants. Communities and providers can also scale-up access to medication disposal and harm reduction services.

The researchers note that their dataset started assessing sexual identity among adults in 2015, so these relationships could not be examined in earlier years or among adolescents. The options for gender included only "male" or "female" and thus did not allow researchers to differentiate between transgender and cis-gender individuals. The dataset does not assess sexual behavior, so this study only captured associations based on individuals' sexual identity.


Explore further Study examines stimulant use in context of state medical cannabis laws

More information: Morgan M. Philbin et al, Medical, Nonmedical, and Illegal Stimulant Use by Sexual Identity and Gender, American Journal of Preventive Medicine (2020). DOI: 10.1016/j.amepre.2020.05.025

Journal information: American Journal of Preventive Medicine


Provided by Columbia University's Mailman School of Public Health

Twinkling, star-shaped brain cells may hold the key to why, how we sleep

by Washington State University

Astrocytes in the brain expressing a fluorescent calcium indicator captured with a two-photon microscope. Credit: Ashley Ingiosi, courtesy of Current Biology

A new study published today in the journal Current Biology suggests that star-shaped brain cells known as astrocytes could be as important to the regulation of sleep as neurons, the brain's nerve cells.

Led by researchers at Washington State University's Elson S. Floyd College of Medicine, the study builds new momentum toward ultimately solving the mystery of why we sleep and how sleep works in the brain. The discovery may also set the stage for potential future treatment strategies for sleep disorders and neurological diseases and other conditions associated with troubled sleep, such as PTSD, depression, Alzheimer's disease, and autism spectrum disorder.

"What we know about sleep has been based largely on neurons," said lead author and postdoctoral research associate Ashley Ingiosi. Neurons, she explained, communicate through electrical signals that can be readily captured through electroencephalography (EEG). Astrocytes—a type of glial (or "glue") cell that interacts with neurons—do not use electrical signals and instead use a process known as calcium signaling to control their activity.

It was long thought that astrocytes—which can outnumber neurons by five to one—merely served a supportive role, without any direct involvement in behaviors and processes. Neuroscientists have only recently started to take a closer look at their potential role in various processes. And while a few studies have hinted that astrocytes may play a role in sleep, solid scientific tools to study their calcium activity have not been available until recently, Ingiosi said.

Illustration of how a miniature microscope captures fluorescent astrocytes in the brain (left), with a miniature microscope image of fluorescent astrocytes in the brain shown at right. Credit: Ashley Ingiosi, courtesy of Current Biology

To delve deeper into astrocytes' role in sleep, she and her coauthors used a rodent model to record astrocytes' calcium activity throughout sleep and wake, as well as after sleep deprivation. They used a fluorescent calcium indicator that was imaged via tiny head-mounted microscopes that looked directly into the brains of mice as they moved around and behaved as they normally would. This indicator allowed the team to see calcium-driven fluorescent activity twinkling on and off in astrocytes during sleep and waking behaviors. Their one-of-a-kind methodology using these miniature microscopes allowed the team to conduct the first-ever study of astrocytes' calcium activity in sleep in freely behaving animals.


The research team set out to answer two main questions: do astrocytes change dynamically across sleep and wake states like neurons do? And do astrocytes play a role in regulating sleep need, our natural drive to sleep?

Looking at astrocytes in the frontal cortex, an area of the brain associated with measurable EEG changes in sleep need, they found that astrocytes' activity changes dynamically across the sleep-wake cycle, as is true for neurons. They also observed the most calcium activity at the beginning of the rest phase—when sleep need is greatest—and the least calcium activity at the end of the test phase, when the need for sleep has dissipated.

Next, they kept mice awake for the first 6 hours of their normal rest phase and watched calcium activity change in parallel with EEG slow wave activity in sleep, a key indicator of sleep need. That is, they found that sleep deprivation caused an increase in astrocyte calcium activity that decreased after mice were allowed to sleep.

Video of astrocyte activity in the brain during a single sleep cycle, captured using a fluorescent calcium indicator and miniature microscope. The footage shows dynamic changes throughout the cycle as it transitions through non-rapid eye movement sleep (NREMS), rapid eye movement sleep (REMS), and wakefulness (WAKE). Video shown is 16 times faster than normal speed. Credit: Ashley Ingiosi, Current Biology https://medicalxpress.com/news/2020-09-twinkling-star-shaped-brain-cells-key.html

Their next question was whether genetically manipulating astrocyte calcium activity would impact sleep regulation. To find out, they studied mice that lacked a protein known as STIM1 selectively in astrocytes, which reduced the amount of available calcium. After being sleep deprived, these mice did not sleep as long or get as sleepy as normal mice once allowed to sleep, which further confirmed earlier findings that suggest that astrocytes play an essential role in regulating the need for sleep.

Finally, they tested the hypothesis that perhaps astrocyte calcium activity merely mirrors the electrical activity of neurons. Studies have shown that the electrical activity of neurons becomes more synchronized during non-REM sleep and after sleep deprivation, but the researchers found the opposite to be true for astrocytes, with calcium activity becoming less synchronized in non-REM sleep and after sleep deprivation.

"This indicates to us that astrocytes are not just passively following the lead of neurons," said Ingiosi. "And because they don't necessarily display the same activity patterns as neurons, this might actually implicate a more direct role for astrocytes in regulating sleep and sleep need."

More research is needed to further unravel the role of astrocytes in sleep and sleep regulation, Ingiosi said. She plans to study astrocytes' calcium activity in other parts of the brain that have been shown to be important for sleep and wake. In addition, she would like to look at astrocytes' interactions with different neurotransmitters in the brain to start to tease out the mechanism by which astrocytes might drive sleep and sleep need.

"The findings of our study suggest that we may have been looking in the wrong place for more than 100 years," said senior author and professor of biomedical sciences Marcos Frank. "It provides strong evidence that we should be targeting astrocytes to understand why and how we sleep, as well as for the development of therapies that could help people with sleep disorders and other health conditions that involve abnormal sleep."

Explore further Researchers discover new clues on how sleep works in the brain

More information: Current Biology (2020). DOI: 10.1016/j.cub.2020.08.052 , www.cell.com/current-biology/f … 0960-9822(20)31242-2

Journal information: Current Biology

Provided by Washington State University

Researchers use artificial intelligence tools to predict loneliness

by University of California - San Diego

Credit: CC0 Public Domain

For the past couple of decades, there has been a loneliness pandemic, marked by rising rates of suicides and opioid use, lost productivity, increased health care costs and rising mortality. The COVID-19 pandemic, with its associated social distancing and lockdowns, have only made things worse, say experts.

Accurately assessing the breadth and depth of societal loneliness is daunting, limited by available tools, such as self-reports. In a new proof-of-concept paper, published online September 24, 2020 in the American Journal of Geriatric Psychiatry, a team led by researchers at University of California San Diego School of Medicine used artificial intelligence technologies to analyze natural language patterns (NLP) to discern degrees of loneliness in older adults.

"Most studies use either a direct question of ' how often do you feel lonely,' which can lead to biased responses due to stigma associated with loneliness or the UCLA Loneliness Scale which does not explicitly use the word 'lonely,'" said senior author Ellen Lee, MD, assistant professor of psychiatry at UC San Diego School of Medicine. "For this project, we used natural language processing or NLP, an unbiased quantitative assessment of expressed emotion and sentiment, in concert with the usual loneliness measurement tools."

In recent years, numerous studies have documented rising rates of loneliness in various populations of people, particularly those most vulnerable, such as older adults. For example, a UC San Diego study published earlier this year found that 85 percent of residents living in an independent senior housing community reported moderate to severe levels of loneliness.

The new study also focused on independent senior living residents: 80 participants aged 66 to 94, with a mean age of 83 years. But, rather than simply asking and documenting answers to questions from the UCLA Loneliness Scale, participants were also interviewed by trained study staff in more unstructured conversations that were analyzed using NLP-understanding software developed by IBM, plus other machine-learning tools.

"NLP and machine learning allow us to systematically examine long interviews from many individuals and explore how subtle speech features like emotions may indicate loneliness. Similar emotion analyses by humans would be open to bias, lack consistency, and require extensive training to standardize," said first author Varsha Badal, Ph.D., a postdoctoral research fellow.

Among the findings:
Lonely individuals had longer responses in qualitative interview, and more greatly expressed sadness to direct questions about loneliness.
Women were more likely than men to acknowledge feeling lonely during interviews.
Men used more fearful and joyful words in their responses compared to women.

Authors said the study highlights the discrepancies between research assessments for loneliness and an individual's subjective experience of loneliness, which NLP-based tools could help to reconcile. The early findings reflect how there may be "lonely speech" that could be used to detect loneliness in older adults, improving how clinicians and families assess and treat loneliness in older adults, especially during times of physical distancing and social isolation.

The study, said the authors, demonstrates the feasibility of using natural language pattern analyses of transcribed speech to better parse and understand complex emotions like loneliness. They said the machine-learning models predicted qualitative loneliness with 94 percent accuracy.

"Our IBM-UC San Diego Center is now exploring NLP signatures of loneliness and wisdom, which are inversely linked in older adults. Speech data can be combined with our other assessments of cognition, mobility, sleep, physical activity and mental health to improve our understanding of aging and to help promote successful aging" said study co-author Dilip Jeste, MD, senior associate dean for healthy aging and senior care and co-director of the IBM-UC San Diego Center for Artificial Intelligence for Healthy Living.


Explore further Loneliness levels high during COVID-19 lockdown

More information: Varsha D. Badal et al, Prediction of Loneliness in Older Adults using Natural Language Processing: Exploring Sex Differences in Speech, The American Journal of Geriatric Psychiatry (2020). DOI: 10.1016/j.jagp.2020.09.009

Journal information: American Journal of Geriatric Psychiatry

Provided by University of California - San Diego

Waste generation by hospital emergency departments is highlighted for first time

by Massachusetts General Hospital

Credit: CC0 Public Domain

Emergency departments of hospitals generate significant amounts of environmentally harmful waste which could be reduced through basic changes to disposal policies and practices, while producing lower operating costs, researchers from Massachusetts General Hospital (MGH) have found. Efforts to optimize the daily waste stream through improvements such as switching from disposable to reusable items in the ED, better sorting of infectious waste, and more effective recycling of items like glass and aluminum could have meaningful impact both environmentally and financially, according to the study published in the Western Journal of Emergency Medicine.


"People working in emergency departments have no idea how much waste they routinely generate, nor that the environmental impact is totally at odds with their professional mission to improve health and save lives," says Jonathan E. Slutzman, MD, investigator in the Department of Emergency Medicine at MGH and senior author of the study. "A greater awareness of the harm that's being done, along with the opportunities that are available to turn that situation around, should be on the agenda of every hospital in America."

Healthcare facilities in the U.S. generate 6,600 metric tons of waste each day, making them the second largest contributor to landfill waste (next to the food industry). They also produce 10 percent of all greenhouse gas emission as well as other pollutants known to adversely affect human health. The MGH investigation is the first to quantify and characterize the volume of waste emanating from emergency departments. To that end, researchers conducted a 24-hour waste audit in July 2019 at MGH's Level 1 trauma center in Boston. The team collected, manually sorted into separate categories, and weighed each waste stream component. It also calculated direct pollutant emissions from ED waste disposal activities.

Among the findings was that 85 percent of all items disposed of as regulated medical waste (RMW)—the most hazardous ED materials that must be deposited in red bags and autoclaved to render them safe prior to being sent to landfills—did not meet the criteria for regulated medical waste. "We always want healthcare workers to err on the side of caution when it comes to waste disposal, but the fact is regulated medical waste costs up to ten times as much to dispose of as solid waste," notes Sarah Hsu, with the Warren Alpert Medical School at Brown University, and lead author of the study. "But if we could divert through better sorting some fraction of medical waste that now goes into red biohazard bags to regular solid waste, it would open up significant cost-saving opportunities for hospitals."

Another area rife with opportunity, according to the researchers, is transitioning from the use of disposable devices to more durable, reusable alternatives that would lead to waste reduction and supply savings. One example is the laryngoscope, commonly used in the ED to insert a breathing tube into the trachea, which could be reprocessed onsite and safely used multiple times rather than discarding it after a single use. Rethinking the use of plastic packaging, which was estimated by the MGH study to be responsible for over 40 percent of all emergency department solid waste, also holds the potential for significant waste reduction. MGH, for its part, asks suppliers to ship products in non-disposable bulk packaging, whenever possible, enabling reuse. Suppliers are also "debulking" items at distribution centers, enabling packaging to be reused from that point rather than being shipped all the way to the hospital.

To determine the best opportunities for waste reduction, Slutzman suggests that hospitals conduct their own audits of emergency department waste. "Gaining a full awareness of the problem and its downstream consequences on the health of the community is an important first step toward a solution," he says. "In addition to audits, hospitals should assemble all stakeholders around the table to explore alternatives to their current waste disposal practices. Our study shows that significant improvements can be made to optimize ED waste management, and as healthcare professionals we owe it to our patients and the community to take responsible action."

Explore further To cut food waste, we may need to pay more for what we eat

More information: Sarah Hsu et al, Dumpster Diving in the Emergency Department: Quantity and Characteristics of Waste at a Level I Trauma Center, Western Journal of Emergency Medicine (2020). DOI: 10.5811/westjem.2020.6.47900

Provided by Massachusetts General Hospital

Job security, finances strongly related to increased anxiety during pandemic

by Jaclyn Severance, University of Connecticut

Credit: CC0 Public Domain

In mid-April 2020, the national unemployment rate reached 14.7 percent—the highest since the Great Depression. Forty-one million American workers filed for unemployment between February and May of 2020.

Unprecedented unemployment rates don't just have an impact on the unemployed, though. For people still employed during the COVID-19 pandemic, job insecurity and financial concern are associated with greater symptoms of depression and anxiety, according to findings from the UConn School of Nursing published recently in the Journal of Occupational and Environmental Medicine, or JOEM.

"The impact the virus and the pandemic is having on the economy and employment is not surprisingly taking a big toll," says Natalie J. Shook, a social psychologist, associate professor in the School of Nursing, and principal investigator for the study.

The findings are part of a year-long examination of how behavior and social attitudes change, and what factors influence those changes, when people in the United States are faced with the threat of widespread disease. Supported by a National Science Foundation grant, the study is tracking the well-being, feelings, and behavioral practices of about 1,000 individuals across the United States, and more than 18 surveys of the participants have already been conducted since March.

"We definitely are seeing, within our employed participants, higher rates of anxiety than in individuals who indicated they were not employed," says Shook, noting that most study participants who are not employed are retirees. "Controlling for demographics, controlling for income level, and also taking into account participant health and concerns about COVID—and the extent to which people were engaging in social distancing or quarantine—we are seeing that job security and financial concerns are the significant predictors associated with anxiety and depression."

The study asked participants to identify symptoms of anxiety by asking if they were feeling nervous, anxious, or on edge, or if they were not able to stop or control their worrying. They were also asked about the extent of their financial concerns—how worried they were about their employment and financial situation, if they expected their financial situation to get worse over the next 12 months, and if they had the means to secure food and housing for their family for the next 12 months.

Most study participants reported some level of worry about the effects of COVID-19 on their employment. While previous studies have linked large-scale disruptions like recessions and pandemics with poor mental health, the researchers note that their study importantly expands on these associations by demonstrating independent links between greater financial concern with greater anxiety symptoms, and greater job insecurity with greater depressive symptoms, after accounting for demographics, health, and other COVID-19 concerns and experiences.

Shook and her research team say employers can play a critical role in supporting the mental health of their employees by recognizing the increased anxiety that workers experience when their job security feels threatened during the pandemic.

"Our results demonstrate the potential adverse consequences that job insecurity and financial concern have on employee mental health," the researchers write. "Based on these findings, for those experiencing depressive symptoms during the pandemic, it may be particularly important for employers to be mindful and try to minimize feelings of uncertainty for the employees, as well as instilling hope or agency in employees. For those experiencing anxiety symptoms, employers could attempt to reduce financial concerns by allowing employees to continue to work (eg, telework), even with reduced hours and income, to ensure that employees do not lose their entire income."

More information: Jenna M. Wilson et al, Job Insecurity and Financial Concern During the COVID-19 Pandemic Are Associated With Worse Mental Health, Journal of Occupational & Environmental Medicine (2020). DOI: 10.1097/JOM.0000000000001962

Journal information: Journal of Occupational and Environmental Medicine

Provided by University of Connecticut

Intersecting social inequities increase the likelihood of severe illness due to COVID-19

by University of Toronto

Credit: Pixabay/CC0 Public Domain

Black, South Asian and Aboriginal populations from disadvantaged socioeconomic backgrounds in Canada are nearly four times more likely to have three or more medical conditions that have been identified as risk factors for severe illness from COVID-19.

Shen (Lamson) Lin, a doctoral candidate in gerontology and course instructor at the University of Toronto's Factor-Inwentash Faculty of Social Work and Institute for Life Course and Aging, compared 1,102 racialized immigrants and 338 Aboriginal Canadians with 23,802 Canadian-born Whites, aged 45 and older, using population-based data from the baseline Canadian Longitudinal Study on Aging (CLSA, 2012-2015). His findings were recently published in The Gerontologist (Special collection: Gerontology in a Time of Pandemic).

"We know that COVID-19 outbreak is not affecting everyone at the same levels, and the prevalence of multiple chronic conditions within an individual—known as multimorbidity—has also been linked to social inequalities for decades," says Lin, the sole author of the study. "I was curious to explore how one's family income, education levels and experience of racism and nativism—and the intersection of these three social standings—shape the health of aging populations."

Lin's study examined nine chronic conditions associated with an increased likelihood that one will experience severe illness due to COVID-19 infection, requiring hospitalization, intensive care and the use of a ventilator. These medical conditions include diabetes, asthma, cancer, previous heart attack or myocardial infarction, kidney disease, cardiovascular disease, hypertension, chronic obstructive pulmonary disease and obesity.

The odds of having three or more of these medical conditions was greater for Black and South Asian immigrants and close to double for Aboriginal populations in Canada, relative to Canadian-born Whites. Black, South Asian and Aboriginal populations from disadvantaged socioeconomic backgrounds (those without any post-secondary education and/or those who earned less than the median household income) had the highest odds of having three or more medial conditions.

The multimorbidity differences associated with these populations were enhanced for older adults (aged 66 to 85) compared to their middle-aged counterparts (aged 45-65). Among older respondents, Black immigrants were five times more likely and Aboriginal Canadians three times more likely to have three or more medical conditions.

"These observed health gaps illustrate various minority struggles that are often obscured within a discourse of multiculturalism and diversity" says Lin, "Given the lack of socio-demographic and race-based data in Canadian health systems, my study provides a timely frame of reference for public-health decision makers to reconsider measuring upstream health inequalities to mitigate the pandemic's long-term societal harms."

Additional risk factors for multimorbidity were identified. These included being male, experiencing chronic pain, having a physical impairment, living without partners, and a lifetime of smoking.

"Widespread chronic disease and racism in addition to the contemporary pandemic make living conditions more difficult for vulnerable older adults, especially those from racialized, immigrant, and impoverished communities," says Lin. "With COVID-19 spreading globally, health equity should be placed at the center of all policy responses designed to mitigate the disproportionate impact of the pandemic on underserved aging communities."

Explore further Follow the latest news on the coronavirus (COVID-19) outbreak

More information: Shen (Lamson) Lin, Intersectionality and inequalities in medical risk for severe COVID-19 in the Canadian Longitudinal Study on Aging, The Gerontologist (2020). DOI: 10.1093/geront/gnaa143

Provided by University of Toronto

COVID-19 infected workers return to work faster using time and symptom-based protocols

by Massachusetts General Hospital

Credit: CC0 Public Domain

One of the of the most important questions in managing a hospital's response to the COVID-19 pandemic is determining when healthcare workers infected with COVID-19 can return to the job. Recently, investigators from Mass General Brigham (MGB) assessed the experience of using a test-based protocol in over 1,000 infected health care workers.


Their research was published in the latest edition of Infection Control & Hospital Epidemiology.

The "test-based" approach involves repeat testing after resolution of symptoms until two consecutive negative tests are obtained 24 hours apart. In the alternative time-plus-symptoms approach, healthcare workers return to work after a set period of time since their symptom onset (or in the case of asymptomatic infection, the date of their positive test) has elapsed and symptoms, if present, have improved or resolved.

"We've learned a lot throughout the pandemic," explains Erica S. Shenoy, MD, Ph.D., associate chief of the Infection Control Unit at Massachusetts General Hospital (MGH) and the study's lead author. "For example, we now know from multiple published studies that individuals can have repeat positive tests for weeks and those positive test do not reflect infectivity after their initial illness has resolved." These findings have led to modifications in how public health and healthcare facilities determine how long individuals need to be isolated to prevent transmission to others, Shenoy says.

The Centers for Disease Control and Prevention (CDC)'s April guidance advised either repeat "test-based" strategy to determine when workers could return to their healthcare jobs or "time-plus-symptoms" approach. Under the test-based strategy, healthcare workers had to have two negative back-to-back PCR tests to return to work.

For this study, conducted between March 7 and April 22, 2020, employees from across Mass General Brigham (MGB) health system who showed symptoms of COVID-19 were referred to its Occupational Health Services department for evaluation and a nasopharyngeal (NP) sample test using viral RNA nucleic acid amplification methods.

Return to work criteria at that time required: resolution of fever without fever-reducing medications, improvement in respiratory symptoms, and at least two consecutive negative nasopharyngeal tests collected longer than or equal to 24 hours apart. There was no minimum interval of time from resolution of symptoms to first test of clearance specified.


The researchers then analyzed the data to evaluate results of the two strategies and found that using resolution of symptoms and passage of time would have averted more than 4,000 days of lost worktime, or a mean of 7.2 additional days of work lost per employee compared to using a time-plus-symptom approach. Both approaches are options per public health recommendations, though more recently, the time-plus-symptom approach is now the preferred strategy per the CDC the Massachusetts Department of Public Health, and has replaced the prior test-based approach at MGB. One additional potential benefit of moving away from test-based approaches, though not assessed in this study, was the psychological impact on employees of repeat testing. "We've had employees who tested positive repeatedly but had recovered for weeks and they were frustrated we couldn't bring them back to work," Shenoy says. About 70 percent of participants had at least one negative test result during the study, and of those, about 62 percent had a two negative test results in a row, she adds.

A substantial number of healthcare workers diagnosed and treated for COVID-19 had repeatedly positive PCR tests. Such long duration of PCR positivity has been seen in other studies as well.

Determining when workers can return to work is a process that can affect many aspects of hospital operations, Shenoy says. "Patient and worker safety, flow of resources, speed and access to care, are some of the things impacted."

Based on the studies findings, and evolving public health guidance to prefer time-plus-symptom over test-based strategies, MGB moved to the latter over the summer. "Moving to a time+symptom approach was a vast improvement over past reliance on a less predictable test-based approach. Employees are now able to anticipate when they will be allowed to return to work, and it has reduced the strain on our testing capacity. This revision in testing strategy is consistent with our evolving medical understanding of test results and in keeping with our high commitment to workplace safety," said Dean Hashimoto, MD, chief medical officer of MGB Occupational Health Services.

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More information: Erica S. Shenoy et al, Healthcare worker infection with SARS-CoV-2 and test-based return to work, Infection Control & Hospital Epidemiology (2020).

DOI: 10.1017/ice.2020.438

Provided by Massachusetts General Hospital

During pandemic, racism puts additional stress on Asian Americans

by Sarah Alger, Massachusetts General Hospital

Credit: Unsplash/CC0 Public Domain

Many people are feeling anxious during these uncertain times as they navigate the risks associated with COVID-19 and experience the tension from physical distancing or isolation for what can seem like an eternity. But people of Asian ancestry face yet another set of challenges posed by racism and xenophobia which has soared during the COVID-19 pandemic amidst rumors and blame placed on China.


This pandemic-driven rise in anti-Asian racism is so pronounced, that in a commentary recently published in the American Journal of Public Health, psychiatrist Justin A. Chen, MD, MPH, and his coauthors have described it as a "secondary contagion" threatening this population.

Chen is an investigator in the Department of Psychiatry at Massachusetts General Hospital (MGH) and an assistant professor at Harvard Medical School. In addition, he serves as executive director and co-founder of the MGH Center for Cross Cultural Student Emotional Wellness. He is lead author on the commentary, and his co-authors are Emily Zhang Counseling Psychology Ph.D. candidate at Boston College Lynch School of Education and Human Development and Cindy H. Liu, director of the Developmental Risk and Cultural Resilience Program within Pediatric Newborn Medicine and Psychiatry at Brigham and Women's Hospital.

The United States, the authors report, is no exception to this trend toward an uptick in anti-Asian racism during the pandemic. In the U.S., Asians share a long and well-documented history of discrimination and have been the frequent targets of both interpersonal and structural persecution. Asians of all ethnicities have been scapegoated, verbally attacked with racial slurs, coughed at, spat on, physically assaulted and more.

Observers may consider such acts as just small slights or brief episodes that can be shrugged off. But there is strong evidence that they can have much more serious effects than most people realize, especially on people who are already vulnerable.

In their commentary, Chen and his collaborators provide an overview of the history of anti-Asian discrimination in the United States, reviewing associations between discrimination and health, describing the associated public health implications of the COVID-19 pandemic and reviewing evidence from previous disasters in U.S. history that were "racialized."

The scope of the problem is large and growing. Asian Americans comprise just 5.6 percent of the US population. However, they are the fastest-growing racial/ethnic group in the country, with a 72 percent increase from 2001 to 2015, and are projected to become the largest immigrant group by 2055.


"Prior to the pandemic, Asians were often held up as the 'model minority' who were always successful and excelled at academics," explains Chen. This seemingly positive stereotype comes with its own set of problems, including overlooking differences between different Asian ethnicities and added pressure for Asian American youths to conform to a certain ideal of success and hide their challenges. But since COVID-19 swept across the world and news spread that the virus had originated in China, stereotyping of Asians has assumed a more negative tone, resulting in increasing racism, suspicion, xenophobia, bullying and even more aggressive behavior.

Stop AAPI Hate, a U.S.-based Web site created in March 2020 to track attacks against Asian Americans, received 1135 reports nationwide within the first two weeks of launching. Moreover, the FBI has warned of increased hate crimes against Asian Americans. The cumulative burden of these incidents, along with their coverage in the media, has the potential to exert significant negative health effects.

That trend is starting to be more widely appreciated, Chen says. For example, two recent reports released by the two groups Stop AAPI Hate and Stop Asian Americans and Pacific Islanders (AAPI) Hate Youth Campaign, both looked at the impact of racism and xenophobia against Asian-American youth during the COVID-19 pandemic.

The report They Blamed Me Because I Am Asian, was written and analyzed by the Stop AAPI youth campaign—a group of 87 high school interns—and based on nearly 1,000 interviews they conducted with AAPI youth over the summer. The Stop AAPI Hate report, meanwhile, was written by experts who analyzed 341 incidents of anti-Asian discrimination involving youth reported to the Stop AAPI Hate reporting center from March 19—July 22, 2020.

Findings from the 990 interviews in They Blamed Me Because I Am Asian show that eight out of 10 Asian American youth (77 percent) expressed anger over the current anti Asian hate in this nation, and six out of 10 (60 percent) are disappointed over the racism. Incidents of harassment focused on blaming China and Chinese people as the source of the virus and on mocking Chinese dietary habits, such as the consumption of bats.

Chen emphasizes that not all the news is bad. Positive developments include the emergence of mechanisms for reporting and tracking incidents of racial bias, increased awareness of racism's insidious harms and subsequent civic and political engagement by the Asian American community, and further research into resilience-promoting factors that can reduce the negative health effects of racism.


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More information: Justin A. Chen et al, Potential Impact of COVID-19–Related Racial Discrimination on the Health of Asian Americans, American Journal of Public Health (2020). DOI: 10.2105/AJPH.2020.305858

Journal information: American Journal of Public Health

Provided by Massachusetts General Hospital