Author: Futurity (National Geo)

Children’s Valentine’s cards often introduce and reinforce stereotypes and attitudes about gender as well as expectations about young children’s bodies, interests, and behaviors, argues Deborah Borisoff.

Typically thought of as a commercial holiday for adults fueled by purchases of wine, chocolates, jewelry, and lingerie, Valentine’s Day has also served as an opportunity for children to explore friendships, budding crushes, and social circles.

In 1989, Borisoff and her coauthor Judythe Isserlis published an analysis of Valentine’s Day cards in which they shared their lack of surprise by the “cards’ portrayal of little girls as sweet, loving, lovely, fragile, or, of little boys as active and strong.”

More than 30 years later, Borisoff says the Valentine’s landscape is largely unchanged.

Here, she discusses the gendered messages of cards, the expectations and pressures they create for children, changes she has noticed in recent years, and five ways kids’ cards still make for a very gendered Valentine’s day:

1. Valentine’s Day cards for children depict distinct color palettes and fonts for boys and girls.

“Even before reading the message, one can tell at a distance which cards are intended for boys and which cards are intended for girls. Cards for young girls are remarkably consistent in using pastels such as pink, lilac, and pale blue, as well as red,” says Borisoff. “Hearts are typical on the cover as well. Moreover, the font is often swirly or in script. In contrast, bold block lettering on blue, purple, orange, yellow, and red backgrounds appear in cards for boys, and with fewer hearts.”

2. Cartoon characters and animals on cards differ according to gender too.

“Beyond coloristics and fonts, the figures on the cards convey at a glance the subject for whom the card is intended. Cartoon figures in boys’ cards are replete with athletes who play basketball, football, baseball, hockey, and golf. Race car drivers, astronauts, and ubiquitous action heroes are represented as well. In contrast, puppies, teddy bears, seal pups, bunny rabbits, and mice grace the cover of cards for young girls,” says Borisoff.

“When girls appear on the cover, they are depicted as princesses or other cartoon figures wearing makeup and having slim or hourglass figures. They are shown engaging in activities such as cheerleading, shopping, eating, and reading, and are always smiling. Often shiny stickers or other trinkets are included for girls to use. It’s important to note the absence of potential careers or sports for young girls, as those are reserved for boys’ cards, with few exceptions.”

3. Messages in cards designed for parents to give to children also reward different qualities and traits for sons and daughters.

“In light of the distinct activities reflected in Valentine’s cards that boys and girls exchange, it is not surprising that distinct qualities and traits are also conveyed in cards that parents give their children,” says Borisoff. “Sons are ‘great,’ ‘daring,’ ‘strong,’ ‘amazing,’ and ‘special.’ Parents are ‘proud’ of them. While daughters are also ‘special’ and can be ‘smart‘ as well, they are ‘loved’ and ‘treasured’ for being ‘sweet,’ ‘beautiful,’ ‘loving,’ ‘poised,’ and ‘popular.’ They can also be ‘wonderful,’ whether they ‘eat or diet,’ or are ‘outgoing or quiet.”

4. Gender-based messaging creates a number of challenges and barriers for children.

“The above-mentioned differences in the imagery and messages conveyed in Valentine’s cards for children reflect binary thinking and dividing practices that perpetuate stereotypes, presumptions, and expectations about identity and behavior,” Borisoff says.

“The traits, behaviors, and thinking about one’s body and aspirations speak volumes. These early messages comprise only one area that impacts how young children learn to navigate their lives, and it is important to consider what is absent. Ignored in the cards for boys are those who do not identify with athletes or super heroes, and the emotional landscape of kindness and care for others,” says Borisoff.

“Ignored in the cards for girls are those whose interests are not limited to how they look or their future aspirations. Whether these messages are intended or not, being sweet and caring is not solely the purview of girls, and being strong and daring is not solely the purview of boys. Early messages in the home, whether about the color of one’s room, clothing, activities, gifts, or even cards for birthdays and holidays can impact children’s experiences as they progress through school and work, as well as in the personal relationships they forge. It is a training ground for how young people learn to see themselves and how to treat one another.”

5. Valentine’s cards have yet to join other mediums that have expanded offerings regarding gender-neutral messaging and greater diversity.

“Valentines for children is but one arena of the media landscape. As shown, they largely adhere to many traditional stereotypes about gender identity. Cards don’t create, but rather they reflect societal norms, values, and stereotypes,” Borisoff says.

“I’ve found very few cards in the children’s section that include neutral messages, but examples I have found include a card for babies with a pink pastel background with 12 hearts in shades of white, pink, and red. The text reads, ‘Happy Valentine’s Day’ and ‘Wishing you a day filled with simple joys and all the things you love.’

“Note, there are no descriptors of ‘sweet’ or ‘brave’ to suggest traditional stereotypes of gendered traits. There are no human figures to suggest the male/female binary, but such examples are limited.

“In other arenas, changes in our current societal norms and values are increasingly reflected and celebrated. An example of such is in books for children, which I also discuss in my class. This is where I have seen a clear evolution in the representation of non-binary identifiers, same-sex families, and more direct coverage of race, culture, ethnicity, disability, class, etc. It will be interesting to see if, over time, these changes will be reflected in the cards we give our children on this special day.”

Source: NYU

A study in mice shows that a drug makes mammalian pain receptors more like those in birds—and more resistant to some forms of pain.

Researchers have discovered a possible new way to treat pain without the use of opioids. By targeting a specific area of a well-known pain receptor, they were able to reduce pain sensitivity in mice without affecting the receptor’s other functions, such as sensitivity to heat.

Their inspiration? Chickens.

Many chicken farmers know that squirrels and mice won’t eat chicken feed laced with capsaicin—the chemical that gives chili peppers their spiciness. In mammals, capsaicin activates a pain receptor to cause a burning sensation. In most bird species, capsaicin has little effect.

“It turns out that birds are naturally resistant to capsaicin,” says Eric Gross, associate professor of anesthesiology, perioperative and pain medicine at Stanford University School of Medicine.

That fact prompted Gross to wonder whether it was possible for humans to have a genetic variant that made the receptor, known as transient receptor potential cation channel subfamily V member 1, or TRPV1, more birdlike—and more resistant to pain.

Bird and human pain receptors

In a study in the Journal of Clinical Investigation, Gross’s team and their collaborators identified a specific genetic variant of TRPV1 that reduces pain sensitivity in humans. Though this variant is extremely rare, the researchers were able to replicate the effects of the altered gene with a custom-designed drug.

The researchers first used a computational approach to find genetic variants of human TRPV1 that resemble avian TRPV1. When they tested these variants in genetically modified cells, one variant, known as K710N, drastically reduced the receptor’s reaction to capsaicin.

“We were quite amazed that there was such a decrease in activity of TRPV1’s response to capsaicin when we made that genetic variant,” says Gross, who is the senior author of the study. “It was to the point where we actually tried this several times to make sure that was really what we were seeing.”

Spicy chicken feed for mice

Next, they used the CRISPR/Cas9 gene editing technique to create mice with the K710N mutation. The plan was to see if these mice would find palatable the capsaicin-laced bird food that normal mice reject. The response was more immediate than the researchers expected: As soon as the spicy bird food was placed on the floor of their cage, normal mice lifted their paws as much as they could to avoid touching the capsaicin—suggesting that even skin contact caused pain. The K710N mice, meanwhile, lifted their paws much less frequently and were comfortable enough with the capsaicin to sample some spicy bird food.

Based on these and other behavioral responses, Gross estimates that the mutation reduced pain by about 50%.

The TRPV1 receptors in our sensory neurons do more than generate a burning sensation when we eat chili peppers. They also respond to other stimuli such as heat and physical injury—playing an important role in protecting us from danger—and they regulate body temperature.

“You don’t want to take away the full sensation of pain,” Gross says. “You still want to have somebody, if they place their hand over a hot stove or step on a Lego, to have that pain sensation.”

The K710N mice enjoyed a happy medium—they felt less pain but could still sense harmful stimuli and maintain normal body temperatures. “We were able to dial it down rather than take it away completely,” Gross says.

TRPV1 has yet more functions throughout the body, such as protecting against organ damage. The researchers found that the K710N variant retained and even enhanced these protective benefits of TRPV1. Heart cells with the variant, for example, were less likely to die when temporarily deprived of oxygen.

A potential drug for pain

With an understanding of precisely how the K710N mutation changed the structure and function of TRPV1, the researchers were able to design a drug that had the same effect. When they gave the drug, a peptide named V1-cal, to mice by injection or infusion, it reduced their sensitivity to capsaicin and lessened chronic pain from nerve injury. Just like the K710N mutation, the drug had little impact on heat sensation and regulation of body temperature.

Compared with previous attempts at treating pain by targeting TRPV1, the new chicken-inspired drug works more selectively, with fewer side effects.

“People have always used a direct approach, so they looked at ways to specifically activate or block the receptor,” Gross says. “That’s been a challenge because activation of the receptor causes pain, while inactivation may cause unwanted changes in body temperature.”

A high concentration of capsaicin activates and eventually desensitizes the receptor, and has been used in analgesic creams or patches, but the treatments increase pain before reducing it. On the other hand, drugs that block the receptor have failed in clinical trials because they caused people to overheat.

“Instead of directly activating or inactivating the receptor, the drug we developed modulates only a specific area of the receptor,” he says. “We’re able to avoid the side effects that have been plaguing drug discovery for TRPV1 for quite some time.”

Gross’s team hopes to modify the peptide so that it is more stable and can relieve pain longer. In the study, the mice were given the drug by continuous infusion.

As an anesthesiologist, Gross often treats patients with post-operative pain. “We’re really excited to see if this is a potential therapeutic for pain after surgery, and to help us move toward an opioid-free approach.”

Researchers from the Second Hospital of Anhui Medical University in China, the Butantan Institute in Brazil, the University Hospital Munster in Germany, and Emory University also contributed to the work.

The study had funding from the National Institutes of Health, the Stanford Cardiovascular Institute, the National Natural Science Foundation of China, the State Scholarship Fund of China Scholarship Council, the Second Hospital of Anhui Medical University, Sāo Paulo Research Foundation, Coodernacāo de Aperfeiçoamento de Pessoal de Nível Superior-Brasil, the Stanford Diabetes Research Center, the American Heart Association, and the German Research Foundation.

Source: Stanford University

Neglecting the psychological trauma many older adults with HIV/AIDS experience will make it difficult, if not impossible, to end the epidemic, according to a new study.

Once considered a death sentence, HIV/AIDS has evolved into a manageable illness—with the availability of antiretroviral treatments—and people with the disease are living longer. But as this population ages, they are facing mental and psychosocial health challenges that could have a profound effect on their well-being—and on the trajectory of the virus.

“Our findings support the need to target post-traumatic stress disorder and substance dependence and use among older HIV/AIDS-positive people and suggest that resilience might help increase adherence to antiretroviral therapy regimes,” says Kristen D. Krause, an instructor of urban health at the Rutgers School of Public Health and lead author of the study in the Journal of Gay & Lesbian Mental Health.

In 2016, the United Nations set a global target to end HIV as a public health threat by 2030. To succeed, however, antiretroviral therapy (ART) adherence—taking medication as directed and avoiding so-called “pill fatigue”—would – would need to continue. Krause says resilience, namely the ability to thrive amid challenge situations, may play an important role in ART adherence.

To understand the association between HIV-related resilience and mental health, Krause and colleagues at the Rutgers Center for Health, Identity, Behavior and Prevention Studies (CHIBPS) surveyed 250 HIV-positive gay men ages 50 to 69 living in the New York City area between April 2017 and October 2018. Participants were recruited from dating apps, gay-related events, community-based organizations, and word of mouth.

Using an HIV-related resilience assessment tool Krause helped create, researchers asked participants a series of questions about their ability to deal with adversity, whether they had or were experiencing post-traumatic stress disorder (PTSD), how they viewed HIV-related stigma, and whether they’d ever had suicidal thoughts.

The researchers found that people with higher levels of HIV-related resilience were more likely to have lower levels of PTSD and substance dependence and were more likely to feel financially secure.

About 16% of participants were symptomatic for PTSD, 14% met the criteria for severe depression, 18% reported a substance dependency, 18% suffered generalized anxiety disorder, and nearly 33% expressed suicidal tendencies.

A majority of the sample (64.4%) indicated they could barely or could not get by on the money they have.

Krause says the findings point to major gaps in mental health coverage for older people living with HIV/AIDS and support calls for a more holistic approach to health care for this population.

“More and more people are surviving with HIV, and we don’t really know what the long-term effects of that will be,” Krause says. “We’re finding out in real time. Any piece of information that we can collect will help mitigate the negative impacts of HIV later in life.

“As we wait for a vaccine or a cure, it’s important to continue building a toolbox of methods and best practices to bring this epidemic to an end. Resilience is one tool in that box.”

Source: Greg Bruno for Rutgers University

The 150 minutes of moderate to intense aerobic activity per week recommended by the US Department of Health and Human Services can significantly reduce liver fat, according to new research.

A meta-analysis of 14 previous studies confirms that exercise leads to clinically meaningful reductions in liver fat for patients with nonalcoholic fatty liver disease.

While prior research suggested that physical activity was beneficial, it had not determined the specific amount of exercise needed to make clinically meaningful improvement.

“Our findings can give physicians the confidence to prescribe exercise as a treatment for nonalcoholic fatty liver disease,” says Jonathan Stine, associate professor of medicine and public health sciences, and hepatologist at Penn State Health Milton S. Hershey Medical Center.

“Having a target amount of physical activity to aim for will be useful for health care and exercise professionals to develop personalized approaches as they help patients modify their lifestyles and become more physically active.”

Nonalcoholic fatty liver disease (NAFLD) affects close to 30% of the global population and over time, can lead to cirrhosis, also known as liver scarring, and cancer. There are no approved drug treatments or an effective cure for this common condition; however, research has shown that exercise can improve liver fat, physical fitness, body composition, and quality of life for patients.

According to Stine, prior research had not deduced what the required “dose” of exercise was to help patients with NAFLD achieve clinically meaningful improvement—defined as at least a 30% relative reduction of liver fat, measured by magnetic resonance imaging (MRI).

Stine reviewed 14 studies with a total of 551 subjects who had NAFLD and participated in randomized, controlled trials involving exercise interventions. His team evaluated data pooled from all the studies including age, sex, body mass index, change in body weight, adherence to the exercise regimen, and MRI-measured liver fat.

The researchers’ primary goal was to examine the association between exercise training and a clinically relevant improvement in liver fat. Independent of weight loss, the team found exercise training was 3 1/2 times more likely to achieve clinically meaningful treatment response (greater than or equal to 30% relative reduction in MRI-measured liver fat) compared to standard clinical care.

In its secondary analysis, the team determined what the optimal “dose” of exercise was to achieve clinically meaningful improvements in liver fat. They found that 39% of patients prescribed greater than or equal to 750 metabolic equivalents of task (for example, 150 minutes per week of brisk walking) achieved significant treatment response compared to only 26% of those prescribed lesser doses of exercise. This is the same amount of physical activity recommended by the American
Gastroenterological Association and the European Association for the Study of the Liver.

The results are published in the American Journal of Gastroenterology.

According to Stine, when this amount of exercise was prescribed, clinically relevant reductions in MRI-measured liver fat were achieved at a rate similar to those reported in early-phase NASH drug trials evaluating medications that block fat production.

“Exercise is a lifestyle modification, so the fact that it might match the ability of in-development therapeutics to achieve the same outcome is significant,” says Stine, a Penn State Cancer Institute researcher.

“Clinicians counseling patients with NAFLD should recommend this amount of activity to their patients. Brisk walking or light cycling for 1/2 an hour a day five times a week is just one example of a program that would meet these criteria.”

More research, particularly controlled randomized trials, are needed to validate their findings and to compare the impact of different exercise doses head-to-head, Stine says.

Additional coauthors are from the University of California, San Diego and Penn State. Penn State researchers have no conflicts of interest to disclose.

The National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health supported the work. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Source: Penn State

A “white light” added to traffic signals could enable self-driving vehicles to help control traffic flow—and let human drivers know what’s going on.

In computational simulations, the new approach significantly improves travel time through intersections and reduces fuel consumption.

“This concept we’re proposing for traffic intersections, which we call a ‘white phase,’ taps into the computing power of autonomous vehicles (AVs) themselves,” says Ali Hajbabaie, an associate professor of civil, construction, and environmental engineering at North Carolina State University, and corresponding author of the paper in IEEE Transactions on Intelligent Transportation Systems.

“The white phase concept also incorporates a new traffic signal, so that human drivers know what they are supposed to do. Red lights will still mean stop. Green lights will still mean go. And white lights will tell human drivers to simply follow the car in front of them.”

The white phase concept rests on the fact that it is possible for AVs to communicate wirelessly with both each other and the computer controlling the traffic signal. When enough AVs are approaching the intersection, this would activate the white light.

The white light is a signal that AVs are coordinating their movement to facilitate traffic through the intersection more efficiently. Any non-automated vehicles—those being driven by a person—would simply be required to follow the vehicle in front of them: if the car in front of them stops, they stop; if the car in front of them goes through the intersection, they go through the intersection.

When too many vehicles approaching the intersection are being controlled by drivers, rather than AVs, the traffic light would revert to the conventional green-yellow-red signal pattern.

“Granting some of the traffic flow control to the AVs is a relatively new idea, called the mobile control paradigm,” Hajbabaie says. “It can be used to coordinate traffic in any scenario involving AVs. But we think it is important to incorporate the white light concept at intersections because it tells human drivers what’s going on, so that they know what they are supposed to do as they approach the intersection.

“And, just to be clear, the color of the ‘white light’ doesn’t matter. What’s important is that there be a signal that is clearly identifiable by drivers.”

The researchers first introduced a “white phase” traffic intersection concept in 2020. However, that initial concept relied on a centralized computing approach, with the computer controlling the traffic light being responsible for receiving input from all approaching AVs, making the necessary calculations, and then telling the AVs how they should proceed through the intersection.

“We’ve improved on that concept, and this paper outlines a white phase concept that relies on distributed computing—effectively using the computing resources of all the AVs to dictate traffic flow,” Hajbabaie says.

“This is both more efficient, and less likely to fall prey to communication failures. For example, if there’s an interruption or time lag in communication with the traffic light, the distributed computing approach would still be able to handle traffic flow smoothly.”

To test the performance of the distributed computing white phase concept, the researchers made use of microscopic traffic simulators. These simulators are complex computational models designed to replicate real-world traffic, down to the behavior of individual vehicles. Using these simulators, the researchers were able to compare traffic behavior at intersections with and without the white phase, as well as how the number of AVs involved influences that behavior.

“The simulations tell us several things,” Hajbabaie says. “First, AVs improve traffic flow, regardless of the presence of the white phase. Second, if there are AVs present, the white phase further improves traffic flow. This also reduces fuel consumption, because there is less stop-and-go traffic. Third, the higher the percentage of traffic at a white phase intersection that is made up of AVs, the faster the traffic moves through the intersection and the better the fuel consumption numbers.”

When only 10-30% of the traffic at a white phase intersection was made up of AVs, the simulations found there were relatively small improvements in traffic flow. But as the percentage of AVs at white phase intersections increased, so did the benefits.

“That said, even if only 10% of the vehicles at a white phase intersection are autonomous, you still see fewer delays,” Hajbabaie says. “For example, when 10% of vehicles are autonomous, you see delays reduced by 3%. When 30% of vehicles are autonomous, delays are reduced by 10.7%.”

The researchers acknowledge that AVs are not ready to adopt the new distributed computing approach tomorrow, nor are governments going to install brand new traffic lights at every intersection in the immediate future.

“However, there are various elements of the white phase concept that could be adopted with only minor modifications to both intersections and existing AVs,” Hajbabaie says. “We also think there are opportunities to test drive this approach at specific locations.

“For example, ports see high volumes of commercial vehicle traffic, for which traffic flow is particularly important. Commercial vehicles seem to have higher rates of autonomous vehicle adoption, so there could be an opportunity to implement a pilot project in that setting that could benefit port traffic and commercial transportation.”

Source: NC State

Scoring highly on racial resentment is strongly associated with believing that abortion should be illegal, research finds.

By the same token, people who had low scores on racial resentment were much less likely to believe abortion should be illegal, the study shows.

“There’s been plenty of historical analysis of the relationship between the pro-life movement and racial attitudes, but this is the first effort to demonstrate the clear, empirical relationship between racial attitudes and abortion attitudes,” says Steven Green, coauthor of the study and a professor of political science at North Carolina State University. “And we found that the strength of this relationship has increased considerably in the past decade.”

“In essence, the data tell us that beliefs about abortion rights are closely tied to beliefs about racial justice issues.”

Racial resentment is a well-established, standardized scale that is used to measure attitudes toward Black people in the United States. The higher the score on the racial resentment scale, the less an individual believes in systemic racism and the legacy of slavery.

“Some have argued that evangelicals oppose abortion not simply because of their views on the sanctity of life, but due to racial resentment against government policies and other cultural shifts related to a broader movement towards greater racial equality,” Greene says. “We wanted to explore this possible relationship, as it has only become more important to understand these attitudes in the wake of the Dobbs decision.”

In June 2022, the US Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization that abortion is not a constitutional right, allowing states to impose restrictions on abortion and access to related medical care.

For this study, researchers drew on data from two nationally representative surveys conducted in 2020: the American National Election Study (ANES) and the Public Religion Research Institute American Values Survey. Both surveys asked respondents questions related to their attitudes about abortion, racial resentment, and religious beliefs, in addition to other demographic and political information.

“One of the things that really stood out to us was that the relationship between racial resentment and abortion attitudes was remarkably strong regardless of an individual’s partisan affiliation and political beliefs,” Greene says. “For example, conservative Republicans who had low racial resentment scores were substantially more likely to support abortion rights than their fellow conservative Republicans.”

To get a handle on how the relationship between racial resentment and abortion attitudes has changed over time, the researchers looked at ANES survey data from 2000, 2004, 2008, 2012, and 2016, as well as the 2020 data.

From 2000 through 2008, the researchers found no statistically significant relationship between racial resentment and abortion rights attitudes. The relationship first showed up in 2012, and grew significantly stronger through 2016 and 2020.

“Ultimately, we found that religious beliefs are absolutely a factor in whether people think abortion should be legal,” Greene says. “However, the evidence strongly suggests that racial attitudes are also closely tied to how people view abortion.

“In essence, the data tell us that beliefs about abortion rights are closely tied to beliefs about racial justice issues,” Greene says. “Understanding this relationship offers a lens through which to view the ongoing political debates about these issues both on the national stage and in state legislatures across the country.”

The paper appears in Social Science Quarterly. Coauthors are from the Public Religion Research Institute and Augusta University.

Source: NC State

Community gardens and urban farms positively affect biodiversity, local ecosystems, and the well-being of people that work in them, a new study shows.

Traditionally, it has been assumed that cultivating food leads to a loss of biodiversity and negative impacts on an ecosystem.

For the study, researchers looked at 28 urban community gardens across California over five years and quantified biodiversity in plant and animal life, as well as ecosystem functions such as pollination, carbon sequestration, food production, pest control, and human well-being.

“We wanted to determine if there were any tradeoffs in terms of biodiversity or impacts on ecosystem function,” says Shalene Jha, an associate professor of integrative biology at the University of Texas at Austin, and lead author of the study in Ecology Letters

“What we found is that these gardens, which are providing tremendous nutritional resources and increasing well-being for gardeners, are also supporting incredibly high levels of plant and animal biodiversity. It’s a win-win.”

Previous assumptions by scientists about the negative effect of food production on biodiversity have been almost entirely based on intensive rural agriculture enterprises that tend to grow only one or two types of crops, often at a massive scale.

Urban community gardens, private gardens, and urban farms and orchards tend to grow more types of plants in smaller areas. The new study is the first to explore the effects of urban gardens across a wide range of biodiversity measures and ecological services.

“It’s estimated that by 2030, about 60% of the world’s population will live in cities,” Jha says. “And urban farms and gardens currently provide about 15%-20% of our food supply, so they are essential in addressing food inequality challenges. What we’re seeing is that urban gardens present a critical opportunity to both support biodiversity and local food production.”

The study also found that the choices that gardeners make can have a large impact on their local ecosystem. For instance, planting trees outside crop beds could increase carbon sequestration without limiting pollinators or decreasing food production from too much shade. And mulching only within crop beds could help improve soil carbon services, while avoiding negative effects on pest control and pollinators.

The US Department of Agriculture’s National Institute of Food and Agriculture, the National Science Foundation, and grants from the University of California funded the work.

Additional coauthors are from UC Santa Cruz, Seattle University, and Water Flagship in Australia.

Source: UT Austin

The mortality rate for pregnant people with sickle cell disease is 26 times higher than the national average, research finds. That figure hasn’t improved since the last time assessment.

Researchers have further documented an association between a substantially higher risk of maternal morbidity and mortality among those with the inherited blood disorder sickle cell disease, compared to those without it.

Their analysis, completed using a large national administrative database with records for pregnant people with sickle cell disease, appears in JAMA Network Open.

A double research disparity

The study findings highlight a need for increased disease-specific interventions for pregnant people with sickle cell disease, or SCD, as well as health disparities long known to affect people with the disorder.

In the United States, the condition is most prevalent in the Black community, according to the US Centers for Disease Control and Prevention. From 2000 to 2003, the maternal mortality rate for people with sickle cell disease was 7.2 deaths per 10,000. In this study looking at data collected 15 years later, the mortality rate among pregnant people with SCD was 13.3 deaths per 10,000.

“People with sickle cell disease are already lacking profoundly needed research and clinical care. Pregnant people with sickle cell disease are at an even greater disadvantage,” says Lydia Pecker, assistant professor of medicine specializing in hematology at the Johns Hopkins University School of Medicine.

Pregnancy with SCD

In the new study, researchers applied the US Centers for Disease Control and Prevention Severe Maternal Morbidity index to the National Inpatient Sample—a nationally representative sample of hospital admissions in the United States. Their analysis covered information collected from 2012 to 2018, which included 5,401,899 deliveries. This figure comprised 3,901 deliveries among pregnant people with SCD and 742,164 deliveries among Black people. 84% of those with sickle cell disease who delivered were Black pregnant people.

Maternal mortality—defined as death during pregnancy, at delivery, or soon after delivery—was highest among those with SCD, at 13.3 per 10,000, compared to 1.2 per 10,000 among pregnant Black people and without SCD and 0.5 per 10,000 among non-Black, non-SCD patients during the study period.

“Pregnancy can bring out negative side effects of any pre-existing condition, and sickle cell disease is no exception,” says Ahizechukwu Eke, associate professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine. “Sickle cell patients require more interventions, including increased blood transfusions, and more frequent ultrasounds to assess the condition of the fetus.”

The researchers note that despite improvements in the care of people with SCD and improvements in the care of high-risk pregnancies, maternal mortality and morbidity rates of people with SCD have not improved. These findings suggest that advancements in SCD and high-risk OB care are not reaching enough pregnant people with SCD, the researchers say.

In the United States, 90% of people with SCD are Black, so pregnancies among people with SCD are often exposed to the harms of systemic and interpersonal racism. These factors contribute to high rates of maternal morbidity and mortality among pregnant Black Americans and, the investigators show, this also affects people with SCD.

“Our work demonstrates that people with sickle cell disease face risk over and above other pregnant people with Black race. Among the risks that are specific to people with sickle cell disease are a highly morbid pre-existing condition and a lack of treatment options, in part due to the insufficient research focused on pregnant people with sickle cell disease and in part to the absence of high-quality specialty care in many regions of the country,” says Macy Early, a fourth-year medical student at Johns Hopkins University School of Medicine, and lead author of this study.

Sickle cell disease

SCD is an inherited blood disorder that is estimated to affect 70,000 to 100,000 Americans. The genetic alteration at the root of the disease affects red blood cells that contain hemoglobin, the protein responsible for transporting and delivering oxygen to the body, to become “sickled” in appearance. The disease not only causes anemia, strokes, organ damage, and shortened life spans, but also repeated and frequent episodes of severe pain when the misshapen red blood cells get stuck in small blood vessels.

Although SCD is a lifelong debilitating illness, advances in treatment have led to nearly all affected people in the United States reaching their reproductive years. As such, there is a growing population of people affected by the effects of SCD in pregnancy and study of possible treatments is needed.

For the pregnant person, SCD is linked to heightened risks of blood clots, chronic pain, anemia, and preeclampsia (high blood pressure during pregnancy). The researchers confirmed that babies born to people with SCD tend to be smaller than average, delivered early, and show damage to the placenta. Data from this study also affirm that SCD is associated with an increased risk of fetal death.

Researchers say they next plan to study data at the individual clinic level to analyze how outcomes for patients differ when high-quality OB care is accessible. They hope to accelerate research on risk and treatment during pregnancy, as well as continue to advocate for funding to ensure that all people in the United States receive high-quality care.

A companion paper to this study comparing outcomes in pregnant people with sickle cell disease and those with nutritional anemia also appears in JAMA Network Open.

Source: Johns Hopkins University

Night staff at nursing homes had lower rates of COVID-19 testing and vaccination than day-shift staff, according to a new study.

Throughout the COVID-19 pandemic, regular testing and vaccinations of nursing home staff have been critical strategies for containing virus outbreaks in nursing homes.

In order to assess how various structural factors affected the differences in testing rates and vaccinations, researchers analyzed data from nursing homes across the country, looking specifically at work shifts.

They found that day-shift staff had the highest testing rates and odds of primary vaccination, while night-shift staff had the lowest.

Work shift has not been recognized as a significant factor contributing to implementation of testing and vaccination programs at nursing homes, says lead author Elizabeth White, an assistant professor of health services, policy, and practice at Brown University’s School of Public Health.

“Testing and vaccination programs have been so critical to mitigating the effects of COVID-19 in nursing homes,” White says. “Our findings suggest that any future booster campaigns or testing campaigns need to consider equitable distribution of resources across shifts to reduce the variation we saw in our study.”

She emphasizes that the study findings have broader relevance beyond nursing homes as well as beyond the pandemic.

“Our findings highlight that work shift is an important structural factor to consider when implementing public health initiatives—from COVID vaccination and testing to flu vaccine—in organizations with shift-based workforces,” White says.

For the study in Health Affairs, the researchers had access to a large and unique data set, White says, due to Brown’s involvement with an initiative by the National Institute on Aging called the Imbedded Pragmatic Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias Clinical Trials (IMPACT) Collaboratory, co-led by Vincent Mor, a professor at Brown who is a senior author of the study.

They analyzed nursing home data, including staff COVID-19 testing and immunization records, from 294 facilities for the period from April 2020 to March 2021.

The researchers found significant differences in testing rates and odds of primary vaccination by work shift: Night-shift staff testing rates were 0.71 times those of the day-shift staff, and evening-shift testing rates were 0.91 times those of the day shift. Controlling for staff and facility characteristics, adjusted vaccination rates were 67% among day shift staff, 62% among evening-shift staff, and 50% among night-shift staff.

The authors note that differences in staffing levels and resources, work demands and the presence of senior and mid-level leadership across nursing home shifts may influence the implementation of organization-wide processes such as COVID-19 testing and vaccination.

Compared to staff who work during the day, staff who work the evening and night shift have less exposure to senior leaders, in particular the directors of nursing, medical directors, and nursing home administrators, White explains.

Other research throughout the pandemic has shown that those leaders, in particular, are important in building trust around vaccines and for helping to successfully implement changes in workplace health protocols.

Another important study finding, White says, was that the lower rates of COVID-19 testing among Black employees was almost entirely attributed to a disproportionate number of Black employees working on evening and night shifts.

“That tells us that shift is a structural factor contributing to a racial disparity in testing among staff,” White says.

The authors conclude that their findings highlight the need to coordinate resources and communication evenly across shifts when implementing large-scaled public health initiatives in nursing homes and other organizations with shift-based workforces.

“These results apply not only to nursing homes, but also to hospitals or even Amazon and other organizations with shift-based workforces,” White says.

This study was funded under an IMPACT Collaboratory supplement through an initiative of the National Institutes of Health called Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP), aimed at reducing disparities in underserved populations who are disproportionately affected by COVID-19.

The residents of nursing homes have been disproportionately affected by COVID, White says, as have the staff, who are often from underserved populations.

Additional coauthors are from the University of Michigan at Ann Arbor, Harvard University, RAF Healthcare Solutions, Hebrew Senior, and Brown.

The National Institute on Aging funded the work.

Source: Brown University