Publisher Health

A new study by Indiana University researchers has found that about 45% of patients who visit the emergency department for physical injuries and ailments also have mental health and substance use problems that are often overlooked. It also found that patients who reported high levels of suicidal thinking and plans were more likely to have frequent emergency department visits.
That’s why IU researchers, expanding on previous studies, used a computer adaptive test to screen for mental health and substance use problems in patients with nonpsychiatric complaints to examine whether emergency department visits are an important opportunity to screen for mental health issues.
With findings recently published in the Journal of the American College of Emergency Physicians, this is the most extensive study to use a multidomain mental health screening of nonpsychiatric patients in an emergency department. The test, known as the Computerized Adaptive Test-Mental Health, adjusts questions based on the respondents’ answers.
“The results of our study are really important for health care companies and health economists,” said Brian D’Onofrio, principal investigator on the study and a professor of psychological and brain sciences in the College of Arts and Sciences at IU Bloomington. “The people who keep coming back to the emergency department are high-risk patients. It’s a place where screening could be very helpful to identify people who are at high risk — whether for suicide, depression, anxiety, PTSD or substance use problems — and to get them the care they need.”
Along with follow-up care, mental health screening could also lessen the need for future visits, reducing burdens on emergency departments, he said.
To conduct the study, researchers asked randomly selected patients in an Indianapolis emergency department to complete this computer adaptive test that screens for five conditions: depression, anxiety, post-traumatic stress disorder, suicidality and substance use disorders. The study’s goal was to understand the prevalence of these issues with a screening process that is sustainable in a large urban emergency department, where doctors have competing and pressing interests.

Children who have experienced deprivation are more likely to make more impulsive choices than those who don’t and can lead to addictions in later life — research has shown.
‘Trait impulsivity’, the preference for immediate gratification, has been linked to spending more on food, especially unhealthy, highly calorific food. Studies have shown that children who experience poverty and food insecurity tend to have a higher body-mass index as adults than those who do not.
Researchers from the School of Psychology at Aston University found a link between deprivation in childhood and impulsive behaviour — leading to addictions later in life. The findings, which are a culmination of six years of research, also found a further link between impulsivity, obesity and the cost of living crisis.
Professor Richard Tunney, head of the School of Psychology at Aston University, published a study in Scientific Reports earlier this year where he showed that children who experience deprivation make more impulsive choices than children who don’t.
The research team studied 146 children, with an average age of eight, living in some of the most deprived areas of England and compared them with children living in some of the most affluent neighbourhoods.
Children were given a choice between taking home a small amount of money (for example, £1) or getting £10 a week, or even more a year later. How long a person is willing to wait for the larger amount of money can be used to calculate a ‘discount rate’ that shows how much the waiting time reduces the value of the money.

A study led by a North Carolina State University researcher found that although there were steep learning losses in reading for elementary school students during the COVID-19 pandemic, in-person learning opportunities helped some of those students mitigate learning loss and accelerate gains in reading compared to online learners. Younger elementary students from lower socioeconomic backgrounds, English learners and students with disabilities were particularly affected by the pandemic school closures.
“Online instruction was inevitable during the pandemic, but in-person schooling was an equalizer,” said the study’s lead author Jackie Relyea, assistant professor of education at NC State. “Even though kids in this large North Carolina school district who chose in-person instruction spent around two months in school during the pandemic, many of them made faster growth over time in reading than their peers who opted for fully remote instruction. This aligns with the evidence we’ve seen from summer learning loss.”
The study, published in the journal Reading and Writing, compared average reading gains for third, fourth and fifth graders in a single large school district in North Carolina on the Northwest Evaluation Association (NWEA) Measure of Academic Progress (MAP) Growth reading test, a computer test looking at students’ foundational reading skills, language and writing, vocabulary and text comprehension.
They compared students’ average scores at the beginning and end of the 2020-21 school year with students’ average gains made across the 2018-19 school year. During the pandemic, the district offered students the choice of returning to school, which allowed researchers to compare the impact of in-person versus online instruction.
“During the fall semester, students had 10 days in-person, while the rest of the semester was online, and in the spring, they came to school for almost 50 days,” Relyea said. “The other group was in fully remote instruction the entire time.”
During the pandemic, third, fourth and fifth graders made lower reading gains on average compared to students in the 2018-19 school year. The steepest declines by age were for third graders. During the pandemic, their average gain was less than half — at 48% — of average gains made by students in the 2018-19 school year, while fourth graders’ average was 65% of gains made by students in 2018-19, and fifth graders was 58%.

The first two years of the COVID-19 pandemic saw an increase in mortality rates, both from COVID-19 and other causes, but the groups hardest hit shifted between the first and second years, according to an analysis of publicly available data.
Both years saw an increase in deaths over the five years preceding the pandemic, even with COVID-19 numbers removed. But while the first year was most deadly for those over age 65, the second year hit middle-aged adults the hardest, University of Illinois Urbana-Champaign researchers found. Graduate student Ian Ludden, computer science professor Sheldon H. Jacobson and Janet A. Jokela, the interim executive associate dean of the Carle Illinois College of Medicine, published their findings in the journal Health Care Management Science.
“If the pandemic had not hit, many of those people, potentially, would still be alive today — not only because of COVID-19 deaths, but as a consequence of the changes that transformed society and resulted in people dying prematurely,” said Jacobson, a data scientist who also is affiliated with the Carle Illinois College of Medicine. “So the question is, what can we do better in the future?”
The new study builds on an analysis Jacobson and Jokela published in 2021 focusing on excess deaths during the first year of the pandemic. The new study gives insights into the trends in death rates among various demographic groups year to year, according to data from the Centers for Disease Control and Prevention, Ludden said.
“The big trends that we see are that the second year, from April 2021 through March 2022, was harder on the middle-aged subgroups, while deaths declined for the elderly,” he said.
The drop in deaths among the highest-aged groups can partly be attributed to displaced deaths — the phenomenon of deaths happening earlier than they statistically would have, so they can’t occur again later. However, data also provide evidence that higher vaccination rates among the elderly beginning in the second year of the pandemic reduced mortality among them, Ludden said. “This underscores the importance of vaccination as a preventative measure,” he said.

Tick-borne pathogens, known for causing illnesses such as Lyme disease, are on the rise in Central Canada — presenting new risks in areas where they were never previously detected.
The findings from researchers at McGill University and the University of Ottawa demonstrate the need for more comprehensive testing and tracking to detect the spread and potential risk of tick-borne pathogens to human and wildlife populations throughout Canada.
“Most people know that diseases can be transmitted to humans through the bite of infected ticks. Ticks can carry and spread several disease agents, called pathogens, that can make people and animals sick,” explains Kirsten Crandall, a PhD candidate under the joint supervision of McGill University Professor Virginie Millien and University of Ottawa Professor Jeremy Kerr.
“While the bacteria that causes Lyme disease is the most common tick-borne pathogen in Canada, other tick-borne pathogens are moving in,” she adds.
To investigate the presence and prevalence of several emerging tick-borne pathogens, Crandall and her team analyzed small mammals and ticks collected in Ontario and Quebec. The researchers found that five emerging pathogens were present across their study sites in Central Canada, including the pathogens causing Lyme disease and babesiosis, a malaria-like parasitic disease.
They discovered that two pathogens, Babesia odocoilei and Rickettsia rickettsii, were detected outside of their historic geographic range in Quebec. These pathogens spread both babesiosis and Rocky Mountain spotted fever. “The presence of these pathogens changes the risk of disease for Canadians and animals in some densely populated areas of Canada,” says Crandall.

When people in the United States die by firearm suicide, they most frequently use handguns, many of which are stored loaded and unlocked, according to a Rutgers study.
Researchers, whose findings are published in Death Studies, examined data from the National Violent Death Reporting System to examine the deaths of 117,126 individuals who died by firearm suicide between 2003 and 2018. Details about the circumstances of the deaths were recorded in death scene narratives, which the research team used in combination with information from death certificates and interviews with loved ones of the decedents to determine information regarding the type of firearm used, how that firearm had been stored and where on their bodies the individuals shot themselves.
In the majority of the deaths, the victims used a handgun (65.3 percent) that they themselves owned (77.1 percent) and which was stored loaded (63.1 percent) and unlocked (59.1 percent). The large majority of individuals died from wounds to the head (81.4 percent), with chest injuries accounting for the bulk of the remaining deaths. Men were twice as likely as women to use a rifle in their death and were more likely to store their firearms unlocked. Younger individuals also were more likely to have used firearms that had been stored unlocked, which the researchers said may indicate they were accessing unsecured firearms owned by their parents.
Very few differences emerged between individuals of various racial identities. However, those who died by suicide who identified as American Indian/Alaskan Native were far more likely than those who identified as white to use a rifle or shotgun in their suicide death, a pattern likely explained in part by firearm ownership and use (e.g., hunting) differences between these two groups. While the vast majority of firearm suicide deaths resulted from wounds to the head, one consistent finding was that those who died from gunshot wounds to areas of the body other than the head tended to be female. For those who died from wounds to the chest or abdomen tended to be younger.
“These results highlight that, more often than not, unsecured handguns are the driving force in firearm suicide in America,” said senior author Michael Anestis, executive director of the New Jersey Gun Violence Research Center at Rutgers and an associate professor at Rutgers School of Public Health. “That said, some groups — like men and individuals who identify as American Indian/Alaskan native — are more likely than their peers to use long guns in their suicide death. As we encourage secure firearm storage and storing firearms away from home during times of stress, it is important to discuss more than just handguns, particular with certain individuals.”
Nationwide, firearms account for more than half of all suicide deaths each year and research has repeatedly demonstrated the risk for death by suicide is elevated for every individual living in a home with firearms. The researchers say to minimize this risk, tools like lethal means counseling is needed to ensure that individuals store their firearms securely — locked and unloaded. Policies that promote legal storage of firearms away from home, they say, should also be considered.
Although handguns account for the majority of firearm suicides, it is vital that conversations about secure storage include discussions of rifles and handguns, particularly within certain communities, they argue.
“These findings highlight the powerful role that secure firearm storage could play in firearm suicide prevention, including our efforts to prevent suicide among children and adolescents who might otherwise access their parents’ unsecured firearms,” Anestis said. “If we can shift social norms on securing firearms and if we can provide easy paths toward legally storing firearms away from home during times of stress, we have an opportunity to prevent thousands of tragedies every year. Doing this requires not only that we understand the disproportionate role of unsecure firearms, but that we acknowledge the risk that comes from rifles and shotguns, particularly in communities in which hunting is common.”
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The gene DDX41 encodes the nuclear enzyme, DEAD-box-type RNA helicase. Mutation of DDX41 leads to hematopoietic cancers. However, the mechanism underlying this malignancy development is unclear. To this end, researchers from Japan characterized the functional significance of DDX41 in great detail. Their findings reveal that DDX41 serves crucial functions in transcriptional processes, RNA splicing, and overall genomic integrity maintenance. The findings may hold significance in treating hematopoietic malignancies.
DNA replication, transcription, and post-transcriptional changes are essential cellular processes that are regulated by a plethora of enzymes. RNA helicases are one such crucial group of enzymes involved in several transcriptional and post-transcriptional processes. Of these, an important RNA helicase is the DEAD-box-type RNA helicase, which is mainly located in the nucleus, and is encoded by the gene, DDX41.
Mutations in the gene DDX41 can lead to cancer of the hematopoietic cell progenitors (blood cell precursors) and include acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). However, the mechanisms underlying malignancy development are poorly understood. For bridging this gap, a group of researchers from Japan, led by Prof. Hirotaka Matsui from the Graduate School of Life Sciences, Kumamoto University, conducted a comprehensive study to unravel the detailed functional mechanisms of DDX41. “Our research group is investigating the DDX41 gene, which is known to be one of the causative genes of AML/MDS. Focusing on this gene, we have analyzed the details of the damage caused to cells by the mutation of this gene,” states Prof. Matsui. Their findings, co-authored by multiple researchers including Prof. Toshiya Inaba from the Research Institute for Radiation Biology and Medicine, Hiroshima University, and Dr. Akihiko Yokoyama from the Tsuruoka Metabolomics Laboratory, National Cancer Center, have been published on 14 October 2022 in the journal Leukemia.
Through a series of cellular assays on the parental K562 cell line and the DDX41-mutant R525H-expressing cell line, the researchers showed that DDX41 plays an important role in mRNA synthesis by binding to the 5′ splice site (SS) of the coding RNA. Further experiments revealed that DDX41 interacts with proteins related to RNA splicing, the molecular process essential for generating mRNA. These experiments reiterated the functional importance of DDX41 in transcriptional processes.
To further characterize the functional significance of DDX41 and understand the mechanism underlying malignancy development, the researchers observed the effects in DDX41-knockdown cells, where the levels of DDX41 were reduced. These experiments revealed that the DDX41-knockdown cells had abnormalities in DNA replication and mitosis (the process by which cells divide). The researchers also observed increased formation of R-loops, which are structures consisting of DNA:RNA hybrid and an unpaired DNA, in the knockdown cells.
These results were also consistent with the results of experiments in which the DDX41 function was inhibited. Upon inhibition, there was mild replication stress, eventually leading to disruption in the cell cycle due to delayed G2-M transition, a crucial check-point in the cell-cycle. Furthermore, the experiments suggested that DDX41 regulates the pausing of RNA polymerase II, an essential process for executing successful transcription.
Taken together, these results shed light on the functional significance of DDX41 and reveal its role in maintaining genomic stability. The findings will help our understanding of the mechanisms underlying the development of hematopoietic malignancies in DDX41 mutations, which may ultimately contribute to the therapeutic domain.
Pondering over the future implications of their study, Prof. Matsui observes, “In the future, we will elucidate detailed mechanisms by which hematopoietic malignancies develop. If we can establish a molecular target therapy, such malignancies will have greater potential for cure.”
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The protein medin is deposited in the blood vessels of the brains of Alzheimer’s patients along with the protein amyloid-β. Researchers from DZNE have discovered this so-called co-aggregation. They have now published their observation in the journal Nature. “Medin has been known for over 20 years, but its influence on diseases was previously underestimated. We were able to show that pathological changes in the blood vessels of Alzheimer’s patients are significantly enhanced by medin,” says Dr. Jonas Neher from the Tübingen site of DZNE, who led the study. The Hertie Institute for Clinical Brain Research in Tübingen, the University of Tübingen and several international institutions and cooperation partners were also involved in this long-term project.
Medin belongs to the group of amyloids. Of these proteins, amyloid-β is best known because it clumps together in the brains of Alzheimer’s patients. These aggregates then deposit both as so-called plaques directly in the brain tissue, but also in its blood vessels, thereby damaging the nerve cells and the blood vessels, respectively. But while many studies have focused on amyloid-β, medin has not been a focus of interest. “There was little evidence of pathology, that is, of a clinically striking finding associated with medin — and that is often the prerequisite for a more in-depth study of an amyloid,” Jonas Neher explains.
However, medin is actually found in the blood vessels of almost everybody over 50 years of age, making it the most common amyloid known. With his team, Jonas Neher originally found that medin even develops in aging mice, and reported this discovery two years ago in the scientific journal PNAS. The older the mice get, the more medin accumulates in the blood vessels of their brains, was the finding at the time. What’s more, when the brain becomes active and triggers an increase in blood supply, vessels with medin deposits expand more slowly than those without medin. This ability of blood vessels to expand, however, is important to optimally supply the brain with oxygen and nutrients.
For their latest results, the researchers built on this foundation and looked specifically at Alzheimer’s disease. First, they were able to show in Alzheimer’s mouse models that medin accumulates even more strongly in the brain’s blood vessels if amyloid-β deposits are also present. Importantly, these findings were confirmed when brain tissue from organ donors with Alzheimer’s dementia was analysed. However, when mice were genetically modified to prevent medin formation, significantly fewer amyloid-β deposits developed, and as a result, less damage to blood vessels occurred.
“There are only a handful of research groups worldwide working on medin at all,” says Jonas Neher. Most recently, a study from the U.S. reported that medin levels may increase in Alzheimer’s patients. However, it remained unclear whether this increase is merely a consequence of the disease or whether it is one of the causes. “We have now been able to show through many experiments that medin actually promotes vascular pathology in Alzheimer’s models,” Neher said. So medin deposits are indeed a cause of blood vessel damage. “And this indicates that medin is one of the causes of the disease,” Neher said.
In their studies, the researchers stained tissue sections from both mice and Alzheimer’s patients in such a way that specific proteins become visible. This allowed them to show that medin and amyloid-β are deposited together in blood vessels of the brain — co-localization is the technical term for this. In a next step, they were able to prove that these two amyloids also co-aggregate — that is, form mixed deposits. “Amazingly, medin interacts directly with amyloid-β and promotes its aggregation — this was completely unknown,” Jonas Neher summarizes the results.
It is precisely from this insight that the researchers draw hope for the development of a new treatment. “Medin could be a therapeutic target to prevent vascular damage and cognitive decline resulting from amyloid accumulation in the blood vessels of the brain,” they conclude. It is undisputed among experts that in addition to amyloid-β aggregates in brain tissue, the development of Alzheimer’s disease is also promoted by vascular alterations — that is, reduced function or damage to blood vessels. Therefore, treatments that target not only plaques but also affected blood vessels could help patients.
In a next step, it will now be necessary to determine if medin aggregates can be removed therapeutically and whether this intervention actually has an effect on cognitive performance. The scientists first want to test this in mouse models, because these reflect the pathological changes in Alzheimer’s patients very well.

Sharing medical data between laboratories and medical experts is important for medical research. However, data sharing is often sufficiently complex and sometimes even impossible due to the strict data regulatory legislation in Europe. Researchers at the University of Jyväskylä Digital Health Intelligence Laboratory addressed the problem and developed an artificial neural network that creates synthetic x-ray images that can fool even medical experts.
A group of researchers from University of Jyväskylä’s AI Hub Central Finland project developed an AI based method to create synthetic knee x-ray images to replace or complement real x-ray images in knee osteoarthritis classification.
Researchers used synthetically generated X-ray images to complement a data set of real X-ray images from the osteoarthritis study. The authenticity of the images was then assessed together with specialists from the central Finland healthcare district.
Medical experts were asked to rate osteoarthritis severity without knowing that the data set included synthetic images. In the second phase, experts tried to identify authentic and synthetic images. The results showed that on average, it was improbable even for medical experts to distinguish between real and synthetic x-ray images.
“The use of synthetic data is not subject to the same data protection regulations as real data. Using synthetic data can facilitate collaboration between, for example, research groups, companies and educational institutions,” says Sami Äyrämö, Head of Digital Health Intelligence Laboratory at the University of Jyväskylä.
According to Äyrämö, the use of synthetic data also speeds up authorisation processes and thus, among other things, testing of new ideas.

In the past 30 years, the non-profit organization Friends of Trees planted trees along the streets of Portland, Oregon. Now, a new study shows that each tree planted was associated with significant reductions in non-accidental and cardiovascular mortality (of 20% and 6%, respectively, for trees planted in the preceding 15-30 years). The researchers also estimate that the annual economic benefits of planting trees greatly exceed the cost of maintaining them. The study, co-led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by the “la Caixa” Foundation, together with the USDA Forest Service, was published in Environment International.
Evidence pointing to an association between exposure to nature and lower mortality is accumulating. “However, most studies use satellite imaging to estimate the vegetation index, which does not distinguish different types of vegetation and cannot be directly translated into tangible interventions,” says Payam Dadvand, ISGlobal researcher and senior author of the study.
Thus, the authors took advantage of a natural experiment that took place in the city of Portland: between 1990 and 2019, Friends of Trees planted 49,246 street trees (and kept records of where the trees were planted, and when). So, the research team looked at the number of trees planted in a given area (specifically, a census track, where approximately 4,000 people live) in the preceding 5, 10 or 15 years. They associated this information with mortality due to cardiovascular, respiratory or non-accidental causes in that same area, using data from the Oregon Health Authority.
The results show that in neighbourhoods in which more trees had been planted, mortality rates (deaths per 100,000 persons) were lower. This negative association was significant for cardiovascular and non-accidental mortality (that is, all causes excluding accidents), particularly for males and people over the age of 65.
Furthermore, the association got stronger as trees aged and grew: the reduction in mortality rate associated with trees planted 11-15 years before (30%) was double that observed with trees planted in the preceding 1-5 years (15%). This means that older trees are associated with larger decreases in mortality, and that preserving existing mature trees may be particularly important for public health.
This study doesn’t provide a direct insight into how trees improve health. However, the finding that large trees have a greater health impact than smaller ones is telling, because larger trees are better at absorbing air pollution, moderating temperatures, and reducing noise (three factors linked to increased mortality).
“We observed the effect both in green and less green neighbourhoods, which suggests that street tree planting benefits both,” says Geoffrey H. Donovan, from the USDA Forest Service and first author of the study. The analysis took into account other factors that may influence mortality, such as income, education and racial composition of the neighbourhoods.
Finally, according to the authors’ estimates, the benefits of tree planting greatly outweigh the cost: the annual cost of planting and maintaining one urban tree in each of Portland’s 140 census tract areas would range somewhere between 3,000 and 13,000 USD, while it would generate around 14.2 million USD annually in lives saved.
“Our results provide an important evidence-base for tangible interventions (e.g., planting trees) to increase the longevity of urban residents,” concludes Dadvand.