Publisher Health

Men who say they have stressful jobs and also feel they exert high efforts for low reward had double the risk of heart disease compared to men free of those stressors, according to new research published today in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed American Heart Association journal.
“Considering the significant amount of time people spend at work, understanding the relationship between work stressors and cardiovascular health is crucial for public health and workforce well-being,” said lead study author Mathilde Lavigne-Robichaud, R.D., M.S., doctoral candidate, Population Health and Optimal Health Practices Research Unit, CHU de Quebec-University Laval Research Center in Quebec, Canada. “Our study highlights the pressing need to proactively address stressful working conditions, to create healthier work environments that benefit employees and employers.”
Heart disease is the No. 1 cause of death in the U.S. according to American Heart Association statistics. In 2020, nearly 383,000 Americans died of heart disease.
Research has shown that two psychosocial stressors — job strain and effort-reward imbalance at work — may increase heart disease risk. However, few studies have examined the combined effect.
“Job strain refers to work environments where employees face a combination of high job demands and low control over their work. High demands can include a heavy workload, tight deadlines and numerous responsibilities, while low control means the employee has little say in decision-making and how they perform their tasks,” Lavigne-Robichaud explained.
“Effort-reward imbalance occurs when employees invest high effort into their work, but they perceive the rewards they receive in return — such as salary, recognition or job security — as insufficient or unequal to the effort. For instance, if you’re always going above and beyond, but you feel like you’re not getting the credit or rewards you deserve, that’s called effort-reward imbalance.”
The study found: Men who said they experienced either job strain or effort-reward imbalance had a 49% increase in risk of heart disease compared to men who didn’t report those stressors. Men reporting both job strain and effort-reward imbalance were at twice the risk of heart disease compared with men who did not say they were experiencing the combined stressors. The impact of psychosocial stress at work on women’s heart health was inconclusive. In men, the impact of job strain and effort-reward imbalance combined was similar to the magnitude of the impact of obesity on the risk of coronary heart disease.”Our results suggest that interventions aimed at reducing stressors from the work environment could be particularly effective for men and could also have positive implications for women, as these stress factors are associated with other prevalent health issues such as depression,” Lavigne-Robichaud said. “The study’s inability to establish a direct link between psychosocial job stressors and coronary heart disease in women signals the need for further investigation into the complex interplay of various stressors and women’s heart health.”

It turns out yogurt may have a previously unknown benefit: eliminating garlic odors.
A new study conducted in a lab — with follow-up human breath tests being planned — showed that whole milk plain yogurt prevented almost all of the volatile compounds responsible for garlic’s pungent scent from escaping into the air.
Researchers tested the garlic deodorizing capacity of yogurt and its individual components of water, fat and protein to see how each stood up to the stink. Both fat and protein were effective at trapping garlic odors, leading the scientists to suggest high-protein foods may one day be formulated specifically to fight garlic breath.
“High protein is a very hot thing right now — generally, people want to eat more protein,” said senior study author Sheryl Barringer, professor of food science and technology at The Ohio State University.
“An unintended side benefit may be a high-protein formulation that could be advertised as a breath deodorizer in addition to its nutritional claims,” she said. “I was more excited about the protein’s effectiveness because consumer advice to eat a high-fat food is not going to go over well.”
The study was published recently in the journal Molecules.
Barringer has a history of identifying foods that can combat garlic breath, among them apples, mint and lettuce and milk, thanks to their enzymes and fat, respectively, that snuff out the sulfur-based compounds that cause garlic’s persistent smell.

Studying genes in families with a propensity for certain diseases has led to many critical advances in medicine, including the discovery of statins in family members who suffered heart attacks at an early age.
Now, a team of researchers at Case Western Reserve University has identified an inherited mutation in a gene linked to a highly lethal cancer of what is commonly known as the food pipe, called esophageal adenocarcinoma (EAC).
“With this discovery, we will be able to identify early those at a high risk of developing EAC in their lifetime, and accordingly tailor screening, lifestyle and treatment strategies to prevent cancer development,” said Kishore Guda, an associate professor at the Case Western Reserve School of Medicine and member of the Case Comprehensive Cancer Center.
Guda led the study, published in the journal Gastroenterology,with Amitabh Chak, a professor at the School of Medicine and physician at University Hospitals Cleveland Medical Center.
Their previous studies found that up to 10% of patients with EAC or Barrett’s esophagus — a precursor to EAC — have a family member with the disease, suggesting a potential genetic predisposition.
But the molecules contributing to EAC’s development have been poorly understood.
By studying families with the disease, they identified the gene — Caveolin-3 (CAV3) — that plays a critical role in its development.

Encouraging immigrants to visit primary care doctors creates a striking decline in costly emergency room use, according to a new study co-authored by an MIT economist.
The findings are from a New York City program that helped arrange medical appointments for undocumented immigrants with limited incomes, from May 2016 to June 2017. Those who received assistance in scheduling visits with primary care physicians experienced a 21 percent drop in emergency department use. For individuals with high-risk medical profiles who received the same help, emergency department use dropped by 42 percent.
Program participants were also far more likely to have screenings for high blood pressure and diabetes, tests that play a significant role in helping to reduce cardiovascular illness.
“This program is fairly low-touch and minimalist, yet it had a meaningful effect,” says MIT economist Jonathan Gruber, co-author of a new paper detailing the study’s results.
He adds: “It had the biggest impact on those who were the most ill. Lowering the barriers to care for these in-need individuals really pays off in terms of keeping them out of the emergency room.”
The paper, “Reducing Frictions in Health Care Access: The ActionHealthNYC Experiment for Undocumented Immigrants,” appears in the September issue of the journal American Economic Review: Insights. The co-authors are Adrienne Sabety, an assistant professor in the Department of Health Policy at Stanford University; Gruber, who is the Ford Professor of Economics and head of the Department of Economics at MIT; Jin Yung Bae, a visiting associate professor at New York University’s Global School of Public Health; and Rishi Sood, executive director of health care access and policy in the New York City Department of Health and Mental Hygiene.
States and local jurisdictions in the U.S. have a variety of policy approaches regarding undocumented immigrants. A New York City government task force launched in 2014 recommended finding new ways to extend health care access for such residents. To conduct this study, the researchers worked with officials from the New York City Mayor’s Office and the Department of Health and Mental Hygiene to design a pilot program drawing on the city’s estimated population of 1.1 million undocumented immigrants.

Most solid tumors become stiff as the cancer progresses. Although researchers recognize that the environment around the cancer cells influences their behavior, it is unclear how it does so. In a new paper, published in Scientific Data, researchers from the University of Illinois Urbana-Champaign have collected gene expression data in response to mechanical stiffness in tumors. Their work can help guide our understanding of the crosstalk between cancer cells and their surroundings.
Historically, researchers have focused on how cancer cell genes change their expression over time. Based on this information, scientists have developed several therapeutic strategies, and yet over 600,000 people die every year in the US alone.
“We haven’t made as much progress as we would have liked against cancer,” said Bashar Emon, a postdoctoral researcher of mechanical science and engineering in the Saif (M-CELS/RBTE) lab. “Even with all the advances, the patient survival rate has not improved proportionately, when you consider how much research and funding has gone into studying cancer.”
As a result, there has been a recent push to understand the tumor environment holistically. Cancer cells are surrounded by non-cancerous stromal cells, the most abundant of which are the cancer-associated fibroblasts. Although researchers have recognized that CAFs play a role in metastasis, they do not understand which signals are involved in the process.
“In this paper we focused on the tumor microenvironment because it becomes stiffer with time and we know that CAFs can sense this change,” Emon said. “We wanted to understand how they convey this information to cancer cells.”
The researchers cultured human colorectal CAFs on gels that had increasing stiffness ranging from 1 kPa to 40 kPa. “One kPa is very soft, like Jell-O whereas 40 kPa is firmer, like rubber erasers. Imagine pressing your finger against a layer of Jell-O or rubber; one should feel like a normal tissue, while the other one is more like a tumor,” Emon said.
After isolating and sequencing the RNA from the CAFS, the researchers were able to compare which genes were being expressed differently in response to the increasing stiffness. Furthermore, they were also able to decipher changes in signaling molecules and pathways, and observe which biological functions were being affected.
“A gradient of increasing pressures from 1 kPa to 40 kPa created dramatic changes in gene expression, indicating that these CAFs were able to sense changes in stiffness and adapt. Comparing 1 kPa to 40 kPa, which are similar to the pressure inside a solid tumor, showed differentially expressed genes and molecules that may be relevant for cancer progression,” said You Jin Song, a graduate student of cell and developmental biology in the Prasanth lab.
The study looked at CAFs whereas other groups have looked at how cancer cells respond to different pressure conditions. In future studies, the authors would like to grow the two types of cells together and see how the crosstalk manifests. “Our study was a necessary step in this direction because we need to first understand the individual responses of each cell type before we study their interactions,” Song said.
“The importance of our paper lies in the fact that it is an unbiased experiment that monitored the expression of several genes simultaneously. It could be a good resource for other researchers who want to see whether the genes that they are interested in change in response to stiffness,” Song said.

Adults with atopic dermatitis (AD) have a 34 percent increased risk of developing new-onset inflammatory bowel disease (IBD) compared with individuals who do not have the skin condition, and children have a 44 percent increased risk, according to a new study from the Perelman School of Medicine at the University of Pennsylvania. Additionally, as the severity of AD increased, the risk of developing IBD rose. These findings clear up ambiguity from previous research, especially among populations of children and between the different types of inflammatory bowel disease: ulcerative colitis and Crohn’s disease. Insight offered from this study, recently published in JAMA Dermatology,could lead to new treatments for both IBD and AD.
IBD encompasses the diseases ulcerative colitis and Crohn’s disease, which are disorders involving chronic digestive tract inflammation. While IBD is located in the gut and AD affects the skin, both diseases are driven by the immune system and are categorized by severe inflammation.
“It is imperative for clinicians to understand atopic dermatitis and the trajectory of our patients with it in order to provide the best standard of care,” said senior author Joel M Gelfand, MD, the James J. Leyden, M.D. Endowed Professor in Clinical Investigation in the department of Dermatology at Penn. “There are new and better treatments for AD today, and there will likely continue to be more. But providers have to understand how those treatments could impact other autoimmune diseases. For patients with AD and another autoimmune disease, some currently available medications can exacerbate symptoms of their other disease or can help treat two immune diseases at the same time.”
While this is not the first study to explore AD and IBD, its size, its population made up of adults and children, and its separation between ulcerative colitis and Crohn’s disease advances previous research. The Penn study included over 1 million children (participants from under 1-year old to 18-years old) and adults with AD.
When looking at ulcerative colitis and Crohn’s disease separately, AD was not linked to higher ulcerative colitis in children unless the kids had severe AD. Children with AD, however, had a 54 to 97 percent increased relative risk of Crohn’s disease, and among children with severe AD, their risk was roughly five times higher. Results among adults were more straightforward. Adults with AD had a 32 percent increased relative risk of ulcerative colitis and a 36 percent increased relative risk of Crohn’s disease. Gelfand notes that the absolute extra risk of developing IBD in individuals with atopic dermatitis is still quite small, but the association is meaningful in better understanding health outcomes in AD. Moreover, since millions of people have atopic dermatitis, this small increase in risk spread among many people is likely important from a public health perspective.
Although Penn researchers did not look at the root cause of IBD linked to AD, they have strong hypotheses about the links.
“AD and IBD can cause changes in the microbiome, chronic inflammation, and the dysfunction in the skin and gut barrier respectively,” said Gelfand, who is also the director of the Center for Clinical Sciences in Dermatology at Penn. “There are also specific cytokines, certain kinds of proteins, that play a role in immune system activity and that seem to be related to AD and IBD. For example, we think dysfunction of types of T cells common to both AD and IBD, could be the culprits. Those need to be explored further to uncover both what’s happening at a microscopic level and what proteins or structures could be targeted to treat one or both conditions.”
As a leading expert on psoriasis, a disease known to be tied to IBD genetically, Gelfand is well aware of how closely skin health can affect other parts of the body. He and his colleagues are also studying AD’s relationship to infections, neurologic and psychiatric disorders, and cardiovascular disease.

Rutgers researchers have developed a way of detecting the early onset of deadly infectious diseases using a test so ultrasensitive that it could someday revolutionize medical approaches to epidemics.
The test, described in Science Advances, is an electronic sensor contained within a computer chip. It employs nanoballs — microscopic spherical clumps made of tinier particles of genetic material, each of those with diameters 1,000 times smaller than the width of a human hair — and combines that technology with advanced electronics.
“During the COVID pandemic, one of the things that didn’t exist but could have stemmed the spread of the virus was a low-cost diagnostic that could flag people known as the ‘quiet infected’ — patients who don’t know they are infected because they are not exhibiting symptoms,” said Mehdi Javanmard, a professor in the Department of Electrical and Computer Engineering in the Rutgers School of Engineering and an author of the study. “In a pandemic, pinpointing an infection early with accuracy is the Holy Grail. Because once a person is showing symptoms — sneezing and coughing — it’s too late. That person has probably infected 20 people.”
For the past 20 years, Javanmard has been developing biosensors — devices that monitor and transmit information about a life process. During the COVID-19 pandemic, he became disheartened about the extent of infections and the extreme loss of life. He believed there had to be a way of using biosensors as a test to detect illness earlier.
Working with Muhammad Tayyab, a Rutgers doctoral student and co-author of the study, Javanmard and research colleagues at the Karolinska Institute in Sweden and Stanford and Yale universities started brainstorming.
“We thought: How is there a way where we can leverage our individual expertise to build something new?” Javanmard said.
The biosensor developed by the team works through a series of steps. First, it zeroes in on a virus’ characteristic sequence of nucleic acids — naturally occurring chemical compounds that serve as the primary information-carrying molecules in a cell. Next, because it amplifies any nucleic acid sequence found in the sample, it makes many more copies, as many as 10,000. Then, it clumps those thousands of specks of nucleic acids into nanoballs that are “large” enough to be detected.

Go ahead. Try asking a crying child or baby what’s wrong, and you most likely will come away as baffled as you were at first wail. This becomes a particular problem in hospitals where assessing pediatric pain and treating it correctly can be critical. The fact is pain can be downright harmful to little ones. If they experience it often or for a long time, it can make them more sensitive to pain, change their brain structure and cause emotional, behavioral and learning problems. Good news though — a nursing researcher from the University of Houston has published the importance of following protocols to understand and evaluate pain in children.
“The use of evidence-based protocols for the management of pain and sedation in pediatric intensive care patients can provide adequate pain relief while decreasing the risk of adverse effects such as respiratory depression, withdrawal and delirium,” reports Alicia Kleinhans, clinical assistant professor at the University of Houston Andy & Barbara Gessner College of Nursing, in the journal Pediatric Intensive Care Nursing. “Knowledge of pediatric pain management protocols may assist health care providers because these evidence-based pain management protocols have been shown to decrease adverse effects, morbidity, mortality, ventilator days and overall length of stay.”
Plus, adds Kleinhans, understanding how to properly assess pain and apply current research findings in pediatric pain management can help decrease opioid usage. Opioids bring not only a myriad of adverse effects, but prescribing opioids contributes to the opioid epidemic.
“The combination of poor recognition of pediatric pain and the highly variable nature of patients within a pediatric ICU complicates the adequate management of pain,” said Kathryn Tart, founding dean, Professor and Humana Endowed Dean’s Chair in Nursing at the Gessner College of Nursing. “Improvements in assessing pediatric pain and a greater understanding of the adverse effects of opioids and opioid dosing using additional medications have laid the groundwork for the recent development of protocols for pain management in the pediatric ICU.”
The Protocols
There are various types of assessment tools available such as the self-reporting Wong-Baker FACES scale for children older than 4 years; behavioral scales for nonverbal patients including the Face, Legs, Activity, Cry and Consolability scale; the COMFORT scale specifically developed for nonverbal patients in a pediatric ICU; and scales for neonatal patients including CRIES neonatal pain assessment scale and the premature infant pain profile.
Protocol for pain and anxiety in pediatric patients undergoing procedures in the pediatric emergency department is divided into categories based on the patient’s pain score. Interventions include nonpharmacologic measures for a pain score of 1 to 2, pharmacologic measures including acetaminophen and NSAIDs for a pain score of 3, and pharmacologic measures with a consult of a prescriber for a pain score of 4 to 7, as well as additional measures for a pain score of 8 or more.
“Pain management protocols for pediatric patients should include and discuss all validated tools. They are vital to proper pain control in pediatric patients,” said Kleinhans.

Virtual reality simulators can help learners improve their technical skills faster and with no risk to patients. In the field of neurosurgery, they allow medical students to practice complex operations before using a scalpel on a real patient. When combined with artificial intelligence, these tutoring systems can offer tailored feedback like a human instructor, identifying areas where the students need to improve and making suggestions on how to achieve expert performance.
A new study from the Neurosurgical Simulation and Artificial Intelligence Learning Centre at The Neuro (Montreal Neurological Institute-Hospital) of McGill University, however, shows that human instruction is still necessary to detect and compensate for unintended, and sometimes negative, changes in neurosurgeon behaviour after virtual reality AI training.
In the study, 46 medical students performed a tumour removal procedure on a virtual reality simulator. Half of them were randomly selected to receive instruction from an AI-powered intelligent tutor called the Virtual Operative Assistant (VOA), which uses a machine learning algorithm to teach surgical techniques and provide personalized feedback. The other half served as a control group by receiving no feedback. The students’ work was then compared to performance benchmarks selected by a team of established neurosurgeons.
Comparing the results, AI-tutored students caused 55 per cent less damage to healthy tissues than the control group. AI-tutored students also showed a 59 per cent reduction in average distance between instruments in each hand and 46 per cent less maximum force applied, both important safety measures.
However, AI-tutored students also showed some negative outcomes. For example, their dominant hand movements had 50 per cent lower velocity and 45 per cent lower acceleration than the control group, making their operations less efficient. The speed at which they removed tumour tissue was also 29 per cent lower in the AI-tutored group than the control group.
These unintended outcomes underline the importance of human instructors in the learning process, to promote both safety and efficiency in students.
“AI systems are not perfect,” says Ali Fazlollahi, a medical student researcher at the Neurosurgical Simulation and Artificial Intelligence Learning Centre and the study’s first author. “Achieving mastery will still require some level of apprenticeship from an expert. Programs adopting AI will enable learners to monitor their competency and focus their intraoperative learning time with instructors more efficiently and on their individual tailored learning goals. We’re currently working towards finding an optimal hybrid mode of instruction in a crossover trial.”
Fazlollahi says his findings have implications beyond neurosurgery because many of the same principles are applied in other fields of skills’ training.
“This includes surgical education, not just neurosurgery, and also a range of other fields from aviation to military training and construction,” he says. “Using AI alone to design and run a technical skills curriculum can lead to unintended outcomes that will require oversight from human experts to ensure excellence in training and patient care.”
“Intelligent tutors powered by AI are becoming a valuable tool in the evaluation and training of the next generation of neurosurgeons,” says Dr. Rolando Del Maestro, the study’s senior author. “However, it is essential that surgical educators are an integral part of the development, application, and monitoring of these AI systems to maximize their ability to increase the mastery of neurosurgical skills and improve patient outcomes.”

Brigham researchers found that patients prescribed amoxicillin-clavulanate had higher rates of gastrointestinal symptoms and yeast infections than those prescribed amoxicillin
Acute sinusitis is one of the most common causes for children to be put on antibiotic medications, with patients in the United States filing nearly 5 million antibiotic prescriptions every year to treat the condition. The drugs amoxicillin and amoxicillin-clavulanate make up most of those prescriptions, but there is a lack of consensus on which should be first-line for children.
In a new study published today in JAMA and led by researchers at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, scientists analyzed the treatment outcomes of over 300,000 children who were prescribed either of the two drugs. They found that there was no difference in the rates of treatment failure — that is, having to go on a new course of antibiotics or seek additional treatment for sinusitis or complications — between patients prescribed amoxicillin and amoxicillin-clavulanate. Treatment failure was so rare, in fact, that the study’s authors say that physicians should be confident that either medication will clear a case of acute sinusitis that requires antibiotics. But the risk of adverse events, especially gastrointestinal symptoms and yeast infections, were higher among those prescribed amoxicillin-clavulanate.
“This study adds recent, actionable data and evidence to inform what antibiotic a clinician should choose to treat a child with acute bacterial sinusitis,” said lead author Timothy Savage, MD, MPH, MSc, an associate epidemiologist in the Brigham’s Division of Pharmacoepidemiology and Pharmacoeconomics. “As seen from this study, there’s no difference in the treatment failure rate regardless of which of these two antibiotics you choose.”
Amoxicillin-clavulanate is believed to treat a wider range of bacteria than amoxicillin, but it is also associated with more gastrointestinal side effects. Scientists also worry that in the long-term, overprescribing amoxicillin-clavulanate may accelerate the rate at which infectious bacteria develop antimicrobial resistance. Doctors have therefore wondered whether the benefits of prescribing amoxicillin-clavulanate to children with acute sinusitis outweigh the short- and long-term risks.
The researchers pulled data from 320,141 clinical cases of children diagnosed with acute sinusitis and compared whether children on amoxicillin or amoxicillin-clavulanate were more likely to undergo treatment failure. They discovered that there was no difference in the rates of treatment failures associated with either medication. Treatment failure in general was exceedingly rare; less than two percent of prescriptions failed, most of which were corrected by an outpatient medication change. Only 0.1% of children had failures so severe that they required a visit to the emergency room or hospitalization.
The clinical data showed that adverse events were somewhat rare but more frequent among patients treated with amoxicillin-clavulanate, occurring in 2.3% of patients treated with amoxicillin-clavulanate and 2% of patients treated with amoxicillin. Patients treated with amoxicillin-clavulanate had a 15% increased risk of gastrointestinal side effects and 33% higher risk of yeast infections compared to patients treated with amoxicillin. The study’s authors conclude that the more narrow-spectrum amoxicillin may be the best first-line choice to combat acute sinusitis.