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Neuroscientists have found that a region of the forebrain known as the striatum was on average 10% larger in individuals with psychopathy compared to a control group of individuals who had low or no psychopathic traits, according to a study.

Psychopathic individuals are generally defined as those who have an egocentric and antisocial personality, marked by a lack of remorse for their actions, a lack of empathy for others, and often criminal tendencies. The striatum is the subcortical region of the brain that contains the entire cerebrum and coordinates multiple aspects of cognition, including motor and action planning, decision-making, motivation, reinforcement, and reward perception.

Notably, although not all individuals with psychopathic traits end up breaking the law and not all criminals meet the criteria for psychopathy, there is a correlation. Clear evidence has linked psychopathy to more violent behavior, according to the study. Understanding the role of biology in antisocial and criminal behavior may help improve existing theories of behavior, as well as inform policy and treatment options.

“Our study’s results help advance our knowledge about what underlies antisocial behavior such as psychopathy,” said Olivia Choy, PhD, an assistant professor at Nanyang Technological University, in the press release. “We find that in addition to social environmental influences, it is important to consider that there can be differences in biology—in this case, the size of brain structures—between antisocial and non-antisocial individuals.”

Earlier research has suggested that psychopaths may have an overly active striatum but have not conclusively determined the impact of its size on behaviors. The new study, conducted by researchers at Nanyang Technical University Singapore, the University of Pennsylvania, and California State University, reveals a significant biological difference between individuals who have psychopathic traits and those who do not.

In their study, the researchers scanned the brains of 120 participants in the United States and interviewed them using the Revised Psychopathy Checklist, which helps determine the presence of psychopathic traits in individuals. Through an analysis of the MRI scans and interviews, the researchers linked having a larger striatum to an increased need for stimulation through thrills and excitement, and a higher likelihood of impulsive behaviors.

As part of the basal ganglia, the researchers noted that this region of the brain receives signals from the cerebral cortex, which controls cognition, social behavior, and discerning which sensory information warrants attention. In the past 20 years, however, the understanding of the striatum has expanded, with hints that the region is linked to difficulties in social behavior.

However, earlier studies have not addressed whether striatal enlargement is observed in adult women with psychopathic traits. Within the study of 120 individuals, the researchers examined 12 women and observed, for the first time, that psychopathy was linked to an enlarged striatum in females, just as in males. In human development, the striatum typically becomes smaller as a child matures, suggesting that psychopathy could be related to differences in brain development.

“A better understanding of the striatum’s development is still needed,” Choy said in the press release. “Many factors are likely involved in why one individual is more likely to have psychopathic traits than another individual. Psychopathy can be linked to a structural abnormality in the brain that may be developmental in nature. At the same time, it is important to acknowledge that the environment can also have effects on the structure of the striatum.”

Study finds psychopathic individuals are more likely to have larger striatum region in the brain. News release. Nanyang Technological University; May 10, 2022. Accessed May 11, 2022. 

https://www.ntu.edu.sg/docs/default-source/corporate-ntu/hub-news/study-finds-psychopathic-individuals-are-more-likely-to-have-larger-striatum-region-in-the-brain.pdf?sfvrsn=fd7259b3_1

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Earlier research has suggested that psychopaths may have an overly active striatum but have not conclusively determined the impact of its size on behaviors.

Research Finds Psychopathic Individuals Are More Likely to Have a Larger Striatum Region in the Brain

A new analysis found that the organizational performance during the COVID-19 pandemic may be reflected in the nursing workforce retention as the risk for workforce attrition appears high, according to a study published in 

The purpose of the study was to get a better glimpse of the perspective of nurses working in the United States on the frontlines during the COVID-19 pandemic’s first wave. The impact of the pandemic on nurses’ roles, professional relationships, and the organizational cultures of their employers were a focus as well.

The research team conducted an online qualitative study through social networking recruitment to find frontline nurses across the country to participate. The participants provided long form, text-based responses to 4 questions designed to capture their experiences between the first COVID-19 wave between May and July 2020.

In total, 318 nurses participated from 29 out of 50 states, with 242 nurses completing all of the questions. The findings from the study suggest that the place of work mattered significantly in terms of the frontline working experience. Role changes, risk assumption, interprofessional teamwork experiences, and likelihood to leave their jobs or the profession altogether were major influences.

Although it was known that the working conditions varied during the pandemic, nurses shared that they experienced high levels of occupational risk to their health and were observed to be seen as threats to patient outcomes.

The data emphasized that nurses showed several signals about the potential impact to the stability and sustainability of the United States nursing workforce that are now manifesting, including a massive loss to the frontline of the US nursing workforce stemming from high rates of burnout. 

A. Squires, M. Clark-Cutaia, M. Henderson, et al., "Should I stay or should I go?” Nurses’ Perspectives AboutWorking During the Covid-19 Pandemic in the United States: A Summative Content Analysis Combined with Topic Modelling (2022), 

https://doi.org/10.1016/j.ijnurstu.2022.104256

The purpose of the study was to get a better glimpse of the perspective of nurses working in the United States on the frontlines during the COVID-19 pandemic’s first wave. 

Study: Potential Threats to Stability, Sustainability for US Nursing Workforce

A small animal study found that female rats exposed to the sound of a scream may have diminished ovarian reserve and reduced fertility, according to research published in the Endocrine Society’s journal 

According to the study authors, ovarian reserve is the reproductive potential left within a woman’s 2 ovaries based on the number and quality of eggs. For each woman, they are born with a limited number of eggs and her body is not able to create more, although diminished ovarian reserve can also occur over time. However, the cause of the diminished quality and quantity of eggs in the ovaries has remained unknown for some time.

To assess one potential source of diminished ovarian reserve, the researchers looked to the potential role of stress in this process.

“We examined the effect of stress on ovarian reserve using a scream sound model in rats,” said Wenyan Xi, PhD, of the Second Affiliation Hospital of Xi’an Jiao Tong University in Xian, China, in a press release. “We found that female rats exposed to the scream sound had diminished ovarian reserve and decreased fertility.”

The research team used a scream sound model to investigate the effect of stress on ovarian reserve in female rats, and they exposed the female rats to a scream sound for 3 weeks and analyzed the effect on their sex hormones, the number and quality of their eggs, and their ability to get pregnant and have babies after mating.

The analysis found that the scream sound decreased the rats’ estrogen and Anti-Mullerian hormone levels. The Anti-Mullerian hormone is a hormone made by the ovaries which helps build reproductive organs, whereas estrogen is a group of hormones that play an important role in growth and reproductive development.

Furthermore, the investigators observed that the scream sound appeared to lower the number and quality of the rats’ eggs and resulted in smaller litters.

“Based on these findings, we suggest stress may be associated with diminished ovarian reserve,” Xi said in the press release. “It is important to determine an association between chronic stress and ovarian reserve because doing so may expand our appreciation of the limitations of current clinical interventions and provide valuable insight into the cause of diminished ovarian reserve.”

Stress may be associated with fertility issues in women. Endocrine Society. May 10, 2022. Accessed May 11, 2022. 

https://www.endocrine.org/news-and-advocacy/news-room/2022/stress-may-be-associated-with-fertility-issues-in-women#:~:text=Female%20rats%20exposed%20to%20a,the%20Endocrine%20Society's%20journal%2C%20Endocrinology

Study: Stress May Be Associated with Fertility Issues in Women

Adults who failed to pay down student debt or took on new educational debt between young adulthood and early mid-life faced an elevated risk of cardiovascular (CV) illness, results of a study published in the 

Additionally, individuals who repaid their student debt had better or equivalent health than individuals who never faced student debt, which suggests that relieving the burden of student debt could improve population health.

“As the cost of college has increased, students and their families have taken on more debt to get to and stay in college. Consequently, student debt is a massive financial burden to so many in the United States, and yet we know little about the potential long-term health consequences of this debt,” Adam Lippert, PhD, from the Department of Sociology at University of Colorado Denver, said in a statement.

“Previous research showed that, in the short term, student debt burdens were associated with self-reported health and mental health, so we were interested in understanding whether student debt was associated with cardiovascular illness among adults in early mid-life,” Lippert said.

The study included data from the National Longitudinal Study of Adolescent to Adult Health, which is a panel of 20,745 adolescents in grades 7 to 12 who were first interviewed during the 1994-1995 school year.

Four subsequent waves of data were collected, which included wave 3, where the respondents were aged 18 to 26 years, and wave 5, where the respondents were aged 22 to 44 years, and were invited to in-home medical exams.

Investigators assessed biological measures of CV health of 4193 qualifying individuals using the 30-year Framingham cardiovascular disease (CVD) risk score, which considers age, antihypertensive treatment, body mass index, blood pressure, diabetes diagnosis, sex, and smoking status, to measure the likelihood of CVD over the next 30 years.

Additionally, investigators looked at levels of C-reactive protein (CRP), a biomarker of chronic or systemic inflammation.

Student debt was classified into categories that included consistently in debt, never had student debt, paid off debt between waves 3 and 5, and took on debt between waves.

The models were adjusted for respondent family and household characteristics, including education, income, and other demographics.

Investigators found that more than one-third of respondents did not report student debt in either wave, while 24% consistently had debt, 12% had paid off their loans, and 28% took on student debt.

Individuals who consistently had debt or took on debt had higher CVD risk scores than those who had never been in debt and those who paid off their debt. Additionally, individuals who paid off debt had significantly lower CVD risk scores than those never in debt.

Investigators also found clinically significant CRP value estimates for those who took on new debt and those who were consistently in debt between young adulthood and early mid-life, which exceeded those who never had debt or paid off debt.

Ethnicity and results had no impact on the results, according to investigators.

Student debt can impair your cardiovascular health into middle age. EurekAlert. News release. May 3, 2022. Accessed May 3, 2022. https://www.eurekalert.org/news-releases/951393

Individuals with college debt have a higher risk of cardiovascular illness, undermining the typical benefits of a post-secondary education, data indicate.

Student Loans Can Impair Heart Health into Middle Age, Study Results Show

Several recent clinical trials demonstrated pre-exposure prophylaxis (PrEP) can effectively reduce the risk of HIV transmission and in Europe, which led the European Center for Disease and Prevention (ECDC) to recommend the integration of PrEP into national HIV prevention programs for those most at risk of HIV infection.

A survey conducted in 2018 and 2019 investigated testing frequencies and factors associated with intermittent testing among self-funded PrEP users in Germany. This stems from existing guidelines that found PrEP users are periodically tested for HIV, sexually transmitted infections (STIs), and renal function.

There were 4848 survey participants, and between 1 in 5 and 1 in 4 did not follow the recommended testing frequencies for HIV, STI, and renal function required in the German guidelines for PrEP use. Respondents who frequently tested for STI had higher proportions of self-reported STI diagnoses during PrEP use, overall and across levels of partner numbers and condom use.

According to the study authors, the strongest factors associated with less frequent testing were that respondents did not test before they started taking PrEP, they obtained PrEP from informal sources, and they used it on-demand or occasionally. Further, they concluded that infrequent testing such as this during PrEP use “can lead to missed diagnoses,” and barriers to testing should be addressed to enable proper medical supervision.

The study authors suggest that the most likely mode of transmission was sex with a person on antiretroviral treatment who was not virally suppressed at the time of HIV transmission. They added that further promotion of adherence to antiretroviral therapy among HIV-positive individuals is an important pillar in preventing onward transmission.

As for asymptomatic men who have sex with men (MSM) who use PrEP, regular STI screening and testing is just as important in this population because previous studies found a similar predominance of asymptomatic cohorts of MSM who would have been missed without testing.

HIV pre-exposure prophylaxis works but needs regular testing. EurekAlert! April 7, 2022. Accessed April 18, 2022. 

https://www.eurekalert.org/news-releases/949068

Pre-exposure prophylaxis can effectively reduce the risk of HIV transmission.

Regular Testing Needed for HIV PrEP, Study Shows

More than half of parents said that it is difficult to get their children to eat well-balanced diets, and half say their children regularly takes supplements, according to the University of Michigan Health CS Mott Children’s National Poll on Children’s Health.

“A balanced diet helps children get the nutrients they need for healthy growth and development,” Sarah Clark, MPH, co-director at Mott Poll, said in a statement. “Our poll finds that many turn to dietary supplements as a solution but may not always consult with a health provider.”

Additionally, approximately one-third of parents said that their children are picky, and one-third said they do not think their children eat enough fruits and vegetable.

Approximately 13% said that they worried that their children were not getting enough of certain minerals and vitamins, while 9% said that their children needed more fiber in their diets.

The survey was nationally representative and included 1251 parents each of whom had at least 1 child between age 1 and 10 years.

Another potential barrier is cost. About half of parents agreed that it is more expensive to provide their children with healthy diets.

“We know that fresh, healthy foods can be more expensive than processed or packaged items that are often higher in sodium and added sugars,” Clark said. “This can make it especially frustrating for parents when children waste or refuse to eat healthy foods.”

More than three-quarters of parents said that they gave their multivitamins.

Approximately half said they had also provided their children with probiotics, which are live bacteria and yeast that help digestion by providing good microbes in the gut.

More than one-fifth of parents said that they have given their children Omega-3 supplements, a fatty acid that supports brain development and cell growth..

Additionally, about one-third of parents said that their children have not taken them regularly.

Among those who have given their child supplements, 4 in 5 said that they chose products made specifically for children.

However, only approximately 2 in 5 of parents said that they discussed supplement use with their children’s health care providers.

“Dietary supplements are often intended to enhance the amount of vitamins children consume through a regular diet,” Clark said. “The use of dietary supplements in children is an important health decision to discuss with doctors, but less than half of parents who have given their child a supplement talked to their child’s health provider.”

Parents in lower-income households were also less likely to talk about supplement use with their children’s health care providers compared with higher-income parents, according to the survey results.

Because supplements are classified by the FDA as food, they do not receive the same premarketing evaluation and review as medications, which results in limited research on the efficacy and safety of vitamins, Clark said.

“To minimize the risks of supplement use, parents should share concerns about their child’s diet with a pediatrician who can help them identify the best strategies to improve the nutritional quality of their child’s diet and determine whether supplements are recommended,” she said.

Half of parents regularly give kids a dietary supplement. EurekAlert. News release. April 18, 2022. Accessed April 20, 2022. https://www.eurekalert.org/news-releases/949682

Three in 5 say it is hard to get kids to eat well-balanced diets, because of not eating enough fruits and vegetables, pickiness, and other reasons.

Half of Parents Regularly Give Their Children Dietary Supplements, Study Results Show

Lydia Yeager, DNP, MSN, RN, CPNP-PC, AE-C, is director of care management and director of school-based health at Ryan Health in New York, New York.

The United States is celebrated as a melting pot for its unique blend of cultures, languages, and races.

Approximately 14%, or 1 in 7, US residents are immigrants, including an estimated 2.5 million children, according to the American Immigration Council.

Additionally, 25% of children in the United States have at least 1 parent who was not born in this country,

 and 6.1 million children live with at least 1 undocumented family member.

 Children who are immigrants may face unique emotional, health, and social challenges. Pediatric advanced practice providers must be thoroughly prepared to face these challenges with families to promote the health and well-being of these children.

Language barriers can result in worse health outcomes.

 In addition to using trained medical interpreters, however, it is important for pediatric providers to go beyond bridging the language gap. Recognizing cultural bias when caring for immigrant children is of paramount importance, as health care providers’ implicit biases can result in worse care to patients with diverse cultural backgrounds.

 Cultural competency allows practitioners to effectively interact with patients from other cultures. However, the concept of “cultural competency” is problematic, because the term suggests that practitioners can obtain definitive knowledge about each culture and that there is a finish line for learning to interact with other cultures.

 In recent years, there has been a marked shift away from cultural competency to cultural humility, which recognizes the rich complexities of cultures and acknowledges that practitioners cannot possibly be completely competent in another culture, though they can strive daily to address their own biases to provide the best care possible.

 A common tool for communication with other cultures is the LEARN framework (Listen, Explain, Acknowledge, Recommend, Negotiate), which can improve the patient experience and quality of care.

 Practitioners should assess for potential cultural concerns or concerns and should always discuss and elicit feedback regarding treatment plans with patients and their families.

Mental health is a primary concern when providing health care to children who are immigrants. Immigration inherently disrupts typical childhood experiences, which may affect development. Children who are immigrants are at increased risk for trauma and violence and often require more mental health support than their US-born peers.

 Children who are immigrants should be initially screened for mental health concerns after their arrival in the United States and screened at least annually thereafter. The Ages and Stages Questionnaire – Social Emotional,

 and the Strengths and Difficulties Questionnaire

 are all validated tools that may be used to assess for behavioral or mental health concerns, in addition to the commonly used PHQ-9 screening for depression and GAD-7 screening for anxiety.

Another consideration when caring for children who are immigrants is social determinants of health, which have extensive effects on health and quality of life. Children who are immigrants are disproportionately negatively affected by social determinants of health.

 Children who are immigrants may face difficulty accessing health care or legal services, food and housing insecurity, lack of education, and poverty.

 Pediatric providers should routinely screen for social determinants of health and address needs by referring to community agencies as indicated. Both patients and providers may search for assistance programs by zip code using FindHelp.Org, which is available in a wide variety of languages.

 Services on FindHelp include, but are not limited to, childcare assistance, food pantries, general medical care, health education, housing resources, job placement, legal services, maintenance and repairs, medical supplies, and transportation.

In addition to these complex issues, pediatric practitioners must focus on overall physical health. They should obtain a birth, dental, developmental, family, and general medical history and review available diagnostic imaging and laboratory results, growth charts, and newborn screening and vaccination records. Pediatric providers should also ask about the use of OTC and prescription medications, as well as cultural or herbal therapies, which are common among immigrants and may lead to negative health outcomes.

In addition, pediatric providers should conduct a thorough physical exam, including hearing and vision screenings.

 Providers should pay particular attention to the oral exam and provide dental referrals, as children who are immigrants experience increased rates of dental disease compared with their US-born peers.

 When conducting skin assessments, practitioners should be careful not to confuse signs of traditional healing measures, such as coining or cupping, with integumentary disease.

 A genital exam is also important, but pediatric providers must determine cultural barriers that would preclude this.

 If barriers exist, referrals should be provided to a practitioner that the family deems appropriate.

Vaccines schedules vary by country and can differ in both the types of vaccines given and the number and timing of vaccines recommended.

 Timely vaccination should be a focus for children who do not yet have all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Accept vaccines given outside the United States if the timing and types align with ACIP recommendations. Providers should use the CDC’s catch-up immunization schedule as a resource for the timing of these catch-up vaccinations.

Blood work should be a routine part of the care for children who are immigrants shortly after their arrival to the United States. A complete blood count with differential is recommended for immigrants of all ages, and a urinalysis is recommended if the child is developmentally able to provide a clean catch specimen.

 All children who are immigrants aged 6 months to 16 years should be screened for lead.

 Children aged 6 months to 6 years should be tested again between 3 and 6 months later.

 Standard newborn screening is recommended for any newborns who are immigrants.

 As newborn screening may not have been done in the child’s native country, evaluation for hemoglobinopathies, hypothyroidism, and metabolic abnormalities may be performed.

Tuberculosis screening should also be considered. Children aged 2 to 14 years who immigrate to the United States from a country with a tuberculosis incidence rate of greater than or equal to 20 cases per 100,000 population should have an interferon gamma release assay (IGRA) blood test to screen for tuberculosis exposure.

 Children aged 15 years and older must have a chest X-ray, regardless of tuberculosis incidence in their country of origin.

Regardless of age and tuberculosis incidence in their country of origin, any child with confirmed HIV infection must have both a chest X-ray and IGRA and should also undergo sputum testing.

 HIV testing is recommended for all children who are immigrants aged 13 years and older.

 Adolescents should also be offered comprehensive reproductive care, as should children with a history of trafficking or other suspected abuse.

 Additional screening for infectious disease should be considered based on travel history and exposure risk.

Children who are immigrants may face a host of unique health challenges, which can be wide-ranging and difficult to address. It is important for practitioners to approach the care of these children in an evidence-based, holistic, and supportive manner. With the right expertise and tools, pediatric practitioners can make a positive impact in the lives of these children.

1. Immigrants in the United States. American Immigration Council. September 21, 2021. Accessed April 8, 2022. 

https://www.americanimmigrationcouncil.org/research/immigrants-in-the-united-states

2. Linton JM, Green A, Council on Community Pediatrics. Providing care for children in immigrant families. 

. 2019;144(3):e20192077. doi:10.1542/peds.2019-2077

3. Pandey M, Maini RG, Amoyaw J, et al. Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study. 

. 2021;21(1):741. doi:10.1186/s12913-021-06750-4

4. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. 

. 2017;18(1):19. doi.org/10.1186/s12910-017-0179-8

5. Khan S. Cultural humility vs. cultural competence — and why providers need both.Boston Medical Center – HealthCity. March 9, 2021. Accessed April 8, 2022. https://healthcity.bmc.org/policy-and-industry/cultural-humility-vs-cultural-competence-providers-need-both#:~:text=Cultural%20competence%20is%20loosely%20defined,knowledgeably%20with%20people%20across%20cultures.&text=The%20term%20%22cultural%20humility%22%20was,critique%2C%20acknowledging%20one's%20own%20biases

6. Ladha T, Zubairi M, Hunter A, Audcent T, Johnstone J. Cross-cultural communication: tools for working with families and children. 

. 2018;23(1):66-69. doi.org/10.1093/pch/pxx126

7. Betancourt TS, Newnham EA, Birman D, Lee R, Ellis BH, Layne CM. Comparing trauma exposure, mental health needs, and service utilization across clinical samples of refugee, immigrant, and U.S.-origin children. 

. 2017;30(3):209-218. doi.org/10.1002/jts.22186ASQ:SE-2. 

8. Ages & Stages Questionnaires. Accessed April 22, 2022.https://agesandstages.com/products-pricing/asqse-2/

9. Mansolf M, Blackwell CK, Cummings P, Choi S, Cella D. Linking the child behavior checklist to the strengths and difficulties questionnaire. 

 Advance online publication.2022;34(3):233-246. doi:10.1037/pas0001083

10. Bryant A, Guy J, CALM Team, Holmes J. The strengths and difficulties questionnaire predicts concurrent mental health difficulties in a transdiagnostic sample of struggling learners. 

2020;11:587821. doi:10.3389/fpsyg.2020.587821

11. Kroenke K, Wu J, Yu Z, Bair MJ, Kean J, Stump T, Monahan PO. (2016). Patient health questionnaire anxiety and depression scale: initial validation in three clinical trials. 

. 2016;78(6):716-727. doi:10.1097/PSY.0000000000000322

12. Chang CD. Social determinants of health and health disparities among immigrants and their children. 

. 2019;49(1):23-30. doi.org/10.1016/j.cppeds.2018.11.009

13. FindHelp. 2022. Accessed April 22, 2022. https://www.findhelp.org/

14. Immigrant, refugee, and migrant health. CDC. Updated March 10, 2021. Accessed April 22, 2022. https://www.cdc.gov/immigrantrefugeehealth/index.html

15. Crespo E. (2019). The importance of oral health in immigrant and refugee children. 

2019;6(9):102. doi:10.3390/children6090102

16. Vaccine Knowledge Project. Oxford Vaccine Group. Updated March 25, 2022. Accessed April 22, 2022. https://vk.ovg.ox.ac.uk/vk/vaccination-schedules-other-countries

17. Catch-up immunization schedule for persons aged 4 months–18 years who start late or who are more than 1 month behind, United States. CDC. February 17, 2022. Accessed April 22, 2022. https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html17 

18. Tuberculosis technical instructions for panel physicians. CDC. October 17, 2019. Accessed April 22, 2022. https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/tuberculosis.html

With the right expertise and tools, pediatric health care professionals can make a positive impact in the lives of these young people.

Practitioners Can Help Children Who Are Immigrants

Individuals with hepatitis C who injected drugs and were treated at a non-stigmatizing accessible-care treatment with a syringe service program (SSP) were about 3 times more likely to be cured of the infectious disease than those referred out to local clinics through patient navigation services, results of a clinical trial showed.

The results of the study, conducted by CUNY Graduate School of Public Health and Health Policy, NYU Grossman School of Medicine, New York-Presbyterian, and Weill Cornell Medicine, suggests that expanding and supporting the accessible-care model could be instrumental in eliminating the disease.

The trial was conducted between July 2017 and March 2021 and included 167 individuals who were randomly assigned to either accessible care or referred out to local physicians by patient navigators who facilitated the process.

Individuals in the study were followed for 1 year after study enrollment.

“We were able to engage and offer treatment to people who are currently injecting drugs, people who are often excluded from traditional health care settings because of their drug use,” Shashi Kapadia, MD, assistant professor of medicine in the Division of Infectious Diseases at Weill Cornell Medicine, said in a statement.

The hepatitis C cure rate was approximately 86% for both arms of the study for those who completed treatment, but approximately 67% of those enrolled in accessible care at the SSP finished the course compared with approximately 23% of those assigned to the standard care.

In more traditional settings, individuals are required to document to that they are no longer using drugs to qualify for hepatitis C treatment, but investigators said that individuals who still use drugs can be cured, because requiring abstinence adds another barrier to care access.

Individuals who use drugs, specifically injectable drugs, are often stigmatized in health care settings and might be treated poorly, which makes them reluctant to get help, investigators said.

Additionally, drug use could be a distraction for individuals for treatment as well as contribute to missing appointments, which in a traditional setting can lead to them being dropped from care.

By contrast, the accessible-care team that was part of the study offered walk-in appointments. Additionally, individuals who had appointments and missed them were contacted to reschedule.

The staff members were also available and trained to interact with individuals who used drugs.

Flexibility made the accessible-care models attractive, investigators said, adding that participants were not just locals but individuals who lived in other New York City’s borough and not just Manhattan.

“This study provides a practical guide for how to make an effective treatment accessible to the population most likely to have the disease,” Kristen Marks, MD, associate professor of medicine at Weill Cornell Medicine and an infectious disease specialist at New York-Presbyterian/Weill Cornell Medical Center, said in the statement.

The investigators acknowledged that most individuals in the study had insurance that covered their treatment, which could be a limitation of the study.

Accessible care key to treating hepatitis C in people who inject drugs. EurekAlert. News release. April 7, 2022. Accessed April 14, 2022. https://www.eurekalert.org/news-releases/949093

These individuals were 3 times more likely to be cured of the infectious disease than those referred out to local clinics through patient navigation services, clinical trial results indicate.

Accessible Care Is Key to Treating Hepatitis C in Individuals Who Inject Drugs, Study Shows

Researchers from the University of California San Francisco have found that individuals who are vaccinated against SARS-CoV-2 and have a history of certain psychiatric conditions may have a heightened risk of breakthrough COVID-19 infection.

The investigators found that patients over the age of 65 with substance abuse, psychotic disorders, bipolar disorder, adjustment disorder, and anxiety faced increased risks up to 24% for breakthrough COVID-19. For those under 65 years of age, risks were up to 11% higher than for those without a psychiatric history.

Data for both age groups were adjusted for age, sex, race, ethnicity, and vaccine type, as well as for smoking and underlying conditions, such as obesity, diabetes, sleep apnea, cardiovascular, lung, kidney and liver diseases, HIV, and cancer. The findings could be related to impaired immune responses in patients with certain psychiatric conditions, as well as risky behaviors associated with some disorders.

In the study, investigators tracked data from more than one-quarter of a million United States Department of Veterans Affairs patients, who had completed their COVID-19 vaccine regimen and had at least 1 test for SARS-CoV-2. Just over half (51.4%) of the patients had received at least 1 psychiatric diagnosis within the past 5 years, and 14.8% developed breakthrough COVID-19 confirmed by a positive test. The average age of the 263,697 participants was 66 years and 90.8% were male.

“Our research suggests that increased breakthrough infections in people with psychiatric disorders cannot be entirely explained by socio-demographic factors or pre-existing conditions,” said senior author Aoife O’Donovan, PhD, in a press release. “It’s possible that immunity following vaccination wanes more quickly or more strongly for people with psychiatric disorders and/or they could have less protection to newer variants.”

An earlier study led by the same researchers found that individuals with elevated anxiety and probable post-traumatic stress disorder—conditions associated with impulsivity—were more likely to engage in behaviors that put them at higher risk of COVID-19.

According to the new study, participants with psychiatric disorders had an overall 3% increased risk for breakthrough COVID-19 infections in 2021 compared with participants without a psychiatric history. However, the risk was 24% higher for individuals over 65 years of age with substance abuse, 23% higher for those with psychotic disorders, 16% higher for those with bipolar disorder, 14% higher for patients with adjustment disorder, and 12% for individuals with anxiety.

Surprisingly, given the greater incidence of breakthrough infections among younger individuals, the study showed significantly smaller effects in those under 65 years of age. Moreover, risks were 10% lower in participants with psychotic disorders compared to those without a psychiatric diagnosis, which O’Donovan attributed to possible lower socialization among younger patients with psychiatric disorders. She noted that older patients “may be less socially isolated because of their greater burden of ill health and contacts with caregivers.”

However, risks of breakthrough infections associated with substance abuse, adjustment disorder, anxiety, and post-traumatic stress disorder were all higher in the younger cohort than in their peers without a psychiatric diagnosis—11%, 9%, 4%, and 3%, respectively.

A potential reason for the higher incidence of breakthrough infections among older participants could be due to a lower immunological response to the vaccines, which has been associated with some psychiatric disorders and could be more substantial among older adults, according to the study. It is also possible that older adults with psychiatric disorders may require more frequent in-person care, thereby increasing their risk of contracting COVID-19 from a health care provider.

To provide context, breakthrough risk for other non-psychiatric conditions were also calculated and adjusted for factors such as obesity and smoking status, as well as other underlying conditions. The researchers found that patients with chronic kidney disease had an increased risk of 23%, compared with 20% for HIV, 19% for cardiovascular disease, 18% for COPD, and 13% for sleep apnea. These findings demonstrate that patients with certain psychiatric conditions, particularly those 65 years of age and older, face risks that are on par with other conditions, according to the study authors.

“Mental health is important to consider in conjunction with other risk factors, and some patients should be prioritized for boosters and other critical preventive efforts,” O’Donovan concluded in the press release.

Your Mental Health May Impact Your Chances of Breakthrough COVID. News release. University of California San Francisco; April 14, 2022. Accessed April 20, 2022. 

https://www.ucsf.edu/news/2022/04/422616/your-mental-health-may-impact-your-chances-breakthrough-covid

Findings demonstrate that patients with certain psychiatric conditions, particularly those aged 65 and older, face risks that are on par with other conditions. 



Study Shows Heightened Risk of Breakthrough COVID-19 in Patients with Psychosis, Substance Abuse, Anxiety

A new Northwestern Medicine study found that exposure to the slightest ambient lighting during nighttime sleep harms cardiovascular function during sleep and increases insulin resistance the following morning compared to sleeping in a dimly lit room.

“The results from this study demonstrate that just a single night of exposure to moderate room lighting during sleep can impair glucose and cardiovascular regulation, which are risk factors for heart disease, diabetes and metabolic syndrome,” said senior study author Phyllis Zee, MD, PhD, chief of sleep medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician, in a press release. “It’s important for people to avoid or minimize the amount of light exposure during sleep.”

Zee added that the results indicate that a similar effect is also present when exposure to light occurs during nighttime sleep.

“We showed your heart rate increases when you sleep in a moderately lit room,” said co-first author Daniela Grimaldi, MD, research assistant professor of neurology at Northwestern, in a press release. “Even though you are asleep, your autonomic nervous system is activated. That’s bad. Usually, your heart rate together with other cardiovascular parameters are lower at night and higher during the day.”

The study authors found that insulin resistance occurred the morning after people slept in a light room, which means that the cells in the muscles, fat, and liver do not respond well to insulin and cannot use glucose from blood for energy.

“Now we are showing a mechanism that might be fundamental to explain why this happens. We show it’s affecting your ability to regulate glucose,” Zee said in a press release.

Artificial light exposure at night during sleep is very common, either from indoor light emitting devices or from sources outside the home, specifically in large urban areas. Additionally, a significant proportion of individuals sleep with a bedside lamp on, with a light on in the bedroom, and/or the television on.

“In addition to sleep, nutrition and exercise, light exposure during the daytime is an important factor for health, but during the night we show that even modest intensity of light can impair measures of heart and endocrine health,” said co-first author Ivy Mason, MD, who at the time of the study was post-doctoral fellow at Northwestern and now is a research fellow at Harvard Medical School, in a press release.

Close the blinds during sleep to protect your health. Northwestern Now. March 14, 2022. Accessed April 18, 2022. 

https://news.northwestern.edu/stories/2022/03/close-the-blinds-during-sleep-to-protect-your-health/#:~:text=Exposure%20to%20even%20moderate%20ambient,a%20new%20Northwestern%20Medicine%20study

Study: Closing the Blinds During Sleep Protects Health

Offering accessible and non-stigmatizing care can significantly improve outcomes in people who inject drugs (PWID) who are infected with hepatitis C virus (HCV), according to a 

. The study wasconducted by investigators from Weill Cornell Medicine, New York-Presbyterian, NYU Grossman School of Medicine, and the CUNY Graduate School of Public Health and Health Policy.

According to National Institutes of Health estimates, between 70% and 90% of individuals in the United States who have injected drugs for 10 years or more are infected with HCV.

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