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The Native Hawaiian (NH) and Pacific Islander (PI) communities were severely impacted by the COVID-19 pandemic, according to 2 studies published in 

. During the pandemic, 1 in 5 NH/PI participants lost a family member; they also had a mortality rate of 1 per 400 individuals by the end of 2021. Further, the NH/PI communities’ rates of alcohol use disorder were 2.6 times greater than the national rates.

"NH/PIs may carry the highest rates of COVID-19 infections and deaths of any US racial/ethnic minority group during the pandemic," said Andrew Subica, PhD, associate professor in the School of Medicine's Department of Social Medicine, Population, and Public Health, at the University of California, Riverside, in a press release.

In an earlier study, Subica noted that the data demonstrated the NH/PI population had the most deaths per capita in 90% of all states. To investigate this further, Subica and a team of researchers surveyed more than 300 NH/PIs in states with the highest NH/PI populations—including Washington, Utah, Oregon, California, and Arkansas—between April 2021 and November 2021.

More than 50% of NH/PI participants had a family member who was diagnosed with COVID-19, and 30% were diagnosed themselves. The results of the first study identified factors that increased NH/PI COVID-19 exposure risk—these include a job on the frontline, living in a densely populated house or neighborhood, or participation in large-scale group social events.

The second study observed that the NH/PI communities consumed high levels of alcohol, tobacco, and other drugs during the pandemic. Among NH participants, 47% used alcohol or cigarettes, and in PIs the rate was 22%. Additionally, 35% of all NH/PIs used illegal substances. Among NH/PIs, 1 in 4 screened positive for alcohol use disorder.

Based on the data, smoking has been shown to be a comorbidity of severe COVID-19 outcomes, making the high rate of smoking among NH/PIs an increased risk factor during the pandemic, explained Subic. The author added that the NH/PI communities have other high-risk comorbidities as well, such as obesity, cancer, and heart disease, which can further increase the severity of COVID-19 outcomes in NH/PIs.

This population also had high levels of depression, anxiety, and unmet treatment needs. During the pandemic, the researchers found that 27% of patients had major depressive disorder, 20% had generalized anxiety disorder, and 50% of non-binary NH/PI participants screen positive for probable alcohol use disorder.

"Our findings call for greater attention and funding of NH/PI research to prevent and reduce NH/PIs' glaring health disparities associated with COVID-19," Subica said in the press release. "This illuminates the need for further research exploring the behavioral health needs of these at-risk individuals. We need to develop and implement culturally responsive prevention, intervention, and recovery programs to reduce NH/PI substance use and mental health disparities during and after the COVID-19 pandemic."

University of California- Riverside. COVID-19 took serious toll on Native Hawaiian/Pacific Islander mental and physical health. Science Daily. September 19, 2022. Accessed on September 20, 2022. https://www.sciencedaily.com/releases/2022/09/220919103205.htm

Articles

Native Hawaiians and Pacific Islanders are suggested to have had some of the highest levels of mortality, depression, alcohol use, and anxiety disorders during the COVID-19 pandemic.

Native Hawaiian, Pacific Islander Communities Faced Significant Disparities in Mental, Physical Health During Pandemic  

Probiotics are live organisms that have a symbiotic relationship with the body, most often in the gastrointestinal (GI) tract.

The most common probiotics included in various formulations are bidifobacteria, lactobacilli, and the yeast 

 Probiotics are available in a wide range of products, formulations and strains. 

Evidence indicates that certain probiotics are possibly effective for GI conditions, such as antibiotic-associated diarrhea, chronic pouchitis associated with ulcerative colitis, constipation, diarrhea in adults and children, Helicobacter pylori in conjunction with standard therapies, irritable bowel syndrome (IBS), and reducing the risk of C. difficile infection.

The natural medicines database generally defines a “possibly effective” rating as “some clinical evidence supporting its use for a specific indication.”

However, the evidence is limited by quality, quantity, or contradictory findings.

Products rated “possibly effective” might be beneficial but do not have enough high-quality evidence to recommend for most individuals.

In 2020, the American Gastroenterological Association (AGA) published clinical practice guidelines on the role of probiotics for gastrointestinal diseases.

 The AGA concluded that certain probiotics may be beneficial for preventing C. difficile in patients taking antibiotics, but the quality of evidence was low and thus required further study. The AGA concluded similar findings for effectiveness of probiotics in patients with IBS and inflammatory bowel disease (IBD). An 8-strain combination probiotic including various lactobacillus and bifidobacteria species was helpful in patients with pouchitis related to IBD. Evidence also supported the use of certain bifidobacterial- and lactobacilli-containing probiotics in preterm infants to prevent necrotizing enterocolitis.

Probiotics are safe and well tolerated when taken appropriately in generally healthy people. There are some reports of mild GI effects, such as bloating, diarrhea, and flatulence.

 summarizes the most commonly used probiotics.

 Common Probiotic Products, Formulation/Strains, and Overview of Clinical Efficacy

Probiotics play a key role in the maintenance of immunologic equilibrium in the gastrointestinal tract through the direct interaction with immune cells. There is high-quality evidence that probiotics are effective for acute infectious diarrhea, antibiotic-associated diarrhea, Clostridium difficile–associated diarrhea, functional constipation, H pylori eradication, and IBS. Probiotics may improve human health, nutrition, and regulation of common GI abnormalities.

1. Editorial principles and process. Natural Medicines. Accessed April 3, 2022. 

https://naturalmedicines.therapeuticresearch.com/about-us/editorial-principles-and-process.aspx

2. Su GL, Ko CW, Bercik P, et al. AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. 

. 2020;159(2):697-705. doi:10.1053/j.gastro.2020.05.059

3. Probiotics. What works and what doesn’t. Natural Medicines. March 20, 2020. Accessed August 1, 2022. https://naturalmedicines.therapeuticresearch.com/news/news-items/2020/march/probiotics-what-works-and-what-doesn%E2%80%99t.aspx

4. Comparison of common probiotic products. 

 Accessed April 3, 2022. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2015/Jul/Comparison-of-Common-Probiotic-Products-8626

5. Guyonnet D, Schlumberger A, Mhamdi L, Jakob S, Chassany O. Fermented milk containing bifidobacterium lactis DN-173 010 improves gastrointestinal well-being and digestive symptoms in women reporting minor digestive symptoms: a randomized, double-blind, parallel, controlled study. 

 2009;102;1654-1662. doi:10.1017/S0007114509990882

6. Whorwell PJ, Altringer L, Morel J, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. 

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7. Riezzo G, Orlando A, D'Attoma B, Linsalata A, Martulli M, Russo F. Randomized double-blind placebo-controlled trial on Lactobacillus reuteri DSM 17938: improvement in symptoms and bowel habit in functional constipation. 

. 2018;9(1):51-60.doi:10.3920/BM2017.0049

8. Poonyam P, Chotivitayatarakorn P, Vilaichone RK. High effective of 14-day high-dose PPI- bismuth-containing quadruple therapy with probiotics supplement for helicobacter pylori eradication: a double blinded-randomized placebo-controlled study. 

. 2019;20(9):2859-2864. doi:10.31557/APJCP.2019.20.9.2859

9. Blaabjerg S, Artzi DM, Aabenhus R. Probiotics for the prevention of antibiotic-associated diarrhea in outpatients: a systematic review and meta-analysis. 

. 2017;6(4):21. doi:10.3390/antibiotics6040021

10. Zhou BG, Chen LX, Li B, Wan LY, YW A. Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: a systematic review and meta-analysis with trial sequential analysis. 

. 2019;24(5):e12651. doi:10.1111/hel.12651

11. Johnston BC, Lytvyn L, Lo CK, et al. Microbial preparations (probiotics) for the prevention of clostridium difficile infection in adults and children: an individual patient data meta-analysis of 6,851 participants. 

. 2018;39(7):771-781. doi:10.1017/ice.2018.84

12. Wang Z, He Y, Zheng Y. Probiotics for the treatment of bacterial vaginosis: a meta-analysis. 

. 2019;16(20):3859. doi:10.3390/ijerph16203859

13. Dimidi E, Christodoulides S, Fragkos KC, Scott SM, Whelan K. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. 

. 2014;100(4):1075-1084. doi:10.3945/ajcn.114.089151

14. Visbiome. Product inserts. Accessed August 1, 2022. https://www.visbiome.com/pages/product-inserts

15. Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. 

 2000;119(2):305-309. doi:10.1053/gast.2000.9370

The live organisms help maintain immunologic equilibrium through direct interaction with immune cells.

Probiotics Play Key Role in the Gastrointestinal Tract

Among men with COVID-19, individuals with lower testosterone levels are 2.4 times more likely to become seriously ill and be hospitalized than men with normal levels, according to investigators at the Washington University School of Medicine in St. Louis and Saint Louis University School of Medicine.

Additionally, investigators found that men who were once diagnosed with low testosterone but successfully treated with hormone replacement therapy were no more likely to be hospitalized with COVID-19 than men with normal levels.

“It is very likely that COVID-19 is here to stay,” Abhinav Diwan, MD, a professor of medicine at Washington University, said in a statement.

“Low testosterone is very common; up to a third of men over 30 have it. Our study draws attention to this important risk factor and the need to address it as a strategy to lower hospitalizations,” Diwan said.

The findings also suggest that treating men with low testosterone could help prevent severe disease and reduce hospitalization.

Investigators previously found that men hospitalized with COVID-19 have abnormally low testosterone levels. Severe illness or traumatic injury can cause hormone levels to temporarily drop.

Investigators analyzed 723 cases of men who tested positive for COVID-19, with most of the cases from 2020 and before vaccines were available. The data showed that low testosterone was an independent risk factor for COVID-19 hospitalization, similar to chronic lung disease, diabetes, and heart disease.

Of those studied, 427 men had normal testosterone levels, 116 had low levels, and 180 previously had low levels but were successfully treated.

Investigators conducted a chart review of individuals at BJC HealthCare and SSM Health, 2 major hospital systems in St. Louis, Missouri. All individuals were identified between January 1, 2017, and December 31, 2021, and had documented cases of COVID-19 in 2020 or 2021.

Investigators found that some testosterone levels were measured after the individuals recovered from COVID-19. However, men who tested low a few months after recovering from COVID-19 probably had low testosterone levels before their infections.

“Low testosterone turned out to be a risk factor for hospitalization from COVID[-19], and treatment of low testosterone helped to negate that risk,” Sandeep Dhindsa, MD, an endocrinologist at Saint Louis University, said in the statement. “The risk really takes off below a level of 200 nanograms per deciliter, with the normal range being 300 to 1,000 nanograms per deciliter.”

Physicians should look at testosterone levels, especially in individuals who have symptoms of low testosterone, before deciding on individualized care, investigators said.

Additionally, hormone replacement therapy could be an option for individuals with low levels, and it could lower their risk of COVID-19 hospitalizations, according to Diwan.

This study is only observational, so a clinical trial would be needed to demonstrate if boosting testosterone levels could help men avoid severe COVID-19, investigators said.

Two main concerns related to testosterone therapy are an increased risk of prostate cancer and disease, according to the statement.

A clinical trial on the relationship between heart health and testosterone supplementation is expected to be completed soon.

Low testosterone may increase risk of COVID-19 hospitalization for men. News release. Science Daily. September 2, 2022. Accessed September 8, 2022. https://www.sciencedaily.com/releases/2022/09/220902111333.htm

Investigators find that those successfully treated with hormone replacement therapy were no more likely to be hospitalized. 

Low Testosterone Levels Is Linked to Increased Risk of COVID-19 Hospitalization for Men

Women may have worse mental health outcomes if they work a paid job while also performing unpaid labor at home, based on the results of a study conducted by investigators from the University of Melbourne, Australia. According to the study, men did not show the same mental health outcomes.

This was the first study to connect and evaluate existing evidence that looked at the relationship between gender, unpaid labor, and mental health. The team observed a mental health cost on women who perform unpaid labor—which is an addition to the already high economic cost of working without pay.

"We found substantial gender differences in exposure to unpaid labour, with women uniformly doing more in every geographical and time setting—in more than 35 countries—around the world," said the study lead Jen Ervin, a PhD candidate within The Centre for Health Equity at the University of Melbourne, Australia, in a press release.

The researchers identified 14 completed studies to use as the base for their analysis. Among the studies, which included more than 66,000 participants around the world, 5 analyzed unpaid labor. The other 9 studies looked at the time women spent on housework, with an additional 4 studies evaluating the impact of childcare.

The researchers identified a possible association between the cost of mental health and workload demand. In more than 75% of the studies, women self-reported increasing levels of depressive or psychological distress symptoms as their unpaid labor demands increased.

This was 3 times higher than the rate among men. In the 12 studies which looked at men, only 25% of respondents reported a negative association between mental health outcome and increasing unpaid labor demands.

"This double burden of paid and unpaid work exposes women to greater risk for overload, time poverty, and poorer mental health,” Ervin said in the press release.

The lead researcher added that women disproportionally traded paid work hours to meet unpaid labor responsibilities, highlighting that there is a need to create a more equitable division of unpaid labor through attention and meaningful action.

Further, Ervin suggests that social change can happen with policy change. These policies could include universal childcare or normalizing a flexible working arrangement for men.

She and her colleagues found that their review of existing studies which looked at gender, unpaid labor, and mental health highlight a need for more high-quality and longitudinal research—this could help to better understand the nuances around how unpaid labor is defined and measured.

"There is an undeniable mental load that accompanies unpaid labour and family responsibilities," Ervin said in the press release. “Reducing the disproportionate unpaid labour burden on women, by enabling men to take on their equal share, has the potential to improve women's mental health

University of Melbourne. Double burden of paid and unpaid labor leading to poorer mental health in women, review finds. Science Daily. September 1, 2022. Accessed on September 13, 2022. https://www.sciencedaily.com/releases/2022/08/220831210017.htm

There may be a negative mental health burden on women who do unpaid work at home while also working a paid job.

Women Who Perform Paid, Unpaid Labor May Have Worse Mental Health Outcomes

Findings from a new study in the United Kingdom suggest that it does not matter which types of fish are eaten during pregnancy, because essential nutrients found in fish could protect against the mercury content.

Although researchers have known for some time that the children of women who eat fish during pregnancy are likely to benefit in various ways, official guidelines have warned pregnant individuals against eating types of fish that have relatively high levels of mercury. As a result, some women may stop eating any fish as a precaution. The new research, however, suggests that protective nutrients in fish would protect against the mercury levels.

“We found that the mother’s mercury level during pregnancy is likely to have no adverse effect on the development of the child, provided that the mother eats fish,” said study co-author Caroline Taylor, PhD, in a press release. “If she did not eat fish, then there was some evidence that her mercury level could have a harmful effect on the child. This could be because of the benefits from the mix of essential nutrients that fish provides, including long-chain fatty acids, iodine, vitamin D, and selenium.”

Although several studies have considered this issue, the new research looked at 2 contrasting analyses of populations with mercury levels measured during pregnancy, in which the researchers followed up with the children at frequent intervals.

The first is a study focused on a population in the Seychelles, where nearly all pregnant women eat fish. The second study considered analyses of data from the University of Bristol’s Avon Longitudinal Study of Parents and Children, based in a relatively industrialized area in southwest England where fish are consumed less frequently. No summary of findings from the second study have been published before.

“It is important that advisories from health professionals revise their advice warning against eating certain species of fish,” said co-author Jean Golding, PhD, DSc, FSS, FFPHM, MRCPCH, F.Med.Sci, in the press release. “There is no evidence of harm from these fish, but there is evidence from different countries that such advice can cause confusion in pregnant women. The guidance for pregnancy should highlight ‘Eat 

 2 portions of fish a week, 1 of which should be oily’—and omit all warnings that certain fish should not be eaten.”

Study calls for change in guidance about eating fish during pregnancy. News release. University of Bristol; September 6, 2022. Accessed September 12, 2022. 

https://www.bristol.ac.uk/news/2022/september/fish-pregnancy.html

Researchers recommend guidelines specify that pregnant women should eat at least 2 portions of fish per week and should omit warnings against certain types of fish.

Researchers Call for Change in Guidelines About Eating Fish During Pregnancy

A new study has found that having easier access to primary care physicians may increase high blood pressure awareness and control regardless of where a person lives, according to the authors of a study published in 

Circulation: Cardiovascular Quality and Outcomes

In the study, the authors noted that health care professionals at community clinics and primary care practices specifically can help expand awareness and detection of high blood pressure by providing affordable treatment and management.

“Access to primary care is the key to hypertension management, however, many Americans have limited access to primary care where they live. This is especially true of people in economically disadvantaged neighborhoods or people from diverse racial and ethnic groups, particularly among African American individuals,” said senior study author Brisa Aschebrook-Kilfoy, PhD, an associate professor of public health sciences at the University of Chicago in Illinois, in a press release.

The study analyzed neighborhood socioeconomic status using the Area Deprivation Index (ADI) created by the Health Resources & Services Administration over 3 decades ago. This system allows for rankings of neighborhoods by socioeconomic status in a region and can be valuable to inform health care delivery and policy, especially for populations living in the most disadvantaged neighborhoods.

“Some argue that minority health disparities are solely the product of socioeconomic factors, or that increasing the number of primary care professionals in diverse racial and ethnic neighborhoods would not reduce health disparities and improve public health. To our knowledge, there is little research to support or rebut this argument,” first study author Jiajun Luo, PhD, a post-doctoral fellow at the University of Chicago’s Institute for Population and Precision Health, said in a press release. “We conducted this study to examine whether accessibility of primary care is associated with better hypertension control and awareness across various socioeconomic and neighborhood factors.”

The study focused on Chicago, which saw a 30-year gap in life expectancy that was observed between people who live in southern neighborhoods in Chicago versus northern neighborhoods, the latter of which is more affluent compared to the former. The researchers looked specifically to assess whether the socioeconomic differences impacted the higher rates of high blood pressure, heart disease, and stroke in the southern neighborhoods of the city.

Health data was analyzed for more than 5000 predominantly African American adults who participated in the Chicago Multiethnic Prevention and Surveillance Study (COMPASS) between 2013 to 2019, which is an initiative that explores the health of Chicagoans, primarily who are in communities in the south of the city. When the researchers did their analysis, they considered annual income, BMI, ADI, the effect of distance to primary care, and spatial accessibility during their investigation.

Approximately 80% of the COMPASS participants had previously experienced hypertension, using the standard American Heart Association guideline-based blood pressure criteria of measures ≥130 mm Hg systolic (top number) or ≥80 mm Hg diastolic (bottom number).

Approximately 38% of those with hypertension did not have their blood pressure under control, whereas 41% were not aware they had high blood pressure.

Spatial accessibility scores ranged from 16.4 (lower access to primary care) to 86.6 (higher access) per 100,000 residents.

Adults living in areas with the fewest primary health care professionals had 37% increased odds of having hypertension in comparison to the adults living in neighborhoods with the most primary care physicians.

The listed associations existed in both poor and wealthy neighborhoods, which the researchers suggest that residents in all neighborhoods may benefit from increasing the number of primary care professionals.

When clarified by neighborhood type (advantaged or disadvantaged), accessibility to primary care was not associated with use of anti-hypertension medications among those who reported they had hypertension prior to enrolling in the study.

“Based on these findings, we need to encourage primary care physicians to expand access to people who live in underserved communities with the fewest primary care professionals,” Aschebrook-Kilfoy said in the press release. “Mobile health units may be one approach to increase primary care service in underserved areas by eliminating the challenge of getting transportation to and from an office visit. The use of anti-hypertension medications also needs to be studied and addressed, especially as it was not linked to primary care accessibility in this study.”

High blood pressure awareness, control improved with better access to primary health care. American Heart Association. September 6, 2022. Accessed September 9, 2022. 

https://newsroom.heart.org/news/high-blood-pressure-awareness-control-improved-with-better-access-to-primary-health-care

The authors noted that health care professionals at community clinics and primary care practices specifically can help expand awareness and detection of high blood pressure by providing affordable treatment and management.

Study: Better Primary Health Care Access Leads to Improved Control of High Blood Pressure

Hallucinogen and marijuana use by adults aged 19 to 30 years increased significantly in 2021 compared with 5 and 10 years ago, reaching historic highs in the age group since 1988, according to the results of the Monitoring the Future panel study.

“As the drug landscape shifts over time, [these] data [provide a window into the substances and patterns of use favored by young adults. We need to know more about how young adults are using drugs, like marijuana and hallucinogens, and the health effects that result from consuming different potencies and forms of these substances,” Nora Volkow, MD, director of the National Institute on Drug Abuse, said in a statement.

“Understanding how substance use can impact the formative choices in young adulthood is critical to help position the new generations for success,” she said.

For hallucinogen use, investigators found that use in the past year had been relatively stable until 2020 when reports dramatically increased. In 2021, approximately 8% of young adults reported past-year hallucinogen use, which was an all-time high since 1998. In 2016, just 5% reported hallucinogen use, and in 2011, just 3% reported use.

Types of hallucinogens included LSD, MDMA, mescaline, peyote, psilocybin, and PCP.

MDMA was the only hallucinogen for which use significantly decreased within 1 year, as well as the past 5 years, to 3% in 2021 from 5% in both 2016 and 2020.

For marijuana use, the past-year, past-month, and daily use, defined as use on 20 or more occasions in the past 30 days, reached the highest levels ever recorded since first monitored in 1988. The proportion of adults who reported that past-year marijuana use reached 43% in 2021, increasing from 34% 5 years ago and 29% 10 years ago.

Daily use also increased during this time, at 11% of young adults in 2021 compared with 8% 5 years ago and 6% 10 years ago.

Additionally, rates of past-month nicotine vaping, which have been increasing among young adults for the past 4 years, continued the upward trend in 2021, despite leveling off in 2020.

The continued increase in 2021 reflects a long-term upward trend at 16% compared with 6% in 2017, when it was first recorded.

Past-month marijuana vaping, which decreased in 2020, rebounded to pre-pandemic levels in 2021.

These levels were first recorded in 2017 and reached 6% but doubled to 12% in 2021.

Alcohol remains the most frequently used substance among adults, though in past-year, past-month, and daily use have all decreased over the past decade, the study results showed.

Investigators found that binge drinking, defined as 5 or more drinks in a row in the past 2 weeks, rebounded in 2021 from a historic low in 2020 during the early stages of the COVID-19 pandemic to 32% compared with 28% in 2020 and 32% in 2019.

However, high-intensity drinking, defined as 10 or more drinks in a row in the past 2 weeks, has been steadily increasing over the past decade, where it reached the highest level ever recorded in 2021 of 13% compared with 11% when first recorded in 2005.

Past-month, past-year, and daily alcohol use have been declining for the past 10 years. In 2021, 66% of young adults reported alcohol use in the past 30 days, decreasing from 70% in 2016 and 69% in 2011.

The study also showed significant decreases in past-month cigarette use as well as non-medical use of opioid medications in the past year compared with a decade earlier.

The Monitoring the Future study has surveyed substance use behaviors and attitudes among a nationally representative sample of teens annually A panel study component conducts follow-up surveys on a subset of these individuals to track their drug use behaviors across 3 primary time periods: lifetime, past month, and past years.

The study was conducted by investigators at the Institute for Social Research at the University of Michigan Ann Arbor.

Data from the 2021 survey were collected online between April 2021 and October 2021.

The panel study also includes drugs use reported by adults aged 35 to 50 years old, college/non-college young adults, and various demographic subgroups.

Marijuana and hallucinogen use among young adults reached all time-high in 2021. News release. Science Daily. August 22, 2022. Accessed August 29, 2022. https://www.sciencedaily.com/releases/2022/08/220822130344.htm

Past-month vaping levels rebounded after early COVID-19 pandemic drop, analysis results indicate.

Study: Hallucinogen, Marijuana Use Among Young Adults Hits Record in 2021

A new analysis to examine and compare the effectiveness of the previously identified DAAs in PTSD symptom improvement has led to a potential new medication for PTSD in patients without hepatitis C virus infection.

Previous studies have shown that 6% of Americans will develop PTSD in their lifetime, which can disrupt lives and lead to or worsen existing health issues, like depression, anxiety, eating disorders, and suicidal thoughts.

The FDA has only approved of 2 medications to treat PTSD- sertraline and paroxetine, and both have shown limited effectiveness in reducing PTSD symptoms.

The new study revealed that the medication combination glecaprevir and pibrentasvir had the strongest connection with PTSD symptom improvement among the DAAs most prescribed in the VA.

“Many people have PTSD, but there few effective pharmacologic treatments and limited drug development for PTSD,” said co-principal investigator and study senior author Jaimie Gradus, associate professor of epidemiology, in a press release. “Existing effective treatments are mostly psychotherapy, and while they work well, there are also issues with them, including a lot of treatment drop-out and they’re time-intensive, so adding to the suite of treatment options for people is a high priority.”

The researchers also examined the same national cohort of VA patients as the prior study, but narrowed the group to include only patients who were diagnosed with hepatitis C.

“There really has been a lot of interest in finding new medications for PTSD in the field,” said co-principal investigator Brian Shiner, a psychiatrist and acting associate chief of staff for research at the White River Junction VA Medical Center, as well as associate professor of psychiatry at Dartmouth University’s Geisel School of Medicine, in a press release. “The idea to look at VA data in this way grew out of a conversation in the scientific literature between the VA PTSD Psychopharmacology Working Group and the National Institutes of Mental Health. Paula Schnurr from the National Center for PTSD connected Jaimie and I, and we were really fortunate to obtain funding to bring a team together to do this work.”

The team analyzed 254 VA patients who were diagnosed with PTSD and hepatitis C between October 1999 and September 2019. Each participant received 1 combination of FDA-approved hepatitis C medications, like glecaprevir and pibrentasvir (GLE/PIB), ledipasvir and sofosbuvir (LDV/SOF), and sofosbuvir and velpatasvir (SOF/VEL). The research team then monitored the patients’ symptoms for both PTSD and HCV between 2 clinical visits over 8 to 12 weeks.

After adjusting for variables that could potentially influence results, like opioid prescription use, liver disease diagnoses, emergency department care for psychiatric crises, the researchers found that the GLE/PIB medications were more strongly associated with PTSD symptom improvement that the LDV/SOF and SOF/VEL treatments, consistent with previous results.

“At BUSPH, we have been working with our VA colleagues to look at PTSD symptom improvement in routine care using medical records for several years,” Gradus said in a press release. “The level of improvement we see for GLE/PIB is impressive and over twice what we have seen for paroxetine and sertraline. I think we have done the best we can with medical records data, an important next step in this line of work will be a prospective placebo-controlled study in patients without hepatitis C virus infection.”

Shiner added that they recently received funding from the Department of Defense to study GLE/PIB as a potential treatment for PTSD in a prospective randomized placebo-controlled trial and will serve as principal investigator. “It will be several years until we see the results, but this is a very exciting case where we used VA patient data to identify a potential treatment for PTSD, which is a very important problem for veterans’ health. In this way, veterans have informed PTSD treatment development,” Shiner said in a press release.

Hepatitis C drugs may reduce PTSD symptoms. BU School of Public Health. August 22, 2022. Accessed August 29, 2022. 

https://www.bu.edu/sph/news/articles/2022/hepatitis-c-drugs-may-reduce-ptsd-symptoms/

Study: Hepatitis C Drugs May Reduce PTSD Symptoms

Data show neurofeedback therapy may improve symptoms of “chemo brain” in patients with cancer by returning abnormal brain waves to normal frequency, according to researchers who conducted a pilot study at University of California Los Angeles (UCLA). The study is one of the first to use neurofeedback, also known as electroencephalogram (EEG) biofeedback, to improve cognitive function in patients post-chemotherapy.

"The history of neurofeedback shows that it's helpful for a whole range of disorders and symptoms. This study was an opportunity for seeing whether neurofeedback is something that could be helpful with chemo brain," said study lead Stephen Sideroff, a professor at UCLA's Department of Psychiatry & Biobehavioral Sciences, in a press release.

Chemo brain is a term for some common neurological symptoms that occur after chemotherapy treatment, which can include memory, organization, and concentration problems. The symptom of chemo brain has also been found to cause troubled sleep and emotional distress in some patients.

Neurofeedback involves training the brain waves to operate at optimal frequency patterns. In past studies, it has been shown to remediate cognitive impairments such as attention-deficit/hyperactivity disorder, stroke, seizures, and even improve the brain activity of substance use patients.

For this study, Sideroff and UCLA colleagues David Wellisch and Valerie Yarem looked at 9 female patients with breast cancer between the ages of 21 and 65 years. All participants went through chemotherapy at least 1 year prior and complained of debilitating chemo brain symptoms, such as poor concentration, memory, organization, and confusion. Among patients included in the clinical trial, no patients currently had breast cancer, a present/recent major depressive disorder diagnosis, other mental illness, or took cognitive-altering medications.

During the trial, participants were administered pre-training neurocognitive and psychological tests, along with a quantitative EEG to measure brain wave frequency—the pre-training EEG showed that participants had abnormal brain wave activity compared to a healthy adult brain.

The test consisted of putting a sensor on the scalp and earlobes to monitor brain wave frequency. The participant saw their brain frequency in the form of a bar graph and were tasked with turning the bars green by manipulating their brain wave frequencies. They received 18 neurofeedback sessions, each 30-minutes long and administered during a 6-week period.

After the sessions, 7 of the 9 participants had completely normalized brain wave frequencies on their EEG. Every participant exhibited improved everyday functioning. The researchers also found improved psychological wellbeing among every participant.

Participants’ information processing, executive set shifting, and sustained visual attention significantly improved, according to the neurocognitive testing that followed the neurofeedback sessions.

Shortfalls of this study include a small sample size and no control group. Additionally, most participants took 7 to 9 weeks to complete the neurofeedback sessions, which is considered long when compared to prior studies evaluating the efficacy of neurofeedback therapy.

However, the study authors noted they do believe the strong study results support the pursuit of further research on neurofeedback and effectively addressing chemo brain, which may ultimately extend into finding the ideal protocols around length of time for these neurofeedback sessions.

"Our results are more impressive given we were not able to have subjects stick to the schedule," Sideroff said in the press release.

University of California – Los Angeles Health Sciences. Neurofeedback shows promise for addressing 'chemo brain'. Science Daily. August 25, 2022. Accessed on August 29, 2022. https://www.sciencedaily.com/releases/2022/08/220825120413.htm

Research looking at neurofeedback and “chemo brain” found that most patients had normal brain function after 18 weeks of neurofeedback therapy, significantly improving patient symptoms.

Groundbreaking Pilot Study Suggests Neurofeedback Can Treat ‘Chemo Brain’ 

Investigators at Tel Aviv University in Israel have developed a method of musical tests and a portable instrument for measuring brain activity that detects cognitive decline in older individuals.

The method is based on a measurement of 15 minutes of electrical activity in the brain while performing simple tasks, according to the investigators.

They added that this could be easily implemented by staff in any clinic without requiring special training, they said.

“Our method enables routine monitoring and early detection of cognitive decline in order to provide treatment and prevent rapid, severe deterioration. Prophylactic tests of this kind are commonly accepted for a variety of physiological problems such as diabetes, high blood pressure or breast cancer,” investigators said in a statement.

“However, to date no method has yet been developed to enable routine, accessible monitoring of the brain for cognitive issues,” they said.

The investigators developed the method by combining a portable device for the measurement and analysis of electroencephalography (EEG), which was developed by Neurosteer, and a short musical test of about 12 to 15 minutes, which was developed by Neta Maimon, PhD, from Neurosteer.

As part of the test, the individual is connected to the portable EEG device with an adhesive band with 3 electrodes attached to the forehead. The individual performs a series of musical-cognitive tasks according to the audible instructions given through earphones.

The tasks include short melodies played by various instruments where the individual is instructed to perform various tasks with varying difficulty. One task includes the individual pressing a button each time any melody is playing, while another is pressing it when a violin plays.

Additionally, the test has several minutes of musically guided meditation to bring the brain into a resting state, which can indicate cerebral functioning in various situations.

Music influences different centers in the brain by being a quick mood stimulant, particularly related to positive emotions, Maimon said.

Music can also be cognitively challenging, activating the frontal part of the brain.

By combining these capabilities, the cognitive tests can be complex but are still easy to perform, she said.

In the study, investigators included 50 elderly individuals who were hospitalized at Dorot-Netanya Geriatric Medical Center and scored 18 to 30 on the mini-mental test, which is a standard test to evaluate cognitive condition as part of the intake process. A higher score shows normal cognition.

The individuals performed the musical-cognitive tasks, and the EEG devices measured the electrical activity in the brain. Investigators analyzed the results using machine learning technology.

The investigators found that the mathematical indices could be correlated with the mini-mental test scores, which showed that the investigators discovered new brain markers that could stand alone as indices of an individual’s cognitive status.

“We have actually succeeded in illustrating that music is indeed an effective tool for measuring brain activity. The brain activity and response times to tasks correlated to the [individuals’] cerebral conditions, correlating to the mini-mental score assigned to them,” Maimon said.

“More importantly, all those who underwent the experiment reported that, on the one hand, it challenged the brain, but on the other it was very pleasant to perform,” she said.

Musical tests can detect mental deterioration in old age. News release. Science Daily. August 17, 2022. Accessed August 23, 2022. https://www.sciencedaily.com/releases/2022/08/220817104010.htm

The method is based on a measurement of 15 minutes of electrical activity in the brain while performing simple tasks.

Musical Tests Detect Mental Deterioration in Older Individuals

A new study led by University of California San Francisco (UCSF) showed that screening for depression at the primary care level could dramatically increase the likelihood of treatment for those who are traditionally undertreated, such as among racial and ethnic minority individuals, older adults, those with limited English proficiency, and men.

Depression tends to go unrecognized in more than half of patients presenting with symptoms in primary care, although data show that an approximate 60% of patients receive their depression care from the primary care setting.

Over a period of 2 years, the electronic health data of 52,944 adult patients seen at 6 UCSF primary care facilities was tracked by researchers. It was reported that after a routine screening policy was implemented, depression screening rates more than doubled, from 40.5% in 2017 to 88.8% in 2019.

In 2018, the research team found that for every 100 patients between the ages of 18 and 30 years screened for depression, 75 patients aged 75 years and older were likely to be screened for depression. Further, for every 100 English-speaking White patients screened for depression, there were 59 non-English-speaking patients likely to be screened for depression.

However, statistically significant disparities seemed to virtually disappear among older patients, African Americans, other English-speaking patients, and patients with language barriers by 2019. Screening for men remained relatively low, and for every 100 women screened for depression, 87 men were likely to be screened for depression.

“Our study is the largest since 2016, when the US Preventive Services Task Force recommended that adult patients be screened for depression, and the first to investigate patient predictors of screening,” said first study author Maria E. Garcia, MD, MPH, MAS, assistant professor in the UCSF Division of General Internal Medicine and the Department of Epidemiology and Biostatistics, in a press release. “Because depression impacts so many other chronic diseases, implementation of routine depression screening could also improve patient outcomes for complications from other conditions.”

The data showed that the average age of the patients was 49 years. Additionally, 59% of the patients were female, 43% English-speaking and White, 25% English-speaking and Asian, 9% Latino, 7% Black, 1.4% Pacific Islander, 0.3% American Indian/Alaskan Native, and 5.5% were patients with language barriers. There was missing or unknown data for race and ethnicity for 9% of the English-speaking patients.

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