Aislinn Antrim, Associate Editor

New research from Baycrest Foundation suggests that the gut microbiome plays a role in how diet and exercise affect brain health and dementia risk. The findings could help experts optimize strategies to prevent dementia, according to the study authors.

Lifestyle interventions to reduce risk of dementia often include diet and exercise, which in turn affect the gut microbiome.

“We know that imbalances in the microbiome are associated with impaired cognition,” said lead author Noah Koblinsky, an exercise physiologist and project coordinator at Baycrest’s Rotman Research Institute (RRI), in a press release. “However, we don’t know much about the role of the microbiome when we use lifestyle interventions, such as diet and exercise, to support brain health. Can we tailor lifestyle interventions to specifically target the gut microbiome, and will this help to optimize their effects on cognition? In this review study, we aimed to address this gap in knowledge.”

The team reviewed any existing research on diet and exercise interventions that looked at both the microbiome and brain health and published their findings in 

According to the study, the gut microbiome does appear to play a role in how diet and exercise affect brain health, although more research is needed to understand exactly how.

Studies have shown that diets have a significant impact on the microbiome, with a Mediterranean-style diet appearing to have the greatest benefit to a healthy gut microbiome and brain, according to the study. For example, one study with 1200 older adults asked half the participants to follow a Mediterranean-style diet for 12 months, while the other half did not follow this diet. Those in the Mediterranean diet group showed significant improvements in cognition and had healthier microbiomes associated with better brain health.

In another study, investigators used antibiotics to “kill off” the gut microbiome in a sample of rats. They then gave the rats microbiome transplants from rats that had either been fed an unhealthy diet or a healthy diet. According to the study, the researchers found that the rats in the unhealthy diet group showed worse memory performance, as well as inflammation in the intestines and brain.

These findings support the idea that the microbiome plays a role in the way diet impacts brain health. The team found fewer studies examining exercise, but the studies that did suggest that starting exercise, specifically aerobic exercise, can lead to changes in the gut microbiome and brain health at the same time.

After this review of existing research, the team is now launching a randomized controlled trial focused on diet and exercise and are looking to secure funding to include analysis of microbiome changes.

“By better understanding how changes to the gut microbiome affect the relationship between lifestyle and brain health, we can strengthen existing lifestyle interventions and create new strategies to reduce dementia risk, helping older adults everywhere age fearlessly,” said senior author Nicole Anderson, PhD, senior scientist at the RRI, in the press release.

Research suggests gut microbiome plays a role in lifestyle’s effects on dementia risk. News release. Baycrest; October 11, 2022. Accessed October 26, 2022. 

https://www.baycrest.org/Baycrest-Pages/News-Media/News/Research/Research-suggests-gut-microbiome-plays-a-role

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A Mediterranean-style diet appears to provide the greatest benefit to a healthy gut microbiome and brain.

Research Suggests Gut Microbiome Impacts Brain Health, Dementia Risk

A new study suggests that moral values and beliefs have a significant impact on regional disparities in vaccination rates, according to investigators from the University of Southern California who published their research findings in 

Despite the fact that COVID-19 vaccines are safe, effective, and widely available, many Americans are still hesitant. In some counties in the country, nearly all residents are vaccinated, whereas other counties have only a minority of vaccinated residents.

According to a press release, structural barriers such as access to health care, historic under-vaccination rates, and political barriers explained why residents of some counties were less likely to be vaccinated against COVID-19. This finding is in line with what was already known about vaccination behavior. However, the researchers also showed that Americans’ moral values were also an important aspect of understanding the stark disparities.

“If you look at a map of the proportion of vaccinations across US counties, you find very stark differences across counties, across regions, and across states,” said study co-author Nils Karl Reimer, PhD, in the press release. “Our goal is to interrogate why these differences in political ideology coincide with differences in vaccination rates.”

The study utilized moral foundation theory, which argues that there are 5 basic moral foundations: care, fairness, loyalty, authority, and purity. Using data from an online crowd-sourced website that collects a range of psychological data, the researchers estimated county-level moral values and conservatism. This data was combined with county-level vaccination rates from the CDC, the US COVID-19 Vaccine Coverage Index, and presidential election data to control for variables not included in the study.

The analysis found that moral concerns about fairness, loyalty, and purity influenced county-level vaccination rates, but care and authority did not. Counties with residents who prioritized purity were 0.8 times less likely to be vaccinated, and the researchers pointed to previous research showing that “conservatives care more about contamination and things they find disgusting.”

“We found that some values that are traditionally associated with conservatism were associated with lower vaccination rates, the biggest of which was a desire for bodily and spiritual purity,” Reimer said in the press release. “Endorsing these beliefs is related to all kinds of opinions such as being opposed to non-mainstream sexual practices or immigration.”

On the other hand, the investigators found that counties with higher loyalty were 1.14 times more likely to have higher vaccination rates. Or, if loyalty increased while other values remained the same, the vaccination rate could have been expected to rise 3% countywide. Placing a high value on fairness was associated with a 2% increase in vaccination rates in similar conditions.

To verify the accuracy of the model, the researchers compared it against 2 other models, one of which included only structural and demographic predictor variables, and the other in which partisanship was an additional predictor variable. Both models failed to predict county-level vaccination rates as accurately as the third model, which included county-level endorsement of moral concerns.

Although the researchers’ hypotheses were largely borne out in the study, they did see a few surprising trends. Notably, loyalty is typically associated with conservative values, which in turn are associated with vaccine skepticism. However, the study found that loyalty is associated with higher vaccination rates, but only when controlling for the 4 other moral foundations.

“The loyalty finding is quite surprising because there is a lot of rhetoric about anti-vaccination among conservatives. However, what we’re showing is that typical conservatives do not tend to be anti-vaxxers,” said co-author Morteza Dehghani, PhD, in the press release. “The anti-vaxxers tend to be not high on loyalty, but high on purity. These include conservatives who are low on loyalty, and also liberals who tend to prioritize purity concerns, most likely focusing on bodily aspects of purity contamination.”

Although the findings support the idea that county-level moral values can predict COVID-19 vaccination rates, the authors urged policymakers to exercise caution when utilizing the insights. Notably, the results from the county level cannot be extrapolated to smaller (cities, neighborhoods, or individuals) or larger (states) groups.

However, policymakers and public health communicators could use the findings to reframe their public health communications related to COVID-19. The researchers suggest appealing to loyalty concerns by framing vaccination as a patriotic duty to fellow citizens. In regions prioritizing purity, they suggest communications emphasizing the vaccine’s ability to protect from spreading the virus.

“I think a lot of people who are skeptical of vaccination might think of it as a foreign chemical introduced into your body,” Reimer said in the press release. “This sounds very scary, like something you wouldn’t necessarily want to put in your body, but I think framing it in terms of the natural immune system response could resonate with some skeptics. These things are, importantly, mere speculation before further experiments, but our findings could point toward public health messaging that could be tested.”

Moral values explain differences in COVID-19 vaccination rates across US counties. News release. USC News; September 15, 2022. Accessed September 23, 2022. 

https://news.usc.edu/202178/moral-values-explain-differences-in-covid-19-vaccination-rates-across-u-s-counties/

The data showed moral concerns about fairness, loyalty, and purity influenced county-level vaccination rates, but care and authority did not.

Study Suggests Moral Values Predict Regional Differences in COVID-19 Vaccination Rates

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

Racial and ethnic minorities bore a disproportionate mental health burden during the COVID-19 pandemic, according to the authors of a study published in 

During the heights of the pandemic, research established that minority groups were disproportionately impacted by COVID-19 when compared to non-Hispanic whites, including experiencing higher rates of infection, severe disease, hospitalization, and death. Following the pandemic, reports showing a 3-fold increase in the incidence of depression symptoms showed that the pandemic had a significant impact on mental health broadly, but the effects of COVID-19 on the mental health of minorities was not clear based on the data.

In the new study, investigators used data on 691,473 individuals in the United States and United Kingdom who responded to the smartphone-based COVID Symptom Study between January 23, 2021, and June 9, 2021. Recruited through social media, participants reported baseline information before logging daily information on their symptoms and COVID-19 testing results using an app called Zoe.

According to the study, after controlling for personal factors including prior mental health diagnoses and changes in leisure time activities, Black participants in the United States were 1.16 times more likely to screen positive for depression than White participants. Hispanic participants were also 1.23 times more likely to screen positive for depression and 1.23 times more likely to show signs of anxiety compared to White participants.

“The early phase of [the] COVID-19 pandemic was incredibly disruptive to everyday life,” wrote the authors in the study. “We found that racial and ethnic minorities in the US and UK were more likely to screen positive for depression and anxiety.”

Similar results were found for Black and Asian participants in the United Kingdom, as well as those within other participant subgroups, including Black health care workers, who had higher rates of depression and anxiety than White health care workers.

Based on these findings, the authors concluded that minority communities in both the United States and the United Kingdom experience a mental health burden that was disproportionate to other communities during the COVID-19 pandemic. These problems could also last well beyond any presumed conclusion of the pandemic.

“[The findings] suggest a disproportionate impact and mental health burden on persons of color, which need to be considered as we reshape health care systems to prioritize the long-term consequences of this disease,” the authors wrote in the study.

Minorities bore disproportionate mental health impact of pandemic. News release. Science Daily; August 10, 2022. Accessed August 17, 2022. 

https://www.sciencedaily.com/releases/2022/08/220810161148.htm

Research found that Black health care workers had higher odds of depression and anxiety than White health care workers.

Study: COVID-19 Pandemic Disproportionately Impacted the Mental Health of Minority Populations

Retaining staff and facility administrators in long-term care facilities continues to be challenging after the height of the COVID-19 pandemic, despite the importance of care continuity for patients, according to researchers.

The pandemic exacerbated and drew attention to staffing challenges for nursing home residents, their families, and other health care workers in long-term care environments. Further, recruiting and retaining staff have become significant challenges in recent years.

Researchers from the Regenstrief Institute and Indiana University School of Medicine noted that continuity of staff and leadership has been associated with improving quality of resident care in long-term care facilities, including onsite treatment, post-hospital care, assistance with basic care needs, and more. To discuss the issue further, researchers Jennifer L. Carnahan, MD, MPH, and Kathleen Unroe, MD, MHA, wrote an editorial published in the 

Journal of the American Geriatrics Society.

According to Carnahan and Unroe, building trust between patients, their families, and long-term care staff allows residents to feel comfortable with the very personal care that they receive. In addition to focusing on tasks, caregivers in such environments must know and interact personally with residents.

In addition to impacting the trust with patients, staff turnover can affects patients’ families as well. Family members rely on staff to care for their loved ones and keep them apprised of changes to their family members’ health and lifestyle. Changes in patients in long-term care can be subtle, including mood changes, loss of interest in activities, or inability to perform a task that they could previously accomplish, necessitating close attention from long-term care staff.

“Doctors and nurses are obviously important, but it should be recognized that frontline nursing home staff deliver 90% of care and thus are critical to creating a high-quality long-term care system,” Unroe said in a press release. “Everyone agrees we have a recruitment and retention problem. We need to devise incentives to attract and keep people in this workforce who enjoy working with older adults and are well trained, especially in the needs of people with dementia.”

Unroe, a geriatrician and past chair of the American Geriatrics Society Public Policy Committee, currently serves as a member of the technical expert panel of the Centers for the Medicare & Medicaid Services Five-Star Quality Rating System. In the editorial, Unroe said the tool provides more than 100 quality metrics divided into 5 categories: mortality, safety of care, readmission to hospitals, patient experience, and timely and effective care. These measurements allow patients, their families, social services, and others to compare quality of care at facilities.

“We need to prioritize nurturing and supporting staff so that they can deliver the hands-on care nursing home residents require,” Carnahan said in the press release. “Given the importance of continuity to quality of care for this vulnerable population and the current lack of viable solutions to improve staff and leadership recruitment and retention, researchers, in partnership with nursing home operators, must take the lead in developing and testing practical and reproduceable strategies to attract and keep a talented workforce and leadership.”

Staff and facility administrator retention has been challenging for long-term care facilities. News release. Regenstrief Institute; August 4, 2022. Accessed August 10, 2022. 

https://www.regenstrief.org/article/staff-retention-challenging-for-long-term-care-facilities/

Building trust between patients, their families, and long-term care staff allows residents to feel comfortable with the very personal care that they receive.



Staff Retention Continues to Be Challenging in Long-Term Care Facilities

Frequent daytime napping in adults was associated with a 12% higher risk of developing high blood pressure as well as a 24% higher risk of stroke, compared to adults who never take daytime naps, according to a study published in 

For the study, researchers in China examined whether frequent or usual napping could be a potential causal risk factor for high blood pressure or stroke. This was the first study to use observational analysis of participants over a long period of time as well as Mendelian randomization, which is a genetic risk validation, to investigate potential links.

“These results are especially interesting since millions of people might enjoy a regular, or even daily, nap,” said corresponding author E. Wang, PhD, MD, a professor and chair of the department of anesthesiology at Xiangya Hospital Central South University in China, in a press release.

The research team used data from UK Biobank, a large biomedical database and research resource containing anonymized genetic, lifestyle, and health information from more than 500,000 UK participants. The database recruited participants between 40 and 69 years of age who lived in the United Kingdom between 2006 and 2010. They provided regular blood, urine, and saliva samples, as well as detailed lifestyle information. The daytime napping frequency survey occurred 4 times between 2006 and 2019 in a small proportion of UK Biobank participants.

Wang’s research team then excluded records of individuals who had already had a stroke or experienced hypertension before the start of the study. This left approximately 360,000 participants to analyze the association between napping and first-time reports of stroke or high blood pressure, with an average follow-up of about 11 years. Participants were divided into groups based on their self-reported napping frequency, including “never/rarely,” “sometimes,” or “usually.”

According to the study, a higher percentage of the “usual” nappers were men, had lower education and income levels, and reported cigarette smoking, daily drinking, insomnia, snoring, and being an evening person compared to participants who said they never or sometimes napped. Compared to individuals who reported never taking a nap, individuals who usually nap had a 12% higher likelihood of developing high blood pressure and 24% higher likelihood of having a stroke.

Furthermore, participants younger than 60 years of age who usually napped had a 20% higher risk of developing high blood pressure compared to individuals the same age who never napped. After 60 years of age, usual napping was associated with a 10% greater risk of high blood pressure compared to those who reported never napping. Approximately three-fourths of participants remained in the same napping category throughout the study.

Finally, the Mendelian randomization result showed that if napping frequency increased by one category (from never to sometimes, or from sometimes to usually), high blood pressure risk increased by 40%. Higher napping frequency was related to the genetic propensity for high blood pressure risk.

“This may be because, although taking a nap itself is not harmful, many people who take naps may do so because of poor sleep at night,” sleep expert Michael A. Grandner, PhD, MTR, said in the press release. “Poor sleep at night is associated with poorer health, and naps are not enough to make up for that.”

The authors recommended further examination of the associations between a healthy sleep pattern, including daytime napping, and heart health. They also noted that they only collected data on daytime napping frequency, not duration, which could be a limitation.

Additionally, nap frequency was self-reported without any objective measurements, making estimates nonquantifiable. The results also may not be generalizable based on the study population.

“This study echoes other findings that generally show that taking more naps seems to reflect increased risk for problems with heart health and other issues,” Grander concluded in the press release.

Study shows link between frequent naps and high blood pressure. Press release. American Heart Association; July 25, 2022. Accessed August 4, 2022. 

https://newsroom.heart.org/news/study-shows-link-between-frequent-naps-and-high-blood-pressure

Although naps may not be unhealthy, frequent napping could reflect poorer sleep at night.