Posts tagged with "JAMA"

Take cover: Are face shields even better than masks at preventing COVID-19 infection?

June 8, 2020

If you wear a face mask when you leave your home, you’re probably not doing it out of a sense of style Masks are awkward and uncomfortable, and they can be difficult to use correctly: If they aren’t applied and removed with clean hands, they can actually transmit infection rather than prevent it, Self magazine reports.

A growing number of researchers think there’s a better way. Face shields—which cover a person’s face with a clear curved plastic panel—are more comfortable, easier to put on and take off, reusable, and simple to clean.

But most importantly, “we feel face shields are far more effective,” Eli Perencevich, M.D., a professor of Internal Medicine and Epidemiology at the University of Iowa Carver College of Medicine, recently told Self in an interview. In April, Dr. Perencevich published a commentary in JAMA in favor of face shields with two of his colleagues.

Research on face shields is limited but promising. In a 2014 Journal of Occupational and Environmental Hygiene study, researchers at the National Institute for Occupational Safety and Health placed a face shield on a breathing robot and had another robot 18 inches away “cough out” flu virus. The shield prevented the breathing robot from inhaling 96% of the virus within five minutes. In additional tests, the shield’s effectiveness varied based on the size of droplets expelled, but the overall indication was that shields can protect their wearers from other people’s germs.

No studies have yet addressed whether face shields protect other people from your germs, however, and this makes some scientists wary. “We don’t have the research to say that they will offer protection for those around you, should you be sick,” Saskia Popescu, Ph.D., an infection prevention epidemiologist at George Mason University, tells Self.

But face shield proponents argue that based on the laws of physics, shields will likely protect others. Everything that flies out of your mouth is “going forward, and it’s hitting a giant piece of plastic,” Dr. Perencevich says. “It just physically can’t go through.”

Dr. Perencevich and others are now designing studies to help address this issue, but he says it’s difficult for research like this to get funded. “We’re more interested as a society in treatment than we are in prevention,” Michael Edmond, M.D., a hospital epidemiologist at the University of Iowa Carver College of Medicine, who co-authored the JAMA commentary with Dr. Perencevich, said in an interview with the magazine. “There’s never money to do this kind of work. It’s never been prioritized.”

Some people are skeptical of shields because they are open on the sides and bottom. But these openings may not pose much of a problem. Research suggests that the coronavirus usually spreads via large droplets expelled out of a person’s mouth or nose, which are pulled down by gravity within a radius of six feet. (Hence the six-foot rule.) Shields prevent close-by expelled viruses from hitting another person’s face before they fall.

To get in through the shield’s openings, the virus would need to linger around in the air in smaller particles known as aerosols and eventually meander around the shield’s sides. But “the patterns of spread of [COVID-19] suggest that aerosol is unusual,” David Fisman, M.D., an Infectious Disease epidemiologist at the University of Toronto, believes. Some studies have found that the virus can linger in the air, but epidemiological findings—such as surprising data suggesting that people often do not get sick even when other members of their household have the coronavirus—suggest that aerosol transmission is uncommon.

Still, for those who are concerned about the potential role of aerosols, or who might be at high-risk for complications from the coronavirus, one solution might be to wear shields and masks at the same time, suggests William Lindsley, Ph.D., a bioengineer with the National Institute for Occupational Safety and Health, who co-authored the 2014 robot coughing study. When robots wore both shields and masks in his study, the shields blocked 97%t of the virus from landing on the masks, keeping them much cleaner.

Research contact: @SELFmagazine

‘A distinctly American phenomenon’: Our workers die younger than those in other wealthy nations

November 27, 2019

Americans work hard and die young, according to findings of a study conducted at Virginia Commonwealth University.  In fact, the engine that powers the world’s most potent economy is succumbing at an alarming pace—a “distinctly American phenomenon’’ with no easily discernible cause or simple solution, USA Today reported on November 26.

Specifically, researchers determined that mortality rates for U.S. adults ages 25-64 continue to increase—driving down the general population’s life expectancy for the three consecutive years following 2014.

The report, Life Expectancy and Mortality Rates in the United States, 1959-2017,’’ was published on November 26  in the Journal of the American Medical Association (JAMA).

According to USA Today, it paints a bleak picture of a workforce plagued by drug overdoses, suicides, and organ-system diseases while grappling with economic stresses.

“This looks like an excellent paper—just what we needed to help unravel the overall decline in life expectancy in the United States’’ said Eileen Crimmins, the AARP Professor of Gerontology at the University of California-Leonard Davis. She’s who’s an expert on the link between health and socioeconomic factors.

In a trend that cuts across racial and ethnic boundaries, America has the worst midlife mortality rate among 17 high-income countries despite leading the world in per-capita spending on health care.

And while life expectancy in those other industrialized nations continues to inch up, ours has been going in the opposite direction—decreasing from a peak of 78.9 years in 2014 to 78.6 in 2017, the last year covered by the report.

By comparison, the news outlet reports, according to the Peterson-Kaiser Health System Tracker, the average longevity in similar countries is 82.2 years. Japan’s is 84.1; France’s, 82.4;and Canada’s, 81.9. They left the United States behind in the 1980s and increased the distance as the rate of progress in this country diminished and eventually halted in 2011.

Steven Woolf, director emeritus of the Virginia Commonwealth University Center on Society and Health and the study’s lead author, said the reasons for the decline go well beyond the lack of universal health care in America—in contrast with those other nations—although that’s a factor.

“It would be easier if we could blame this whole trend on one problem, like guns or obesity, or the opioid epidemic—all of which distinguish [the U.S.] from the other countries,’’ Woolf told USA Today. “But we found increases in death rates across 35 causes of death.’’

They were most pronounced in the industrial Midwest, the 13 Appalachian states, and upper New England, which Woolf attributed partly to the decline in manufacturing jobs and the opioid epidemic.

Of the top 10 states with the highest number of excess deaths in the 25-64 age range —meaning deaths above projections based on U.S. mortality rates—eight were in the Rust Belt or Appalachia. Half of the excess deaths were concentrated in the latter region. The Ohio Valley—comprising Indiana, Kentucky, Ohio, and Pennsylvania—accounted for one-third.

“Not only are employers more likely to see premature deaths in their workers, but also greater illness rates and greater disability, and that puts U.S. businesses at a disadvantage against businesses in other countries that have a healthier and more productive workforce,’’ Woolf said, adding that employers here are already saddled with high health care costs.

The report showed mortality rates among those younger than 25 and older than 64 have decreased. That might point a finger at the country’s dysfunctional health care system for working adults, because many in those other age groups can be covered by either the Children’s Health Insurance Program (CHIP) or Medicare.

Woolf told USA Today that he disputes that notion, saying only 10% to 20% of health outcomes can be attributed to medical care. He said the bigger culprit is a lack of social programs and support systems more common in other wealthy countries for when working families run into difficult times.

Those rough spells, often associated with a job loss, can lead to the kind of unhealthy behaviors – drug and alcohol abuse, smoking, overeating, suicide attempts—that result in what have become known as “deaths of despair.’’

“We’re making a huge mistake if we don’t step back and look at the root causes,’’ Woolf told the news oulet—ncluding a lack of educational opportunities and living wages among the likely causes. “The prescription for the country is we’ve got to help these people. And if we don’t, we’re literally going to pay with our lives.’’

Research contact: @USATODAY