Research Recap: July 5 - July 16
A new biweekly overview of recent studies published by Institute investigators and their collaborators brings a wide variety of topics and research methods.
Topics include: COVID-19 (effects of delays in breast cancer screening and treatment; vaccinations; data collection and validation; effects of hospital surges on mortality); pediatrics (assessing the effectiveness of emerging technologies; the effects of obesity on acute respiratory illness; and epigenetics); diagnostic coding transitions; advocating for clearer drug labeling; and recreational cannabis laws.
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Assessing the feasibility and generalizability of a mobile app for capturing supplemental data during pregnancy
A new study in Pharmacoepidemiology and Drug Safety co-authored by Jeffrey Brown used the FDA MyStudies mobile application to conduct a pilot study to determine the feasibility and generalizability of capturing health data not routinely captured in electronic health records. Using app-based surveys, they learned health conditions and medication and substance use of the population enrolled. The team concluded that mobile apps may be a feasible tool, but more research is needed to determine whether pregnant women willing to use a mobile app may differ from the general pregnant population.
Institute Investigator(s): Jeffrey Brown
Looking beyond the randomized trial: novel approaches for pediatric assessing screening tests
The number of screening tests for children has rapidly grown over the years. While the potential benefit is great, these tests must be assessed for efficacy and subsequent treatment. Randomized trials would be the ideal method of assessment but may not be feasible or provide the timely results needed to inform clinicians and parents. A new article in Pediatrics, led by Ann Wu, reviews innovative methods to assess screening tests without the time burden of RCTs. This paper discusses possible novel methods for assessment of screening tests, offering potential for identifying and addressing differences in access to screening and effectiveness of screening across population groups and communities.
Institute Investigator(s): Ann Wu
Epigenetics: using RNA molecules as the window into allergic asthma
Allergic asthma, the most common type of asthma, has increased in recent years. Exposure to pollen allergens triggers or exacerbates allergic asthma, and seasonal variation in this exposure can lead to seasonal increases in exacerbations. Interestingly, MicroRNAs (miRs), small non-coding RNA molecules, have been shown to be core regulators of inflammatory processes. A new study in Allergy, Asthma, and Immunology Research co-authored by Sharon Lutz examined the association of circulating miRs from asthmatic children with seasonal variation in allergic inflammation and asthma symptoms. From the 398 samples used, the team found 52 unique miRs and 81 differently expressed miRs across the four seasons. Two were found to be significantly associated with seasonal asthma and allergy symptoms. Further research is needed to determine whether they are drivers or results of allergic response.
Institute Investigator(s): Sharon Lutz
A link between COVID-19 surges with increased mortality in patients
How did COVID-19 caseload surges in hospitals affect survival rates? A new retrospective cohort study in Annals of Internal Medicine co-authored by Chanu Rhee examined the association between hospitals' severity-weighted COVID-19 caseload and COVID-19 mortality risk and identify effect modifiers of this relationship. The team looked at cases of COVID-19-coded adult patients admitted between March and August 2020, discharged by October 2020. They found that though survival improved between March and August 2020, surges in caseload may have hindered benefits gained from emerging treatments. They suggest that upping preventing measures and supporting hospitals facing surges will greatly improve COVID-19 mortality.
Institute Investigator(s): Chanu Rhee
Advocating for clearer, more consistent cancer drug labeling
Cancer treatment decisions are often guided by overall survival (OS) – how long patients live after treatment. However, a recent study in JAMA Internal Medicine led by former Institute fellow Huseyin Naci and investigator Anita Wagner showed wide variations in how this information is reported on cancer drug labels. Of 125 indications examined, 18% displayed evidence of overall survival benefit; 32% of drugs showing OS did not explicitly state the benefit; and 45% of indications without evidence of OS did not state the lack of benefit. The authors advocate for consistency in communication, and for labelling to spell out what is known or not known at the time of issue for providers to have a clear picture of how well the drugs work and what remains unanswered.
Institute Investigator(s): Anita Wagner
Recreational cannabis laws: a potential harm reduction tool to address the opioid epidemic?
Recreational cannabis laws (RCLs) have been shown to be a potential harm reduction tool to address the opioid epidemic, but it is unclear whether they are an effective policy tool to reduce adverse opioid-related outcomes. A team including faculty member Hefei Wen and former research fellow Jiebing Wen published a new study in Health Economics that focuses on opioid emergency department (ED) visit rates as one key opioid-related adverse health outcome. They found that, two quarters after implementation of RCLs, ED visit rates were down by roughly 7.6%, primarily driven by men and adults aged 25-22 – effects that then diminish after 6 months. They conclude that, while RCLs do not increase opioid-related ED visits and appear to offer some help in helping restrain the opioid epidemic, they are not a cure-all.
Institute Investigator(s): Hefei Wen
The ambiguity behind defining sepsis: COVID edition
Defined as “life-threatening organ dysfunction resulting from a dysregulated host response to infection”, sepsis has long often been an ambiguous term. A new editorial in Critical Care Medicine discusses the growing consensus that “sepsis” is an appropriate label for SARS-COV-2-associated organ dysfunction and comments on a study by Karakike et al, published in the same issue of the journal.
Examining possible links between maternal insulin resistance and offspring inflammation at birth and 5 years of age
Maternal insulin resistance is associated with greater maternal inflammation during pregnancy, but its relation to inflammation in offspring remains unclear. A team including research fellow Sabrina Faleschini and faculty member Marie-France Hivert examine 653 mother–child pairs from the prospective pre-birth Gen3G cohort. They found that greater maternal insulin resistance during pregnancy was associated with lower cord blood TNFα levels in newborns, though the mechanisms by which maternal insulin resistance may promote lower inflammatory levels in newborns are not currently fully understood. The study appears in Cytokine.
Eight reasons mandating the COVID-19 vaccine for health care workers is more critical than the influenza vaccine
Michael Klompas has spent much of his time during the pandemic on the front lines treating patients but also evaluating how to best keep healthcare workers safe as the body of knowledge of COVID evolved. In a new Ideas and Opinions piece in Annals of Internal Medicine, he and colleagues support the notion of making SARS-COV-2 vaccines mandatory for healthcare workers, comparing against the mandating of influenza vaccines 15 years ago. Though a hotly debated topic, the team discusses eight reasons in favor of a mandate, arguing their belief that the case is significantly stronger than was the case for mandating influenza vaccines. Reasons include the mortality rate and post-COVID-19 symptoms, threat to essential workers’ lives, common transmission by asymptomatic and presymptomatic individuals, the need to protect patients, the safety and efficacy of the vaccines, and COVID’s disruption of the hospital operations community and workforce overall.
Institute Investigator(s): Michael Klompas
Buyer beware: with a new, comprehensive electronic health records database
In a new Invited Commentary published in JAMA Network Open, Jeffrey Brown and colleagues discuss the National COVID Cohort Collaborative (N3C) database, a large-scale centralized resource that aggregates electronic health record (HER) data for COVID-19+ patients from multiple health systems across the country. The authors acknowledge the great feat of creating such a database and laud its transparency; however, they caution that the challenges of EHR-based research must be consistently minded and the N3C data be viewed with caution in order to get the most beneficial use.
Institute Investigator(s): Jeffrey Brown
Projecting the impact of delayed breast cancer screening propagated by COVID-19
Pandemic-associated disruptions in cancer screenings may have long-lasting impacts without intervention. Using established Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer models, a new study in Journal of the National Cancer Institute senior-authored by Natasha Stout projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. The team found that early pandemic-related disruptions in breast cancer care (mammography, symptomatic cancer diagnosis, reduced chemotherapy for early-stage disease) will have a small long-term cumulative impact on breast cancer mortality. Though small, efforts to minimize further delays can help reduce the impact.
Institute Investigator(s): Natasha Stout
Code switching: evaluating the effects of transitioning diagnostic coding systems
A new study in Pharmacoepidemiology & Drug Safety co-authored by Darren Toh sought to evaluate the effect of transitioning a diagnostic coding system on identifying common conditions recorded in Taiwan’s national claims database. The team conducted an interrupted time series analysis of the estimated 3-month prevalence of recorded diagnosis of 32 conditions based on the ICD-9-CM codes in 2014–2015 and the ICD-10-CM codes in 2016–2017. They found that less than half of the 32 conditions studied had a smooth transition between the ICD-9-CM and ICD-10-CM coding systems.
Institute Investigator(s): Darren Toh
Does obesity/overweight affect health-related quality of life or outcomes in children hospitalized with asthma or pneumonia?
Pediatric obesity has been shown to have adverse effects on respiratory health. To determine obesity’s potential effects on health-related quality of life (HRQOL) and hospital outcomes for children hospitalized with asthma or pneumonia, a team including Davene Wright evaluated 716 children, 1 in 3 were classified as having overweight or obesity (11.4% and 19.3% respectively. Among the children in the study, obesity alone does not appear to be associated with worse HRQOL at presentation, length of hospital stay, 2-6 weeks after discharge, or 30-day reuse. Results were published in Hospital Pediatrics.
Institute Investigator(s): Davene Wright
Monitoring vaccine coverage to identify–and address–disparities
A new Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) co-authored by Katherine Yih uses data from CDC’s Vaccine Safety Datalink (VSD) to assess disparities in vaccination coverage among persons aged ≥16 years by race and ethnicity during December 14, 2020–May 15, 2021. Their assessment shows disparities in vaccine coverage among ethnic groups, primarily in non-Hispanic Black and Hispanic populations. They posit that continued monitoring, coupled with efforts to address inequities in vaccine coverage will be critical in helping to end the COVID-19 pandemic.
Institute Investigator(s): Katherine Yih
INVESTIGATORSJeffrey Brown, Ann Chen Wu, Sharon Lutz, Chanu Rhee, Anita Wagner, Hefei Wen, Michael Klompas, Marie-France Hivert, Sabrina Faleschini, Maryam Asgari, Natasha Stout, Sengwee Darren Toh, Davene Wright, Katherine Yih