The study targeted patients with blood pressure higher than 140/90 mmHg who were receiving care in clinics specializing in kidney conditions. The ConnectedCare365 Hypertension Management program provided people in central and northeast Pennsylvania communities with remote blood-pressure monitoring and other devices that transmit information to doctors. Patients were identified and enrolled through a centralized monitoring center, known as ConnectedCare365, to ensure consistent messaging and ample education on the devices and patient communication application. Doctors and pharmacists assigned by the program co-managed patient care and helped adjust medications for patients.

“In our study, we developed a program that builds off what others have done using telemonitoring and pharmacists,” said senior study author Alexander Chang, M.D., M.S., a nephrologist and associate professor in the department of nephrology and the department of population health sciences at Geisinger Health in Danville, Pennsylvania. “By deploying these extra resources to get blood pressure under control in high-risk patients and reducing hospitalizations, we are hoping that we can help provide more justification in expanding these types of programs.”

Notifications from the home blood pressure-monitoring devices were transmitted to the central monitoring center. During the first six months of the program, the notifications were first transmitted to doctors in collaboration with pharmacists through a virtual platform that connected to patients’ phones through an app, which connected to the devices over Bluetooth. Blood pressure measurements were assessed and blood pressure medications were prescribed and/or adjusted accordingly. During the second six months, the notifications were transmitted first to pharmacists, who co-managed blood pressure through a collaborative telehealth practice agreement. While patients were enrolled in the program, they also had real-time access to a nurse during business hours through a live chat feature in the central monitoring center.

Study results include:

• 67% of patients were able to achieve blood pressure control of <140/90 mm Hg at six months, and 74% of patients were able to achieve blood pressure control by 12 months. The 2017 clinical guideline from the American Heart Association and the American College of Cardiology set the threshold for stage 1 hypertension at 130/80 mm Hg and the threshold for stage 2 hypertension at 140/90 mm Hg.
• Systolic blood pressure was lowered by an average of 3.3 mm Hg/month for those with initial blood pressure readings greater than 150/90 mm Hg; lowered by 2.4 mmHg/month for those with initial readings in the range of 140-149/90-99 mm Hg; and lowered by 0.6 mm Hg/month for those with initial readings lower than 140/90 mm Hg.
• Pharmacist telehealth encounters, in which the patients talked directly with pharmacists about hypertension management, were documented in 65% of patients, and pharmacist interactions were associated with a 1.3 mm Hg/month decline in systolic blood pressure over time.
• During the 12-month study period, 46% of patients had a blood pressure medication adjustment, and 37% were prescribed new blood pressure medication.
• Patients experienced fewer hospitalizations during the study period compared to the previous 12 months; however, there was no difference in the number of reported emergency department visits.

“We know that home blood pressure monitoring can be done by patients accurately and can really help engage patients in their own health. However, we also know that these self-measured blood pressure readings often do not make it back to patients’ health care team, therefore, delays in adjusting medications are very common. This type of physician-pharmacist collaborative model with home blood pressure monitoring that is centrally received and monitored by the care team can help address these issues,” Chang said.

Study background and details:

• The study included 205 adults, with an average age of 62 years; 48% self-identified as women and 52% as men.
• 87% of participants self-identified as non-Hispanic white adults, 6% as Black adults; 5% as Hispanic adults, and 1.5% as “other” for race/ethnicity.
• 53% of participants had a diagnosis of chronic kidney disease at the time of enrollment.
• Participants’ blood pressure was tracked for up to 6-12 months between March 2022 and May 2024 with consistent improvements even after participation in the study ended.

The study’s strengths included its ability to review hospitalization data, inclusion of the pharmacists, the careful examination of the pharmacists’ role in this program and that it was conducted in a real-world setting, the authors noted. The study’s limitations included that patients were their own control group to determine the impact of the program and participants had to have internet access.

“This is an important program that allows for more efficient management of a high-risk patient group,” said Wanpen Vongpatanasin, M.D., FAHA, professor in the department of internal medicine at UT Southwestern Medical Center, director of UT Southwestern Medical Center’s Hypertension Section in the division of cardiology and clinical chair of the Hypertension Scientific Sessions 2024 Executive Committee. “This program’s team-based care approach including a pharmacist remotely makes it a feasible option to increase access. In addition, the study’s findings signal a way to reduce hospitalization and to improve blood pressure, which is very encouraging.”

Note: Moderated Poster Presentation MP11 in Session MPS02 New Paradigm and Lessons learn from Hypertension Clinical Trials in 2024 is Friday, September 6, 2024 at 9:35 a.m. CT.

The study targeted patients with blood pressure higher than 140/90 mmHg who were receiving care in clinics specializing in kidney conditions. The ConnectedCare365 Hypertension Management program provided people in central and northeast Pennsylvania communities with remote blood-pressure monitoring and other devices that transmit information to doctors. Patients were identified and enrolled through a centralized monitoring center, known as ConnectedCare365, to ensure consistent messaging and ample education on the devices and patient communication application. Doctors and pharmacists assigned by the program co-managed patient care and helped adjust medications for patients.

“In our study, we developed a program that builds off what others have done using telemonitoring and pharmacists,” said senior study author Alexander Chang, M.D., M.S., a nephrologist and associate professor in the department of nephrology and the department of population health sciences at Geisinger Health in Danville, Pennsylvania. “By deploying these extra resources to get blood pressure under control in high-risk patients and reducing hospitalizations, we are hoping that we can help provide more justification in expanding these types of programs.”

Notifications from the home blood pressure-monitoring devices were transmitted to the central monitoring center. During the first six months of the program, the notifications were first transmitted to doctors in collaboration with pharmacists through a virtual platform that connected to patients’ phones through an app, which connected to the devices over Bluetooth. Blood pressure measurements were assessed and blood pressure medications were prescribed and/or adjusted accordingly. During the second six months, the notifications were transmitted first to pharmacists, who co-managed blood pressure through a collaborative telehealth practice agreement. While patients were enrolled in the program, they also had real-time access to a nurse during business hours through a live chat feature in the central monitoring center.

Study results include:

• 67% of patients were able to achieve blood pressure control of <140/90 mm Hg at six months, and 74% of patients were able to achieve blood pressure control by 12 months. The 2017 clinical guideline from the American Heart Association and the American College of Cardiology set the threshold for stage 1 hypertension at 130/80 mm Hg and the threshold for stage 2 hypertension at 140/90 mm Hg.
• Systolic blood pressure was lowered by an average of 3.3 mm Hg/month for those with initial blood pressure readings greater than 150/90 mm Hg; lowered by 2.4 mmHg/month for those with initial readings in the range of 140-149/90-99 mm Hg; and lowered by 0.6 mm Hg/month for those with initial readings lower than 140/90 mm Hg.
• Pharmacist telehealth encounters, in which the patients talked directly with pharmacists about hypertension management, were documented in 65% of patients, and pharmacist interactions were associated with a 1.3 mm Hg/month decline in systolic blood pressure over time.
• During the 12-month study period, 46% of patients had a blood pressure medication adjustment, and 37% were prescribed new blood pressure medication.
• Patients experienced fewer hospitalizations during the study period compared to the previous 12 months; however, there was no difference in the number of reported emergency department visits.

“We know that home blood pressure monitoring can be done by patients accurately and can really help engage patients in their own health. However, we also know that these self-measured blood pressure readings often do not make it back to patients’ health care team, therefore, delays in adjusting medications are very common. This type of physician-pharmacist collaborative model with home blood pressure monitoring that is centrally received and monitored by the care team can help address these issues,” Chang said.

Study background and details:

• The study included 205 adults, with an average age of 62 years; 48% self-identified as women and 52% as men.
• 87% of participants self-identified as non-Hispanic white adults, 6% as Black adults; 5% as Hispanic adults, and 1.5% as “other” for race/ethnicity.
• 53% of participants had a diagnosis of chronic kidney disease at the time of enrollment.
• Participants’ blood pressure was tracked for up to 6-12 months between March 2022 and May 2024 with consistent improvements even after participation in the study ended.

The study’s strengths included its ability to review hospitalization data, inclusion of the pharmacists, the careful examination of the pharmacists’ role in this program and that it was conducted in a real-world setting, the authors noted. The study’s limitations included that patients were their own control group to determine the impact of the program and participants had to have internet access.

“This is an important program that allows for more efficient management of a high-risk patient group,” said Wanpen Vongpatanasin, M.D., FAHA, professor in the department of internal medicine at UT Southwestern Medical Center, director of UT Southwestern Medical Center’s Hypertension Section in the division of cardiology and clinical chair of the Hypertension Scientific Sessions 2024 Executive Committee. “This program’s team-based care approach including a pharmacist remotely makes it a feasible option to increase access. In addition, the study’s findings signal a way to reduce hospitalization and to improve blood pressure, which is very encouraging.”

Note: Moderated Poster Presentation MP11 in Session MPS02 New Paradigm and Lessons learn from Hypertension Clinical Trials in 2024 is Friday, September 6, 2024 at 9:35 a.m. CT.

The international CLARIFY registry (prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) assessed the impact of smoking status on cardiovascular events in patients with coronary artery disease. The registry included 32,378 patients with the condition. The occurrence of a major adverse cardiovascular event (MACE), defined as cardiovascular death or myocardial infarction during the 5-year follow-up period, was analysed.

Patients were included in the study at an average of 6.5 years after their coronary artery disease diagnosis: at inclusion, 13,366 patients (41.3%) had never smoked, 14,973 (46.2%) were former smokers and 4,039 (12.5%) were current smokers. Among the former smokers who smoked at the time of coronary artery disease diagnosis, 72.8% discontinued smoking within the following year, while only 27.2% quit in subsequent years. “Interestingly, the first year after diagnosis was the crucial window for quitting. At the time of diagnosis, we should emphasise the importance of quitting and support patients in this challenge,” said study author, Dr. Jules Mesnier of Hospital Bichat-Claude Bernard, Paris, France.

Patients who quit smoking after coronary artery disease diagnosis significantly improved their cardiovascular outcomes regardless of when they quit, with a 44% reduction in the risk of MACE (adjusted hazard ratio [HR] 0.56; 95% confidence interval [CI] 0.42–0.76; p<0.001). Among smokers who reduced the amount smoked, the risk of MACE was not significantly altered compared with smokers who did not change their smoking habits (adjusted HR 0.96; 95% CI 0.74–1.26; p=0.78). The risk of MACE after a coronary artery disease diagnosis increased by 8% for each additional year of active smoking (adjusted HR 1.08; 95% CI 1.04–1.12 per year). Although smokers who quit smoking achieved a rapid significant reduction in risk of MACE compared to smokers, they never achieved the cardiovascular risk level of patients who never smoked, even after years of smoking cessation.

Dr. Mesnier concluded: “I like to tell my patients that it is never too soon or too late to stop smoking, though the sooner a patient stops, the better to lower cardiovascular risk. And it is not enough to reduce smoking. Short, clear messages are needed for smokers at every medical intervention highlighting the need to quit. Telling patients they can cut their risk of a subsequent major event or death by half – as we have shown here – is a powerful message.” Measures to promote smoking cessation include brief advice, counselling and behavioural interventions, as well as pharmacological therapy.2

References and notes

1The abstract “Trajectories in smoking habits and outcomes in patients with stable coronary artery disease” will be presented at the session ‘Epidemiology and risk factors in cardiovascular disease’, which takes place on Friday 30 August 2024 at 11:35 BST at Station 3.

2Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227–3337.

COPD comprises several conditions, including chronic bronchitis and emphysema, and can be caused by irritants like smoke or pollution and genetics. The disease affects more than 30 million Americans, yet awareness of the disease’s symptoms, methods to reduce risk, and disease management remains poor. Symptoms, which include breathlessness, fatigue, and chronic cough, are primarily treated using inhaled medications.

In a new study, “Prevalence of Critical Errors and Insufficient Peak Inspiratory Flow in Patients Hospitalized With COPD in a Department of General Internal Medicine: A Cross-Sectional Study,” the authors examined how often inhalers were misused by patients hospitalized with COPD over the course of nine months at Fribourg Hospital in Switzerland.

Inhaler misuse was categorized as either a critical error in inhalation technique or insufficient peak inspiratory flow. These errors result in a lesser dose of medication reaching the person’s lungs, which impacts the person’s ability to manage their symptoms and can lead to increased exacerbations.

“Misuse of inhalers is common, and in our study, we found that approximately two-thirds of inhalers were misused,” said Gaël Grandmaison, M.D., an assistant physician in internal medicine at University and Hospital of Fribourg in Fribourg, Switzerland. “If an inhaler was misused, a physiotherapist conducted up to three teaching sessions with the patient. These sessions helped reduce the number of critical errors in inhaler use. However, despite this education, more than one in 10 inhalers continued to be used suboptimally, either due to an inability to generate sufficient inspiratory effort or because the inhaler was unsuitable for the patient’s characteristics. These results highlight the importance of regular therapeutic education, assessing the patient’s ability to generate a sufficient inspiratory effort, and selecting an inhaler suited to the patient’s characteristics.”

In a perspective article, “Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly,” the author discusses the decreased effectiveness of inhaled medications as the result of inhaler misuse (often due to intricacies and multiple steps required to use the inhaler) and the high cost of inhaler-based therapies. The author also highlights several advances in inhaler use, including the ability to combine therapies and to choose the right inhaler based on patient-centered decisions.

“Education is key to increasing the effectiveness of inhaled medications, and many clinicians – and often even the patients themselves – are unaware that patients are having difficulty getting enough medication into their lungs,” said Valerie G. Press, M.D., MPH, an associate professor of medicine at the University of Chicago. “Additional inhaler technique education is needed to ensure patients are using the device correctly, especially when multiple inhaled medications are prescribed. Additional education, supported by the necessary resources, would help ensure patients are receiving optimal treatment and avoiding adverse health outcomes.”

To access current and past issues of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, visit journal.copdfoundation.org.

Knowledge of cooling centers in the case of extreme heat

Although the locations of cooling centers, or indoor air-conditioned facilities such as libraries, community and senior centers, schools are publicized by city governments on hot days, many of those surveyed report being unaware of where to find one. Two-thirds of respondents (67%) say they do not know the location of a cooling center to which they could go to in case of extreme heat, a number statistically unchanged from last November. “Communities must do a better job of making the public, especially the most vulnerable, aware of these centers,” said Ken Winneg, managing director of survey research at APPC.

More today see link between extreme heat and climate change.

When compared with an APPC survey in November 2023, significantly more people now say that climate change is increasing the risk of heat-related illnesses, respiratory diseases, and insect-borne diseases. Two-thirds (67%) hold this view vs. just under 6 in 10 (58%) in November 2023.

More people indicate that heat waves in the United States are becoming more frequent and intense than in the past. About two-thirds (65%) believe heat waves are becoming more frequent and intense. Fifty-eight percent (58%) felt this way in November 2023, when we last asked the question. About a quarter (24%) believe heat waves are about as frequent and intense as they have always been, statistically unchanged from our earlier survey.

At the same time, the proportion of people who say extreme heat has often or frequently affected their typical daily activities in the past year has increased significantly. Forty-three percent (43%) say extreme outdoor heat has often (22%) or frequently (21%) affected their daily activities, an 8-point increase compared with November 2023 (35% in total said either “often” or “frequently”).

Signs of heat-related illnesses

Notably, most people also know three of the telltale signs of heat-related illnesses:

• Dizziness (89% compared to 86% in August 2022)
• Nausea (83% compared to 79% in August 2022)
• Hot, red, dry, or damp skin (72%, statistically unchanged from August 2022)
• Cold, pale, and clammy skin (42%, statistically unchanged from August 2022).

Public understands some extreme heat risks better than others

Thinking about the next 10 years, just under 6 in 10 (58%) think that people in their community will be more likely to experience heat stroke caused by extreme heat waves. This is significantly higher than in November 2023 when just over half (52%) said they thought people in their community would be more likely to experience heat stroke caused by extreme heat waves in the next 10 years.

However, only 3 in 10 (30%) know that a pregnant person in the U.S. who is exposed to extreme heat is more likely to deliver their baby early than a pregnant person who is not exposed to extreme heat. About a quarter (23%) incorrectly say that a pregnant person in the U.S. is either less or just as likely to deliver a baby early. Forty-seven percent (47%) are unsure which is correct.

Broad awareness that heat-related deaths are most common among seniors

Two-thirds (67%) know that heat-related deaths are most common among older adults, aged 65 or older, slightly but significantly higher than in August 2022 (62%).

Preventing heat-related illnesses

Nearly all (92%) know that drinking water is better to prevent heat-related illnesses than drinking sugary drinks.

APPC’s ASAPH survey

The survey data come from the 20^th wave of a nationally representative panel of 1,496 U.S. adults, first empaneled in April 2021, conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. This wave of the Annenberg Science and Public Health Knowledge (ASAPH) survey was fielded July 11-18, 2024, and has a margin of sampling error (MOE) of ± 3.6 percentage points at the 95% confidence level. All figures are rounded to the nearest whole number and may not add to 100%. Combined subcategories may not add to totals in the topline and text due to rounding.

Download the topline and methodology statement.

The policy center has been tracking the American public’s knowledge, beliefs, and behaviors regarding vaccination, Covid-19, mpox, flu, maternal health, climate change, and other consequential health issues through this Annenberg Science and Public Health (ASAPH) knowledge survey panel for over three years. In addition to Winneg, the APPC team includes senior data analyst Laura Gibson; research analyst Shawn Patterson Jr. and Patrick E. Jamieson, director of the Annenberg Health and Risk Communication Institute.

The Annenberg Public Policy Center was established in 1993 to educate the public and policy makers about communication’s role in advancing public understanding of political, science, and health issues at the local, state, and federal levels.

“People visit their pharmacists up to eight times more often than their physicians. Pharmacists have long-term trusted relationships with the people who come to them for medication and advice on the medications they take,” says Sandhu, first author and principal investigator. “Also, access to a pharmacist may be easier for many people than access to a family physician, especially for people in remote communities.”

The research team worked with pharmacists in 27 communities across Alberta who are specially trained in Afib and to prescribe blood thinners. The pharmacists recruited 80 patients over the age of 65 with one additional stroke risk factor such as diabetes, high blood pressure or heart failure and known, untreated Afib (no blood thinner or suboptimal dose of blood thinner) or performed screening to detect previously undiagnosed Afib.

“We set up heart health stations in participating pharmacies where people could check their blood pressure and heart rhythm using a mobile electrocardiogram (ECG), a digital tool that provides a read out of your heart rhythm. The heart rhythm readings were sent to two cardiologists for analysis,” says Miriam Fradette, co-investigator and pharmacist. “When the cardiologists confirmed an irregular rhythm, the person was booked for another ECG through the health-care system and their doctor was notified.”

Study participants were randomized into two groups; one group was identified as the early intervention group and continued consulting with the pharmacist, the other group was advised to speak with their family doctor and their doctor was notified of the Afib diagnosis. After three months, if the second group had not seen their physician, the pharmacist worked with them directly, and kept the physician looped in. Both groups were followed for a year.

“The findings show allowing trained community-based pharmacists to prescribe to this group increased the number of at-risk individuals taking optimal stroke-preventing blood thinners by 34 per cent,” says Sandhu. “I knew there would be a difference between the groups, but I didn’t realize how large it would be. This collaborative care model which leverages the expertise of pharmacists could have far-reaching impact in addressing the large number of people who remain untreated or undertreated for Afib and who are at risk of stroke particularly since several countries have moved toward pharmacist prescribing independently or through collaborative practice agreements.”

Findings are published in JAMA Open Network.

Sandhu adds it is important that the infrastructure exists where pharmacists can perform patient assessments; order and interpret labs; initiate, adjust, and monitor drug therapy; access electronic health records; and work in a collaborative care model with physicians.

“The results of this study offer an innovative solution to increase the uptake of evidence-based anticoagulant therapy to prevent stroke in patients with atrial fibrillation,” says Dr. Jeff Healey, cardiologist and co-investigator. “This study is the culmination of a multi-year, cross-Canada collaboration initiated by the Canadian Stroke Prevention Intervention Network (CSPIN).”

This study was funded by the  Heart & Stroke Foundation of Canada, Canadian Stroke Prevention Intervention Network, University Hospital Foundation at the University of Alberta, Canadian Institutes of Health Research, National Institute on Aging, and in-kind support from AliveCor. The Epidemiology Coordinating and Research (EPICORE) Centre at the University of Alberta supported the study design and data collection. Statistical support was provided by the Alberta Strategy for Patient-Oriented Research SUPPORT Unit.

Along with UCalgary researchers, the team included clinicians, scientists, pharmacists and co-investigators from the University of Alberta (UAlberta), Canadian VIGOUR Centre, University of Toronto, and McMaster University.

More than two-thirds of those people take a type of blood thinner called a direct oral anticoagulant. DOACs, such as rivaroxaban (brand name Xarelto) and apixaban (brand name Eliquis), are under- or over-prescribed in up to one in eight patents.

These prescribing issues can have life threatening consequences, and they most often occur after a provider writes the initial prescription, according to a study led by Michigan Medicine.

“Direct oral anticoagulants may be viewed as simpler to manage than traditional blood thinners, like warfarin, but our results highlight why providers need to be consistently monitoring anticoagulant medications before a patient experiences thrombotic or bleeding harms,” said Geoffrey Barnes, M.D., M.Sc., senior author and associate professor of cardiology-internal medicine at U-M Medical School.

At hospitals across Michigan, off-label dosing of DOACs was relatively common among patients being treated for atrial fibrillation and venous thromboembolism, when blood clots form in the veins.

Researchers evaluated five years of prescribing data from 2018-2022 through the Michigan Anticoagulant Improvement Initiative, a statewide quality improvement collaborative funded by Blue Cross Blue Shield and Blue Care Network of Michigan.

Nearly 70% of the alerts to off-label dosing occurred during a follow up visit compared to the time of the initial prescription, according to results published in Thrombosis and Haemostasis.

When prescribers were contacted about the dosing issue, they made changes three-quarters of the time.

However, only 18% of dosing alerts resulted in contact to a prescriber.

“While many clinical decision support tools are designed to ensure accurate medication dosing at the time of an initial prescription, few address the need for ongoing monitoring,” said first author Grace C. Herron, a fourth-year student at U-M Medical School.

“Any health system that aims to improve safe and effective DOAC prescribing must address the ongoing prescribing period which can last months to years.”

Direct oral anticoagulants became available in 2010 and quickly gained popularity because, unlike conventional blood thinners, they do not require routine monitoring to test their effectiveness.

However, these medications have their own complicated dosing schemes that can vary based on factors such as kidney function and select interactions between drugs.

“The hospital systems in the Michigan Anticoagulation Quality Improvement Initiative are leading national efforts to develop, implement and test anticoagulation stewardship teams that ensure patients are always receiving the safest and most appropriate blood thinner possible,” Barnes said.

“The nurses and pharmacists on these teams play a critical role in helping to monitor for any prescription issue that might develop, even months or years after a patient starts on a blood thinner medication.”

Additional authors: Deborah DeCamillo, R.N., B.S.N., Xiaowen Kong, M.A., Brian Haymart, R.N., M.S., James B. Froehlich, M.D., M.P.H., all of University of Michigan, Scott Kaatz, D.O., M.S.C., Stacy Ellsworth, R.N., M.S.N., both of Henry Ford Health, Mona A. Ali, Pharm.D., of Corewell Health William Beaumont University Hospital, and Christopher Giuliano, Pharm.D., M.P.H., of Wayne State University and Ascension St. John Hospital.

Funding: Funding for this study was provided by the Agency for Healthcare Research and Quality (R18HS026874). Blue Cross Blue Shield of Michigan and Blue Care Network provided funding for data abstraction and statistical analysis as part of the BCBSM Value Partnership program.

Disclaimer: Although Blue Cross Blue Shield of Michigan and the Michigan Anticoagulation Quality Improvement Initiative work collaboratively, the opinions, beliefs and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees.

Paper Cited: “Timing of Off-Label Dosing of Direct Oral Anticoagulants in Three Large Health Systems,” Thrombosis and Haemostasis. DOI: 10.1055/a-2365-8681

The study, published today in the journal Nature Communications, tested an OHSU-developed vaccine platform against the virus considered most likely to trigger the next pandemic.

Researchers reported the vaccine generated a robust immune response in nonhuman primates that were exposed to the avian H5N1 influenza virus. But the vaccine wasn’t based on the contemporary H5N1 virus; instead, the primates were inoculated against the influenza virus of 1918 that killed millions of people worldwide.

“It’s exciting because in most cases, this kind of basic science research advances the science very gradually; in 20 years, it might become something,” said senior author Jonah Sacha, Ph.D., professor and chief of the Division of Pathobiology at OHSU’s Oregon National Primate Research Center. “This could actually become a vaccine in five years or less.”

Researchers reported that six of 11 nonhuman primates inoculated against the virus that circulated a century ago — the 1918 flu — survived exposure to one of the deadliest viruses in the world today, H5N1. In contrast, a control group of six unvaccinated primates exposed to the H5N1 virus succumbed to the disease.

Sacha said he believes the platform “absolutely” could be useful against other mutating viruses, including SARS-CoV-2.

“It’s a very viable approach,” he said. “For viruses of pandemic potential, it’s critical to have something like this. We set out to test influenza, but we don’t know what’s going to come next.”

A senior co-author from the University of Pittsburgh concurred.

“Should a deadly virus such as H5N1 infect a human and ignite a pandemic, we need to quickly validate and deploy a new vaccine,” said co-corresponding author Douglas Reed, Ph.D., associate professor of immunology at the University of Pittsburgh Center for Vaccine Research.

Finding a stationary target

This approach harnesses a vaccine platform previously developed by scientists at OHSU to fight HIV and tuberculosis, and in fact is already being used in a clinical trial against HIV.

The method involves inserting small pieces of target pathogens into the common herpes virus cytomegalovirus, or CMV, which infects most people in their lifetimes and typically produces mild or no symptoms. The virus acts as a vector specifically designed to induce an immune response from the body’s own T cells.

This approach differs from common vaccines — including the existing flu vaccines — which are designed to induce an antibody response that targets the most recent evolution of the virus, distinguished by the arrangement of proteins covering the exterior surface.

“The problem with influenza is that it’s not just one virus,” Sacha said. “Like the SARS-CoV-2 virus, it’s always evolving the next variant and we’re always left to chase where the virus was, not where it’s going to be.”

The spike proteins on the virus exterior surface evolve to elude antibodies. In the case of flu, vaccines are updated regularly using a best estimate of the next evolution of the virus. Sometimes it’s accurate, sometimes less so.

In contrast, a specific type of T cell in the lungs, known as effector memory T cell, targets the internal structural proteins of the virus, rather than its continually mutating outer envelope. This internal structure doesn’t change much over time — presenting a stationary target for T cells to search out and destroy any cells infected by an old or newly evolved influenza virus.

Success with a century-old template

To test their T cell theory, researchers designed a CMV-based vaccine using the 1918 influenza virus as a template. Working within a highly secure biosafety level 3 laboratory at the University of Pittsburgh, they exposed the vaccinated nonhuman primates to small particle aerosols containing the avian H5N1 influenza virus — an especially severe virus that is currently circulating among dairy cows in the United States.

Remarkably, six of the 11 vaccinated primates survived the exposure, despite the century-long period of virus evolution.

“It worked because the interior protein of the virus was so well preserved,” Sacha said. “So much so, that even after almost 100 years of evolution, the virus can’t change those critically important parts of itself.”

The study raises the potential for developing a protective vaccine against H5N1 in people.

“Inhalation of aerosolized H5N1 influenza virus causes a cascade of events that can trigger respiratory failure,” said co-senior author Simon Barratt-Boyes, Ph.D., professor of infectious diseases, microbiology and immunology at Pitt. “The immunity induced by the vaccine was sufficient to limit virus infection and lung damage, protecting the monkeys from this very serious infection.”

By synthesizing more up-to-date virus templates, the new study suggests CMV vaccines may be able to generate an effective, long-lasting immune response against a wide suite of new variants.

“I think it means within five to 10 years, a one-and-done shot for influenza is realistic,” Sacha said.

The same CMV platform developed by OHSU researchers has advanced to a clinical trial to protect against HIV, and a recent publication by those scientists suggests it may even be useful targeting specific cancer cells. The HIV clinical trial is being led by Vir Biotechnology, which licensed the vaccine platform from OHSU.

Sacha sees the development as the latest in the rapid advance of medical research to treat or prevent disease.

“It’s a massive sea change within our lifetimes,” Sacha said. “There is no question we are on the cusp of the next generation of how we address infectious disease.”

In addition to OHSU, research institutions involved in the study included the Tulane National Primate Research Center, the University of Pittsburgh, the University of Washington, and the Washington National Primate Research Center at the UW.

In the interest of ensuring the integrity of our research and as part of our commitment to public transparency, OHSU actively regulates, tracks and manages relationships that our researchers may hold with entities outside of OHSU. In regard to this research, OHSU and OHSU faculty involved in this research, including Jonah Sacha, Ph.D., have a significant financial interest in VIR Biotechnology Inc., a company that may have a commercial interest in the results of this research and technology.

All research involving animal subjects is reviewed and approved by a university’s Institutional Animal Care and Use Committee (IACUC). The IACUC’s priority is to ensure the health and safety of animal research subjects. The IACUC also reviews procedures to ensure the health and safety of the people who work with the animals. The IACUC conducts a rigorous review of all animal research proposals to ensure they demonstrate scientific value and justify the use of live animals.

The research was supported by the Bill & Melinda Gates Foundation Grand Challenges grant awards OPP1213553 and National Institute of Allergy And Infectious Diseases of the National Institutes of Health award R01AI40888; with support from the Office of the Director of the National Institutes of Health award P51OD011092 to the Oregon National Primate Research Center at OHSU. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation or the National Institutes of Health.

IMAGE: JONAH SACHA, PH.D., SENIOR CO-AUTHOR OF A STUDY PUBLISHED TODAY IN THE JOURNAL NATURE COMMUNICATIONS, SAYS THE RESEARCH COULD LEAD TO A UNIVERSAL INFLUENZA VACCINE WITHIN FIVE YEARS.

view more CREDIT: OHSU/CHRISTINE TORRES HICKS

The study, published in JAMA Network Open and funded by Cancer Research UK, looked at blood tests and survey data for 1,777 children aged three to 11 in the United States.

The researchers said that second-hand exposure to harmful substances in e-cigarettes would likely be much lower still, as e-cigarettes deliver similar levels of nicotine to tobacco but contain only a fraction of the toxicants and carcinogens.

The researchers looked at nicotine absorption in children, but they said the findings were likely to be similar for adults.

Lead author Dr Harry Tattan-Birch, of the UCL Institute of Epidemiology & Health Care, said: “Our study shows, using data from the real world rather than an artificial lab setting, that nicotine absorption is much lower from second-hand vapour than from second-hand smoking.

“Nicotine itself is of limited risk, but it shows what the highest possible exposure might be from second-hand vaping. Exposure to harmful non-nicotine substances present in vapour will likely be substantially lower still.”

Senior author Professor Lion Shahab, of the UCL Institute of Epidemiology & Health Care, said: “This paper suggests that concerns about second-hand vaping may be somewhat overstated, with second-hand exposure to toxic substances likely to be very low.

“The findings confirm the risks of smoking indoors around children, which should be avoided at all costs. However, as second-hand vaping still exposes children to more harmful substances than no vaping or smoking exposure at all, it is best to avoid indoor vaping around children, too.”

The study used data from a nationally representative sample of children in the US, collected between 2017 and 2020 as part of the annual US National Health and Nutrition Examination Survey (NHANES).

Blood tests that detected the concentration of cotinine were used to assess how much nicotine the children had absorbed. Cotinine is a chemical the body produces after exposure to nicotine. Survey responses indicated if the children had been exposed to smoking or vaping indoors in the past week.

The researchers focused on data from children as, unlike adults, children were unlikely to have vaped or smoked themselves, meaning higher nicotine absorption was a result of second-hand vapour or smoke only. However, two children were excluded from the analysis for having a cotinine concentration that suggested they had vaped or smoked directly. Children exposed to both indoor smoking and vaping were also excluded from the analysis.

The team found that children exposed to indoor vaping absorbed 84% less nicotine than children exposed to indoor smoking, while children exposed to neither absorbed 97% less.

The lower levels of nicotine among those exposed to second-hand vaping were consistent with previous laboratory studies finding that people retained 99% of the nicotine they produced during vaping. With tobacco cigarettes, smoke is generated both by smokers breathing out as well as by the lighted end of the cigarette. E-cigarettes, however, do not generate aerosol aside from when vapers exhale.

The researchers said their findings had implications for whether vaping should be allowed indoors, providing further evidence that the impact of vaping on bystanders’ health will be much less than smoking.

However, the researchers said there were other factors to consider when assessing whether indoor spaces should be made vape-free. In particular, if vaping commonly occurs indoors, this may normalise the behaviour, encouraging people to start vaping and making it harder for them to stop.

Previous research from the same team showed that adults in England were much more likely to vape than smoke indoors, with nine in 10 vapers found to vape inside, while only half of smokers smoked inside.

A global spike in temperatures has increased the likelihood of frequent and intense heatwaves. Previous research on the impact of these changes has revealed that extreme heat disproportionately affects vulnerable groups such as children, the elderly, individuals with chronic health conditions, and those in the low-income group. Despite these observations, however, there are limited studies on the impact of high temperatures on the health of people with disabilities.

To better understand the impact of extreme heat on public health, especially on vulnerable population like people with disabilities, the researchers examined the association between heat and patient admissions in the emergency department. Their study, published in the journal The Lancet Planetary Health, reveals disparities in admissions and medical expenses for individuals with disabilities and those without disabilities.

The researchers examined the health records of 59,527 beneficiaries with disabilities and 1,060,797 beneficiaries without disabilities from the Korean National Health Insurance Service–National Sample Cohort database. They examined the link between short-term exposure to hot temperatures and admissions to the emergency department (ED) in hospitals during warm seasons (June to September) between January 1, 2002, to December 31, 2019.

The study covered four types of disabilities — physical, brain lesion disorders, vision, and hearing impairments — and examined hospitalisations for cardiovascular, genitourinary, mental, and respiratory diseases.

The findings revealed that exposure to heat increased the risk of hospitalisations among individuals with disabilities, especially due to the occurrence of mental and respiratory diseases. In addition, individuals with brain lesion disorders and severe physical disabilities, females, and those older than 65 years were more vulnerable to the effects of heat exposure.

Overall, these results suggest that people with disabilities faced a 1.07 times higher risk, with a four-fold increase in ED admissions and seven times higher medical costs, compared to those without disabilities.

The number of people with disabilities is expected to rise with increases in population ageing and non-communicable diseases. In this context, the findings of this study highlight the need for well-informed public health policies to support and address the specific needs of this group, the scientists said.

‘There are still a limited number of guidelines against climate change in the context of people with disabilities,’ Dr Whanhee Lee, Pusan National University. ‘Our study sheds light on the importance of considering population with disabilities while developing guidelines against climate change.

People with chronic migraine who overused pain medication had fewer monthly migraine and headache days and fewer days using pain medication when taking the migraine prevention drug atogepant.

“There is a high prevalence of pain medication overuse among people with migraine as they try to manage what are often debilitating symptoms,” said study author Peter J. Goadsby, MD, PhD, of King’s College London and a member of the American Academy of Neurology. “However, medication overuse can lead to more headaches called rebound headaches, so more effective preventive treatments are needed. Our findings are encouraging, suggesting atogepant may help reduce the need for pain medication among people with chronic migraine.”

The study involved 755 participants who had chronic migraine, defined as having 15 or more headache days per month with eight or more qualifying as migraine.

Of this group, 66% met the criteria for medication overuse defined as taking pain medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for 15 or more days in a month, triptans or ergots for 10 or more days a month, or any combination for 10 or more days.

At the start of the study, average monthly migraine days ranged from 18 to 19, and average monthly pain medication days ranged from 15 to 16.

For 12 weeks, participants were either given 30 milligrams (mg) of atogepant twice daily, 60 mg once daily, or a placebo. Atogepant is a calcitonin gene-related peptide receptor antagonist, or CGRP inhibitor. CGRP is a protein that plays a key role in starting the migraine process.

Participants recorded their migraines and headaches in an electronic diary, noting characteristics including duration and intensity, whether they experienced aura or nausea, and if they took other medications.

Researchers found for participants with medication overuse, those taking atogepant twice daily had an average of three fewer migraine days a month and three fewer headache days when compared to those taking placebo. Those taking the drug once a day had two fewer migraine days a month and two fewer headache days compared to placebo. Both groups also had three fewer days of taking pain medications to treat their symptoms when compared to placebo. Researchers say similar reductions were found among participants without medication overuse.

In those with medication overuse, 45% of those taking the drug twice daily and 42% of those taking it once a day had a 50% or more reduction in average monthly migraine days compared to 25% taking the placebo.

The number of people meeting the criteria for medication overuse also declined by 62% among those taking the drug twice daily and by 52% among those taking it once a day.

“Based on our findings, treatment with atogepant may potentially decrease the risk of developing rebound headache by reducing the use of pain medications,” said Goadsby. “This could lead to an improved quality of life for those living with migraine.”

Goadsby noted more studies are needed to evaluate the long-term safety and effectiveness of atogepant, as well as to assess the potential risk of medication overuse relapse among people with migraine.

A limitation of the study was that participants recorded their headaches and medication use in electronic diaries, so it is possible some participants may not have recorded all information accurately.

The study was funded by AbbVie, the maker of atogepant. Goadsby reported that he received personal fees from AbbVie during the study.

Many adults in the United States take multivitamins with the hope of improving their health. However, the benefits and harms of regular multivitamin use remain unclear. Previous studies of multivitamin use and mortality have yielded mixed results and been limited by short follow-up times.

To more deeply explore the relationship between long-term regular multivitamin use and overall mortality and death from cardiovascular disease and cancer, the researchers analyzed data from three large, geographically diverse prospective studies involving a total of 390,124 U.S. adults who were followed for more than 20 years. The participants included in this analysis were generally healthy, with no history of cancer or other chronic diseases.

Because the study population was so large and included lengthy follow-up and extensive information on demographics and lifestyle factors, the researchers were able to mitigate the effects of possible biases that may have influenced the findings of other studies. For example, people who use multivitamins may have healthier lifestyles in general, and sicker patients may be more likely to increase their use of multivitamins.

The analysis showed that people who took daily multivitamins did not have a lower risk of death from any cause than people who took no multivitamins. There were also no differences in mortality from cancer, heart disease, or cerebrovascular diseases. The results were adjusted for factors such as race and ethnicity, education, and diet quality.

The researchers noted that it is important to evaluate multivitamin use and risk of death among different kinds of populations, such as those with documented nutritional deficiencies, as well as the potential impact of regular multivitamin use on other health conditions associated with aging.

Who: Erikka Loftfield, Ph.D., M.P.H., Division of Cancer Epidemiology and Genetics, National Cancer Institute

The Study: “Multivitamin Use and Mortality Risk in 3 Prospective US Cohorts” appears June 26, 2024, in JAMA Network Open.