Radically different
WASHINGTON — Last week, Sen. Ben Ray Luján (D-N.M.) asked health secretary Robert F. Kennedy Jr. whether he would release — by Friday — the contract of a longtime vaccine critic who was hired by the Department of Health and Human Services.
“Yeah, I’m happy to,” Kennedy responded.
But Friday came and went without a response from Kennedy. On Monday, Luján’s office said they plan to follow up with HHS.
Background: The Sustainable Development Goals (SDGs) aim to eradicate poverty and inequality while ensuring that all individuals enjoy good health. Among these, target 3.1 seeks to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. However, progress toward this target has been limited, particularly in low- and middle-income countries (LMICs), where health care delivery remains constrained by limited resources. While digital innovations have increasingly been adopted to improve health care access and service delivery, a significant proportion of populations in LMICs continues to experience inadequate access to essential maternal health services. This gap underscores the need for affordable, sustainable, and contextually appropriate strategies that are cost-effective in improving maternal health outcomes in underserved communities. Objective: This study leverages the principles of frugal innovation and information and communication technologies for development (ICT4D) to propose a frugal-oriented ICT4D framework to deliver low-cost digital maternal health solutions in LMIC settings. The framework seeks to optimize the use of available resources, foster equitable access to maternal health care, and contribute toward achieving SDG 3, particularly target 3.1. Methods: The study was conducted in both rural and urban-poor settings in Kenya using a 2-phased quantitative approach. In phase 1, eight theoretical themes relevant to maternal health uptake were explored. These themes were represented on color-coded sorting cards, which participants ranked according to perceived importance. Phase 2 involved administering structured survey questionnaires to collect empirical data. The study included a total of 32 participants, whose insights provided a foundation for analyzing the significance of contextual factors influencing maternal health service utilization. Results: The weighted scores for 3 of the 8 predetermined theoretical themes—such as resources, information services, and social support programs—emerged as the most influential factors shaping maternal health promotion (N=32). Resources ranked highest (n=6, 18.81%), followed by information services (n=6, 17.99%), while social support programs accounted for 9.64% (n=3) of the overall influence. These findings highlight critical enablers and barriers within the maternal health care landscape and provide a nuanced understanding of contextual dynamics that affect the uptake of maternal health services. The results informed the design of a frugal-oriented ICT4D framework that prioritizes low-cost digital interventions tailored to resource-limited settings. Conclusions: Despite increasing recognition of digital innovations as tools for health care transformation in LMICs, adoption of existing capital-intensive solutions remains low due to financial and infrastructural constraints. This study emphasizes the importance of adopting frugal innovation and ICT4D principles in designing low-cost, scalable digital health interventions to improve access to maternal health care. Implementing such approaches can address resource limitations, enhance maternal health outcomes, and support progress toward SDG 3, particularly target 3.1. The proposed framework provides a foundation for future research and practical interventions aimed at sustainable, equitable maternal health service delivery in LMIC contexts.
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Background: Long-term care facilities are increasingly caring for persons living with dementia as this population grows. Frontline care workers provide most hands-on support, yet they often have limited access to formal dementia education and training. Traditional training formats frequently fail to support experiential learning or accommodate the linguistic, cultural, and demographic diversity of the long-term care workforce. Objective: This mixed methods pilot study examined the effects of the combined use of online learning, immersive virtual reality (VR) simulation, and facilitated group discussions on the training and preferred learning formats. In particular, this study tested whether training based on relationship-centered care (eg, emphasizing the importance of mutual respect, empathy, and shared humanity) in care relationships embodied in the immersive VR simulation allows staff to experience dementia-related cognitive and sensory changes from the perspective of persons living with dementia. Methods: A total of 21 certified nursing assistants from 1 US nursing home participated in a 3-month mixed methods intervention. Empathy and knowledge were measured using pre- and postintervention standardized tests; qualitative feedback was collected through open-ended surveys and group discussions. Results: Participants were predominantly female, Black certified nursing assistants with approximately 68% reporting 8 years or more of care experience. Among the 76.2% (16/21) of the participants who completed the pre- and postintervention surveys, empathy scores increased from pretest (mean 5.31, SD 0.74) to posttest (mean 5.51, SD 0.61). The mean difference of 0.20 (SD 0.43) did not reach statistical significance (=1.88; =.08), but the effect size was moderate (Cohen =0.47, 95% CI −0.03 to 0.43). Dementia knowledge scores also increased from pretest (mean 5.50, SD 2.37) to posttest (mean 5.94, SD 2.11), with a mean difference of 0.44 (SD 1.63), which was not statistically significant (=1.07; =.30), and demonstrated a small effect size (Cohen =0.27, 95% CI −0.43 to 1.31). Qualitative findings revealed that participants perceived the VR training as engaging and emotionally impactful. Participants described reframing their understanding of dementia, reporting reduced stigma and increased empathy toward persons living with dementia. Many noted that experiencing dementia-related symptoms through VR helped them better understand residents’ behaviors and respond with greater compassion. Participants expressed a strong preference for immersive VR and facilitated group discussions over online modules, and cultural differences in the VR scenarios were not perceived as barriers to learning. Conclusions: While preliminary, these findings suggest that combining relationship-centered care with immersive VR may enhance empathy and engagement among staff, particularly when paired with facilitated discussion and plain language explanations. This multimodal model appears particularly valuable for supporting empathic learning within diverse and experienced workforces. Larger, multisite studies with sustained follow-up are needed to determine long-term effects and optimize training for linguistically and culturally diverse workforces.
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Background: Depression is the most common mental health disorder worldwide and frequently leads to workplace absence. As face-to-face treatment can be difficult to access, app-based interventions are a popular solution, although their effectiveness in working populations and their mechanisms of action are unclear. Deficits in executive function may contribute to the onset and maintenance of depression, and executive function training is proposed to improve symptoms by enhancing executive function. Responders to cognitive behavioral therapy (CBT) show improvements in executive function, suggesting that this may be one mechanism of action. Objective: This study investigated the effectiveness of app-based interventions (executive function or CBT-based) for reducing depressive and anxiety symptoms and improving workplace well-being, and assessed whether changes in executive function mediated improvements. Methods: A total of 228 participants (147 female participants) with mild-to-moderate symptoms of depression and anxiety were recruited online and randomly assigned to a waitlist control group, an executive function training group (NeuroNation app, Synaptikon GmbH), or a self-guided CBT group (Moodfit app, Roble Ridge LLC) for a 4-week intervention period. Participants assigned to the active intervention groups were asked to use their apps a minimum of 21 times during the intervention. Participants completed measures of depressive symptoms, anxiety symptoms, and workplace well-being, and a working memory task at baseline, postintervention, and follow-up (12 weeks). Results: Executive function training reduced anxiety (β=−2.79; =.004) and depressive (β=−2.77; =.02) symptoms at follow-up but not at postintervention, and it did not affect workplace well-being. There were no reductions in depressive or anxiety symptoms in the self-guided CBT group, though workplace well-being was improved at postintervention (β=3.72; =.02) and follow-up (β=4.46; =.02). Improvements in executive function did not mediate intervention-related changes in symptoms or workplace well-being. Self-reported adherence rates were high (executive function training: 48/54, 89%; self-guided CBT: 52/54, 96%), although attrition was high at follow-up (58% missing). Conclusions: These results suggest that app-based executive function training may be effective at managing symptoms of anxiety and depression in a working population, while self-guided CBT apps may improve workplace well-being. However, improving executive function did not appear to be a mechanism of action of either intervention. Trial Registration: ISRCTN 12730006; https://www.isrctn.com/ISRCTN12730006
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Bone loss related to obesity is partly caused by changes inside the bone marrow fat compartment that reshape immune signaling and increase osteoclast formation, according to researchers at the MaineHealth Institute for Research. In a study published in Bone Research, the team found that expansion of bone marrow adipose tissue in obese people changes the marrow environment toward immunosuppression through PD-L1 signaling, which in turn promotes bone-resorbing osteoclast activity that reduces bone volume.
“We discovered that bone marrow fat is not simply a passive tissue but actively reshapes immune signaling in ways that accelerate bone loss in obesity,” said senior author Clifford J. Rosen, MD, senior scientist at the MaineHealth Institute for Research.
The team noted that obesity influences bone health not just due to a higher body weight but also by altering the bone marrow environment. The increase in bone marrow fat promotes immunosuppressive PD-L1 signaling, which enhances osteoclast formation and accelerates bone loss.
The study identified a pathway in which bone marrow adipocytes increase expression of MCP-1, a signaling molecule that recruits myeloid immune cells. These recruited cells shift toward a PD-L1–expressing phenotype, with PD-L1 interacting with PD-1 receptors, which are found not only on T cells but also on osteoclast precursors. In immune biology, PD-1/PD-L1 signaling is typically known for suppressing T-cell activation and promoting immune braking. This new study shows that this same form of suppressive signaling also directly enhances osteoclast differentiation.
According to the study results, as PD-L1+ myeloid cells accumulate, they suppress T-cell activity in bone marrow, creating an immunosuppressive environment. At the same time, PD-L1 engagement with PD-1 on osteoclast precursors promotes their maturation into active osteoclasts, which break down bone tissue, increase resorption and reduce bone density.
To learn more about this mechanism, the investigators used diet-induced obese mouse models, co-culture systems, and genetic depletion approaches. An important model in this work were mice lacking bone marrow adipocytes, which allowed the researchers to isolate the role of marrow fat. The team also blocked PD-1/PD-L1 signaling during early osteoclast formation in vitro. In both cases, osteoclast differentiation decreased and bone structure improved. The mice lacking bone marrow adipocytes showed fewer PD-L1+ myeloid cells, fewer PD-1+ osteoclast precursors, and higher trabecular bone volume even under high-fat diet conditions.
Earlier research has shown a link between obesity and bone loss, but studies reported trabecular bone loss without cortical effects, while others found no significant bone changes under diet-induced obesity. The MaineHealth team noted that these earlier studies often focused on shifts in osteoblast activity as opposed to their approach which identified a pro-osteoclastic mechanism driven by immune signaling.
In addition, the Maine Health finding also added to evidence that has established that obesity is associated with impaired immune responses, including reduced vaccine effectiveness and altered macrophage activity. In this study, the marrow environment in obese mice resembled features seen in tumor-associated immune suppression, where PD-L1 expression is elevated and immune activity is dampened. The researchers wrote that “the increase in PD-L1 expression seen in OB-HFD mice is related to the increase in Mcp-1 in part because previous cancer research has suggested the recruitment of myeloid cells via Mcp-1 creates an immunosuppressive tumor microenvironment.”
The findings suggest potential strategies for preserving bone bones in obese people by targeting bone marrow adiposity or the PD-1/PD-L1 pathway. Because PD-1/PD-L1 inhibitors are already used in oncology, there is a compelling case for repurposing or adapting immune checkpoint modulation therapies already approved for cancer treatment for bone disorders linked to metabolic disease. The authors also noted another strategy could be to reduce the amount of bone marrow fat itself to restore immune balance and limit osteoclast-driven bone loss.
The post PD-L1 Inhibitors for Cancer Treatment Could Be Repurposed to Treat Bone Loss in Obesity appeared first on Inside Precision Medicine.
An early stage clinical study shows removing a protein known as soluble Fms-like tyrosine kinase 1 (sFlt-1) from the blood of pregnant women with early stage, severe preeclampsia seems to help both mothers and babies with no significant side effects.
The treatment, which involved filtering the patient’s blood through a machine to remove the harmful protein, reduced blood pressure and allowing pregnancies to continue for around 10 extra days.
Up to 5% of pregnancies in the U.S. are affected by preeclampsia, a condition where a woman develops high blood pressure during pregnancy, and organs like the kidneys, liver, or brain can also be affected. It can be life threatening in some cases and there are currently no available treatments, so the only real option is to deliver the baby, which can cause problems for the baby if delivered preterm.
The single exact cause of preeclampsia is unknown, but most evidence points to problems with how the placenta and its blood vessels develop early in pregnancy, which then triggers widespread damage in the mother’s blood vessels. Women with preeclampsia seem to have high levels of sFlt-1 in their blood and research suggests it binds and neutralizes VEGF and PlGF, key proteins that normally help keep blood vessels healthy and relaxed.
In this study, published in Nature Medicine, the researchers tested whether filtering the blood of women with early onset preeclampsia (at 24-32 weeks gestation) to remove the excess sFlt-1 protein could help improve their symptoms and prolong pregnancy.
This was an early stage study to check safety and tolerability and included 16 women in total. Seven women were in an initial group to test the safety of the filtering process and to assess how much protein could be removed. This showed the treatment was safe and well tolerated with no major side effects observed.
The second group of nine women had several treatments and the researchers looked at how effective the treatment was in this group. In the second group, the women’s symptoms improved; blood pressure went down by 4.1 mmHg on average and pregnancy was extended by 3-19 days (median 10 days).
“Even a few extra days in the womb can make a meaningful difference in outcomes for premature infants,” said co-lead study author Ananth Karumanchi, MD, professor of medicine and director of the Renovascular Research Center at Cedars-Sinai, in a press statement. “We found a way to potentially buy that time safely. Our approach could shift how we manage very early preeclampsia.”
The researchers acknowledge the treatment needs to be tested further but are hopeful it could be a good treatment option for women with this condition in the future, particularly as it does not involve introducing a drug or therapy into the body and therefore reduces the risk of side effects for both mother and baby.
The post Removing Harmful Protein from Blood Helps Women with Preeclampsia appeared first on Inside Precision Medicine.
The Trump administration is doubling down on its opposition to harm reduction services for people who use illicit drugs.
In an open letter on April 24, the federal agency overseeing addiction and mental health policy warned its grantees against using federal funds to buy harm reduction supplies including sterile syringes and pipes, or to distribute test strips for common drug supply adulterants like fentanyl, xylazine, and medetomidine.
