What is it, and how does it affect mental health?

What is it, and how does it affect mental health?

Over the last several decades, gender roles have evolved and changed to reflect shifting societal norms. Yet, despite these changes, unpaid household labor disparities still exist between partnered men and women worldwide. In this Special Feature, we take an in-depth look at how this unequal division of unpaid work affects women’s mental health and relationships. We also spoke with three experts to gain insight into this global issue.

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Women continue to shoulder the majority of unremunerated tasks. What does this mean for their mental health? Image credit: Juana Mari Moya/Getty Images.

Although gender roles are less rigid than they were decades ago, data suggest that, in heterosexual relationships, the burden of unpaid work still falls on women — even in cohabitating relationships where both partners are employed.

For example, 2021 US Bureau of Labor Statistics data shows that both spouses were employed in 46.8{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of married couple families. Yet statistics also indicate that 59{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of women report doing more household work than their partners.

However, other data suggest that since the mid-1970s, the amount of time men spend on household tasks has doubled. For instance, in 1976, men spent around 6 hours a week on household duties. In 2005, that number increased to around 12.5 hours per week.

But, in those same years, women still spent more time completing unpaid household labor — specifically, around 26 hours per week in 1976 and around 16.5 hours per week in 2005.

Still, the impact unpaid labor inequities may have on women’s mental health is often overlooked.

To examine this further, scientists from the University of Melbourne, Melbourne, VIC, Australia, investigated the relationship between unpaid labor and mental health among employed adults.

Their findings, published in The Lancet Public Health, suggest a negative association between unpaid labor and mental health for employed women. However, the researchers did not find the same associations for working men.

To conduct the research, the scientists reviewed 19 studies with 70,310 total participants from across the globe. Qualifying studies were peer-reviewed and measured the amount of unpaid labor among employed adults. They also outlined associations between this type of work and self-reported mental health concerns, including depression and psychological distress.

After examining the research, the study authors found that women reported taking on more unpaid work regardless of geographical location and time setting. Moreover, this added burden was associated with poorer mental health in women. However, the impact on men was less clear.

In addition, the researchers also found that a 1-hour increase in unpaid work per week led to small but significant changes in mental health status. Furthermore, some studies in the review reported a 0.2–0.4-point rise in depression scores for every 10-hour increase in unpaid labor time.

Although more investigation is needed, the study authors suggest that persistent household labor inequities continue to exist among male and female partners worldwide. And this imbalance exposes women to an increased risk of negative mental health effects.

Study author Jennifer Ervin, a doctoral researcher in the Centre for Health Equity at the Melbourne School of Population and Global Health, told Medical News Today:

“There is no universally recognized term or definition for unpaid labor — also referred to as unpaid work, unpaid care work, domestic labor, or household labor — but it is considered broadly inclusive of all responsibilities and tasks done to maintain a household and its family members without any explicit monetary compensation.”

“So childcare is a big one, and relatedly so is care for people with disability, health conditions or who are elderly. But it also includes domestic work like laundry, food preparation, cleaning, running errands, and outdoor tasks,” she added.

The study authors suggest that a significant unpaid workload combined with the responsibilities of employment may contribute to role overload, conflict, and time scarcity, which can negatively affect mental health.

Additionally, housework is often perceived as mundane, undervalued, or unenjoyable.

However, men may experience less adverse mental health concerns with unpaid labor because of the nature of the tasks.

Ervin explained:

“We know that men commonly do the less time-sensitive jobs within the household, such as outdoor or maintenance tasks. These are referred to in the literature as high-schedule-control tasks — as one has more control over when one undertakes this type of unpaid labor work.”

To clarify further, Ervin said that “a good example is that you can delay mowing the lawn until the weekend, for instance, when you are less time-pressured, whereas you cannot delay feeding a hungry child or driving a dependent to a medical appointment.”

“Outdoor tasks are also theorized to not only be less time-sensitive but may also be more enjoyable and possibly protective than other types of household work,” she added.

Dr. Naomi Murphy, consultant clinical and forensic psychologist and co-founder of Octopus Psychology, told MNT: “Inequality causes anxiety and depression. It creates distance between unequal parties and causes mistrust and resentment. […] It can leave women feeling devalued and resentful of their partner and overwhelmed by the volume of responsibilities they have.”

She also noted that the unequal burden “can lead to feelings of isolation and loneliness within the relationship.”

“If significantly more of the responsibility is shouldered by one person, it can create a sense of overwhelm and a feeling that you can’t meet all your responsibilities; it can also lead to a reduction in confidence,” Dr. Murphy explained.

Household labor disparities between men and women may have resulted from several factors. Ervin suggests that it may be “substantially rooted in historical context and times — when it was normative for women to be homemakers and for men to be breadwinners.”

“Resultantly, there remain deeply entrenched gender roles and social norms around the gendered division of household labor. Unfortunately, despite women entering the paid workforce in unprecedented numbers during the 20th century, there has not been a parallel or remotely equal increase in men’s participation in labor on the home front,” Ervin explained.

Dr. Murphy further noted the intergenerational impact of unpaid labor inequities:

“Families often socialize daughters into helping more with household chores; generations of women have done this, so the patterns are entrenched. As girls are more likely to emulate their female role models, this pattern gets transferred from one generation to the next.”

In addition to mental health harm, ongoing unpaid work inequities may impact personal and professional relationships.

According to Dr. Mark Goulston, psychiatrist and executive coach, and founding member at Newsweek Expert Forum, unpaid labor imbalances “can cause women to feel more overwhelmed, [to] often feel […] that at any moment they are disappointing someone so that if they’re focused on work, they’re neglecting home and children and if they’re focused on home and children, they’re neglecting work.”

He also noted that “women who are exhausted can become impatient with their children and inside feel deep resentment which can cause them to feel shame and that they are an awful mother.”

According to Dr. Murphy, “the loss of confidence created by overwhelm can [also] spill out to professional life.”

Moreover, “the person shouldering the burden of household work may feel anger at their partner for not pulling his weight which can translate into intimacy problems,” she added.

To facilitate changes when experiencing unequal division of household work, Dr. Murphy offered the following suggestions to women:

  • talk with your partner and tell them how you feel before the issue becomes problematic
  • discuss and negotiate a fair division of labor
  • find ways to appreciate each other and remind yourself why you fell in love
  • find ways to value yourself and appreciate yourself
  • consider couples counseling to rekindle closeness, intimacy, and improve communication.

“Try not to criticize how your partner does the contributions they do make – they may not be doing it as fast as you like or in the same way, but criticism is likely to deter them from contributing,” she also advised.

On a larger scale, changing deeply rooted unpaid labor inequities within families may require specific policy changes.

Moving forward, Ervin suggested that “[p]olicies such as universal childcare and normalizing flexible working arrangements and extended paternity leave for men can help in shifting the dial and driving greater gender equality in the division of unpaid labor and unpaid care.”

“Importantly, however, we need to be careful about policies that only target women as this may reinforce gender inequalities,” she emphasized.

“We need to dismantle norms around what it means to be an ideal worker and highlight the importance of gender-neutral approaches to leave and flexible working – accommodating how work integrates with home life for both women and men. This is fundamental to gender equality.”

– Jennifer Ervin

Can monkeypox affect heart health? A case study weighs in

Can monkeypox affect heart health? A case study weighs in

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A new case analyze implies that heart issues could in some cases be a complication ensuing from a monkeypox infection. Style and design by MNT Photography by NIAID, CC BY 2., by means of Wikimedia Commons & PhotoAlto/Frederic Cirou/Getty Visuals.
  • Although monkeypox is largely recognised to trigger blisters and rashes, a new situation report displays that the virus may well also result in coronary heart challenges.
  • A patient with monkeypox had to be admitted to the emergency department 8 times just after his signs and symptoms 1st started.
  • Testing uncovered that the affected person experienced heart irritation, and medical professionals subsequently diagnosed acute myocarditis.

Just as with SARS-CoV-2, the virus that results in COVID-19, as additional time passes and the virus carries on spreading, officials decide up on more possible symptoms and issues monkeypox can lead to.

In a report that appears in JACC: Scenario Studies, scientists covered a case of monkeypox maybe staying joined to acute myocarditis, which takes place when the myocardium — the heart muscle — turns into infected.

Whilst this can most likely be a life threatening condition in a lot more serious conditions, the patient, in this circumstance, designed a entire restoration.

Monkeypox is a zoonotic virus, this means it is a form of virus that can unfold concerning animals and humans. According to the Facilities for Illness Regulate and Avoidance (CDC), monkeypox belongs to the exact same virus spouse and children as the variola virus, which causes smallpox.

Monkeypox has been close to for a long time, but instances had been largely confined to distinctive locations of Africa. Nonetheless, monkeypox started producing news in excess of the earlier number of months when there was an outbreak of the virus that speedily spread exterior Africa.

Considering that then, monkeypox instances have regularly amplified, with the CDC reporting close to 52,000 cases of monkeypox worldwide, like almost 19,500 in the United States. The virus has been related with 15 deaths globally, like a single in Texas last thirty day period.

Some indicators and signs of monkeypox include things like:

  • rash
  • blisters
  • fever
  • chills
  • exhaustion.

Recently, the virus has often unfold through sexual intercourse, but it can also distribute through other types of near contact.

The individual in the situation report sought healthcare therapy after emotion ill for 5 days. In accordance to the authors, the male individual noted indications of “malaise, myalgias, and fever, followed by the eruption of many swollen and umbilicated cutaneous lesions on his confront, hands, and genitalia.”

The 31-yr-previous patient took a PCR examination to confirm the monkeypox prognosis, and then he went household. 3 days later on, the affected individual went to the crisis space simply because he woke up in the course of the night enduring a chest tightness that radiated to his upper remaining arm.

The authors report that the individual still experienced obvious monkeypox blisters at this time, and medical practitioners administered a range of checks to check out for coronary heart challenges.

Just after an ECG showed abnormalities, the providers did bloodwork and found that the patient experienced elevated stages of C-reactive protein, creatine phosphokinase, large-sensitivity troponin I, and brain natriuretic peptide. These precise blood checks indicated a cardiovascular difficulty.

Amongst the abnormalities on the ECG and the irregular blood do the job, the medical professionals performed a cardiac magnetic resonance examine and identified the client with acute myocarditis.

Right after spending a 7 days in the clinic, the client recovered and was discharged.

Even though the individual had a SARS-CoV-2 infection 2 months before contracting monkeypox, the scientists suspect the monkeypox health issues may perhaps have brought about acute myocarditis in this situation.

In accordance to the study authors, “there have been handful of conditions of histologically verified myocarditis, and viral myocarditis brought on right by SARS-CoV-2 has not been definitively verified but assumed simply because of epidemiologic context.”

Given that the individual had now recovered from COVID-19 and was even now presenting with monkeypox signs or symptoms, the medical professionals consider monkeypox was the supply of the heart illness.

Furthermore, the authors note that monkeypox is a virus intently linked to other folks that “already have an established immediate or indirect affiliation with cardiac tissue harm.” For illustration, smallpox has been related with cardiovascular issues.

“This scenario highlights cardiac involvement as a probable complication linked with monkeypox an infection,” says Dr. Ana Isabel Pinho, direct author of the analyze.

“We believe that reporting this prospective causal marriage can raise much more awareness of the scientific local community and health industry experts for acute myocarditis as a feasible complication affiliated with monkeypox. [It] might be useful for near checking of afflicted individuals for even further recognition of other problems in the upcoming,” feedback Dr. Pinho.

Dr. Pinho operates in the cardiology department at São João College Hospital Center in Portugal.

Dr. Armand Balboni, a former personnel officer at the U.S. Military Analysis Institute of Infectious Disorders and present-day CEO of Appili Therapeutics, spoke with Health care News These days about the case report.

“While it is an attention-grabbing scenario, it is vital to be aware that myocarditis is scarce but not surprising with viral health problems. Provided that myocarditis is mostly discovered by symptoms equivalent to these in this case examine, it is likely now on the look at checklist for a individual presenting any viral disease. I really do not feel this paper modifications how main care suppliers would perspective or deal with their sufferers that are presenting indications of monkeypox.”

– Dr. Armand Balboni

Dr. Jonathan Fialkow, main of Cardiology and deputy director at Baptist Health’s Miami Cardiac & Vascular Institute, also spoke with MNT about the situation. His views are equivalent to Dr. Balboni’s, and Dr. Fialkow was not shocked that a patient with monkeypox seasoned this issue.

“While we don’t have a great deal very long-phrase expertise with big populations of men and women infected with monkeypox, all viruses have a risk of resulting in myocarditis, and the household of viruses in which monkeypox sits have been acknowledged to do so,” claimed Dr. Fialkow.

“The complete numbers stay reduced and at this time does not seem to be a specially higher risk in monkeypox relative to other viruses,” he reassured us.

Are children more likely to share mental health concerns with a robot?

Are children more likely to share mental health concerns with a robot?

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New research shows that a “child-like robot” was able to detect mental health concerns in children with more accuracy than humans. Aitor Diago/Getty Images
  • The growing youth mental health crisis highlights a need for early detection and treatment of mental health disorders.
  • A new study by University of Cambridge researchers found that socially assistive robots (SARs) could serve as a potential diagnostic tool for mental health.
  • According to the researchers, the study is the first time robots have been used to asses children’s mental well-being.
  • The study shows that robots were more likely to identify cases of well-being anomalies than self-reports filled by children or reports made by their parents.
  • Still, researchers did not use robots to deliver mental health interventions, but rather, to detect and diagnose children’s mental health concerns.

Even before the pandemic, an estimated 4.4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of children (about 2.7 million) between the ages of three and 17 had been diagnosed with depression in the United States, according to the National Survey of Children’s Health. The same survey found about 9.4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} (about 5.8 million) of children had been diagnosed with anxiety.

Experts believe that stress from COVID-19 has led to increased depression and anxiety in young people.

Mental health-related emergency room visits for children ages 5 to 11 increased by 24{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} in 2020 compared to the year prior, according to a report from the Centers for Disease Control and Prevention (CDC). Among children between the ages of 12 and 17, visits increased by 31{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

At the same time, adequate mental health care and access are still lacking in the U.S.

Nearly 91 million Americans live in regions with shortages of mental health providers, according to the Substance Abuse and Mental Health Services Administration, which estimates a minimum of 1,846 psychiatrists and 5,931 other practitioners are needed to fill the gap.

Recently, a group of researchers from the University of Cambridge studied the effects of socially assistive robots (SARs), which could potentially serve as an assessment and diagnostic tool in areas where mental health professionals are in short supply.

Their work was presented this week at the 2022 IEEE International Conference on Robots and Human Interactive Communication in Naples, Italy.

For the study, researchers selected 28 children from Cambridgeshire, England, ages 8 to 13 years old. Among the participants, 21 were female and 7 were male with an average age of 9.5.

Children who had already been diagnosed with neurological or psychological disorders were excluded from the research.

First, the participants answered about their well-being on an online questionnaire. Additionally, parents or guardians answered a questionnaire about the well-being of their children.

Later, the young participants spent 45 minutes with a Nao robot, created by SoftBank Robotics. The robot then administered the Short Mood and Feelings Questionnaire, which measures symptoms of depression, and the Revised Child Anxiety and Depression Scale.

Additionally, the robot asked the children about happy and sad memories they experienced over the last week and administered a task where children were shown pictures and then asked questions about them.

The researchers found that questionnaires conducted by robots were more likely to identify cases of well-being anomalies than the children’s online self-reports or parent or guardian reports.

Some participants shared information with the robot that they did not share via self-report.

Study co-author Prof. Hatice Gunes, Ph.D., a professor of affective intelligence and robotics and head of the Affective Intelligence and Robotics Lab at the University of Cambridge, explained to Medical News Today that among participants, “the group that might have some well-being related concerns” were more likely to provide negative response ratings during the robot-led questionnaires.

“The interesting finding here is when they interact with the robot their responses become more negative,” Prof. Gunes noted.

Socially assistive robots have previously demonstrated potential as a tool to improve the accessibility of care, the researchers explain in their paper. For instance, a 2020 study illustrated that robots may be helpful in assessing risk factors for autism spectrum disorder (ASD).

“Robots have been used for various tasks — and they’ve been shown to be effective in certain things because they have this physical embodiment, unlike a mobile phone or a virtual character or even videos,” Prof. Gunes said.

And despite the potential dangers of allowing a child too much time with an electronic device, working one-on-one with a robot is different from screentime, Prof. Gunes noted.

“This is a physical interaction, right? So, it’s not virtual. It’s not a video — they’re physically interacting with a physical entity,” she said.

Prof. Gunes also pointed to a key aspect of the study: the “child-like robot” used for the research was less than 2 feet tall.

“Here we have a child-looking and child-sounding robot. “In such situations, children actually see the robot more as a peer. So, it’s not an adult that is trying to get some information out of them.”

– Prof. Hatice Gunes, Ph.D., professor of affective intelligence and robotics at the University of Cambridge

Diane Hodge, Ph.D., LCSW, director of the school of social work at Radford University in Virginia, said she’s used puppets and dolls to help make her pediatric clients feel more at ease while she worked as a clinical social worker earlier in her career.

Robots, she told MNT, are the 21st-century equivalent of those puppets.

“I’m all about technology that really enhances and helps people,” Hodge said. “More kids today are just so used to it that they expect it.”

Hodge also pointed out that in the study, the researchers did not use a robot to deliver mental health care interventions, but rather, to assess the well-being of children. “This is just to get people access,” she said.

Hodge also highlighted how the Nao robot was able to successfully identify more “well-being-related anomalies” in children compared to those revealed by humans. “[That] shows that if we had done nothing, right, they wouldn’t have caught that,” she said.

According to Prof. Gunes, her research interests evolved after having a baby in 2018. “I think I became more sensitive to child-related issues and their well-being,” she said.

In the future, Prof. Gunes said the researchers hope to study how children respond to interacting with a diagnostic robot over video chat.

Already, researchers are preparing to conduct a study similar to the one they presented at the conference only with a more equal ratio of male and female participants, according to Prof. Gunes.

“We want to see actually if the findings are consistent across genders,” she said.

Smoking and heart health: Tobacco damages heart structure

Smoking and heart health: Tobacco damages heart structure

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New research suggests that smoking directly affects the heart. Image credit: sankai/Getty Images.
  • Over 8 million people globally die each year from tobacco use.
  • Researchers from Herlev and Gentofte Hospital in Copenhagen found that smoking weakens the structure of the heart, affecting how well it functions.
  • The research team also found that quitting smoking helped the heart recuperate.

Tobacco use, including smoking, claims more than 8 million lives around the world each year.

Past research shows that smoking has a negative impact on a person’s blood vessels — more than 30{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of deaths from coronary heart disease occur from active smoking or secondhand smoke exposure.

Smoking doubles a person’s heart attack risk and triples their stroke risk.

Now, researchers from Herlev and Gentofte Hospital in Copenhagen, Denmark, have found evidence suggesting that smoking not only impacts a person’s blood vessels but also weakens the structure of the heart itself, impacting how well it functions.

The researchers recently presented their findings at the European Society of Cardiology (ESC) Congress 2022.

Past research shows that smoking negatively impacts a person’s blood vessels, potentially causing heart issues.

For example, the nicotine in cigarettes can cause blood vessels to narrow, limiting the amount of blood allowed to flow through them. Nicotine can also demonstrably increase a person’s blood pressure.

“We know that smoking causes coronary artery disease and heart failure,” explained Dr. Eva Holt of Herlev and Gentofte Hospital, Copenhagen, Denmark, lead author of this study.

“But the aim of this study was to investigate if smoking had an independent effect on cardiac structure and function in a large general population without known heart disease,” she specified.

Dr. Holt and her team evaluated data from over 3,800 participants of the fifth Copenhagen City Heart Study. This study examined cardiovascular diseases and risk factors in the general population. Study participants ranged in age from 20 to 93 years and did not have a history of heart disease.

Data collected during the study included a questionnaire addressing participants’ smoking history, as well as an echocardiogram or ultrasound of the heart.

Researchers determined that the current smokers in the participant pool had hearts that were thicker, heavier, and weaker compared to those who had never smoked. The study also found a correlation between increased cigarette “pack years” — 1 pack-year equals 20 cigarettes smoked every day for 1 year — and the heart’s decreased ability to pump blood.

“We found that current smoking and accumulated pack-years were associated with worsening of the structure and function of the left heart chamber — the most important part of the heart,” Dr. Holt says. “Furthermore, we found that over a 10-year period, those who continued smoking developed thicker, heavier and weaker hearts that were less able to pump blood compared to never smokers and those who quit during that time.”

MNT spoke with Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in this study.

“What’s interesting about this study is that it’s looking at changes in the main pumping chamber of the heart, the left ventricle, by tobacco use, which thus far has been less well explained,” he commented.

“We always talk about the link between tobacco use and disease of blood vessels, including arteries of the heart, but we haven’t really delved into the particulars of how it affects the structure and function of the heart itself,” he noted.

According to Dr. Tadwalkar, cigarettes increase the propensity for plaque development on the inside walls of the arteries, clinically known as atherosclerosis. This can lead to heart damage both directly and indirectly, he said.

“Directly, smoking damages the vascular wall, blood vessel wall, leading to constriction and reduced elasticity, as well as impaired function of the endothelial, which is the inner layer of the blood vessels,” he explained.

“Indirectly, there are multiple effects. Smoking can increase [the] inflammatory burden and this is demonstrated in a variety of ways, including increased platelet activity [and] increased homocysteine levels. It can increase thrombosis — which is the creation of clots — cholesterol levels, and it can lead to activation of the sympathetic nervous system, which is the part of the nervous system that’s responsible for increasing blood pressure and heart rate. So that chronic increase in blood pressure heart rate can lead to this dysfunction.”

– Dr. Rigved Tadwalkar

According to the new study, Dr. Holt and her team found evidence that quitting smoking can help the heart recuperate to some degree.

“The result that the heart seems to regain former structure and function after smoking cessation might be a valuable motivation to give the patient to stop smoking,” she added.

Dr. Tadwalkar agreed. “We certainly have data that it does and this study follows in a line of other prior studies that shows that in a variety of ways, and not just the heart alone, that quitting smoking will improve one’s health as a whole,” he explained.

“Immediately quitting smoking will lessen heart rate and blood pressure, as well as [the] sympathetic nervous system response,” Dr. Tadwalkar continued.

“So the good news is that even immediately, there are physiological benefits to this,” he pointed out. “And then the decrease over time in that inflammatory burden and these other destructive pathophysiologic processes, from a lack of chronic exposure, are part of the reasons for this improvement.”

Vaccine hesitancy and trust in health experts: Shifting the focus

Vaccine hesitancy and trust in health experts: Shifting the focus

In a bid to curb the spread of SARS-CoV-2, the virus that causes COVID-19, public health experts have been pushing for a fast and effective vaccine rollout. However, some members of the public have been hesitant to take up vaccines. What happened, and is there something that science communicators keep getting wrong about vaccine hesitancy?

Millions of people around the world have now received a vaccine for COVID-19, yet for many the decision was not an easy one — indeed, some people are yet to accept a COVID-19 vaccine, even though it is available to them.

Some researchers have named this phenomenon “vaccine hesitancy” — the European Centre for Disease Prevention and Control (ECDC) defines it as the “delay in acceptance or refusal of vaccines despite availability of vaccination services.”

But what renders people unsure about accepting any given vaccine? And is vaccine hesitancy something that science communicators can help resolve?

Theories about the reasons behind people’s vaccine-related worries abound, and they may all hold some truth. Some researchers surmise that what makes people hesitant about whether or not they should accept a vaccine is the lack of access to accurate, complete information about that vaccine.

Others say that it all comes down to the spread of willful dis- and misinformation about vaccination. Yet others point out that, during the COVID-19 pandemic, those belonging to some historically marginalized communities, such as Black Americans, were the most likely to be hesitant about COVID-19 vaccines.

This is due to a long history of medical experimentation and gaslighting experienced by this community, as well as to present experiences of racism and discrimination when attempting to access healthcare.

But the lack of trust in scientists and public health authorities spreads much farther and deeper, and it may be a core factor in vaccine hesitancy around the world.

In this installment of the In Conversation podcast, we spoke with Prof. Maya Goldenberg, who is a professor of philosophy at the University of Guelph in Ontario, Canada, and the author of Vaccine Hesitancy: Public Trust, Expertise, and the War on Science.

We were also joined by reporter Aaron Khemchandani, who is a science communication MSc student at Imperial College London in the United Kingdom, and who has studied the phenomenon of mistrust in science.

This feature is based on an edited and shortened record of the discussion featured in our podcast. You can listen to the podcast in full below or on your preferred platform.

In her book, Prof. Goldenberg explains that vaccine hesitancy is a spectrum phenomenon — people may feel anywhere from vaguely uncertain about whether or not a vaccine is safe and effective, to very anxious about its potential effects.

Yet the concept itself, she explains, is a fairly new one for public health experts to focus on — historically, public health institutions have focused on recording rates of vaccine refusal rather than looking at what makes people hesitant about accepting vaccines, regardless of their final decision.

Understanding what drives vaccine hesitancy, however, is far more helpful when it comes to promoting public health, Prof. Goldenberg argues. Firstly, she writes, understanding people’s misgivings about vaccines and allaying those fears can help boost vaccine uptake.

Secondly, failing to effectively communicate with people about what makes them hesitant when it comes to vaccination can actually make up their minds to refuse it.

So what are the factors that drive vaccine hesitancy? The COVID-19 pandemic has made one of them clear: Many people around the world do not trust national and international health authorities, often for complex reasons.

In our latest podcast episode, Aaron Khemchandani gave the situation in Hong Kong as an example, explaining that the mistrust in governmental institutions initially led to low COVID-19 vaccine uptake. However, the ensuing rise in COVID-19 cases eventually flipped the script, Aaron noted.

“[P]eople decided that the vaccine was important to protect the community, and community is one of the values that, especially in East Asia, is widely prioritized among the population. From the start of the pandemic, [in] Hong Kong mask wearing was widespread, because masks […] protect other people from you, so people wanted to protect their loved ones,” he explained.

“[T]hat just showed how [much] Hong Kong valued protecting the wider society, and so vaccines became part of that when [COVID-19] case numbers started to rise,” Aaron added.

While the outcome here is a positive one, for Prof. Goldenberg, the initial resistance to vaccines in Hong Kong was very telling about the way in which people’s relationship with institutions can influence their views about, and trust in, medical interventions.

“The things that really stand out to me from this account from Hong Kong,” she told us,” is the way that general trust in government and social structures influence opinions about vaccines.”

“[T]his goes against the common thinking that people who don’t vaccinate somehow don’t understand the science, or have some kind of cognitive break that keeps them from doing the right thing. Instead, there’s lots of social science research, not just in Hong Kong, but in many countries, pre-COVID and during COVID, showing that a person’s trust in government, especially [in a] government dealing with a crisis is largely correlated with your likelihood to get vaccinated. […] You have to trust the system that brings you vaccines, in order to be willing to participate in [vaccination programmes].”

– Prof. Maya Goldenberg

“It’s not about understanding science, […] it’s about trusting the scientific and regulatory process that is bringing us vaccines and telling us that [they are] safe and effective, and something that we should [accept]. If you don’t trust the system, you’re not going to trust the vaccine,” she pointed out.

While it may be helpful to think about hesitancy rather than refusal when it comes to understanding the factors that influence vaccine uptake, not everybody agrees that the term “vaccine hesitancy” is a useful one in every context.

For some, it is a misnomer that fails to acknowledge the fact that medical institutions themselves are sometimes to blame for the low uptake of vaccines in the community.

“[T]here were serious political complaints about the use of the term when, let’s say, there wasn’t enough access [to] vaccines [among] marginalized groups,” Prof. Goldenberg told us.

“And politicians would say, ‘well, they’re just vaccine-hesitant.’ And people from within those communities would say, ‘well, that’s [a] lazy use of the term, we have an access problem, we don’t have a vaccine hesitancy problem, and they’re using [the term] as a slide for not taking responsibility, for the lack of infrastructure, for the lack of supports for people who are not fully integrated into the system’,” she explained.

In fact, in the United States and elsewhere in Western countries, the people who have been disproportionately affected by COVID-19 throughout the pandemic are those belonging to historically marginalized communities, such as migrants, Black and Hispanic individuals, and those with undocumented status.

Oftentimes, individuals belonging to these communities work in customer-facing roles that increase their risk of infection, may face less safe living conditions such as overcrowded housing, and may have limited or no access to timely healthcare.

Even when they do have access to vaccines, people belonging to marginalized groups may still be hesitant to take them. Why is that?

According to research looking at vaccine hesitancy among Black adults in the U.S., their views on vaccination are “tied to the long legacy of systemic racism in the U.S. healthcare system.”

Both historical and recent personal experiences of discrimination in healthcare have rendered many Black adults less likely to trust the health system and healthcare providers who do not understand their needs and may often perpetuate harmful stereotypes.

“I think [the experience of current and historic discrimination is] a major driver of vaccine hesitancy,” Prof. Goldenberg told us. “I think it was like that before COVID, but it somehow became more visible to the public [during the pandemic.”

“I remember near the beginning of [the] COVID [pandemic], they had done a lot of survey research, when the COVID vaccines become available, [asking] ‘will you get vaccinated?’,” she recalled, “and it was treated as a surprise that marginalized groups who were suffering the most from COVID, [the] people that couldn’t work from home, lived in housing conditions that [weren’t] conducive to social distancing, […] were the least likely to get vaccinated.”

“And it shouldn’t have been treated as a shock, because I think the knowledge about mistrust of healthcare and government among marginalized communities was already there. It’s just that the links hadn’t been made between healthcare decision-making and experiences of marginalization. Truth is, we don’t even need to look that far back to famous case studies, like the Tuskegee syphilis studies — you can look at the experiences of […] people in healthcare today to understand why they’re not front in line there […]”

– Prof. Maya Goldenberg

It is difficult to deny that vaccine hesitancy is also complicated by wilful mis- and disinformation spread by influencers with questionable agendas.

In our discussion, Aaron mentioned the disproportionate impact of the so-called Disinformation Dozen — in 2021, the Center for Countering Digital Hate (CCDH) published the results of an investigation that found that most of the disinformation spread about COVID-19 vaccines online at that time had originated from no more than 12 active social influencers.

In today’s fast-paced digital age, altered information can spread very fast and do much harm. However, while she acknowledged the impact of mis- and disinformation, Prof. Goldenberg cautioned that we must be wary of blaming lack of trust in vaccines exclusively on the wrong information that easily circulates online.

There will always be bad social actors who spread health myths, she noted, and simply debunking those myths over and over will not be enough to restore the trust in health institutions, she argued.

Prof. Goldenberg also thought that some people may be attracted to these bad actors precisely because they place themselves in the role of fighters against an oppressive system — and that is what we need to address.

“[T]hat, for some reason, resonates with a lot of people and people who have experience of [how] this system fails them — the American dream is not something that they feel is within reach for them. So we need to look at the sort of social structures that create this level of dissatisfaction,” she emphasized.

“I look at all the time spent debunking the myths being propagated by these disinformants, and it’s almost beside the point. It’s not that we should let this disinformation linger […] But the point is, it’s just going to move from one [source] to another, you shut down one source another one will open up because there’s an appetite for it. You debunk one myth, it’s OK, another one will pop up in its place because people are looking for that kind of outlet. […] [W]hatever hurts that they are feeling they want to place it on something, and placing it on these kinds of disinformation and conspiracy theories [is] a way to have it all make sense […]”

– Prof. Maya Goldenberg

So if a lack of trust between the public and health experts and organizations is the core driver for vaccine hesitancy, how can we repair that trust?

Recent research suggests that what is most important for scientists, organizations, and individuals is to communicate with empathy, above all.

“There’s been good research demonstrating that the way to talk to people about vaccines is, first of all, not to try to convince them otherwise, and not to ply them with the facts,” said Prof. Goldenberg.

“A sympathetic approach is what works, you have to hear them out, listen to what they have to say, try not to be judgmental about it — that is hard to do sometimes because we’re all kind of tired and would like things to go a little easier. But the best thing to do is listen to what they have to say, respond not with the fact-based approach […] but [instead] ask more questions and try to find out where the source of the misgivings [lies]. There might be concrete pieces of misinformation, perhaps you can deal with that. But it needs to be done in a respectful way, the same way you would want to be spoken to by someone who disagrees with you.”

– Prof. Maya Goldenberg

“It’s more about try[ing] to meet them on common ground,” she noted.

Vaccine mandates may push some people to get vaccinated in the short term, but in the long term they will do little to report the trust between the public, the government, and health organizations, Aaron also pointed out.

“[Goverment-mandated restrictions] did increase the vaccine rate, but didn’t do anything to repair the trust between citizens and the government, because it was sort of done out of necessity and fear, as opposed to sharing any sort of values with government officials and their plan for success in [the COVID-19 pandemic],” he explained.

Aaron was in agreement with Prof. Goldenberg that empathy is key, and science communicators need to shift the way in which they approach vaccine hesitancy to put individuals and their experiences first:

“I think the most important thing is to find common ground, just to find shared values, understand people, understand them as people, as opposed to just [thinking of them as] statistics, […] understand historical context, empathize.”

Statins for cardiovascular health: Latest guidelines, evidence

Statins for cardiovascular health: Latest guidelines, evidence

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Statins can reduce the risk of cardiovascular disease by lowering the level of low-density lipoprotein (LDL) cholesterol in the blood. clubfoto/Getty Images
  • Statins were first approved by the Food and Drug Administration (FDA) in 1987.
  • Updated guidelines from the U.S. Preventive Services Task Force (USPSTF) suggest that statins benefit those ages 40 to 75 with at least one risk factor for cardiovascular disease.
  • However, questions remain about who exactly can benefit from them.

Cardiovascular disease is the leading cause of death and disability globally, and there have been concerted efforts for decades to prevent and minimize its impact.

According to the World Health Organization, there were 17.9 million deaths from cardiovascular diseases in 2019, representing 32{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of all global deaths. Cardiovascular disease is also a leading cause of premature death, causing 38{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of deaths before age 70.

Lifestyle interventions are important for preventing cardiovascular disease, with smoking, obesity, diabetes, lack of physical exercise, and excessive consumption of alcohol all increasing the risk of developing cardiovascular disease. Statins are also an important pharmaceutical option for lowering cardiovascular disease in people at risk. It was estimated that more than 173 million people took statins in 2018.

Evidence published in the journal The Lancet in 2010 shows that reducing low-density lipoprotein cholesterol by 1mmol/L with statins reduces the risks of ischaemic heart disease and stroke by 24{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} to 25{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

Statins reduce the risk of cardiovascular disease by lowering the level of low-density lipoprotein (LDL) cholesterol in the blood. Too much LDL cholesterol can build up as “plaques” in your blood vessels and narrow their diameter. Over time this narrowing can block blood flow to certain organs. If blood flow to the heart is blocked, it can cause a heart attack, and if it occurs in the brain, it can cause an ischemic stroke.

Targeting the right patients with statins is key to gaining the most benefit. The U.S. Preventive Services Task Force (USPSTF) recently published its Recommendation Statement for Statin Use for the Primary Prevention of Cardiovascular Disease in Adults in the Journal of the American Medical Association (JAMA). The recommendations were both slightly more conservative but also very similar to existing recommendations by the American College of Cardiology (ACC) and the American Heart Association (AHA).

The new guidance was published following an evidence review that included 22 randomized clinical trials, including additional data from three randomized control trials not included in the last set of guidelines published in 2016. On the back of this, they have issued three main recommendations for clinicians dealing with patients.

They advised:

  • Statin use would yield moderate benefit for those ages 40-75 with one or more factors that could increase the risk of cardiovascular disease, no history of cardiovascular disease, and an estimated 10-year cardiovascular event risk of 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} or greater.
  • Those of the same age with the same risk factors with a 10-year cardiovascular event risk factor of 7.5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} to 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} will have a small net benefit from taking statins.
  • However, there was not enough evidence to determine whether it’s beneficial to initiate statin use in those older than 75.

Dr. Edo Paz, cardiologist and VP of Medical at K Health, told Medical News Today in an email:

“In these updated guidelines, the USPSTF recommends that clinicians assess a patient’s risk of having a cardiovascular event (like a heart attack or stroke) to decide which patients should be treated with statin therapy.

The ACC/AHA also gives additional guidance around the intensity of statin therapy, differentiating between moderate and high intensity options. Overall, the USPSTF guidelines are a bit simpler, as it is geared to all primary care doctors, rather than to cardiologists.”

In the same week, a model was presented at the European Society of Cardiology Congress 2022 which echoed the findings of the review, supporting the use of statins in patients over 40 with high cardiovascular disease risk.

The study created a model using data from 118,000 participants of the Cholesterol Treatment Trialists’ Collaboration and 500,000 individuals from the UK Biobank. It looked specifically at the difference between continuing statins for life, compared to stop taking them at 80, as there is little evidence of their value in people older than age 75.

Lead author Dr. Runguo Wu of the Queen Mary University of London said: “Our study suggests that people who start taking statins in their 50s but stop at 80 years of age instead of continuing lifelong will lose 73{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the QALY benefit if they are at relatively low cardiovascular risk and 36{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} if they are at high cardiovascular risk – since those at elevated risk start to benefit earlier.

“Women’s cardiovascular risk is generally lower than men’s. This means that for women, most of the lifelong benefit from statins occurs later in life, and stopping therapy prematurely is likely more detrimental than for men.”

Rather than suggest that statin treatment was potentially controversial, clinicians should focus on the areas where statin guidelines overlap, said Prof. Salim Virani, professor of Cardiology at Baylor College of Medicine, Houston, TX, and one of the authors of the ACC/AHA Primary Prevention Guideline from 2018.

In an editorial published by the JAMA in the same issue as the USPSTF Recommendation Statement, Prof. Virani outlined that the review of the data did not find “any significant harm associated with statin therapy,” and called the recommendations “sensible and practical.”

In an interview with MNT, he explained that the main difference between these guidelines and the 2018 ACC/AHA guidelines was over whether the cut-off for introducing statins was for people with a 7.5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} 10-year risk of cardiovascular disease as is the case with the ACC/AHA guidelines, or 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} as is the case with the most recent guidelines from the US Preventive Services Task Force.

“Most of the patients whose 10-year risk is 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} or higher, well, they have to be treated based on both the guidelines,” said Prof. Virani. He added that further modeling of how many people these slight differences would affect was due to be published in the coming weeks.

Prof. Virani explained that individual risk factors needed to be considered by clinicians and patients when considering whether or not they needed to initiate statin treatment. While risk factors such as obesity and diabetes were considered in both sets of guidelines, the guidelines from USPSTF did not mention South East Asian ancestry or pre-eclampsia, or the risks for postmenopausal women for example.

“Last but not the least, the ACC/AHA guidelines have what we call these risk enhancers, which are factors that are not there when somebody is doing their tenure risk calculation but might be important for a patient, for example, a patient having family history of premature cardiovascular disease, those patients need to be treated early, and the ACC/AHA guidelines account for those factors as well, which is notion the US Preventive Services Task Force recommendations.”