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Researchers create a bodywide map of molecular changes linked to exercise and health

A Stanford Medicine-led effort to learn more about exercise’s molecular effects paints the broadest picture yet of why, in the health arena, sweat is king.

May 1, 2024 - By Krista Conger

Researchers at Stanford Medicine and their colleagues conducted nearly 10,000 measurements in nearly 20 types of tissues, learning about the   effects of exercise on the immune system, stress response, energy production and metabolism. Alan Poulson Photography/Shutterstock.com

Exercise. It’s associated with increased muscle strength, improved heart health, lower blood sugar and just about every other physical improvement you can name. But how does regularly puffing away on a treadmill, biking up a steep hill or going for a brisk lunchtime walk confer such a dizzying array of health benefits?

We’re now closer to finding out, thanks to a vast new study led by Stanford Medicine. Researchers conducted nearly 10,000 measurements in nearly 20 types of tissues to uncover the effect of eight weeks of endurance exercise in laboratory rats trained to run on rodent-sized treadmills.

Their results highlight striking effects of exercise on the immune system, stress response, energy production and metabolism. They uncovered significant links between exercise, molecules and genes already known to be involved in myriad human diseases and tissue recovery.

The study is one of a series of papers published May 1 by members of a multicenter research group meant to lay the groundwork for understanding — on a bodywide, molecular level — exactly how our tissues and cells react when we push them to perform.

“We all know exercise is beneficial for us,” said professor of pathology Stephen Montgomery , PhD. “But we don’t know much about the molecular signals that manifest across the body when people exercise, or how they may change when people train. Our study is the first to take a holistic, bodywide look at molecular changes, from proteins to genes to metabolites to fats and energy production. It’s the broadest profiling yet of the effects of exercise, and it creates an essential map to how it changes the body.”

Montgomery, who is also a professor of genetics and of biomedical data science, is a senior author of the  paper , which published on May 1 in  Nature . Other senior authors are  Michael Snyder , PhD, the Stanford W. Ascherman, MD, FACS Professor in Genetics, and associate professor of medicine  Matthew Wheeler , MD. First authors are former genetics PhD student Nicole Gay, PhD; former postdoctoral scholar David Amar, PhD; and Pierre Jean Beltran, PhD, a former postdoctoral scholar at the Broad Institute.

Additional papers by Stanford Medicine researchers include a related published report in  Nature Communications  investigating the effect of exercise-induced changes in genes and tissues known to be involved in disease risk as well as a  paper  published on May 2 in  Cell Metabolism , which focuses on the effects of exercise on the cellular energy factors called mitochondria in various tissues. Montgomery is the senior author of the  Nature Communications  paper and postdoctoral scholar  Nikolai Vetr , PhD, is its lead author. Instructor of cardiovascular medicine  Malene Lindholm , PhD, is the senior author of the  Cell Metabolism  paper, and Amar is the lead author.

Stephen Montgomery

“These papers further highlight the multiple impacts exercise training has on metabolism and health,” Montgomery said.

A coordinated look at exercise

The researchers involved in the study and the other simultaneous publications are part of a national group called the Molecular Transducers of Physical Activity Consortium, or MoTrPAC, organized by the National Institutes of Health. The effort was launched in 2015 to investigate in detail exactly how physical exercise improves health and prevents disease.

The Stanford Medicine team took on a lot of the heavy lifting, studying the effects of eight weeks of endurance training on gene expression (the transcriptome), proteins (the proteome), fats (the lipidome), metabolites (the metabolome), the pattern of chemical tags placed on DNA (the epigenome), the immune system (the…you get the idea).

Let’s just call it the sweat-ome.

They performed 9,466 analyses on multiple tissues in rats as the animals were trained to run increasing distances and compared the results with those of rats that loafed about in their cages. They paid special attention to the muscles of the leg, the heart, the liver, the kidney and a type of fat called white adipose tissue (the kind of fat that accumulates as pounds pile on); other tissues included the lungs, brain and brown adipose tissue (a more metabolically active type of fat that helps burn calories). The combination of multiple assays — think of all those -omes! — and tissue types pumped out results numbering in the hundreds of thousands for non-epigenetic changes to more than 2 million distinct changes in the epigenome. The results will keep scientists hopping for years.

Although this study served primarily to create a database for future analysis, some interesting nuggets vaulted to the top. First, they noted that the expression of 22 genes changed with exercise in all six of the tissues they focused on. Many of these genes were involved in what are known as heat shock pathways, which stabilize the structure of proteins when cells undergo stress including changes in temperature (feel that burn?), infection or tissue remodeling (hello new muscle fibers!). Others have been implicated in pathways that reduce blood pressure and increase the body’s sensitivity to insulin, which lowers blood sugar levels.

The researchers also noted that the expression of several genes involved in Type 2 diabetes, heart disease, obesity and kidney disease was reduced in exercising rats as compared with their sedentary counterparts — a clear link between their studies and human health.

Sex differences

Finally, they identified sex differences in how multiple tissues in male and female rats responded to exercise. Male rats lost about 5% of their body fat after eight weeks of exercise while female rats didn’t lose a significant amount. (They did, however, maintain their starting fat percentage while the sedentary females packed on an additional 4% of body fat during the study period.) But the largest difference was observed in gene expression in the rats’ adrenal glands. After one week, genes associated with the generation of steroid hormones like adrenaline and with energy production increased in male rats but decreased in female rats.

Despite these early, tantalizing associations, the researchers caution that exercise science is nowhere near the finish line. It’s more like the starting gun has just fired. But the future is exciting.

“In the long term, it’s unlikely we will find any one magic intervention that reproduces what exercise can do for a person,” Montgomery said. “But we might get closer to the idea of precision exercise — tailoring recommendations based on a person’s genetics, sex, age or other health conditions to generate beneficial whole-body responses.”

A full list of researchers and institutions involved in the study can be found online.

The MoTrPAC study is supported by the National Institutes of Health (grants U24OD026629, U24DK112349, U24DK112342, U24DK112340, U24DK112341, U24DK112326, 612 U24DK112331, U24DK112348, U01AR071133, U01AR071130, 613 U01AR071124, U01AR071128, U01AR071150, U01AR071160, U01AR071158, U24AR071113, U01AG055133, U01AG055137, 615 U01AG055135, 5T32HG000044, P30AG044271 and P30AG003319), the National Science Foundation, and the Knut and Alice Wallenberg Foundation.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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Turning microbiome research into a force for health

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The microbiome comprises trillions of microorganisms living on and inside each of us. Historically, researchers have only guessed at its role in human health, but in the last decade or so, genetic sequencing techniques have illuminated this galaxy of microorganisms enough to study in detail.

As researchers unravel the complex interplay between our bodies and microbiomes, they are beginning to appreciate the full scope of the field’s potential for treating disease and promoting health.

For instance, the growing list of conditions that correspond with changes in the microbes of our gut includes type 2 diabetes, inflammatory bowel disease, Alzheimer’s disease, and a variety of cancers.

“In almost every disease context that’s been investigated, we’ve found different types of microbial communities, divergent between healthy and sick patients,” says professor of biological engineering Eric Alm. “The promise [of these findings] is that some of those differences are going to be causal, and intervening to change the microbiome is going to help treat some of these diseases.”

Alm’s lab, in conjunction with collaborators at the Broad Institute of MIT and Harvard, did some of the early work characterizing the gut microbiome and showing its relationship to human health. Since then, microbiome research has exploded, pulling in researchers from far-flung fields and setting new discoveries in motion. Startups are now working to develop microbiome-based therapies, and nonprofit organizations have also sprouted up to ensure these basic scientific advances turn into treatments that benefit the maximum number of people.

 “The first chapter in this field, and our history, has been validating this modality,” says Mark Smith PhD ’14, a co-founder of OpenBiome, which processes stool donations for hospitals to conduct stool transplants for patients battling gut infection. Smith is also currently CEO of the startup Finch Therapeutics, which is developing microbiome-based treatments. “Until now, it’s been about the promise of the microbiome. Now I feel like we’ve delivered on the first promise. The next step is figuring out how big this gets.”

An interdisciplinary foundation

MIT’s prominent role in microbiome research came, in part, through its leadership in a field that may at first seem unrelated. For decades, MIT has made important contributions to microbial ecology, led by work in the Parsons Laboratory in the Department of Civil and Environmental Engineering and by scientists including Institute Professor Penny Chisholm.

Ecologists who use complex statistical techniques to study the relationships between organisms in different ecosystems are well-equipped to study the behavior of different bacterial strains in the microbiome.

Not that ecologists — or anyone else — initially had much to study involving the human microbiome, which was essentially a black box to researchers well into the 2000s. But the Human Genome Project led to faster, cheaper ways to sequence genes at scale, and a group of researchers including Alm and visiting professor Martin Polz began using those techniques to decode the genomes of environmental bacteria around 2008.

Those techniques were first pointed at the bacteria in the gut microbiome as part of the Human Microbiome Project, which began in 2007 and involved research groups from MIT and the Broad Institute.

Alm first got pulled into microbiome research by the late biological engineering professor David Schauer as part of a research project with Boston Children’s Hospital. It didn’t take much to get up to speed: Alm says the number of papers explicitly referencing the microbiome at the time could be read in an afternoon.

The collaboration, which included Ramnik Xavier, a core institute member of the Broad Institute, led to the first large-scale genome sequencing of the gut microbiome to diagnose inflammatory bowel disease. The research was funded, in part, by the Neil and Anna Rasmussen Family Foundation.

The study offered a glimpse into the microbiome’s diagnostic potential. It also underscored the need to bring together researchers from diverse fields to dig deeper.

Taking an interdisciplinary approach is important because, after next-generation sequencing techniques are applied to the microbiome, a large amount of computational biology and statistical methods are still needed to interpret the resulting data — the microbiome, after all, contains more genes than the human genome. One catalyst for early microbiome collaboration was the Microbiology Graduate PhD Program, which recruited microbiology students to MIT and introduced them to research groups across the Institute.

As microbiology collaborations increased among researchers from different department and labs, Neil Rasmussen, a longtime member of the MIT Corporation and a member of the visiting committees for a number of departments, realized there was still one more component needed to turn microbiome research into a force for human health.

“Neil had the idea to find all the clinical researchers in the [Boston] area studying diseases associated with the microbiome and pair them up with people like [biological engineers, mathematicians, and ecologists] at MIT who might not know anything about inflammatory bowel disease or microbiomes but had the expertise necessary to solve big problems in the field,” Alm says.

In 2014, that insight led the Rasmussen Foundation to support the creation of the Center for Microbiome Informatics and Therapeutics (CMIT), one of the first university-based microbiome research centers in the country. CMIT is based at the MIT Institute for Medical Engineering and Science (IMES).

Tami Lieberman, the Hermann L. F. von Helmholtz Career Development Professor at MIT, whose background is in ecology, says CMIT was a big reason she joined MIT’s faculty in 2018. Lieberman has developed new genomic approaches to study how bacteria mutate in healthy and sick individuals, with a particular focus on the skin microbiome.

Laura Kiessling, a chemist who has been recognized for contributions to our understanding of cell surface interactions, was also quick to join CMIT. Kiessling, the Novartis Professor of Chemistry, has made discoveries relating to microbial mechanisms that influence immune function. Both Lieberman and Kiessling are also members of the Broad Institute.

Today, CMIT, co-directed by Alm and Xavier, facilitates collaborations between researchers and clinicians from hospitals around the country in addition to supporting research groups in the area. That work has led to hundreds of ongoing clinical trials that promise to further elucidate the microbiome’s connection to a broad range of diseases.

Fulfilling the promise of the microbiome

Researchers don’t yet know what specific strains of bacteria can improve the health of people with microbiome-associated diseases. But they do know that fecal matter transplants, which carry the full spectrum of gut bacteria from a healthy donor, can help patients suffering from certain diseases.

The nonprofit organization OpenBiome, founded by a group from MIT including Smith and Alm, launched in 2012 to help expand access to fecal matter transplants by screening donors for stool collection then processing, storing, and shipping samples to hospitals. Today OpenBiome works with more than 1,000 hospitals, and its success in the early days of the field shows that basic microbiome research, when paired with clinical trials like those happening at CMIT, can quickly lead to new treatments.

“You start with a disease, and if there’s a microbiome association, you can start a small trial to see if fecal transplants can help patients right away,” Alm explains. “If that becomes an effective treatment, while you’re rolling it out you can be doing the genomics to figure out how to make it better. So you can translate therapeutics into patients more quickly than when you’re developing small-molecule drugs.”

Another nonprofit project launched out of MIT, the Global Microbiome Conservancy, is collecting stool samples from people living nonindustrialized lifestyles around the world, whose guts have much different bacterial makeups and thus hold potential for advancing our understanding of host-microbiome interactions.

A number of private companies founded by MIT alumni are also trying to harness individual microbes to create new treatments, including, among others, Finch Therapeutics founded by Mark Smith; Concerto Biosciences, co-founded by Jared Kehe PhD ’20 and Bernardo Cervantes PhD ’20; BiomX, founded by Associate Professor Tim Lu; and Synlogic, founded by Lu and Jim Collins, the Termeer Professor of Medical Engineering and Science at MIT.

“There’s an opportunity to more precisely change a microbiome,” explains CMIT’s Lieberman. “But there’s a lot of basic science to do to figure out how to tweak the microbiome in a targeted way. Once we figure out how to do that, the therapeutic potential of the microbiome is quite limitless.”

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It may be safe for some to wait 15 years for repeat colonoscopy, study suggests

New research suggests patients with an average risk of colon cancer may only need to undergo a colonoscopy screening every 15 years instead of the recommended 10. 

Swedish researchers found that waiting an extra five years after a first negative colonoscopy carried about the same risk of later having a colorectal diagnosis or dying from the disease as getting screened every 10 years. Extending screening time could reduce “unnecessary invasive examinations,” according to the study published Thursday in JAMA Oncology. 

Colorectal cancer is the fourth most common cancer diagnosed in the U.S. and the second most deadly behind lung cancer. The American Cancer Society recommends that screening begin at age 45 for people who don’t have a family history of colorectal cancer or other risk factors, such as inflammatory bowel disease.

In an editorial accompanying the new study, gastroenterologists suggested that future screening guidelines may safely be prolonged for some people, noting that “15 has the potential to be the new 10.”

While rates are going down among people over 50, colorectal cancer diagnoses are on the rise among younger people , opening up a potentially large new group of people who may require colonoscopies. 

Doctors are grappling with how to best allocate appointments. 

“We do not have enough gastroenterology doctors to do a colonoscopy every 10 years in everyone over 50,” said Dr. Otis Brawley, the Bloomberg distinguished professor of oncology and epidemiology at Johns Hopkins University, who was not associated with the new research. 

For the new study, researchers looked at national registry data of more than 110,000 people whose first colonoscopy had a negative result for colorectal cancer. They compared these people with more than 1 million in a control group. 

The average age in both groups was 59 years, and about 60% of the patients were female. Taking family history into account, they found that after having a first negative colonoscopy, the risk of later having a colorectal cancer diagnosis or dying from the disease was about the same among people who had a colonoscopy every 10 years and those who stretched it to 15. 

They estimated waiting an extra five years between colonoscopies would miss two colorectal cancer cases, and cause one colorectal cancer-related death, for every 1,000 people, while potentially saving 1,000 colonoscopies for other patients. 

Employing cheaper, less invasive screening methods 10 to 15 years after a negative colonoscopy could greatly reduce the number of missed screenings, said the study’s lead author, Dr. Mahdi Fallah, head of the Risk Adapted Cancer Prevention Group at the German Cancer Research Center in Heidelberg. 

“The best screening test is the one that is actually done. So, if a test like colonoscopy is unaffordable for a person, an alternative cheaper valid test is much better than no test at all,” said Fallah, who is also a visiting professor in the department of clinical sciences at Lund University in Sweden.

More diverse population

The research was conducted in Sweden, which has a mostly white population and a health care system that looks very different from that of the U.S. The national health care system also collects information on the family health history of its citizens, meaning the researchers could be sure those who reported no colorectal cancer in their family were correct. 

“It would be really hard to apply these findings to the U.S.,” said Dr. Cassandra Fritz, a gastroenterologist at Washington University in St. Louis. “When we ask patients about colorectal cancer in first-degree relatives, most people don’t know.” Fritz was not involved with the new study.

The U.S. is also much more racially and ethnically diverse, but the research does provide important context that will help doctors understand how they can best delegate their limited resources, Fritz added. 

“We need to think about how we can potentially save resources and impact more people with the resources we have,” said Dr. Andrew Chan, a gastroenterologist and director of epidemiology at Massachusetts General Cancer Center in Boston and a co-author of the JAMA editorial.

The proportion of colorectal cancer that occurred in people under age 55 doubled from 1995 to 2019, from 11% to 20%. But the total number of cases in this population is still relatively low. 

“Once you get younger than 50, the incidents of colorectal cancer are probably not going to require screening everyone. The risk benefit doesn’t outweigh the cost,” Dr. Robert Bresalier, professor of medicine in the department of gastroenterology hepatology and nutrition at the University of Texas MD Anderson Cancer Center in Houston. Bresalier was not involved with the new research.

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That only goes for people without a family history, he added. People who have a parent or sibling who has had colorectal cancer should begin screening 10 years before that parent or sibling was diagnosed, Brawley said. 

Other means of screening, mainly stool tests, have been honed to be more precise in recent years. Fecal occult blood tests detect blood in the stool, which can be a warning sign of colon polyps or cancer. FIT-DNA tests, such as Cologuard, detect altered DNA in the stool, which could indicate cancer, and are about 90% effective at detecting cancer, but are less effective at detecting precancerous polyps. 

These tests are noninvasive and relatively cheap compared to colonoscopy screening. The catch is, they need to be done more often — every one to three years — than colonoscopy. If the test is positive, the person should get a colonoscopy, which could trigger getting one sooner than every 10 years. 

Still, the tests could be a good option for cutting down on the number of colonoscopies given after a negative first screening, Chan said. 

“It is important to get screened, but there is a finite number of resources to screen people,” he said. “To screen as many people as we can, we need to make choices about what type of screening we’re doing and how often we’re doing it.”

Better screening in the U.S. will likely be more tailored to risk factors other than age, which experts don’t yet know much about, Bresalier said. 

“One size may not fit all. We know a lot about the genetics of colorectal cancer, but most of that research was done in white people. There are potential differences among men and women and among different ethnicities,” he said. “We may get to a point where we get to risk-based intervals even in normal risk people, based on these other factors.” 

Warning signs of colon cancer

Symptoms of colorectal cancer often don’t show up until later stages and can be difficult to differentiate from other, less serious conditions.

“You can’t rely on the symptoms,” Chan said. “Many people don’t have symptoms at all and that highlights how important screenings are.” 

Having blood in bowel movements, which can appear as red or black, a change in how often you go, abdominal pain and weight loss can all be warning signs of colorectal cancer — and they can also be signs of irritable bowel syndrome, inflammatory bowel disease and a host of other less-serious issues. 

Nonetheless, people with new symptoms should make an appointment to see a doctor, Fritz said. 

Anyone over age 45 should start getting screened. What that looks like may be determined by where you live. 

“In some areas, it’s more feasible to get a colonoscopy than in others. In some areas, it might be more realistic to get a stool-based test,” said Chan. 

This includes people living in rural areas or areas without access to a gastroenterologist. For those who are underinsured or uninsured, Fritz said it is possible to pay cash for a stool-based test, though a positive stool test will require a colonoscopy later on.

Something everyone should do is understand their risk, Fritz said. 

“A lot of people avoid having conversations about bowel movements, but it’s really important to talk to your family so you know if you are at high risk,” she said. 

Kaitlin Sullivan is a contributor for NBCNews.com who has worked with NBC News Investigations. She reports on health, science and the environment and is a graduate of the Craig Newmark Graduate School of Journalism at City University of New York.

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A Peek Inside the Brains of ‘Super-Agers’

New research explores why some octogenarians have exceptional memories.

By Dana G. Smith

When it comes to aging, we tend to assume that cognition gets worse as we get older. Our thoughts may slow down or become confused, or we may start to forget things, like the name of our high school English teacher or what we meant to buy at the grocery store.

But that’s not the case for everyone.

For a little over a decade, scientists have been studying a subset of people they call “super-agers.” These individuals are age 80 and up, but they have the memory ability of a person 20 to 30 years younger.

Most research on aging and memory focuses on the other side of the equation — people who develop dementia in their later years. But, “if we’re constantly talking about what’s going wrong in aging, it’s not capturing the full spectrum of what’s happening in the older adult population,” said Emily Rogalski, a professor of neurology at the University of Chicago, who published one of the first studies on super-agers in 2012.

A paper published Monday in the Journal of Neuroscience helps shed light on what’s so special about the brains of super-agers. The biggest takeaway, in combination with a companion study that came out last year on the same group of individuals, is that their brains have less atrophy than their peers’ do.

The research was conducted on 119 octogenarians from Spain: 64 super-agers and 55 older adults with normal memory abilities for their age. The participants completed multiple tests assessing their memory, motor and verbal skills; underwent brain scans and blood draws; and answered questions about their lifestyle and behaviors.

The scientists found that the super-agers had more volume in areas of the brain important for memory, most notably the hippocampus and entorhinal cortex. They also had better preserved connectivity between regions in the front of the brain that are involved in cognition. Both the super-agers and the control group showed minimal signs of Alzheimer’s disease in their brains.

“By having two groups that have low levels of Alzheimer’s markers, but striking cognitive differences and striking differences in their brain, then we’re really speaking to a resistance to age-related decline,” said Dr. Bryan Strange, a professor of clinical neuroscience at the Polytechnic University of Madrid, who led the studies.

These findings are backed up by Dr. Rogalski’s research , initially conducted when she was at Northwestern University, which showed that super-agers’ brains looked more like 50- or 60-year-olds’ brains than their 80-year-old peers. When followed over several years, the super-agers’ brains atrophied at a slower rate than average.

No precise numbers exist on how many super-agers there are among us, but Dr. Rogalski said they’re “relatively rare,” noting that “far less than 10 percent” of the people she sees end up meeting the criteria.

But when you meet a super-ager, you know it, Dr. Strange said. “They are really quite energetic people, you can see. Motivated, on the ball, elderly individuals.”

Experts don’t know how someone becomes a super-ager, though there were a few differences in health and lifestyle behaviors between the two groups in the Spanish study. Most notably, the super-agers had slightly better physical health, both in terms of blood pressure and glucose metabolism, and they performed better on a test of mobility . The super-agers didn’t report doing more exercise at their current age than the typical older adults, but they were more active in middle age. They also reported better mental health .

But overall, Dr. Strange said, there were a lot of similarities between the super-agers and the regular agers. “There are a lot of things that are not particularly striking about them,” he said. And, he added, “we see some surprising omissions, things that you would expect to be associated with super-agers that weren’t really there.” For example, there were no differences between the groups in terms of their diets, the amount of sleep they got, their professional backgrounds or their alcohol and tobacco use.

The behaviors of some of the Chicago super-agers were similarly a surprise. Some exercised regularly, but some never had; some stuck to a Mediterranean diet, others subsisted off TV dinners; and a few of them still smoked cigarettes. However, one consistency among the group was that they tended to have strong social relationships , Dr. Rogalski said.

“In an ideal world, you’d find out that, like, all the super-agers, you know, ate six tomatoes every day and that was the key,” said Tessa Harrison, an assistant project scientist at the University of California, Berkeley, who collaborated with Dr. Rogalski on the first Chicago super-ager study.

Instead, Dr. Harrison continued, super-agers probably have “some sort of lucky predisposition or some resistance mechanism in the brain that’s on the molecular level that we don’t understand yet,” possibly related to their genes.

While there isn’t a recipe for becoming a super-ager, scientists do know that, in general , eating healthily, staying physically active, getting enough sleep and maintaining social connections are important for healthy brain aging.

Dana G. Smith is a Times reporter covering personal health, particularly aging and brain health. More about Dana G. Smith

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Stop COVID Cohort: An Observational Study of 3480 Patients Admitted to the Sechenov University Hospital Network in Moscow City for Suspected Coronavirus Disease 2019 (COVID-19) Infection

Collaborators.

• Sechenov StopCOVID Research Team : Anna Berbenyuk ,  Polina Bobkova ,  Semyon Bordyugov ,  Aleksandra Borisenko ,  Ekaterina Bugaiskaya ,  Olesya Druzhkova ,  Dmitry Eliseev ,  Yasmin El-Taravi ,  Natalia Gorbova ,  Elizaveta Gribaleva ,  Rina Grigoryan ,  Shabnam Ibragimova ,  Khadizhat Kabieva ,  Alena Khrapkova ,  Natalia Kogut ,  Karina Kovygina ,  Margaret Kvaratskheliya ,  Maria Lobova ,  Anna Lunicheva ,  Anastasia Maystrenko ,  Daria Nikolaeva ,  Anna Pavlenko ,  Olga Perekosova ,  Olga Romanova ,  Olga Sokova ,  Veronika Solovieva ,  Olga Spasskaya ,  Ekaterina Spiridonova ,  Olga Sukhodolskaya ,  Shakir Suleimanov ,  Nailya Urmantaeva ,  Olga Usalka ,  Margarita Zaikina ,  Anastasia Zorina ,  Nadezhda Khitrina

Affiliations

• 1 Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 2 Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.
• 3 Soloviev Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
• 4 School of Physics, Astronomy, and Mathematics, University of Hertfordshire, Hatfield, United Kingdom.
• 5 Biobank, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 6 Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 7 Chemistry Department, Lomonosov Moscow State University, Moscow, Russia.
• 8 Department of Polymers and Composites, N. N. Semenov Institute of Chemical Physics, Moscow, Russia.
• 9 Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
• 10 Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany.
• 11 Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 12 Department of Intensive Care, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 13 Clinic of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 14 Department of Internal Medicine No. 1, Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 15 Department of Forensic Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 16 Department of Statistics, University of Oxford, Oxford, United Kingdom.
• 17 Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
• 18 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
• 19 Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
• 20 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• PMID: 33035307
• PMCID: PMC7665333
• DOI: 10.1093/cid/ciaa1535

Background: The epidemiology, clinical course, and outcomes of patients with coronavirus disease 2019 (COVID-19) in the Russian population are unknown. Information on the differences between laboratory-confirmed and clinically diagnosed COVID-19 in real-life settings is lacking.

Methods: We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID-19 infection in Moscow between 8 April and 28 May 2020.

Results: Of the 4261 patients hospitalized for suspected COVID-19, outcomes were available for 3480 patients (median age, 56 years; interquartile range, 45-66). The most common comorbidities were hypertension, obesity, chronic cardiovascular disease, and diabetes. Half of the patients (n = 1728) had a positive reverse transcriptase-polymerase chain reaction (RT-PCR), while 1748 had a negative RT-PCR but had clinical symptoms and characteristic computed tomography signs suggestive of COVID-19. No significant differences in frequency of symptoms, laboratory test results, and risk factors for in-hospital mortality were found between those exclusively clinically diagnosed or with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR. In a multivariable logistic regression model the following were associated with in-hospital mortality: older age (per 1-year increase; odds ratio, 1.05; 95% confidence interval, 1.03-1.06), male sex (1.71; 1.24-2.37), chronic kidney disease (2.99; 1.89-4.64), diabetes (2.1; 1.46-2.99), chronic cardiovascular disease (1.78; 1.24-2.57), and dementia (2.73; 1.34-5.47).

Conclusions: Age, male sex, and chronic comorbidities were risk factors for in-hospital mortality. The combination of clinical features was sufficient to diagnose COVID-19 infection, indicating that laboratory testing is not critical in real-life clinical practice.

Keywords: COVID-19; Russia; SARS-CoV-2; cohort; mortality risk factors.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

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How to Thrive as You Age

Got tinnitus a device that tickles the tongue helps this musician find relief.

Allison Aubrey

After using the Lenire device for an hour each day for 12 weeks, Victoria Banks says her tinnitus is "barely noticeable." David Petrelli/Victoria Banks hide caption

After using the Lenire device for an hour each day for 12 weeks, Victoria Banks says her tinnitus is "barely noticeable."

Imagine if every moment is filled with a high-pitched buzz or ring that you can't turn off.

More than 25 million adults in the U.S., have a condition called tinnitus, according to the American Tinnitus Association. It can be stressful, even panic-inducing and difficult to manage. Dozens of factors can contribute to the onset of tinnitus, including hearing loss, exposure to loud noise or a viral illness.

There's no cure, but there are a range of strategies to reduce the symptoms and make it less bothersome, including hearing aids, mindfulness therapy , and one newer option – a device approved by the FDA to treat tinnitus using electrical stimulation of the tongue.

The device has helped Victoria Banks, a singer and songwriter in Nashville, Tenn., who developed tinnitus about three years ago.

"The noise in my head felt like a bunch of cicadas," Banks says. "It was terrifying." The buzz made it difficult for her to sing and listen to music. "It can be absolutely debilitating," she says.

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Tinnitus bothers millions of americans. here's how to turn down the noise.

Banks tried taking dietary supplements , but those didn't help. She also stepped up exercise, but that didn't bring relief either. Then she read about a device called Lenire, which was approved by the FDA in March 2023. It includes a plastic mouthpiece with stainless steel electrodes that electrically stimulate the tongue. It is the first device of its kind to be approved for tinnitus.

"This had worked for other people, and I thought I'm willing to try anything at this point," Banks recalls.

She sought out audiologist Brian Fligor, who treats severe cases of tinnitus in the Boston area. Fligor was impressed by the results of a clinical trial that found 84% of participants who tried Lenire experienced a significant reduction in symptoms. He became one of the first providers in the U.S. to use the device with his patients. Fligor also served on an advisory panel assembled by the company who developed it.

"A good candidate for this device is somebody who's had tinnitus for at least three months," Fligor says, emphasizing that people should be evaluated first to make sure there's not an underlying medical issue.

Tinnitus often accompanies hearing loss, but Victoria Banks' hearing was fine and she had no other medical issue, so she was a good candidate.

Banks used the device for an hour each day for 12 weeks. During the hour-long sessions, the electrical stimulation "tickles" the tongue, she says. In addition, the device includes a set of headphones that play a series of tones and ocean-wave sounds.

The device works, in part, by shifting the brain's attention away from the buzz. We're wired to focus on important information coming into our brains, Fligor says. Think of it as a spotlight at a show pointed at the most important thing on the stage. "When you have tinnitus and you're frustrated or angry or scared by it, that spotlight gets really strong and focused on the tinnitus," Fligor says.

"It's the combination of what you're feeling through the nerves in your tongue and what you're hearing through your ears happening in synchrony that causes the spotlight in your brain to not be so stuck on the tinnitus," Fligor explains.

A clinical trial found 84% of people who used the device experienced a significant reduction in symptoms. Brian Fligor hide caption

A clinical trial found 84% of people who used the device experienced a significant reduction in symptoms.

"It unsticks your spotlight" and helps desensitize people to the perceived noise that their tinnitus creates, he says.

Banks says the ringing in her ears did not completely disappear, but now it's barely noticeable on most days.

"It's kind of like if I lived near a waterfall and the waterfall was constantly going," she says. Over time, the waterfall sound fades out of consciousness.

"My brain is now focusing on other things," and the buzz is no longer so distracting. She's back to listening to music, writing music, and performing music." I'm doing all of those things," she says.

When the buzz comes back into focus, Banks says a refresher session with the device helps.

A clinical trial found that 84% of people who tried Lenire , saw significant improvements in their condition. To measure changes, the participants took a questionnaire that asked them to rate how much tinnitus was impacting their sleep, sense of control, feelings of well-being and quality of life. After 12 weeks of using the device, participants improved by an average of 14 points.

"Where this device fits into the big picture, is that it's not a cure-all, but it's quickly become my go-to," for people who do not respond to other ways of managing tinnitus, Fligor says.

One down-side is the cost. Banks paid about $4,000 for the Lenire device, and insurance doesn't cover it. She put the expense on her credit card and paid it off gradually.

Fligor hopes that as the evidence of its effectiveness accumulates, insurers will begin to cover it. Despite the cost, more than 80% of participants in the clinical trial said they would recommend the device to a friend with tinnitus.

But, it's unclear how long the benefits last. Clinical trials have only evaluated Lenire over a 1-year period. "How durable are the effects? We don't really know yet," says audiologist Marc Fagelson, the scientific advisory committee chair of the American Tinnitus Association. He says research is promising but there's still more to learn.

Fagelson says the first step he takes with his patients is an evaluation for hearing loss. Research shows that hearing aids can be an effective treatment for tinnitus among people who have both tinnitus and hearing loss, which is much more common among older adults. An estimated one-third of adults 65 years of age and older who have hearing loss, also have tinnitus.

"We do see a lot of patients, even with very mild loss, who benefit from hearing aids," Fagelson says, but in his experience it's about 50-50 in terms of improving tinnitus. Often, he says people with tinnitus need to explore options beyond hearing aids.

Bruce Freeman , a scientist at the University of Pittsburgh Medical Center, says he's benefitted from both hearing aids and Lenire. He was fitted for the device in Ireland where it was developed, before it was available in the U.S.

Freeman agrees that the ringing never truly disappears, but the device has helped him manage the condition. He describes the sounds that play through the device headphones as very calming and "almost hypnotic" and combined with the tongue vibration, it's helped desensitize him to the ring.

Freeman – who is a research scientist – says he's impressed with the results of research, including a study published in Nature, Scientific Reports that points to significant improvements among clinical trial participants with tinnitus.

Freeman experienced a return of his symptoms when he stopped using the device. "Without it the tinnitus got worse," he says. Then, when he resumed use, it improved.

Freeman believes his long-term exposure to noisy instruments in his research laboratory may have played a role in his condition, and also a neck injury from a bicycle accident that fractured his vertebra. "All of those things converged," he says.

Freeman has developed several habits that help keep the high-pitched ring out of his consciousness and maintain good health. "One thing that does wonders is swimming," he says, pointing to the swooshing sound of water in his ears. "That's a form of mindfulness," he explains.

When it comes to the ring of tinnitus, "it comes and goes," Freeman says. For now, it has subsided into the background, he told me with a sense of relief. "The last two years have been great," he says – a combination of the device, hearing aids and the mindfulness that comes from a swim.

This story was edited by Jane Greenhalgh

• ringing in ears
• hearing loss

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May 2, 2024

Purdue to open Accessible Precision Audiology Research Center in Indianapolis

Purdue graduate student Natalie Seidl tests a subject’s hearing in a sound-attenuating booth. Purdue’s audiology graduate program was ranked No. 8 in the 2024-25 U.S. News & World Report Best Graduate Schools national rankings. (Photo provided by Purdue Department of Speech, Language, and Hearing Sciences)

The new facility at 16 Tech Innovation District will address hearing health needs, with a focus on underserved groups

INDIANAPOLIS — Leveraging Purdue’s internationally recognized expertise in audiology and auditory neuroscience and AI-driven data analytics, Purdue University announced plans for the new Accessible Precision Audiology Research Center (APARC) in Indianapolis on Wednesday (May 1). The community-facing center will address the urgent need for accessible precision audiology, especially among underserved populations in Indiana. It will be housed in the 16 Tech Innovation District, the city’s destination for innovation and entrepreneurship, and be adjacent to Purdue University in Indianapolis, the urban extension campus that launches July 1.

By establishing the APARC in Indianapolis at 16 Tech, Purdue aims to reach diverse populations in Indiana with information about the many health and economic burdens associated with untreated hearing loss, along with providing research-grade standardized hearing assessments for community members. An open-source data hub of standardized hearing measures for researchers using AI-enabled analysis tools will create more testing and treatment capabilities.

“Purdue’s new Accessible Precision Audiology Research Center in Indianapolis will leverage our leadership in both AI and the speech, language and hearing sciences,” said Karen Plaut, executive vice president for research. “Using AI to better analyze measures of hearing loss, the goal of this research center is to develop better testing methods and improve the hearing and overall well-being for people living in central Indiana and beyond.”

ADDITIONAL INFORMATION

• Purdue’s Manufacturing and Materials Research Laboratories announces new Indianapolis presence
• Purdue University, High Alpha partner to house programs in downtown Indianapolis
• Purdue University in Indianapolis: Launching Purdue’s first comprehensive urban campus and forming America’s Hard-Tech Corridor

The faculty team leading APARC illustrates the interdisciplinary approaches that are required to meet today’s grand challenges. The team is led by Michael Heinz, associate head for research in the Department of Speech, Language, and Hearing Sciences (SLHS), along with fellow SLHS faculty Jennifer Simpson, Maureen Shader and Josh Alexander, as well as Ananth Garma in the Department of Computer Science and Edward Bartlett in the Department of Biological Sciences.  The center is supported by Purdue’s Office of Research and the Office of the Provost and leverages several significant grants from the National Institutes of Health.

“I am especially proud that funding for APARC came about following a research proposal by faculty members during Purdue’s life and health sciences summit in 2023,” Plaut said.

Untreated hearing loss is associated with increased cognitive decline, dementia, social isolation, falls and mental health disorders. Additional comorbidities of hearing loss include cardiovascular disease and diabetes. For people with untreated hearing loss, health care costs are 46% higher and inpatient stays occur 1.5 times more often than for those without hearing loss.

Overcoming these health and economic burdens is made even more difficult by limited access to quality audiological care. In the U.S. today, only one audiologist exists for every 14,000 people, and over 15% of American adults nationwide — around 40 million people — have trouble hearing. This highlights the urgent need for precision audiology to support targeted treatment (for example, hearing aids, cochlear implants or, ultimately, biopharmaceutical approaches), rehabilitation, and identification of population and individual-specific risk factors.

“We are grateful for Purdue's support to help synergize our team's expertise in auditory neuroscience, clinical audiology and data analytics to address the significant issue of untreated hearing loss, which has numerous societal health and economic implications,” Heinz said. “Our Indianapolis presence within the innovation hub in the 16 Tech Innovation District, adjacent to the AMP artisan marketplace and food hall, provides a unique opportunity for us to establish APARC in a community-based ecosystem that includes many other initiatives aimed at accelerating transformative health solutions for central Indiana and beyond.”

At the new APARC in Indianapolis, researchers will be looking for innovative ways to address challenges associated with hearing loss, especially in low-resource urban and rural communities in the state. Indiana-specific populations with elevated risk for untreated hearing loss include farmers, Indianapolis Motor Speedway workers and fans, and those with significant health disparities residing in underserved neighborhoods. The APARC is the latest example of how Purdue is expanding its presence in central Indiana by applying significant education, instruction and research efforts to this real-life issue at 16 Tech, where world-changing discoveries and economic opportunities are being created right in the heart of Indiana’s capital city.

“APARC is a great example of an innovative program that is improving patient outcomes through technology,” said Emily Krueger, president and CEO of 16 Tech Community Corp., the nonprofit manager of the innovation district. “By locating in 16 Tech, APARC joins a growing cluster of health tech and med tech companies that have access to resources that help them scale and the diverse communities they aim to serve.”

Purdue’s Department of Speech, Language, and Hearing Sciences in the College of Health and Human Sciences is highly recognized worldwide for its undergraduate and two clinical graduate and PhD programs. The Doctor of Audiology program ranked No. 8 in the 2024-25 U.S. News and World Report Best Graduate Schools rankings  due to the exceptional work of the clinical and academic faculty, who promote evidence-based practice with a deep scientific foundation.

The overarching goal of the college is to positively impact people’s behavior, health and quality of life, which aligns with the needs of patients and Purdue students. 

About Purdue University in Indianapolis

Purdue University in Indianapolis is a new, fully integrated extension of the West Lafayette campus, expanding the academic rigor and accessible excellence that Purdue is known for to central Indiana. As the state’s only public top 10 university, most trusted university and most innovative university, Purdue is focused and committed to strengthening its presence in Indiana’s industrial and technological center. Purdue University in Indianapolis will create an innovative, STEM-based collegiate experience by connecting future-ready Purdue students and faculty in Indianapolis to local businesses to accelerate Indiana’s STEM pipeline and tech ecosystem, fueling impact for our region and the world. Realignment of the existing IUPUI partnership will be completed by the start of the fall semester in 2024. Learn more about Purdue’s latest giant leap at https://www.purdue.edu/campuses/indianapolis/ .

About 16 Tech

Opened in 2020, the 16 Tech Innovation District is a growing destination for innovation and entrepreneurship and a driver of the tech enablement of the life sciences and advanced manufacturing industries key to Indiana’s economy. Connected to diverse neighborhoods in downtown Indianapolis and intentionally resourced with facilities and programs to foster innovation, 16 Tech is home to three buildings with a variety of office, wet- and dry-lab spaces and makerspaces, and 200-plus innovation-related entities that employ more than 800 people. At full build-out, 16 Tech anticipates more than 2 million square feet of innovation-related space that support 3,000 jobs.  

Writer/Media contact:  Derek Schultz,  [email protected]

Sources:  Michael Heinz [email protected] , Karen Plaut, Emily Krueger

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Who do Americans feel comfortable talking to about their mental health?

Half of Americans or more say they are extremely or very comfortable talking about their mental health with a close friend (57%), an immediate family member (52%) or a mental health therapist (50%), according to a new Pew Research Center survey.

Pew Research Center conducted this analysis to understand who Americans feel comfortable talking to about their mental health and emotional well-being. For this analysis, we surveyed 10,133 U.S. adults from Feb. 7 to Feb. 11, 2024.

Everyone who took part in the survey is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way, nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology .

For this study, respondents who are not married nor living with a partner were not asked about their comfort talking with a spouse or partner about their mental health and emotional well-being. Those who are not working for pay were not asked about someone they work with. Some of the items were asked of half the sample. Refer to the topline questionnaire below for details about the survey administration.

Here are the questions used for this analysis , along with responses, and the survey methodology .

In the United States, the importance of mental health and emotional well-being has grown increasingly visible, particularly in light of the mental health challenges many Americans faced during the COVID-19 pandemic . Health professionals encourage people to turn to a trusted support network to weather life’s difficult moments, so we asked U.S. adults about who they feel they can open up to about their mental health.

Still, not all Americans are comfortable talking about their mental health with people close to them or with professionals. About three-in-ten U.S. adults (31%) say they would be only somewhat comfortable talking with a close friend about their mental health, and an additional 12% would be not too or not at all comfortable with this. Similar shares say this about discussing mental health with an immediate family member or a therapist.

When it comes to other people Americans might open up to about their mental health, comfort levels vary:

Significant others are seen as a source of support for most people who are married or living with a partner. A large majority of these Americans (79%) are extremely or very comfortable talking about their mental health with their spouse or partner. This is the highest level of comfort across the types of people we asked about.

However, this source of support is not available to all adults. About four-in-ten Americans say they are not married nor living with a partner, while roughly six-in-ten say they are.

Americans who frequently attend religious services are largely comfortable discussing their mental health with faith leaders . Overall, 31% of U.S. adults say they would feel extremely or very comfortable talking about this with a spiritual or religious leader. But comfort is much higher among adults who report attending religious services at least once a week: 58% of regular attenders would be comfortable talking about their mental health with a religious leader.

Americans largely feel uncomfortable talking about their mental health with colleagues or neighbors . Nearly half of working Americans (48%) say they would feel not too or not at all comfortable talking about this with a co-worker. And roughly two-thirds of Americans overall (68%) would be uncomfortable talking about their mental health with a neighbor.

Modest differences by gender and age

We did not find large differences in comfort talking about mental health by gender or age, even though these factors are related to the likelihood of experiencing certain mental health conditions .

For example, similar shares of women (53%) and men (47%) say they are extremely or very comfortable talking to a therapist about their mental health. And women and men rank the seven sources of support included in the survey in the same order.

Differences are also modest across age groups. Adults ages 18 to 29 and those ages 65 and older express similar levels of comfort talking about their mental health with a close friend, immediate family member or therapist.

Networks of social support

Health experts say having diverse, supportive relationships can enhance emotional well-being . Our survey offers a mixed picture of the networks Americans turn to for talking about mental health.

On the one hand, nearly half of Americans (47%) say they are extremely or very comfortable having mental health conversations with three or more types of people included in the survey.

On the other hand, 15% of Americans are not extremely or very comfortable talking about their mental health with any of the types of people we asked about.

Between these two ends of the spectrum, 17% of Americans are comfortable talking about their mental health with only one of the types of people included in the survey, and 21% are comfortable doing so with two types of people.

The survey did not ask about the total number of people respondents are comfortable talking with about their mental health. Some respondents may only be comfortable with one type of contact – like a close friend – but could have more than one close friend they’d feel comfortable turning to.

Unpartnered U.S. adults are more likely than partnered U.S. adults to not be highly comfortable talking about their mental health with any of the types of people we asked about. Among Americans who are not married and don’t live with a partner, about a quarter (23%) are not extremely or very comfortable talking about their mental health with any of the people asked about in the survey. That’s larger than the share of married or partnered Americans who give this response (10%).

Note: Here are the questions used for this analysis , along with responses, and the survey methodology .

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Giancarlo Pasquini is a research associate focusing on science and society research at Pew Research Center .

Emma Kikuchi is is a research assistant focusing on science and society research at Pew Research Center .

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Biden-Harris Administration Invests $105 Million in Community-Based Organizations to Improve Maternal and Infant Health Across the Country

Healthy Start funding will better support moms and babies to improve health in communities experiencing high disparities in maternal and infant health outcomes

Announcement made in Atlanta, GA, the second stop of HRSA’s year-long Enhancing Maternal Health Initiative

Today, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced $105 million in funding to support more than 100 community-based organizations working to improve maternal and infant health. HRSA Administrator Carole Johnson highlighted the news during a visit to Southside Medical Center, a new Healthy Start awardee, in Atlanta, Georgia. Georgia is the second stop on HRSA’s national Enhancing Maternal Health Initiative tour. Today’s Healthy Start funding announcement will support the health care and social needs of moms and babies in high need communities to help improve community health and tackle the unacceptable disparities in maternal and infant health outcomes.

“Maternal health is a fundamental human right and every mother deserves access to quality care and support. Having a safe and healthy pregnancy and birth shouldn’t depend on the color of your skin, what language you speak at home, or where you live,” said HHS Secretary Xavier Becerra. “We know that by expanding access to proven health care best practices we can help moms and their children thrive. That’s why the Biden-Harris Administration continues to support organizations working to improve maternal and infant health, especially in communities most at risk of poor outcomes.”

“At the Health Resources and Services Administration, we know that healthy babies begin with healthy moms,” said HRSA Administrator Carole Johnson. “Today’s $105 million investment in our Healthy Start Program is essential to implementing the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis . Through these Healthy Start awards we will support on-the-ground, community-based organizations who will work every day to help expecting and new moms get the health care and key supports – like transportation to prenatal care and food assistance – they need to have healthy pregnancies and healthy babies.”

Healthy Start is a HRSA-funded program that focuses on improving the well-being of expecting mothers and those who have just given birth, addressing needs in communities with infant mortality rates that are 1.5 times the national average or greater, and combatting the disparities in outcomes that have resulted in higher mortality rates for Black and Indigenous women and infants of color. Healthy Start Programs are able to tailor services to community needs, including by supporting culturally responsive health care services, food assistance, emergency supplies, transportation to care, housing navigation, and other critical social supports. Healthy Start also supports clinical service providers and other key members of the workforce, including mental health professionals, doulas, nutritionists, social workers, case managers and other community health workers.

HRSA’s Enhancing Maternal Health Initiative is focused on accelerating HRSA’s maternal health work to address maternal mortality and maternal health disparities in partnership with women, grantees, community organizations, and state and local health officials across the country. HRSA is the arm of the U.S. Department of Health and Human Services (HHS) that funds state and local community efforts to improve maternal and child health; invests in sustaining and expanding maternal health care services in rural communities; funds training and loan repayment to support the next generation of the health workforce including obstetricians (OBs), midwives and community-based doulas; provides community-based maternal health care in high need communities regardless of individuals’ ability to pay through HRSA-funded community health centers; and, runs the National Maternal Mental Health Hotline at 833-TLC-MAMA. The Enhancing Maternal Health Initiative is working in areas of the country with high maternal mortality rates where HRSA has programs that can work together to help advance better outcomes, including Arizona, Alabama, Georgia, Illinois, Kentucky, Maryland, Michigan, Missouri, Montana, North Carolina, Oregon, and the District of Columbia.

For the full list of award recipients, visit the Healthy Start awards page .

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