Billie, who has smoked most of his life, understands how using tobacco can negatively affect many aspects of a person's health. He is also a member of the Navajo Nation and has witnessed the challenges that family, friends and other members of his tribe have faced quitting tobacco. In recent years, he has watched the rising use of vaping among Navajo youth with concern. He wants to discourage young people from using tobacco except for ceremonial purposes.

"Science seeking to cure disease and transform the way we deliver healthcare requires a direct connection to the people we serve."

Annie Rusk, M.D.

Billie's experiences made him an ideal candidate to advise Dr. Rusk on her research through a Mayo Clinic program called Community Engagement (CE) Studios.

CE Studios is a consultation service that connects researchers to a group of "community experts" who represent the researcher's population of interest. These experts meet with the researcher, usually during a study's planning phase, to learn how the study is being designed, ask questions and provide feedback.

Since Mayo Clinic introduced CE Studios in 2021, Dr. Rusk has used it numerous times. She believes community input is essential for all research projects, regardless of their focus. 

"By involving people with lived experiences, we can gain valuable insights and ensure our research is relevant and impactful," says Dr. Rusk. "Even discovery science projects taking place in a lab can benefit from community perspectives."

Lived experiences provide key insights

For the CE Studios session with Dr. Rusk, Billie joined three other community experts from tribes in the Midwest, Alaska and Canada in a virtual meeting. The four community experts were there to advise Dr. Rusk on a new clinical trial.

Kory Billie, a member of the Navajo Nation from Phoenix, wants to discourage youth in his community from using tobacco, except for ceremonial purposes.

Dr. Rusk's research focuses on understanding barriers to smoking cessation among Native Americans. She felt it was important to consult with people from a variety of Indigenous communities to ensure her research aligned with their community health needs and priorities.

Billie says he enjoyed this opportunity to connect with like-minded people from similar backgrounds, and to speak with Dr. Rusk about how tobacco use was affecting communities like his. He shared his experiences with homelessness and addiction, as well as the difficulty of accessing smoking cessation resources in Indian Country.

What Dr. Rusk learned from Billie and the other community experts during the CE Studios session motivated her to make an important change to her study design.

The elements of the study that resonated best with the community experts were those geared toward developing practical behavioral health interventions. Billie and the other experts emphasized that understanding the social and cultural drivers of smoking would be key to achieving meaningful outcomes.  "You have to understand a person's environment and the way they're brought up," says Billie.

The community experts were less keen on a genetic analysis component Dr. Rusk had planned to include. They felt this aspect did not align meaningfully with community health priorities. Based on this feedback, Dr. Rusk eliminated this component from her study. 

While incorporating this kind of feedback can be challenging, Dr. Rusk says the long-term benefits are worth it for all.

"Science seeking to cure disease and transform the way we deliver healthcare requires a direct connection to the people we serve," she says.

Health is a blessing

Billie says he appreciated this chance to participate in CE Studios. He hopes that the knowledge he and the other experts shared will give Dr. Rusk the context she needs to develop a tobacco intervention that will have a lasting impact. He looks forward to hearing from her upon completion of the study to see the results.

He encourages other people to consider participating in CE Studios to help advance research to improve the health of their communities. He connects his motivation for this work to a Navajo proverb that reminds his people to live their lives with purpose:

"Remember to walk in beauty. Beauty before you and beauty behind you."

If the community can improve the health of its people today, he says, they will pass that blessing on to future generations.

Get involved in CE Studios

A CE Studios community expert can be a person with any type of lived experience. Experts receive a small honorarium in exchange for their time. People interested in joining Mayo Clinic’s database of community experts should complete a Community Expert Enrollment Form.  

Mayo Clinic Community Engaged Research

Learn more about community outreach and engagement and community-engaged research at Mayo Clinic.

This work is supported by Mayo Clinic Center for Clinical and Translational Science and by Mayo Clinic Comprehensive Cancer Center.

The post Native community experts guide tobacco cessation research appeared first on Mayo Clinic News Network.

Mayo Clinic researchers have developed organoid models to study uveal melanoma, one of the most common types of eye cancer in adults. Their goal is to use these models to better understand how this disease works and develop treatments for unmet patient needs.

Organoids are 3D models grown from patient tissue that accurately reflect a patient's unique genetic and biological characteristics, also known as "avatars." When derived from a patient's cancer tumor, an organoid will behave and respond to treatments outside the body in a lab (in vitro) just like the original tumor would inside the body (in vivo).

In 50% of patients, uveal melanoma metastasizes, spreading to other parts of the body, leading to a poor prognosis and average survival of less than two years.  Unfortunately, current treatments for this condition often have limited effectiveness, leaving patients and their doctors with few options.

"The hope is that these patient-derived organoid models better represent human cancer in the laboratory," says Lauren Dalvin, M.D., a Mayo Clinic Comprehensive Cancer Center ocular oncologist and surgeon-scientist who is one of the lead researchers. "Using these models as a foundation for drug testing will facilitate new treatment discoveries with higher success rates in clinical trials, ultimately translating to improved outcomes for patients with uveal melanoma."

Growing an eye cancer biobank

In the past, the lack of human disease models representing the entire spectrum of uveal melanoma has created a bottleneck, limiting the ability of scientists to identify effective targets for treatment and prevention. Most laboratory studies have drawn from the same set of commercially available cell lines, which are not representative of the disease and often differ in important ways from the original tumors.

To blast through this bottleneck, a study team led by Dr. Dalvin, in collaboration with Martin Fernandez-Zapico, M.D., a cancer biologist with Mayo Clinic Comprehensive Cancer Center, decided to develop a new, uveal melanoma patient-derived organoid biobank. Their goal is to create a research resource representing the real-world variability of this cancer.

In a paper published in Investigative Ophthalmology & Visual Science, they described the initial development of this biobank. The researchers successfully created organoids derived from Mayo Clinic ocular oncology patients who enrolled in a prospective study involving the collection of tumor tissue for research from July 1, 2019, through July 1, 2024. Their study determined that these organoid models:

• Could be generated, retained their stability through many uses and were a renewable living resource capable of being regenerated at need.
• Retained the clinically relevant features of the original tumors, clustered into appropriate molecular groups based on validated prognostic markers and resembled human disease when compared to in vivo animal models.
• Served as suitable human models for drug screening.

Recognizing the immense value of this organoid biobank, the investigators have already begun expanding it to include other research centers. Their goal is to create a resource capable of representing the global epigenomic variability of uveal melanoma. In the future, they hope this biobank will serve as a comprehensive platform for drug screening and other types of lab research on uveal melanoma. This collaborative effort will accelerate research and pave the way for improved treatments and outcomes for patients with this disease.

Read the paper to learn more about the study, including funding and disclosures.

Mayo Clinic organoid research across the spectrum of disease

Organoids are transforming the landscape of biomedical research. Scientists are using this innovative approach to model diseases, track their progression and identify and characterize potential treatments. Mayo Clinic is at the forefront of organoid research, applying this approach to study a wide range of health conditions including:

• Neurodegenerative and neurological disorders, such as Lewy body dementia, Alzheimer's disease, autism, opioid addiction and alcohol use disorder.
• Measles and other infectious diseases.
• Many types of cancer including breast cancer.
• Inflammatory bowel disease.

The goals of this research extend far beyond its current applications. Mayo Clinic researchers aim to develop organoids representing organs throughout the human body to track disease, screen drugs and regenerate tissues. This approach holds the promise of accelerating research in precision medicine and the search for cures in other areas of biomedical research.

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A new study has revealed a significant link between a common pregnancy complication and early heart disease in women.

Researchers found that women with a history of hypertensive disorders of pregnancy (HDP) were at higher risk of developing coronary artery disease at an earlier age. In addition, they found that women with these disorders were at higher risk of myocardial infarction with non-obstructive coronary arteries (MINOCA) — heart attacks that occur when the coronary arteries appear normal. 

Hypertensive disorders of pregnancy (HDP) — such as gestational hypertension, chronic hypertension and preeclampsia — affect 15% of women during their reproductive years. Marked by high blood pressure, the effects of these disorders continue to impact the health of mothers and babies well after pregnancy.

Compared to women with a history of normotensive (normal blood pressure) pregnancies, women in this study with a history of HDP were at greater risk for:

• Early onset of coronary artery disease: Occurring on average seven years earlier among women with a history of HDP.
• More severe atherosclerotic coronary artery disease: Twice as likely among women with a history of HDP.
• Increased risk of MINOCA: Twice as likely among women with a history of HDP.

"This research highlights the need for earlier screening for heart disease among women with a history of high blood pressure in pregnancy, particularly for MINOCA, which is up to five times more common in women than in men," says Vesna Garovic, M.D., Ph.D., a Mayo Clinic nephrologist and senior author of the study.

To improve patient care and outcomes for women, the researchers say clinicians should not only screen for traditional coronary artery disease risk factors, but they should also screen for non-traditional risk factors associated with MINOCA and other non-obstructive types of coronary artery disease, such as stress, autoimmune diseases — and now, HDP.

How does high blood pressure in pregnancy lead to coronary artery disease?

According to the researchers, there are two related types of small vessel heart disease that may make it more likely for women to develop HDP and coronary artery disease:

1. Microvascular dysfunction: Women with a history of HDP often have this underlying problem, which occurs when the small blood vessels that feed the heart stop working as they should, decreasing blood flow to the heart.
2. Endothelial dysfunction: This is a problem common to both HDP and coronary artery disease. It occurs when the cells that line the inside of blood vessels malfunction, narrowing instead of dilating.

Together, these dysfunctions clog or narrow the arteries and small blood vessels that supply blood to the heart, which can lead to coronary artery disease without any physical blockage (non-obstructive). The researchers think it's possible that these processes may feed on one another, creating an environment where coronary artery disease is more likely to occur.

Further research, including large prospective studies, are needed to understand the mechanisms linking HDP to coronary artery disease, such as specific biomarkers and genetic factors that contribute to increased risk.

Read the paper to learn more about the study, including funding and disclosures.

A growing body of research on high blood pressure in pregnancy

Research led by Dr. Garovic, a Mayo Clinic nephrologist, has shown links between HDP and a greater risk for a wide range of health concerns including:

• Atherosclerosis and stroke
• Renal disease
• Brain cell damage and inflammation
• Accelerated aging and the markers of cellular senescence
• Early-onset hypertension in children

The overall goal of Dr. Garovic's research is to increase understanding of the causes and mechanisms that play a role in the process that leads to HDP. The potential to identify targeted therapies that address the underlying causes of disease may improve treatment options for diseases, such as preeclampsia, that have seen few therapeutic advances in recent decades.

Related:
Mothers with history of pre-eclampsia may encounter cardiovascular challenges later in life

The post High blood pressure in pregnancy a risk factor for early heart disease appeared first on Mayo Clinic News Network.

Growing mini-organs to find new treatments for complex disease

Mayo Clinic investigators are growing three-dimensional human intestines in a dish to track disease and find new cures for complex conditions such as inflammatory bowel disease. These mini-organs function like human intestines, with the ability to process metabolites that convert food into energy on a cellular level and secrete mucus that protects against bacteria. These 3D mini-intestines in a dish, known as "organoids," provide a unique platform for studying the intricacies of the human gut.

"We think this has the potential to revolutionize the way we approach disease research. We hope to save time and resources and avoid the development of therapies that fail upon translation into patients," says Charles Howe, Ph.D., who leads the Translational Neuroimmunology Lab. "Understanding which treatments show potential for success in human organoids could dramatically accelerate the rate of new therapies for patients with unmet needs."

Brain stimulation shows promise in treating drug addiction

Physicians use neurostimulation to treat a variety of human disorders, including Parkinson's disease, tremor, obsessive-compulsive disorder and Tourette syndrome. A Mayo Clinic neurosurgeon and his colleagues believe one form of that treatment, called deep brain stimulation (DBS), is poised to solve one of the most significant public health challenges: drug addiction.

"Drug addiction is a huge, unmet medical need," says Kendall Lee, M.D., Ph.D., who has published nearly 100 journal articles on DBS along with his colleagues. Key to treating it, he says, is cutting off the pleasurable "high" that comes with the addiction — which DBS potentially can do.

A new class of AI aims to improve cancer research and treatments

Mayo Clinic researchers have invented a new class of artificial intelligence (AI) algorithms called hypothesis-driven AI, which is a significant departure from traditional AI models that learn solely from data. The researchers note that this emerging class of AI offers an innovative way to use massive datasets to help discover the complex causes of diseases, such as cancer, and improve treatment strategies.

"This fosters a new era in designing targeted and informed AI algorithms to solve scientific questions, better understand diseases and guide individualized medicine," says co-inventor Hu Li, Ph.D., a Mayo Clinic systems biology and AI researcher. "It has the potential to uncover insights missed by conventional AI."

What's lurking in your body? Mayo probes health risks of tiny plastic particles

Similar to natural elements like iron and copper, people can ingest, absorb, or even inhale microplastics and nanoplastics and their chemical additives. A landmark study published in the New England Journal of Medicine links microplastics and nanoplastics found in plaques of human blood vessels to a potential increased risk of heart attack, stroke or death.

"Plastics have made our lives more convenient and spurred many medical advances, but we must understand their impact on human health for the years to come," says Konstantinos Lazaridis, M.D., the Carlson and Nelson Endowed Executive Director for Mayo Clinic's Center for Individualized Medicine.

Mayo Clinic researchers' new tool links Alzheimer's disease types to rate of cognitive decline

Mayo Clinic researchers have discovered a series of brain changes characterized by unique clinical features and immune cell behaviors using a new corticolimbic index tool for Alzheimer's disease, a leading cause of dementia. The tool categorizes Alzheimer's disease cases into three subtypes according to the location of brain changes and continues the team's prior work, demonstrating how these changes affect people differently. Uncovering the microscopic pathology of the disease can help researchers pinpoint biomarkers that may affect future treatments and patient care.

"Our team found striking demographic and clinical differences among sex, age at symptomatic onset and rate of cognitive decline," says Melissa Murray, Ph.D., a translational neuropathologist at Mayo Clinic.

Mayo scientists explore swabs for early endometrial, ovarian cancer detection

Early detection improves treatment outcomes for endometrial and ovarian cancers, yet far too often, women are diagnosed when in advanced stages of these diseases. Unlike many other cancers, there are no standard screenings for early detection of endometrial and ovarian cancers. Mayo Clinic researchers have uncovered specific microbial signatures linked to endometrial and ovarian cancers, and they are working toward developing innovative home swab tests for women to assess their susceptibility.

"This research not only brings us closer to understanding the microbial dynamics in cancer, but also holds the potential to transform early detection and treatment strategies to positively impact women's health globally," says Marina Walther-Antonio, Ph.D., an assistant professor of surgery leading this research.

Reversing racism's toll on heart health

People who experience chronic exposure to racism may be affected by factors such as intergenerational trauma, reduced access to healthcare, differential treatment in healthcare settings and psychological distress. These negatively affect heart health and can have a cumulative effect throughout a person's life. Researchers from Mayo Clinic and the University of Minnesota published a paper which provides a new framework describing how racism affects heart health among people of color in Minnesota. The researchers are focused on reversing these disparities.

"This framework will help scientists explore and measure how chronic exposure to racism, not race, influences health outcomes," says Sean Phelan, Ph.D., a Mayo Clinic health services researcher. "This will help enable researchers to design interventions that address the root causes of these disparities and improve heart health for people of color everywhere."

Teamwork and research play a key role in Mayo Clinic's first larynx transplant

A team of six surgeons and 20 support staff combined expertise from the Department of Otolaryngology and the Department of Transplantation in an extraordinary 21-hour operation at Mayo Clinic. The team transplanted a donor larynx to a 59-year-old patient with cancer whose damaged larynx hampered his ability to talk, swallow and breathe. This groundbreaking surgery was only the third larynx transplant in the U.S., and the world's first known successful total larynx transplant performed in a patient with an active cancer as part of a clinical trial.

"All transplants are complex, but there are more tissue types and moving parts with laryngeal transplantation than other transplants," says David Lott, M.D., lead surgeon. "Mayo Clinic's team science approach made it possible for us to offer this type of transplant on a scale that was previously unattainable."

Space: A new frontier for exploring stem cell therapy

Two Mayo Clinic researchers say that stem cells grown in microgravity aboard the International Space Station have unique qualities that could one day help accelerate new biotherapies and heal complex disease. The research analysis by Abba Zubair, M.D., Ph.D., a laboratory medicine expert and medical director for the Center for Regenerative Biotherapeutics at Mayo Clinic in Florida, and Fay Abdul Ghani, Mayo Clinic research technologist, finds microgravity can strengthen the regenerative potential of cells. 

"Studying stem cells in space has uncovered cell mechanisms that would otherwise be undetected or unknown within the presence of normal gravity," says Dr. Zubair. "That discovery indicates a broader scientific value to this research, including potential clinical applications."

Mayo Clinic’s largest-ever exome study offers blueprint for biomedical breakthroughs

Mayo Clinic's Center for Individualized Medicine has achieved a significant milestone with its Tapestry study. It generated Mayo's largest-ever collection of exome data, which includes genes that code for proteins—key to understanding health and disease.  

Researchers analyzed DNA from over 100,000 participants of diverse backgrounds, providing important insights into certain genetic predispositions to support personalized and proactive medical guidance.  "The implications of the Tapestry study are monumental," says Konstantinos Lazaridis, M.D., the Carlson and Nelson Endowed Executive Director for the Center for Individualized Medicine. "As this study continues to inform and transform the practice of personalized medicine, it also sets a new standard for how large-scale medical research can be conducted in an increasingly digital and decentralized world."   

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:

• Colette Gallagher, Mayo Clinic Communications, newsbureau@mayo.edu

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Nooren's graduate training included classes about cancer, but Dr. Razidlo suggested Nooren look into an additional opportunity: a course specifically about pancreatic cancer where she could meet others in the field. Nooren applied and was accepted to attend a week-long intensive pancreatic cancer course at Cold Spring Harbor Laboratory in New York — a prestigious program that brings together about 30 nationally and internationally known researchers. "I was excited about the idea of the course — and also nervous," she says. "It was an opportunity to meet many scientists whose journal articles I had been reading."  

But first, she had to figure out how to attain funding to attend the course. The answer was a special — and until now, anonymous — award earmarked for Mayo’s Ph.D. students.     

Since 1999, graduate students who are eligible to take a specialized course outside Mayo have been able to apply to the graduate school for a competitive travel grant to pay their tuition and expenses. The award was financed by an anonymous benefactor, and nearly 100 students over the years have taken advantage of the opportunity.  Students have gone to courses at sites like Woods Hole, Massachusetts, or Jackson Laboratories in Maine, to learn new microscopy techniques or new approaches in genetics. After they return, students send a thank you note for the funding. The donor has been happy to receive a summary from students about what they learned, but otherwise has remained in the shadows.  

This year, the source of the funding came to light: two Mayo educators who initiated the grant decades ago. At her family's request, the newly named Lily Weinshilboum Travel Award for Mayo Clinic Graduate School of Biomedical Sciences, honors the memory of the trained anatomist and biomedical researcher who taught at Mayo Clinic for 25 years. Lily Weinshilboum died in 2023 at the age of 86, but the grant she first imagined is continuing to contribute to the success of Mayo's Ph.D. students. 

The importance of daring and determination 

In the naming of the grant, Lily Weinshilboum's family hopes students will learn about her dedication to biomedical education and her enterprising spirit, says her husband and co-benefactor, Mayo Clinic internist Richard Weinshilboum, M.D., the Mary Lou and John H. Dasburg Professor of Cancer Genomics Research.  

As a young woman, Lily Weinshilboum traveled independently to the United States from Taiwan in 1954, determined to advance her interest in science. A scholarship enabled her to attend Ottawa University in Kansas. She went on to train as a neuroanatomist at the University of Kansas in Lawrence and was a teaching assistant in graduate school when she met her husband, who was then a medical student. After completing her master's degree, she worked with a research group in Boston and later in a lab at the National Institutes of Health as Dr. Weinshilboum completed his training. The Weinshilboums came to Mayo Clinic in Rochester in 1972 for the next stage of their careers. Lily Weinshilboum's outgoing and nurturing personality made her a dynamic anatomy instructor in the medical school, where she connected with students as they embarked on their training and began to recognize the importance of their roles in patients' lives.  

Daring and determination were themes in her life. Once she had retired, she came up with the idea for a fund to help graduate students take an extra step on their career paths. "She wanted to help graduate students gain perspective, learn new topics and begin to create networks with researchers by attending meetings that stretched beyond what was readily available at Mayo," says Dr. Weinshilboum, who serves as a Ph.D. mentor and dissertation advisor for graduate students. "We viewed the travel grants as one way we could help." 

Former graduate students — now established researchers and educators — attest to the lifelong impact of those experiences. Regenerative science researcher and dermatologist Saranya Wyles, M.D., Ph.D., received travel funding in 2014 during her training in Mayo's Medical Scientist Training Program. The money allowed her to attend a meeting in the United Kingdom focused on genetic engineering of stem cells. "Attending this event as a graduate student was a defining moment in my journey in regenerative medicine research," she says. "It reinforced my commitment to this field and paved the way for my current role as a research laboratory leader. Now I have the privilege of training Ph.D. and M.D.-Ph.D. students, and I encourage them to seek out similar opportunities and apply for the grant as well." 

Gaining confidence and building a network 

For Nooren, the meeting earlier this year at Cold Spring Harbor already has been a game-changer. The week of lectures gave her ideas that she brought back to her research in Dr. Razidlo's lab, including a new approach in microscopy that will expand her work. She gained confidence as she gave a presentation of her own research findings and joined scientific conversations with seasoned scientists. "It made me braver, just feeling that my questions were valid and that I could bring my expertise," she says. "Even in graduate seminars now, I'm more confident, and when we discuss works in progress, I'm more likely to raise my hand and say, 'Hey, have you tried this?'" 

Nooren also met like-minded colleagues as she learned about other pancreatic cancer labs around the country and met potential future collaborators. She hopes other students will apply for the grant to attend a course that expands their own research interests. "It's such an opportunity to connect, even though you're a student and you're at the first stages of becoming a scientist," she says. "You're learning and interacting with everyone, and you're all putting your heads together to try to solve the problems in the field. It was an amazing experience." 

That's exactly what Mrs. Weinshilboum intended in establishing the award, says Dr. Weinshilboum.  

"She read students' summary notes with great interest and a great sense of pride in having been able to help make these experiences possible," he says. "She was focused on training the next generation and encouraging them to do bold things."

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On Oct. 14, researchers, community partners and volunteers gathered to celebrate one of Mayo Clinic's longest community-academic partnerships. Rochester Healthy Community Partnership (RHCP) — a research collaboration focused on responding to community-identified health needs affecting immigrants to the U.S. — had just turned 20.

The event featured speakers from Mayo Clinic and the community who shared the story of RHCP’s beginning, its enduring connections to the community, its tremendous influence and its ongoing work.

"Being part of this group has been a blessing," says Yahye Ahmed, a longtime member of RHCP. "It has given me the opportunity to work and serve my community unconditionally."

A community case study published in Frontiers in Public Health described the history of RHCP and the lessons they’ve learned along the way. It also outlined how RHCP has championed and refined the principles of community-based participatory research (CBPR), leading to RHCP’s work being nationally recognized as a model for this type of research. At the 2024 Translational Science meeting, Mark Wieland, M.D., RHCP co-principal investigator, accepted an award on behalf of the partnership honoring it for "Addressing Health Equity Through Partnership and Innovation."  

"This award is a testament to the long-term success of RHCP as a nationally recognized research partnership that leverages the expertise of community and academic partners to create meaningful health equity impact, locally and across the country," says Dr. Wieland.

A timeline shared at RCHP's 20^th Anniversary event highlighted the body of research the partnership has produced, from Let’s Talk About TB (2004-2011) to Healthy Immigrant Families (2010-2018) to a Pandemic Communications Toolkit (launched in 2022 and ongoing). 

Research conducted by RHCP has resulted in the development of:

• An effective, sustainable, community-based tuberculosis (TB) prevention and control program.
• A childhood obesity prevention program for youth in an after-school program.
• Community-informed health care practices, such as digital storytelling for chronic disease prevention.
• Interventions designed to reduce cardiovascular risk and COVID-19 health disparities.

"It's impossible to adequately acknowledge all the thousands of people who have contributed to the success of RHCP," says Irene Sia, M.D., founder and co-principal investigator. "Thank you for 20 years of sharing your talents, your cultures, your knowledge, your time and your support."

Dr. Wieland is director of the Community-Engaged Research Program in Mayo Clinic's Center for Clinical and Translational Science. Dr. Sia is a physician in Mayo Clinic's Division of Public Health, Infectious Diseases, and Occupational Medicine. 

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ROCHESTER, Minn. — Uterine fibroids are a common condition that affects up to 80% of women in their lifetime. Nearly half of those women will experience symptoms that affect their quality of life and fertility, including severe pain and anemia. Uterine fibroids are the major reason for the removal of the uterus by hysterectomy. However, Mayo Clinic researchers recommend minimally invasive treatment alternatives to hysterectomy, in an invited clinical practice paper published in the New England Journal of Medicine.

"Less invasive treatments can help women recover faster and resume their normal activities more quickly. Additionally, many studies have now shown that there are health benefits to keeping the uterus and the ovaries," says Shannon Laughlin-Tommaso, M.D., Mayo Clinic OB-GYN and co-lead author of the paper.

Removing the uterus, even while sparing the ovaries, increases the risks of cardiovascular disease, depression, anxiety and higher mortality. These risks are higher for people who get their uteruses removed at a young age.

"Women contemplating a hysterectomy deserve counseling about these risks since there are other less invasive options for many women with fibroids," Dr. Laughlin-Tommaso says.

A recent study found that nearly 60% of women undergoing hysterectomy for fibroids had not received a less invasive treatment first. Having alternative options to hysterectomy allow women to maintain their uteruses for longer.

These alternatives include medical therapies, hormone-releasing IUDs, radiofrequency ablation, focused ultrasound ablation and uterine artery embolization.

Early detection is key. When fibroids are found early, they tend to be smaller and less extensive. As a result, treating them early is medically less complicated.

The incidence of fibroids increases with age until menopause and is higher among Black women. In addition, this population often presents with more severe fibroids.

"Earlier diagnosis and treatment of uterine fibroids can help reduce this health disparity among Black women," says Ebbie Stewart, M.D., co-lead author and Mayo Clinic gynecologist and reproductive endocrinologist. In survey-based studies, many Black patients preferred minimally invasive therapies over hysterectomies.

Diagnosing fibroids is straightforward with a pelvic ultrasound but determining who to screen is not, and screening usually occurs after the fibroids are large or the patients are symptomatic. Many women with symptomatic fibroids have reported psychological suffering, including depression, concern, anger and body image distress. 

The researchers suggest that future studies should include screening younger women, particularly young Black women, and people with a strong family health history of fibroids to determine if early treatment reduces long-term risks.

Why a hysterectomy?

Hysterectomies have been the most common treatment for uterine fibroids for several reasons.

"Hysterectomy makes decision-making easier for medical providers and patients. For providers, they don't have to determine which fibroids to treat or remove. Hysterectomy is also universally available in OB-GYN practices," explains Dr. Laughlin-Tommaso.

Additionally, concerns about inadvertently missing a rare cancer that grows in the smooth muscle of the uterus, known as leiomyosarcoma, has led to an increased rate of hysterectomies over less invasive approaches.

Lastly, a major reason for hysterectomy is that fibroids can recur about 50% of the time within five years after they are removed. However, the researchers note that not all new fibroids will become symptomatic, especially among women entering menopause.

Review the paper for a complete list of authors, disclosures and funding.

Additional Resources:
NIH award supports new center at Mayo Clinic for health disparities in uterine fibroid treatment

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Kelley Luckstein, Mayo Clinic Communications, newsbureau@mayo.edu

The post Mayo Clinic researchers recommend alternatives to hysterectomy for uterine fibroids, according to study appeared first on Mayo Clinic News Network.

Rural adults are more likely to smoke than their urban counterparts. Enhancing digital literacy and improving access to the internet and digital devices may make it easier for rural smokers to quit. These are the findings of a randomized, controlled pilot clinical trial Mayo Clinic researchers published in Nature Communications Medicine.

Digital tools offer a convenient way for rural residents to access support to quit smoking. However, limited digital literacy and technology access can be obstacles. The study tested a program to equip rural residents to take full advantage of these tools.

"Interventions in previous studies had a sole focus, targeting one of three things: device access, internet access or digital literacy," says Christi Patten, Ph.D., a Mayo Clinic behavioral health researcher and a senior author of the study. "We were curious if bundling those resources would be more effective."

The clinical trial included 90 adults living in rural areas of Minnesota, Wisconsin and Iowa and was co-designed with the collaboration of a rural health community advisory board. Prior to the trial, participants smoked an average of 16-17 cigarettes per day and 83% indicated a high readiness to quit. Each person was enrolled in an online smoking cessation program and randomly assigned to one of three study groups:

• Group 1 participants (the control) received a guide to accessing local computer and internet resources.
• Group 2 participants received a loaner computer tablet with internet connectivity and the guide.
• Group 3 participants received weekly telephone coaching to support their individual technology needs, a loaner computer tablet and the guide.

The researchers evaluated participant engagement in the program to gauge the effectiveness of the intervention. They also closely monitored smoking-related outcomes to evaluate the program’s ability to help participants quit smoking.

Coaching provides digital support on the quitting journey

The study revealed a trend toward higher engagement among participants who received additional support, particularly among those in the coaching group.

Overall, 42% of participants completed a survey at the end of the study, with the coaching group at 57%, the loaner computer tablet group at 43%, and the control group at 27%. This pattern held true for other study activities as well, such as the completion of remote testing to track smoking cessation progress.  Although the researchers acknowledged engagement could have been improved, they found the response to the interventions encouraging, particularly the response to coaching.

The researchers observed that coaching not only improved participant engagement but also had an unexpected, positive "spillover effect" on smoking-related outcomes. Participants who received the digital literacy coaching were more likely to report quitting smoking, abstaining from tobacco overall and using online evidence-based cessation resources. These findings, they say, point to a possible smoking-related treatment response that should be tested in a larger clinical trial.

"Changing behavior is incredibly hard," says Andrea Cheville, M.D., a Mayo Clinic physical medicine and rehabilitation physician and a senior author of the study. "The fact that they responded to the coaching was quite remarkable."

In post-trial interviews, participants expressed appreciation for the personalized coaching support for their technology needs, saying it "gave them a feeling of being supported on their quitting journey."

Mary Anne Wolesky, a member of the community advisory board that co-designed the study, says studies like this tell rural residents that Mayo researchers are "in their corner" and want to help.

"There's still a lot of fear of technology in our rural communities," observes Wolesky. "It sends a real message that Mayo would send participants iPads and invest the time to teach them how to use them to improve their health."

Dr. Patten notes that overcoming barriers to improve digital equity is often less about the technology itself than it is about empowering people and giving them confidence to use it. 

Improving remote healthcare delivery

The researchers note that few people who smoke can quit without help; however, people who use smoking cessation resources such as counseling tend to be more successful. For this reason, the researchers say it is vital to improve access to smoking cessation services in rural communities.

"Rural residents have potentially the most to gain from geographically neutral remote delivery systems, such as digital cessation programs," says Dr. Cheville.

The researchers are encouraged by the results of their study, which demonstrate that digital access interventions, particularly digital literacy coaching, can help bridge the digital divide for rural communities. These findings are especially important in the current era of rapidly evolving digital healthcare.

"If we don’t develop strategies to broadly enfranchise rural dwellers, we risk aggravating disparities in smoking and in all aspects of health," says Dr. Cheville.

Looking to the future

The researchers are committed to advancing digital health interventions through ongoing, community-engaged research. In future studies they plan to focus on refining their digital access and literacy interventions, validating the smoking-related treatment response, and exploring ways to target digital behavior and smoking behavior change. They also plan to study the use of digital literacy coaching to individualize pain management for rural patients and to improve remotely delivered cancer care. 

The first author of this study is Sydney Kelpin, Ph.D., who is now a licensed clinical psychologist at Spectrum Health Medical Group in Grand Rapids, Michigan. Review the study for a complete list of authors, disclosures and funding.

The post Bridging the digital divide to help rural smokers quit appeared first on Mayo Clinic News Network.

Clinical research coordinators manage the day-to-day activities of clinical trials, from recruiting and obtaining consent from participants, to collecting data and tracking adverse events. Known as "CRCs," their job is one of the most vital in research.

"The work of CRCs is highly valued and positions Mayo Clinic as a leader in clinical trials and at the forefront of providing hope and innovative treatments to patients," says Naveen Pereira, M.D., director of the Office of Clinical Trials in the Center for Clinical and Translational Science.

At Mayo Clinic, CRCs support thousands of studies across the enterprise. The role is dynamic, full of opportunities for growth, and much more.

Discovering the unexpected

Carl Griffin II is a lead CRC in Cardiovascular Research. When he first began working as a CRC, he was prepared for a challenge but did not anticipate how absorbing and complex the job would be.

"The intricacy of the work — how you take a participant from start to finish and all of the different pieces of study management involved — surprised me," he says.

A few years into the role, Griffin highlights the job's multifaceted nature as one of its best features. Every day brings new challenges and learning opportunities.

Patsy Caceres Figueroa, a senior CRC in Cardiovascular Research, says that before taking on the role, she did not realize how much work went into producing research publications. She also didn't anticipate how much she would love working with study participants. For her, one of the most rewarding perks of the job has been the long-term relationships she has built with people who volunteer to participate in research.

"We work with participants, sometimes for years, and get to know them well," she says, noting that this personal connection has helped her find added fulfillment in her work.

A strong, supportive team

At Mayo Clinic, the sense of community among CRCs is important to their success. This supportive environment ensures smooth operations and fosters an environment where CRC team members feel valued and have a sense of belonging among team members.

Caceres Figueroa recalls when her team rallied around her after the loss of her grandmother.

"I was coordinating a complex industry study during a particularly busy time," she recalls. "But my team was ready to help me, taking over my duties so that I could be with my family."

Griffin, who balances work with raising young children, says he also values his team's supportive spirit.

"Knowing that my colleagues are there to cover responsibilities when needed—and that I’ll do the same for them—makes all the difference," he says.

Professional growth opportunities

As Griffin reflects on his time as a CRC, he notes how the job has given him opportunities to enhance his skills and boost his confidence. He says he has particularly benefited from training new colleagues.

"I don’t think three years ago I would have felt confident doing that," he says. "I would have been quietly panicking about it. But now it just feels relaxed."

Caceres Figueroa also appreciates how Mayo Clinic has supported her professional growth, particularly through training resources designed exclusively for clinical trials staff. She's pursuing a certification course to improve her knowledge of clinical research.

Beyond their core roles, Griffin and Caceres Figueroa participate in broader aspects of research, which enriches their careers. Griffin is working with a team to enhance scheduling procedures, and Caceres Figueroa has begun learning the ropes of auditing. Both are enthusiastic about contributing to continuous improvement in their work unit.

"I feel so fortunate to be in this position and in this job," says Caceres Figueroa.

Learn more

• Read more about the essential role of clinical research coordinators in clinical trials: Clinical research coordinators: Advancing research, improving care.
• Explore a life-changing career as a Clinic Research Coordinator.

The post The dynamic role of clinical research coordinators appeared first on Mayo Clinic News Network.

Diseases affecting the digestive system, including the upper gastrointestinal (GI) tract, chronic liver disease, cirrhosis, inflammatory bowel disease and others, are significant causes of death worldwide. Mayo Clinic and North Dakota State University researchers recently delved into demographic data at the national, state and county level in the U.S. to see which populations are most affected by digestive diseases mortality. They found a significant upward trend in these deaths among Native populations whose race and ethnicity are designated as "American Indian and Alaska Native" in research, in several regions.

"Our findings revealed that Native people experienced the highest mortality rates from diseases affecting the digestive system, particularly among females, which highlights a critical health disparity. This suggests that we need to address regional health inequalities through healthcare access and disease prevention programs," says Mayo Clinic Advanced Motility Fellow Wafa Aldhaleei, M.D., M.P.H., first author of the study, which was published in the journal Clinical Gastroenterology and Hepatology.

Her research team examined health data from 3,110 U.S. counties and identified 10 counties with the highest prevalence of digestive disease mortality. The 10 counties were Minnehaha County, South Dakota; Cascade County, Montana; Bannock County, Idaho; Gila County, Arizona; Fremont County, Wyoming; La Paz County/Yuma County, Arizona; Oglala Lakota County, South Dakota; Rio Arriba County, New Mexico; Hennepin County, Minnesota; and Woodbury County, Iowa.

They also specifically investigated the digestive diseases mortality rate by race and ethnicity — white, Black, Latino, American Indian and Alaska Native and Asian and Pacific Islander populations — as well as by sex.

Within the 10 counties with the highest digestive disease mortality rate, American Indian and Alaska Native people were affected the most.

Native populations can face barriers such as access to gastrointestinal specialty care and preventive vaccine programs, write the researchers.

"Deep-rooted, systemic racism can affect the design of health policies for certain areas and populations, and that affects health," Dr. Aldhaleei says. "Throughout the world, poverty, food insecurity, lack of access to clean water, environmental exposures, vaccine hesitancy, lack of insurance and healthcare access, as well as personal risk factors such as excess body weight, alcohol and substance use disorders can influence the gut microbiome."

The researchers conducted statistical analyses on data spanning 2000-2019 from the Global Burden of Disease study. This study encompassed 10 non-cancerous digestive disease categories: cirrhosis and other chronic liver diseases; gallbladder and biliary diseases; pancreatitis; upper digestive system diseases; paralytic ileus and intestinal obstruction; inguinal, femoral and abdominal hernia; inflammatory bowel disease; vascular intestinal disorders; appendicitis and other digestive diseases. The results from this first detailed examination of digestive diseases mortality across race, ethnicity, geography and sex were striking.

"Although the overall national digestive diseases mortality rate has declined, when we look closer, we can see that Native people, as well as white women, had an increased risk of mortality from digestive diseases," Dr. Aldhaleei says. All other races and ethnicities saw fewer deaths from these diseases across the study period.

Additionally, among the states, West Virginia had the highest mortality rate from GI disease in 2019 in the nation.

"This research has the potential to inform public health strategies and policy development to reduce these disparities, particularly among Native populations, and to promote health equity across the U.S.," says lead and corresponding author Akshaya Bhagavathula, Ph.D., who is a research collaborator at Mayo Clinic in Florida.

The researchers advocate for targeted interventions to reduce the health disparities revealed by their analyses. They support future research to explore the complex interplay of factors contributing to these disparities, including socioeconomic status, cultural barriers and healthcare access. According to the researchers, developing sustainable solutions will require collaboration between researchers, healthcare providers, policymakers and community organizations that promote equitable digestive health outcomes and gastrointestinal health equity for all populations.

Review the study for a complete list of authors, disclosures and funding.

The post Magnifying U.S. gastrointestinal disease mortality reveals health disparities appeared first on Mayo Clinic News Network.