Jefferson Investigates: Life Post Incarceration, Pain in Your Gut and Cross-cultural Lessons in COVID-19 Eldercare
Read the latest on the barriers to life after prison, a new treatment avenue for visceral pain, and how older people were cared for during the global pandemic
People who have been incarcerated face a number of challenges upon their return to society. Success is rare: 68% of people are rearrested within three years of their release. Researchers in Jefferson’s Department of Occupational Therapy conducted in-depth interviews with people participating in a work rehabilitation program to take a closer look at the barriers to re-entry.
Previous research has relied on statistics — recidivism or employment rates. “What was missing was the perspective of the individuals,” says Rebecca Sinko, first author on the qualitative study published in The Open Journal of Occupational Therapy. “What we learned is that stigma is complicated. There are many layers.” Study subjects perceived external signs of stigma, the sense that people were looking down at them — including potential employers. Many expressed low aspirations, indicating that they had internalized that stigma and felt they would never do well.
Through thematic analysis of individuals’ responses, the researchers have developed a better understanding of how stigma functions in family and community systems to affect day-to-day life. These insights can be used to inform occupational therapy strategies to help people after incarceration, such as mock job interviews, self-advocacy, anger management, self-esteem boosting and identifying one’s own strengths, says co-author Tina De Angelis. “Even small things like making eye contact and shaking hands,” she says.
An approved drug for chronic constipation also relieves the pain associated with that condition. New research by Scott Waldman, MD, PhD, chair of pharmacology, physiology and cancer biology at Jefferson, demonstrates that the drug’s two actions can be separated biologically — a finding that may offer ways to precisely target visceral pain syndromes beyond constipation.
Here’s what was known: A receptor molecule called GUCY2C, present in the lining of the intestines, regulates water and salt balance, and therefore, the looseness of stools. The constipation medicine, called linaclotide, acts on this receptor to increase water secretion. However, the drug’s pain-relieving action does not appear to be a simple consequence of constipation relief, and hypotheses abounded as to how it all worked.
Dr. Waldman and his MD-PhD student Joshua Barton sought to explore how the drug produced analgesia. The study, published in the Journal of Clinical Investigation focused on the GUCY2C receptor in a newly discovered intestinal cell type called neuropods, which can sense stimulation and communicate closely with neurons that send pain messages to the brain. The team partnered with neuroscientist Manuel Covarrubias, MD, PhD, who co-directed the study.
The researchers used molecular tools to delete GUCY2C receptors from neuropods in mice, but not from other intestinal cells. The altered animals experienced spontaneous visceral pain that the drug linaclotide did not relieve; meanwhile water secretion was unaffected. This finding, Dr. Waldman says, means that neuropod receptors are regulating sensory tone in the intestine and that they mediate the drug effect on pain. What was most surprising, he says, is how stark the delineation was. Biological functions are known for redundancies and exploratory scientific research doesn’t often yield such clear results — in this case, separating two seemingly connected functions, pain relief and water secretion.
Dr. Waldman envisions therapies that directly target neuropod cells. “We may be able to side-step a major side effect — diarrhea — in other visceral pain conditions,” he says, such as irritable bowel syndrome with diarrhea or endometriosis. Visceral pain regulation by neuropods may represent “a final common pathway,” he says.
The COVID-19 pandemic hit older people the hardest: People over 60 were more likely than younger people to get infected, to have a severe illness and to die from the virus in many countries around the globe. Preeti Zanwar, PhD, an expert in health policy, worked with a team of international scholars in aging and policy to understand how country-specific control and mitigation policies impacted COVID-19 outcomes. Her study, published in Public Policy and Aging Report covered six high-or middle-income countries: the U.S., Canada, Brazil, Russia, India and Japan.
“The pandemic exposed the existing public health and healthcare systems that were not good for older people,” she says. Access to public health, health care, vaccines and medicines played a role, of course, but also the country-specific policies meant to slow the spread of the virus, as well as economics and cultural attitudes toward older adults.
For instance, the U.S. reported many more deaths, and even though citizens here had easy access to vaccines compared to lower-income countries such as India, vaccine uptake was poor. Many older Americans live in long-term care facilities such as nursing homes, which were epicenters for COVID-19 outbreaks and also for higher death tolls.
In contrast, Japan, a super-aging society, and with the highest proportion of older adults, provides lessons in the care of older adults. Culturally, Japan values its older adults and works to make sure they stay engaged and connected to society. “Japan has an interesting national policy to make sure older adults don’t suffer from social isolation that can lead to suicide: The Loneliness Ministry,” Zanwar says.
There’s definitely room for improvement in the U.S. for better federal and state pandemic mitigation policies , improved data surveillance systems and stronger communication of evidence-based science and risk. Older adults also prefer to age in one's home around the globe, which calls for greater focus on supportive policies that help promote aging-in-place.
Older adults were one of the most vulnerable groups during the COVID-19 pandemic. “How we take care of the most vulnerable is a reflection of what a society values, according to Mahatma Gandhi,” Zanwar says. The world will observe a doubling of older populations 60 years and older by 2050, and understanding the impact of healthcare policies for older adult well-being will only become more critical in the coming decades.
