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Research on Women's Health: Ready for the Future

Regine douthard.

1 Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland, USA.

Lori A. Whitten

2 Synergy Enterprises, Inc., North Bethesda, Maryland, USA.

Janine Austin Clayton

The National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) was established in 1990. With the completion of the office's 30th anniversary year, we look back and recount some of the key events and overall zeitgeist that led to ORWH's formation, and how it became the focal point at the nation's primary biomedical research agency for coordinating research on science to improve the health of women. We discuss ORWH's mission and signature programs and the bold vision that drives the NIH-wide strategic, interdisciplinary, and collaborative approach to research on women's health and efforts to promote women in biomedical careers. Also discussed are several of the many scientific advances in research on the health of women, policy innovations and their effects, and career advancements made by women in medicine and related scientific fields. We also highlight key challenges for the health of women, the need to continue pushing for equity in biomedical research careers, and NIH's approach to addressing these problems to ensure progress for the next 30 years and beyond.

Introduction

In the 1970 s and 1980s, many became aware that women were not benefiting equally from the major advances in biomedical research and health care. One of the driving factors for this inequity was an astonishing lack of knowledge on conditions that are unique to or more prevalent among them. Society was changing rapidly, with the public demanding solutions to multiple inequities, chronic diseases, and emerging health problems. The National Institutes of Health (NIH) responded accordingly and grew in size, scope, and ambition. 1 Knowledge was also expanding, and as we learned more about human biology, fundamental sex differences in physiology not related to reproductive systems emerged. For example, research revealed that myocardial and vascular structure and function—and some important clinical outcomes ( e.g., the mortality rate after myocardial infarction)—differed between women and men. 2 In addition, studies documented more adverse drug reactions among women. 3 , 4

Despite the fact that women and men shared the top three causes of death (heart disease, cancer, and stroke), most knowledge on their etiology, progression, and treatment had been derived from all-male studies. 2 A vanguard of leaders at the U.S. Public Health Service established the Task Force on Women's Health Issues, and this group's report and recommendations charted a course for future research to remedy the inequity and improve the health of women. 5

Principal recommendations were the expansion of biomedical and biobehavioral research on conditions particularly affecting women of all ages and the development of guidelines to ensure adequate numbers of women in clinical trials of medications. 5 The Congressional Caucus for Women's Issues campaigned for implementing these recommendations, and one result of these efforts was the establishment of the NIH Office of Research on Women's Health (ORWH) in 1990. For more information on the history of the office's formation, see https://orwh.od.nih.gov/about/mission-history .

The landmark Report of the National Institutes of Health: Opportunities for Research on Women's Health (commonly referred to as the Hunt Valley report) in 1991 set out an agenda to address gaps in scientific knowledge about the health of women of all ages and to increase the use of research designs that would potentially identify sex and gender differences in outcomes. 2 Standing on the foundation that report helped build, we are now able to envision a world in which the biomedical research enterprise thoroughly integrates sex and gender influences across the life course, every woman receives evidence-based disease prevention and treatment tailored to her own needs and circumstances, and women in scientific careers reach their full potential.

That vision—set out in Advancing Science for the Health of Women: The Trans-NIH Strategic Plan for Women's Health Research 6 —is possible because there has been a congressionally mandated focal point for coordinating research on the health of women at NIH since ORWH was enshrined by statute in this role in the NIH Revitalization Act of 1993 (Public Law 103–43, section 486). 7

ORWH's core areas of focus dovetail with NIH's mission to seek fundamental knowledge about the nature and behavior of living systems and apply that knowledge to enhance health, lengthen life, and reduce illness and disability. The 27 constituent NIH Institutes and Centers (ICs) address women's health in their respective scientific areas. Part of the NIH Office of the Director, ORWH plays a vital coordinating role, collaborating with ICs to ensure that interdisciplinary research on women's health is part of the scientific framework at NIH and throughout the biomedical community—as reflected in the Trans-NIH Strategic Plan for Women's Health Research . Throughout its three decades, ORWH has acted on its mission and worked with its IC partners to build signature programs that advance research on sex and gender, and support women as biomedical scientists ( Table 1 ).

National Institutes of Health Office of Research on Women's Health Mission and Signature Programs

ORWH, Office of Research on Women's Health; NIH, National Institutes of Health.

ORWH's milestone 30th anniversary year caused us to reflect and focus on the future. This article will briefly review (1) a few of the many scientific advances in research on the health of women—some of which were highlighted at the ORWH 30th Anniversary Scientific Symposium (videocast available at https://videocast.nih.gov/watch=40060 ), (2) policy innovations and their effects, (3) the research career advancements made by women in science, technology, engineering, mathematics, and medicine (STEMM), and (4) prominent key challenges for the health of women and NIH's approaches to addressing them.

Thirty Years of Scientific Advances Result in Better Health for Women

Perhaps the most important advancement has been the paradigm shift in the way biomedical researchers conceptualize women's health, from a narrow focus on the reproductive system and maternity (women were viewed to be the same as men except for these functions) to a perspective that encompasses the health of the whole woman over the life course. ORWH has emphasized the life course perspective since its inception 2 and continues on this path in the Trans-NIH Strategic Plan for Women's Health Research .

ORWH champions the intentional integration of the multidimensional framework ( Fig. 1 ) in interdisciplinary multifactorial studies across the continuum of biomedical research to build a knowledge base for personalized medicine. 8–11 Achieving personalized medicine will be bolstered by the inclusion of sex and gender awareness in clinical care and the provision of evidence-based care tailored to every woman's needs, which requires embedding the concepts of sex and gender health into the educational curricula of all health professionals. 12

The multidimensional framework represents the intersection of multiple internal factors ( e.g., sex influences at genetic, molecular, cellular, and physiological levels) and external factors ( e.g., social determinants of health [including gender], behavior, and policies) that affect the health of women across the life course.

It is perhaps not surprising that major scientific advances stem from interdisciplinary research that applies the multidimensional framework. Such is the case with the second scientific accomplishment highlighted in this study: knowledge about the impact of environmental exposures on women of all ages. Exposures are conceptualized broadly and can include lifestyle factors (such as stress, local access to healthful food, substance use, and physical activity), as well as chemicals, radiation, infectious agents, and climate change. 13 Researchers now understand that across the life course, environmental exposures during windows of susceptibility contribute to the developmental origins of disease. 14 , 15

As early as the 1980s, scientists reported changes in human reproduction—such as declining sperm counts in males 16 and earlier puberty in females 17 —as well as deleterious genital and physical alterations among wildlife. 18–20 Since then, research has linked these changes to endocrine-disrupting chemicals (EDCs)—compounds that interfere with sex hormones' production and mechanisms of action. 21–24 EDCs warrant close attention because exposures to them are universal ( e.g., they are present in pesticides, plastics, and fuels). 21 In addition, scientists have established that environmental exposures can have transgenerational effects. 25

EDCs act at receptors, alter hormone synthesis, induce epigenetic changes, and disrupt hormone breakdown or clearance to have detrimental effects on health. Crucially, their effects depend on whether the exposure was before or after puberty. 26 It is important for researchers to pay special attention to the impacts of exposures to personal care, consumer, and occupation-related products—such as cosmetics, scented shampoos, hair sprays, lotions, and household deodorizers—which are affected by gender. For example, as alluded to earlier, the EDC compounds ( e.g., phthalates, parabens, and phenols) contained in these items have been linked with earlier pubertal timing—to a greater extent in girls than in boys, perhaps because of girls' greater use of these items. 27

Our colleagues at the National Institute of Environmental Health Sciences (NIEHS) lead efforts to understand the complex effects of potential exposures, the influence of timing and sensitive periods across the life course, and a multitude of individual and contextual factors. NIEHS supports an approach that incorporates the exposome—the totality of environmental exposures experienced over the life course, the individual biological responses to them, and how those exposures affect health. 14 For more information on NIEHS's efforts to ensure that researchers explicitly incorporate sex and social determinants of health into investigations of individual susceptibility and to advance our understanding of exposure burdens and health disparities, see www.niehs.nih.gov/research/supported/exposure/hhear/index.cfm 28 Importantly, NIEHS and colleagues have outlined the intersectionality of climate change, gender, geography, and socioeconomic status and proposed policy directions to address their negative effects on women's health. 29

Great progress in our understanding, detection, and treatment of postpartum depression (PPD) is the third scientific advancement in research on the health of women featured in this study. When ORWH was founded in 1990, PPD was not yet officially recognized by the Diagnostic and Statistical Manual of Mental Disorders. (That would occur in 1994, with the publication of DSM-4.) 30 Many researchers, clinicians, and members of the public now understand that many women do experience the “baby blues,” a temporary bout of worry, sadness, and fatigue after delivery that resolves without intervention. 31

In contrast, PPD—experienced by about 13% of women with a recent live birth in the United States in 2018 32 —is an intense persistent sadness that can interfere with a woman's ability to care for herself and the baby, 33 last for up to 3 years in some women, 34 and elevate depressive symptoms up to 11 years after childbirth. 35 Worryingly, the rate of women with a depression diagnosis at delivery increased sevenfold between 2000 and 2015. 36 Moreover, PPD is most likely underdiagnosed (because women may be reluctant to report symptoms), which highlights the need to integrate mood disorder screening and treatment services into standard prenatal and postnatal care. 37 The National Child and Maternal Health Education Program, sponsored by our colleagues at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, aims to increase awareness of mental health around the time of pregnancy through science-based information and resources.

Brexanolone, the first medication specifically for persistent postpartum mood disruption, was approved by the Food and Drug Administration (FDA) in 2019. 38 Incorporating the multidimensional framework into research on women's mental health across the life course illuminated the risk factors for PPD—most notably, stress and adverse life events and subsequent neuroendocrine alterations and hormonal fluctuations—and then generated valuable knowledge about their underlying mechanisms. 39 Researchers identified sensitivity to the reproductive hormones estrogen and progesterone (rather than absolute levels), which modulate the neurotransmitter γ-aminobutyric acid (GABA), and dysfunction of GABA A receptors as contributing factors to PPD. 40 , 41

As a synthetic analog of allopregnanolone, brexanolone is thought to boost the ability of GABA A receptors to adapt, thereby improving symptoms. 41 , 42 Brexanolone is currently available as an injection for intravenous use in medical settings, offering effective and immediate relief from what can be a debilitating and potentially life-threatening mood disorder. 42 , 43 An oral version of brexanolone, zuranolone (SAGE-217), is in Phase III trials. 44 If shown to be safe and effective, this more accessible formulation might help many more women who experience PPD.

The fourth scientific advancement reflects a central tenet of NIH Innovative policies that change the way scientists conduct their investigations are crucial and potentially even more transformative than specific experimental findings. In 1986, NIH responded to the recommendation of the Public Health Service Task Force on Women's Health Issues to ensure adequate numbers of women in clinical trials by establishing a policy encouraging researchers to include women in studies. Subsequently, Congress passed the NIH Revitalization Act of 1993 (Public Law 103–43), which requires NIH to ensure that women and minorities are included in all clinical research (unless there is a compelling scientific reason for exclusion) and that trials are designed and conducted in a way that permits an analysis of outcomes by sex/gender, race, and ethnicity. 7

The full history of NIH's efforts to ensure that women and underrepresented minorities are included in the clinical research it supports are detailed on the ORWH website. ( https://orwh.od.nih.gov/toolkit/recruitment/history and https://orwh.od.nih.gov/womens-health-research/clinical-research-trials/nih-inclusion-policies/including-women-and ) Although movement in this area has not always been straightforward, the following examples show that progress has been made and that NIH's policy on inclusion continues to adapt to public health needs.

In 2018, more than half (52.4%) of participants in NIH-supported clinical research were women. 45 However, we recognize that the need to expand inclusion in NIH-sponsored clinical trials continues. For example, women's inclusion in clinical trials lags behind that of men in some important areas, 46 such as clinical trials on cardiovascular conditions. 47 In alignment with the 21st Century Cures Act (Public Law 114–255), the inclusion of pregnant women and lactating women in clinical trials is currently a focus at NIH, led by our colleagues at NICHD and the Task Force on Research Specific to Pregnant Women and Lactating Women (PRGLAC). (See www.nichd.nih.gov/about/advisory/PRGLAC ) NIH's view is that our clinical enterprise should change to protect pregnant people and lactating people through research, not from research. 48

By the 2000s, NIH had seen steady progress in implementation of its inclusion policy, but the consideration of both female and male animals and cells in preclinical research had generally not advanced at the same pace. 49 As part of broader efforts to improve scientific rigor, transparency, and reproducibility, 50 , 51 NIH set out to address the lack of attention to sex as a biological variable (SABV) 7 years ago by announcing its intention to require applicants to report plans for including male and female cells and animals in preclinical investigations. 52

ORWH then led an extensive process of internal and external consultation 53 and an in-depth exploration of methods, experimental designs, and approaches for statistical analysis that consider the incorporation of male and female animals, cells, and tissues in preclinical research. 54 The SABV policy (NOT-OD-15-102) went into effect January 25, 2016, and since then, NIH has expected that “sex as a biological variable will be factored into research designs, analyses, and reporting in vertebrate animal and human studies.” 55 NIH subsequently provided additional guidance for researchers and grant reviewers to facilitate implementation of the SABV policy. 56 , 57

There has been progress in SABV implementation, as the omission of sex has decreased and investigators are increasingly using both females and males in preclinical research. 58 , 59 More NIH grant applicants are appropriately addressing sex in their proposals, and grant reviewers report increased acceptance of the SABV policy. 60 However, basic research and preclinical research continue to over-rely on male cells and animals, 58 , 61 and there has been minimal progress in the disaggregation, analysis, and reporting of data by sex. 62 A detailed summary of NIH's multipronged efforts to increase SABV implementation was published last year. 63 Among the most important efforts to advance SABV implementation is the development of online educational modules (discussed in “The Next 30 Years: Facing Challenges to Improve Health for Everyone” hereunder).

The fifth advancement during the past three decades is the increase in the proportion of women working in laboratories, medical schools, and academic research centers across the nation. Building the participation of women in medical and biomedical research careers has been a core mission area for ORWH since its inception and is part of larger efforts by the NIH Scientific Workforce Diversity Office. NIH is committed to diversity because we need the brightest minds to contribute to the biomedical research enterprise, regardless of background. Workforce diversity is also a best practice backed by research—as heterogenous interdisciplinary teams make better decisions and outperform homogenous ones, particularly when addressing complex problems. 64 , 65

When ORWH was established in 1990, about one-third of medical school graduates and faculty members were women. 66 Now about half (48%) of medical school graduates and about three-fifths (58%) of graduate students enrolled in biomedical doctoral programs are women. The overall proportion of full-time medical school faculty members who are women is now at 41%. 67 Data from NIH also show some progress for women at various stages of their careers ( Fig. 2 ). 68–70 This progress reflects concerted efforts by NIH to improve biomedical workforce diversity, 71 including those focused on promoting the careers of women. 72

(A) The representation of women in positions as NIH postdoctoral fellows and postdoctoral trainees increased between 1990 and 2020. (B) The percentage of women earning NIH research grants and R01-equivalent grants increased between 1998 and 2020. Data sources: National Institutes of Health. 68–70 NIH, National Institutes of Health.

The most seminal moment in all of ORWH'S decades-long work in this crucial area was the 2008 release of the request for applications (RFA) titled “Research on Causal Factors and Interventions that Promote and Support the Careers of Women in Biomedical and Behavioral Science and Engineering” (RFA-GM-09-012). 73 NIH's unprecedented investment of $16 million resulted in an explosion of evidence contributing to our understanding of how individuals make career choices, how workplaces may inadvertently impede advancement, the existing barriers, and effective interventions. The research resulted in >100 publications, but the most profound contribution was the identification of best practices in the recruitment, retention, and advancement of women in academic medicine—with the ultimate effect of accelerating change and progress. 74 NIH is taking an innovative approach to improving women's representation in leadership, described in the next section.

The Next 30 Years: Facing Challenges to Improve Health for Everyone

The coronavirus disease 2019 (COVID-19) pandemic continues to cause widespread illness and deaths (254,215,816 cases and 5,112,710 deaths worldwide and 47,272,975 cases and 765,127 deaths in the United States as of November 16, 2021, according to the Johns Hopkins COVID-19 Dashboard). The FDA approval of one vaccine and authorization of two other vaccines for emergency use have brought some hope, and 58.9% of the U.S. population was fully vaccinated as of November 16, according to the Centers for Disease Control and Prevention. 75 Although COVID-19-related mortality seems to be lower for women, they have greater risk of exposure because of their overrepresentation among the frontline health care workforce and essential workers. 76 , 77

Much more research is needed to understand the effects of COVID-19 on all women. Specifically, rigorous research ( i.e., studies that are fully aligned with the NIH inclusion and SABV policies) is needed for all COVID-19-related areas ( e.g., immune responses, sex differences in risk profiles, mental health effects, vaccine efficacy, and novel therapeutics). Released in July 2020, the NIH-Wide Strategic Plan for COVID-19 Research outlines five strategic priorities for COVID-19 research and NIH's commitment to addressing the needs of health disparity populations and other vulnerable people—including research on COVID-19-related maternal health and pregnancy outcomes. 78

To complement the NIH-wide strategic plan and guide its COVID-19 response, ORWH developed Guiding Principles: Sex and gender influences in COVID-19 and the health of women . The principles promote rigorous research, advance health equity, and enhance the nation's response to the pandemic by laying out a systematic approach to incorporating sex and gender into research to inform and improve the health of women. 79 The document also addresses the disproportionate negative effects of the pandemic on the careers of women scientists, a topic that is discussed as follows. As in all research that includes both sexes, it is crucial to disaggregate data from COVID-19 studies by sex so they can be analyzed for potential differences. 80 A recent study found that although men have a higher COVID-19 mortality rate overall, black women had died at a higher rate than white men in Michigan and Georgia—illustrating the importance of disaggregating and analyzing data for sex, gender, and race interactions in COVID-19 outcomes. 81

Since the beginning of the pandemic, NIH has realized that reassignment to fight COVID-19 and restrictions on physical workspaces would have significant negative effects on the biomedical workforce. Sensitive to the notion that this situation would most likely have a greater effect on early-stage investigators (ESIs) and on scientists who are in populations that are underrepresented in medicine (URiM) 82 , 83 —including women scientists, who are disproportionately affected by additional caregiving and family responsibilities 84 —NIH objectively documented COVID-19's impact on the workforce through an online survey of extramural researchers in October 2020. 85 Some of those findings are shown in Figure 3 . NIH provides numerous flexibility options, offers an opportunity for scientists to apply for an extension of their ESI status because of COVID-19-related delays, and supports efforts to retain early-career biomedical investigators during critical life events (NOT-OD-20-054 and NOT-OD-20-055).

Reported effects of the COVID-19 pandemic among the NIH extramural scientific workforce: (A) lower productivity, (B) negative effect on career trajectory, and (C) more women than men with children under age 5 years saying caregiving made work completion more difficult. Data source: Bernard and Lauer. 85

The second major challenge to the health of women is the abysmal rates of maternal morbidity and mortality in the United States—the highest among wealthy nations 86 —and the marked racial disparities in these outcomes. In 2019, deaths from complications while pregnant or within 42 days of termination of pregnancy numbered 754. 87 About 60% of maternal deaths are considered to be preventable. 88 Black women and American Indian and Alaska Native (AI/AN) women have rates of maternal mortality that are about two to three times higher than those of white and Hispanic women. 89 Importantly, higher levels of education and income do not mitigate the risk for maternal deaths among black women. 89 , 90 A recent scoping review found that black mothers were particularly vulnerable to environmental exposures ( e.g., air pollution, ozone, and heat) that are exacerbated by climate change and their negative effects on pregnancy outcomes. 91

In addition, too many U.S. women—>50,000 annually and disproportionately black women—experience severe maternal morbidity ( e.g., requiring a transfusion, infection, or high blood pressure). 92 , 93 NIH has mounted a robust response to address the crisis—increasing research funding in this area from $334 million in fiscal year (FY) 2019 to $345 million in FY 2020—and makes information on these projects available to the public through the NIH Research Portfolio Online Reporting Tools (RePORT) website. 94 See Table 2 for selected NIH initiatives to address the maternal morbidity and mortality crisis in the United States.

Selected National Institutes of Health Initiatives to Address High Rates of Maternal Morbidity and Mortality in the United States

IC, Institutes and Centers.

The third challenge covered in this study is the furtherance of some aspects of NIH's SABV policy—particularly the analysis and reporting of sex-specific results in scientific articles, which has lagged despite guidance in the literature. 54 , 80 , 95–98 A study that examined SABV implementation across nine biomedical disciplines found that in eight of the disciplines, there was no change in the proportion of studies that included data analyzed by sex. 59 Analysis and reporting by sex—whether significant differences are found or not—is crucial for seeing patterns of results, accurately interpreting data, and guiding the next steps in the research. 95

A lack of analysis and reporting by sex is a lack of transparency that perpetuates an incomplete and possibly inaccurate knowledge base, as aggregated data may mask important sex differences—such as variance in treatment response, toxicity, symptoms, and adverse effects. In addition, analysis and reporting of results by sex facilitates meta-analysis, helps avoid duplication, guides sample size calculations for future studies, 95 improves the design of clinical trials, informs sex- and gender-aware diagnosis and treatment, facilitates personalized medicine, and advances a system-based understanding of sex and gender influences on health and disease. 80 , 96

ORWH and its partners have developed several educational modules on the influences of sex and gender on health—with SABV as a linchpin concept—for researchers and practitioners. Through its e-learning program (found at bit.ly/ORWHeLearning ), ORWH offers free online tools to help researchers apply a sex-and-gender lens (including analyzing and reporting data by sex) to their work ( Table 3 ). These courses would greatly benefit researchers who serve on NIH study sections, scientific peer reviewers, and journal editors. 60 , 98 Because of the myriad influences of sex on health and the impact of gender on how individuals are treated in the health care system, we believe that SABV and information on sex and gender should be included as part of the standard training of physicians, nurses, and other practitioners to advance precision medicine. 99 , 100

Recently Expanded Free Online Learning Modules That Cover Sex as a Biological Variable

The final challenge highlighted in this study is the need to increase the number of women in leadership roles in STEMM fields in academia, particularly women who are in URiM racial and ethnic groups. Inclusive and diverse leadership in academic medicine—the central driver of medical education, biomedical research, scientific training, and clinical care—is a crucial component of spurring innovation, attracting top scientists, and maximizing return on taxpayer investment. 101 Data indicate that the academic medicine workforce pipeline is not the problem. 67 However, women still only represent 18% of department chairs and 18% of deans. 67 A 17-year longitudinal cohort study indicates that women are half as likely to hold senior leadership positions at medical schools, even after controlling for publication productivity. 102

Moreover, URiM women were only 13% of faculty in 2018, and it seems that progress has stalled, as the figure was 12% in 2009. In addition, the majority of URiM women work at the rank of assistant professor. Among the already small proportion of women chairs in basic science and clinical science departments, only 15% were from URiM groups in the 2018–2019 academic year. 67 ORWH continues to support innovative collaborative programs to advance women's participation in biomedical careers and foster their leadership opportunities ( Table 4 )—particularly addressing the barriers identified by research. 74

Examples of National Institutes of Health's Efforts and Leadership to Advance the Careers of Women in Biomedicine

Reasons for Optimism: Responsiveness, Collaborations, and Strategic Thinking

Although these challenges are significant, NIH can leverage collective ability, experience, and infrastructure to solve these problems. We have a clear way forward, as Advancing Science for the Health of Women: The Trans-NIH Strategic Plan for Women's Health Research provides a solid framework for advancing strategic goals and improving the health of women. And we understand that the value of NIH investments in women's health research goes beyond the individual to have a significant impact on society, as demonstrated in recent microsimulation analyses that found large returns from very small health improvements among women. 103

ORWH knows that it cannot do it alone. At the 5th Annual Vivian W. Pinn Symposium, ORWH explicitly focused on building a broad-based network of government, nonprofit, academic, and business organizations to integrate sex and gender into biomedical research. ORWH's strong collaborative partnerships—so crucial to the progress achieved in its first three decades—ensure that the office will meet pressing needs, rise to future challenges, and catalyze the scientific breakthroughs, resulting in optimal health for all women during the next 30 years and beyond. 6 , 104

Acknowledgments

The authors thank all speakers and panelists at the ORWH 30th Anniversary Scientific Symposium. Special thanks to Dr. John Balbus (NIEHS), Dr. Pauline M. Maki (University of Illinois at Chicago), and Dr. Shaheen Lakhan (Virginia Tech University and Carilion Clinic), who inspired the inclusion of some topics discussed in this article.

Authors' Contribution

R.D. and J.A.C. conceived the structure of the information presented and provided references. L.A.W. searched for supporting references and wrote the article with support from R.D. and J.A.C.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding has been received for this article. Dr. Whitten performed her work as part of an ORWH contract with Synergy Enterprises, Inc.

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• Winter mortality and...

Winter mortality and cold stress in Yekaterinburg, Russia: interview survey

• Related content
• Peer review
• G C Donaldson , senior research associate a ,
• V E Tchernjavskii , deputy director, public health institute b ,
• S P Ermakov , principal researcher b ,
• K Bucher , head c ,
• W R Keatinge , emeritus professor of physiology ( w.r.keatinge{at}qmw.ac.uk ) a
• a Department of Physiology, Basic Medical Sciences, Queen Mary and Westfield College, University of London, London E1 4NS
• b Russian Ministry of Health, 11 Dobrolubova Street, Moscow 127254, Russia
• c Dezemat Biosynoptik der Zentralen Medizin-Meteorologischen Forschungsstelle des Deutschen Wetterdienstes, Stefan Maier Strasse 4, 7800 Freiburg 1, Germany
• Correspondence to: Professor Keatinge
• Accepted 31 October 1997

Objectives: To evaluate how mortality and protective measures against exposure to cold change as temperatures fall between October and March in a region of Russia with a mean winter temperature below −6 °C.

Design: Interview to assess factors associated with cold stress both indoors and outdoors, to measure temperatures in living room, and to survey unheated rooms.

Setting: Sverdlovsk Oblast (district), Yekaterinburg, Russia.

Subjects: Residents aged 50–59 and 65–74 living within approximately 140 km of Yekaterinburg in Sverdlovsk Oblast. Survey of sample of 1000 residents equally distributed by sex and age groups.

Main outcome measures: Regression analysis was used to relate data on indoor heating and temperatures, the amount of clothing worn, the amount of physical activity, and shivering while outside, to outdoor temperature; results were compared with mortality patterns for ischaemic heart disease, cerebrovascular disease, respiratory disease, and mortality from all causes.

Results: As mean daily temperatures fell to 0°C the amount of clothing worn outdoors increased, physical activity while outdoors became more continuous, and only 11 (6.6%) of the 167 people surveyed who went outdoors at temperatures above 0°C reported shivering. The mean temperature in living rooms in the evening remained above 21.9°C. Mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes did not change. As the temperature fell below 0°C the number of items of clothing worn plateaued at 16.0 and the number of layers at 3.7. With regression analysis, shivering outdoors was found to increase progressively to 34.6% (P<0.001) of excursions at −25°C, and mortality (after declining slightly) rose progressively (all cause mortality rose by 1.15% for each 1°C drop in temperature from 0°C to −29.6°C, 95% confidence interval 0.97% to 1.32%). 94.2% of bedrooms were directly heated, and evening temperatures in the living room averaged 19.8°C even when outside temperatures reached −25°C.

Conclusions: Outdoor cold stress and mortality in Yekaterinburg increased only when the mean daily temperature dropped below 0°C. At temperatures down to 0°C cold stress and excess mortality were prevented by increasing the number of items of clothing worn and the amount of physical activity outdoors in combination with maintaining warmth in houses.

Key messages

There was no increase in mortality in the population of an industrialised region of western Siberia as the temperature fell to 0°C; in western Europe the same fall in temperature is associated with large increases in mortality

Warm clothing and physical activity prevented cold stress outdoors and warm housing prevented cold stress indoors

These results suggest that the high excess winter mortality in western Europe could be prevented by people wearing sufficient clothing and engaging in physical activity outdoors, and by adequately heating houses

Introduction

In cold and temperate regions mortality is minimal at about 18°C but rises as temperatures fall. 1 2 3 Much of the increase in mortality seems to be associated with cold stress (personal exposure to cold); time series analyses have shown that mortality increases within 24 hours of a fall in temperature. 4 Deaths from thrombosis, which account for most of the excess mortality associated with cold, are probably caused by haemoconcentration resulting from cold stress (general exposure to cold) 5 6 and an increase in plasma fibrinogen concentrations as a result of an acute response to respiratory infections. 7 8 The increase in mortality that occurs with each fall of 1°C in outdoor temperature is smaller in areas of Europe where houses are warmer and more clothing is worn outdoors at a given outdoor temperature. 9 However, it is unclear whether protection against cooling of the body surface alone can entirely prevent higher mortality in winter. This protection would not be effective if, for example, local cooling of the respiratory tract caused by breathing cold air was an important factor in the deaths.

This paper reports patterns of winter mortality and various strategies for protection against cold in the Yekaterinburg region of Russia, 850 miles east and slightly north of Moscow. It is a densely populated region, where many people spend substantial time outdoors. The mean winter temperature is −6.8°C, lower than that in any part of western Europe (fig 1 ). Our objective was to evaluate whether the type and amount of outdoor clothing worn and the amount of physical activity prevented excess mortality when winter temperatures were similar to those found in western European regions with milder winters.

Subjects and methods

Subjects and survey of lifestyle.

Subjects were selected for interview by a two stage process. 11 Primary sampling areas were designated from census data and selected to be representative of population density and composition of social groups. Each interviewer was allocated a sampling area each day. To prevent clustering, interviews were separated by at least four addresses and no more than two interviews were conducted on each street; apartment blocks were considered to be streets. Samples of responses were checked by telephone or by post for quality control. These procedures were similar to those used in the Eurowinter survey in western Europe. 9 The survey was conducted by a Russian-Finnish company associated with Gallup and with advice from Colin McDonald (McDonald Research, Camberley). Briefing of interviewers and the initial interviews in Yekaterinburg were monitored by WRK and by the survey consultant.

Interviews were conducted from the beginning of October 1995 through to the end of February 1996. Interviews occurred on all days of the week. Interviews took place after 1700 in the main living room of the house or apartment. Temperatures were measured to 1°C with Thermax temperature strips (Thermographic Measurements, Burton) which were placed on furniture 0.5 m to 1.2 m above the floor. Interviewers then completed questionnaires. Interviewees were asked about the duration of heating in the bedroom and living room, the duration and number of outdoor excursions, the type of clothing worn outdoors, and physical activity outdoors during the previous 24 hours; interviews were conducted in Russian.

Mortality and temperature

Daily reports of deaths during 1990–4 were obtained for Yekaterinburg and the regions and towns of the Sverdlovsk Oblast (district) which are within about 140 km of Yekaterinburg; the data were reported for those aged 50–59 and 65–74 and for men and women. Census data were used to determine numbers of each sex and age group. There were 192 000 men and 258 000 women aged 50–59 and 77 000 men and 167 000 women aged 65-74. The mean daily temperature was calculated using measurements taken every three hours in Yekaterinburg.

Regression analysis

Regression coefficients for the number of deaths each day in relation to the mean daily temperature were estimated for temperatures between 0°C and 18°C and for temperatures between 0°C and −25°C; generalised linear modelling with identity link function was used and a Poisson distribution was assumed. 10 Regression coefficients were expressed as a percentage of the estimated mortality at baseline, which was taken as 18°C. Deaths were lagged on temperature by 2 days for ischaemic heart disease, by 5 days for cerebrovascular disease, by 12 days for respiratory disease, by 3 days for all cause mortality; these are the delays which give maximal effects. 4 Deaths from influenza averaged over the 10 days before to the 10 days after each mortality were included in the regression model as a second explanatory variable to account for the effects of influenza; these effects were small as only nine deaths from influenza were recorded. For graphs, mortality data per million population were averaged for each temperature interval of 1°C.

Separate regressions on the mean daily temperatures both above and below 0°C were made by ordinary least squares regression for the temperature in the living room. Generalised linear modelling was used for Poisson distributed data, and logit regression was used for binary data. 10

The number of layers of clothing worn was calculated as the total area of all items of clothing and expressed as a fraction of body surface area; this was calculated from the list of garments worn and from the surface area of specific parts of the body of men and women. 12 There was no theoretical case for using a particular model to analyse the number of pieces of clothing worn and the total area covered by the clothing. Since both seemed to fall in a linear fashion as the mean daily temperature fell to 0°C, then fell more slowly and plateaued below −8°C these factors were tested by separate linear regressions for temperatures below −8°C, for temperatures from −8°C to 0°C, and for temperatures above 0°C. The Student's t test was used to compare mortality at temperatures from 0°C to −5°C with mortality from 0°C to 5°C. Values are given as means with 95% confidence intervals except when otherwise stated.

A total of 1000 people in the region were interviewed; respondents were equally divided between men and women and between the ages of 50–59 and 65-74.

Mean daily temperatures from 1990 to 1994 inclusive varied from 26.5°C to −29.6°C during the time that the mortality data were collected. Temperatures varied between 12.5°C and −25°C during the survey. The mean winter temperature (between October and March 1990 to 1994 inclusive) was −6.8°C; this was 4°C colder than the coldest region surveyed in western Europe in the Eurowinter survey (−2.8°C in northern Finland). 9

Mortality from all causes did not change as the mean daily temperature fell to 0°C. At slightly below 0°C, however, mortality fell by 6.1% (P=0.011) as it does in Britain. 4 This may be due to the bactericidal effects of freezing. None the less, mortality then increased progressively by 1.15% (0.97% to 1.32%) for each drop in temperature by 1°C as temperatures fell from 0°C to −29.6°C (P<0.001). There was no increase in mortality related to increases in temperatures above 18°C. 1 9 These patterns were similar for men and women and for those aged 50 to 59 and 65 to 74 (fig 2 ). The relations in each temperature range were broadly linear (fig 2 ). Absolute mortality in men was more than double that in women; absolute mortality among those aged 65 to 74 was more than double that among those aged 50 to 59.

Daily numbers of deaths per million population in each sex and age group by mean daily temperature

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The relation between mortality and temperature was not different for ischaemic heart disease, cerebrovascular disease, respiratory disease, or death from all causes (fig 3 ). Information on the specific cause of death was extracted from the mortality data; there were an average of 11.5 deaths related to ischaemic heart disease each day, 9.4 related to cerebrovascular disease, 2.7 related to respiratory disease, and a total of 46.6 for all causes of death. When the data were plotted for each year there was no systematic change in the relation of mortality to temperature with time although absolute mortality rose with time.

Behaviour outdoors

Most people reported going outside every day for at least 10 minutes (83% to 87% of the 1000 people surveyed). The total time spent outside each day averaged 39 minutes (37 to 41 minutes); neither the amount of time spent outside nor the percentage of people who had gone outside in the last 24 hours was significantly related to the mean daily temperature when temperatures were either above or below 0°C. Many people travelled to work by bus or train, waited outdoors for transport, and walked to transport (WRK, personal observation).

As temperatures outdoors fell to 0°C the people who went outdoors seldom shivered; only 11 of the 167 people who were surveyed (6.6%; 2.6% to 9.6%) reported shivering while out that day, and the percentage of those who did shiver did not change with the temperature (fig 4 ). A probable explanation for this is that when people went outdoors they reported wearing progressively more clothing as the temperature fell to 0°C and they also reported spending less time stationary (P<0.001). When linear regression was used for temperatures below 0°C, the percentage of those who shivered while outside increased to 34.6% at −25.0°C (P<0.001), while the number of items of clothing increased little and stabilised at 16 items when temperatures fell below −8°C (fig 4 ). In temperatures below 0°C the number of people who kept still while outside (mean 26%; 22% to 29%) changed little; there was no significant decline as temperatures fell from 0°C to −25°C. Through the whole range of temperatures the wearing of hats and gloves followed similar patterns to the total number of items of clothing worn (fig 4 ). Estimates of the total area of clothing (fig 4 ) were too scattered to reach significance but suggested a rise in the area covered as temperatures fell to 0°C and a plateau at temperatures below −8°C at 3.67 layers or 367% (360% to 374%) of body surface area (fig 4 ). Conversations in Yekaterinburg by WRK suggested that all available outdoor clothing was then being worn.

Indoor temperatures

The mean temperature in the living room in the evening measured during interviews was high throughout the entire range of outdoor temperatures studied. It declined only a little from 23.1°C (21.4°C to 24.8°C) at outdoor temperatures of 12.7°C, to 21.9°C (20.3°C to 23.5°C) at outdoor temperatures of 0°C, and to 19.8°C (18.8°C to 20.9°C) at outdoor temperatures of −25.0°C (fig 5 ). The temperature of the living room in the evening was 22.6°C (20.9°C to 24.2°C) when outdoor temperatures were 7°C, at which temperature the Eurowinter survey data was standardised. 9 Daytime visits to unheated parts of the house or apartment and the numbers of people sleeping in unheated bedrooms declined as outdoor temperatures fell from 12.7°C to 0°C (fig 5 ); at temperatures below 0°C they stabilised with 12% visiting unheated parts of the house by day and 5.8% sleeping in unheated bedrooms (fig 5 ). Personal observation by WRK showed that rooms which were not heated in cold weather were often small and opened directly on to heated rooms and thus received indirect heating.

Lack of cold stress at temperatures above 0°C

This study found that as outdoor temperatures fell to 0°C in Yekaterinburg there was no increase in mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, or all causes. High temperatures indoors in combination with an increase in the number of layers of clothing worn and the amount of physical activity when outdoors generally prevented cold stress. Both the fall in temperature to 0°C and the associated increase in physical activity when outdoors increase local cooling of the respiratory tract, but without general chilling and cooling did not lead to any detectable increase in mortality.

The mean temperature in the living room in the evening declined slightly as outdoor temperatures fell. When outdoor temperatures reached 0°C living room temperatures were 21.9°C; this is higher than temperatures found in living rooms in western Europe when outdoor temperatures reached 7°C. 9 The indoor temperatures found in this study are expected to have permitted full thermal comfort indoors. Home heating in Yekaterinburg generally could not be controlled by the occupants; the increase in the amount of time spent in unheated parts of the house during the day and in unheated bedrooms at night when the outdoor temperature was above 0°C suggests that heated rooms were at or above optimally comfortable temperatures and people chose to spend time in unheated rooms.

Cold stress and mortality at temperatures below 0°C

Several factors may have contributed to the increase in mortality that occurred when outdoor temperatures fell from 0°C to −29.6°C. An increase in outdoor cold stress was indicated by an increase in shivering. The amount of outdoor clothing that was worn plateaued when temperatures were slightly below 0°C; there were no further increases in the amount of clothing worn when temperatures fell further, apparently because people did not have additional items of outdoor clothing to wear. Cold stress is unlikely to have occurred indoors even when outdoor temperatures were below 0°C since mean temperatures in living rooms were 19.8°C when outdoor temperatures reached −25°C. At these temperatures unheated rooms generally received indirect heating and were not occupied for long. However, when temperatures fell from 0°C to −29.6°C the small fall in indoor temperature from 23.1°C to 19.8°C, occasional visits to unheated rooms, or cooling of the respiratory tract by breathing cold air when outdoors may have contributed to the increase in mortality. The results do not exclude the possibility that genetic or lifetime adaptations to cold by the population of Yekaterinburg have lowered mortality in winter to rates below what they would otherwise be.

Relation between cold stress and mortality

The general cold stress and mortality related to cold seen at temperatures below 0°C in Yekaterinburg, and their absence at temperatures above 0°C, can be most easily explained by a causal relation between mortality and cold stress. These results reinforce those of our earlier study, which showed an association between cold stress and mortality among different populations in western Europe 9 ; they also support the findings of a time series analysis which showed close temporal associations between cold weather and cause-specific mortalities in England. 4 The results of this study suggest that most of the increase in mortality associated with cold weather in western Europe—which occurs mainly at temperatures above 0°C—could be prevented by a combination of simple protective measures against outdoor cold and ensuring that houses are warm.

Acknowledgments

We thank Dr Ruslan Halfin, head of the Health Department Administration, Sverdlovsk Oblast, and Dr Tamara Gribanova, director of the Regional Medical Computer Centre, Sverdlovsk Oblast, for the data on mortality.

Funding: The study was funded by the PECO scheme of the European Union for cooperation in science and technology with central and eastern European countries and with newly independent states of the former Soviet Union.

Conflict of interest: None.

Contributors: GCD contributed to designing the study, writing the paper, and computing the survey data and its relation to mortality. VET and SPE were responsible with staff in Yekaterinburg for assembly and initial analysis of mortality data, they participated in consultations on the design of the study, interpretation of results, and editing the paper. KB provided the climatic data and contributed to editing the paper. WRK initiated the study proposals, designed the study, commissioned the field survey through the field consultant, visited Yekaterinburg with the consultant at the start of the survey, drafted the paper, and is guarantor for the study.

• Auliciems A ,
• de Freitas C
• Heunis JC ,
• Olivier J ,
• Donaldson GC ,
• Keatinge WR
• Keatinge WR ,
• Coleshaw SRK ,
• Mattock M ,
• Syndercombe-Court D ,
• Woodhouse PR ,
• Plummer M ,
• Bainton D ,
• Eurowinter Group
• Lovett AA ,
• Bentham CG ,
• Flowerdew R
• Hayward MG ,

• Feb 21, 2021
• 20 min read

The Dyatlov Pass Incident

What is the Dyatlov Pass incident? Well, as we’ll find out, it was when nine Russian hikers died in the northern Ural Mountains between February 1st & 2nd in 1959, under supposed uncertain circumstances. The experienced trekking group, who were all from the Ural Polytechnical Institute , had established a camp on the slopes of Kholat Syakhl , in an area now named in honour of the group's leader, Igor Dyatlov. During the night, something caused them to cut their way out of their tent and attempt to flee the campsite while not being dressed for the heavy ass snowfall and subzero temperatures. Subzero was one of my favorite Mortal Kombat characters… god I loved that game.

After the group's bodies were grusomly discovered, an investigation by Soviet authorities determined that six of them had died from hypothermia while the other three had been killed by physical trauma . One victim actually had major skull damage, two had severe chest trauma, and another had a small crack in the skull . Was all of this caused by an avalanche or from something nefarious? Four of the bodies were found lying in running water in a creek, and three of these had soft tissue damage of the head and face – two of the bodies were missing their eyes, one was missing its tongue, and one was missing its eyebrows. It’s eyebrows! The Soviet investigation concluded that a "compelling natural force" had caused the untimely deaths. Numerous theories have been brought forward to account for the unexplained deaths, including animal attacks, hypothermia, avalanche , katabatic winds , infrasound -induced panic, military involvement, or some combination of these. We’ll discuss all these in further detail later on.

Recently, Russia has opened a new investigation into the Dyatlov incident in 2019, and its conclusions were presented in July 2020: Simply put, they believe that an avalanche had led to the deaths of the hikers. Survivors of the avalanche had been forced to suddenly leave their camp in low visibility conditions with inadequate clothing, and had died of hypothermia. Andrey Kuryakov, deputy head of the regional prosecutor's office, said: "It was a heroic struggle. There was no panic. But they had no chance to save themselves under the circumstances." A study published in 2021 suggested that a type of avalanche known as a slab avalanche could explain some of the injuries. However, we’ll run through everything and you can come to your own conclusion.

Ok, let’s dive into the details of the event.

In 1959, the group was formed for a skiing expedition across the northern Urals in Sverdlovsk Oblast, Soviet Union. According to Prosecutor Tempalov, documents that were found in the tent of the expedition suggest that the expedition was named for the 21st Congress of the Communist Party of the Soviet Union, and was possibly dispatched by the local Komsomol organisation.Which was a political youth organization in the Soviet Union , which was sometimes described as the youth division of the Communist Party of the Soviet Union . Igor Dyatlov, a 23-year-old radio engineering student at the Ural Polytechnical Institute; now Ural Federal University, was the leader who assembled a group of nine others for the trip, most of whom were fellow students and peers at the university.Ok, so they were mostly students. Each member of the group, which consisted of eight men and two women, was an experienced Grade II-hiker with ski tour experience, and would be receiving Grade III certification upon their return. So, this trekk was like a test. I hated tests. Especially ones that could KILL YOU! At the time, this was the highest certification available in the Soviet Union, and required candidates to traverse 190 mi. The route was designed by Igor Dyatlov's group in order to reach the far northern regions of Sverdlovsk Oblast and the upper-streams of the Lozva river. The route was approved by the Sverdlovsk city route commission, which was a division of the Sverdlovsk Committee of Physical Culture and Sport. They approved of and confirmed the group of 10 people on January 8th, 1959. The goal of the expedition was to reach Otorten, a mountain(6.2 mi north of the site where the incident took place. This path, taken in February, was estimated as a Category III, the most difficult time to traverse.

On January 23rd, 1959 the Dyatlov group was issued their route book which listed their course as following the No.5 trail. At that time, the Sverdlovsk City Committee of Physical Culture and Sport listed approval for 11 people. The 11th person was listed as Semyon Zolotaryov who was previously certified to go with another expedition of similar difficulty (that was the Sogrin expedition group). The Dyatlov group left the Sverdlovsk city (today called Yekaterinburg) on the same day they received the route book.

The members of the group were Igor Alekseyevich Dyatlov, Yuri Nikolayevich Doroshenko, Lyudmila Alexandrovna Dubinina, Georgiy (Yuri) Alexeyevich Krivonischenko, Alexander Sergeyevich Kolevatov, Zinaida Alekseevna Kolmogorova, Rustem Vladimirovich Slobodin, Nikolai Vladimirovich Thibeaux-Brignolles, Semyon (Alexander) Alekseevich Zolotaryov, and Yuri Yefimovich Yudin

The group arrived by train at Ivdel , a town at the centre of the northern province of Sverdlovsk Oblast in the early morning hours of January 25, 1959. They took a truck to Vizhai, a little village that is the last inhabited settlement to the north. As of 2010, only 207 really, really fucking cold people lived there. While spending the night in Vizhai, and probably freezing their baguettes off, the skiers purchased and ate loaves of bread to keep their energy levels up for the following day's hike.

On January 27, they began their trek toward Gora Otorten. On January 28, one member, Yuri Yudin, who suffered from several health ailments (including rheumatism and a congenital heart defect ) turned back due to knee and joint pain that made him unable to continue the hike. The remaining nine hikers continued the trek. Ok, my first question with this is, why in the fuck was that guy there, to begin with??

Diaries and cameras found around their last campsite made it possible to track the group's route up to the day before the incident. On January 31st, the group arrived at the edge of a highland area and began to prepare for climbing. In a wooded valley, they rounded up surplus food and equipment that they would use for the trip back. The next day, the hikers started to move through the pass. It seems they planned to get over the pass and make camp for the next night on the opposite side, but because of worsening weather conditions—like snowstorms, decreasing visibility... large piles of yeti shit—they lost their direction and headed west, toward the top of Kholat Syakhl . When they realised their mistake, the group decided to set up camp there on the slope of the mountain, rather than move almost a mile downhill to a forested area that would have offered some shelter from the weather. Yudin, the debilitated goofball that shouldn’t have even been there speculated, "Dyatlov probably did not want to lose the altitude they had gained, or he decided to practice camping on the mountain slope."

Before leaving, Captain Dyatlov had agreed he would send a telegram to their sports club as soon as the group returned to teeny, tiny Vizhai. It was expected that this would happen no later than February 12th, but Dyatlov had told Yudin, before he departed from the group, that he expected it to actually be longer. When the 12th passed and no messages had been received, there was no immediate reaction because, ya know… fuck it. Just kidding, these types of delays were actually common with such expeditions. On February 20th, the travellers' worried relatives demanded a rescue operation and the head of the institute sent the first rescue groups, consisting of volunteer students and teachers. Later, the army and militsiya forces (aka the Soviet police) became involved, with planes and helicopters ordered to join in on the search party.

On February 26th, the searchers found the group's abandoned and super fucked up tent on Kholat Syakhl . The campsite undoubtedly baffled the search party. Mikhail Sharavin, the student who found the tent, said “HOLY SHIT! THIS PLACE IS FUCKED UP!”... No, that’s not true. He actually said, "the tent was half torn down and covered with snow. It was empty, and all the group's belongings and shoes had been left behind." Investigators said the tent had been cut open from inside. Which seems like a serious and quick escape route was needed. Nine sets of footprints, left by people wearing only socks or a single shoe or even barefoot, could actually be followed, leading down to the edge of a nearby wood, on the opposite side of the pass, about a mile to the north-east. After approximately 1,600 ft, these tracks were covered with snow. At the forest's edge, under a large Siberian pine , the searchers found the visible remains of a small fire. There were the first two bodies, those of Krivonischenko and Doroshenko, shoeless and dressed only in their tighty whiteys. The branches on the tree were broken up to five meters high, suggesting that one of the skiers had climbed up to look for something, maybe the camp. Between the pine and the camp, the searchers found three more corpses: Dyatlov, Kolmogorova, and Slobodin, who died in poses suggesting that they were attempting to return to the tent. They were found at distances of 980, 1,570, and 2,070 ft from the tree.

Finding the remaining four travellers took more than two frigging months. They were finally found on May 4th under 13 ft of snow in a ravine 246 ft further into the woods from the pine tree. Three of the four were better dressed than the others, and there were signs that some clothing of those who had died first had been taken off of their corpses for use by the others. Dubinina was wearing Krivonishenko's burned, torn trousers, and her left foot and shin were wrapped in a torn jacket.

Let’s get into the investigation. A legal inquest started immediately after the first five bodies were found. A medical examination found no injuries that might have led to their deaths, and it was concluded that they had all died of hypothermia .Which would make sense because it was colder than a polar bear’s butthole. Slobodin had a small crack in his skull, but it was not thought to be a fatal wound.

An examination of the four bodies found in May shifted the overall narrative of what they initially believed transpired. Three of the hikers had fatal injuries: Thibeaux-Brignolles had major skull damage, and Dubinina and Zolotaryov had major chest fractures. According to Boris Vozrozhdenny, the force required to cause such damage would have been extremely high, comparable to that of a car crash.Also, the bodies had no external wounds associated with the bone fractures, as if they had been subjected to a high level of pressure.

All four bodies found at the bottom of the creek in a running stream of water had soft tissue damage to their head and face. For example, Dubinina was missing her tongue, eyes, part of the lips, as well as facial tissue and a fragment of her skullbone, while Zolotaryov was missing his friggin eyeballs, and Aleksander Kolevatov his eyebrows. V. A. Vozrozhdenny, the forensic expert performing the post-mortem examination , judged that these injuries happened after they had died, due to the location of the bodies in a stream.

At first, there was speculation that the indigenous Mansi people , who were just simple reindeer herders local to the area, had attacked and murdered the group for making fun of Rudolph. Several Mansi were interrogated, but the investigation indicated that the nature of the deaths did not support this hypothesis: only the hikers' footprints were visible, and they showed no sign of hand-to-hand struggle. Oh, I was kidding about the Rudolph thing. They thought they attacked the hikers for being on their land.

Although the temperature was very low, around −13 to −22 °F with a storm blowing, the dead were only partially dressed, as I mentioned.

Journalists reporting on the available parts of the inquest files claim that it states:

Six of the group members died of hypothermia and three of fatal injuries.

There were no indications of other people nearby on Kholat Syakhl apart from the nine travellers.

The tent had been ripped open from within.

The victims had died six to eight hours after their last meal.

Traces from the camp showed that all group members left the campsite of their own accord, on foot.

Some levels of radiation were found on one victim's clothing.

To dispel the theory of an attack by the indigenous Mansi people, Vozrozhdenny stated that the fatal injuries of the three bodies could not have been caused by human beings, "because the force of the blows had been too strong and no soft tissue had been damaged".

Released documents contained no information about the condition of the skiers' internal organs.

And most obviously, There were no survivors.

At the time, the official conclusion was that the group members had died because of a compelling natural force.The inquest officially ceased in May 1959 as a result of the absence of a guilty party. The files were sent to a secret archive.

In 1997, it was revealed that the negatives from Krivonischenko's camera were kept in the private archive of one of the investigators, Lev Ivanov. The film material was donated by Ivanov's daughter to the Dyatlov Foundation. The diaries of the hiking party fell into Russia's public domain in 2009.

On April 12th, 2018, Zolotarev's remains were exhumed on the initiative of journalists of the Russian tabloid newspaper Komsomolskaya Pravda . Contradictory results were obtained: one of the experts said that the character of the injuries resembled a person knocked down by a car, and the DNA analysis did not reveal any similarity to the DNA of living relatives. In addition, it turned out that Zolotarev's name was not on the list of those buried at the Ivanovskoye cemetery. Nevertheless, the reconstruction of the face from the exhumed skull matched postwar photographs of Zolotarev, although journalists expressed suspicions that another person was hiding under Zolotarev's name after World War II .

In February 2019, Russian authorities reopened the investigation into the incident, yet again, although only three possible explanations were being considered: an avalanche, a slab avalanche , or a hurricane . The possibility of a crime had been discounted.

Other reports brought about a whole bunch of additional speculation.

Twelve-year-old Yury Kuntsevich, who later became the head of the Yekaterinburg-based Dyatlov Foundation, attended five of the hikers' funerals. He recalled that their skin had a "deep brown tan".

Another group of hikers 31 mi south of the incident reported that they saw strange orange spheres in the sky to the north on the night of the incident.Similar spheres were observed in Ivdel and other areas continually during the period from February to March of 1959, by various independent witnesses (including the meteorology service and the military). These sightings were not noted in the 1959 investigation, and the various witnesses came forward years later.

After the initial investigation,

Anatoly Gushchin summarized his research in the book The Price of State Secrets Is Nine Lives. Some researchers criticised the work for its concentration on the speculative theory of a Soviet secret weapon experiment, but its publication led to public discussion, stimulated by interest in the paranormal .It is true that many of those who had remained silent for thirty years reported new facts about the accident. One of them was the former police officer, Lev Ivanov, who led the official inquest in 1959. In 1990, he published an article that included his admission that the investigation team had no rational explanation for the incident. He also stated that, after his team reported that they had seen flying spheres, he then received direct orders from high-ranking regional officials to dismiss this claim.

In 2000, a regional television company produced the documentary film The Mystery of Dyatlov Pass . With the help of the film crew, a Yekaterinburg writer, Anna Matveyeva, published a docudrama of the same name. A large part of the book includes broad quotations from the official case, diaries of victims, interviews with searchers and other documentaries collected by the film-makers. The narrative line of the book details the everyday life and thoughts of a modern woman (an alter ego of the author herself, which is super weird) who attempts to resolve the case. Despite its fictional narrative, Matveyeva's book remains the largest source of documentary materials ever made available to the public regarding the incident. Also, the pages of the case files and other documentaries (in photocopies and transcripts) are gradually being published on a web forum for nerds just like you and i!.

The Dyatlov Foundation was founded in 1999 at Yekaterinburg, with the help of Ural State Technical University, led by Yuri Kuntsevitch. The foundation's stated aim is to continue investigation of the case and to maintain the Dyatlov Museum to preserve the memory of the dead hikers. On July 1st 2016, a memorial plaque was inaugurated in Solikamsk in Ural's Perm Region, dedicated to Yuri Yudin (the dude who pussed out and is the sole survivor of the expedition group), who died in 2013.

Now, let’s go over some of the theories of what actually took place at the pass.

On July 11 2020, Andrey Kuryakov, deputy head of the Urals Federal District directorate of the Prosecutor-General 's Office, announced an avalanche to be the "official cause of death" for the Dyatlov group in 1959. Later independent computer simulation and analysis by Swiss researchers also suggest avalanche as the cause.

Reviewing the sensationalist " Yeti " hypothesis , American skeptic author Benjamin Radford suggests an avalanche as more plausible:

“that the group woke up in a panic (...) and cut their way out the tent either because an avalanche had covered the entrance to their tent or because they were scared that an avalanche was imminent (...) (better to have a potentially repairable slit in a tent than risk being buried alive in it under tons of snow). They were poorly clothed because they had been sleeping, and ran to the safety of the nearby woods where trees would help slow oncoming snow. In the darkness of night, they got separated into two or three groups; one group made a fire (hence the burned hands) while the others tried to return to the tent to recover their clothing since the danger had passed. But it was too cold, and they all froze to death before they could locate their tent in the darkness. At some point, some of the clothes may have been recovered or swapped from the dead, but at any rate, the group of four whose bodies was most severely damaged were caught in an avalanche and buried under 4 meters (13 ft) of snow (more than enough to account for the 'compelling natural force' the medical examiner described). Dubinina's tongue was likely removed by scavengers and ordinary predation.”

Evidence contradicting the avalanche theory includes:

The location of the incident did not have any obvious signs of an avalanche having taken place. An avalanche would have left certain patterns and debris distributed over a wide area. The bodies found within a month of the event were covered with a very shallow layer of snow and, had there been an avalanche of sufficient strength to sweep away the second party, these bodies would have been swept away as well; this would have caused more serious and different injuries in the process and would have damaged the tree line.

Over 100 expeditions to the region had been held since the incident, and none of them ever reported conditions that might create an avalanche. A study of the area using up-to-date terrain-related physics revealed that the location was entirely unlikely for such an avalanche to have occurred. The "dangerous conditions" found in another nearby area (which had significantly steeper slopes and cornices) were observed in April and May when the snowfalls of winter were melting. During February, when the incident occurred, there were no such conditions.

An analysis of the terrain and the slope showed that even if there could have been a very specific avalanche that found its way into the area, its path would have gone past the tent. The tent had collapsed from the side but not in a horizontal direction.

Dyatlov was an experienced skier and the much older Zolotaryov was studying for his Masters Certificate in ski instruction and mountain hiking. Neither of these two men would have been likely to camp anywhere in the path of a potential avalanche.

Footprint patterns leading away from the tent were inconsistent with someone, let alone a group of nine people, running in panic from either real or imagined danger. All the footprints leading away from the tent and towards the woods were consistent with individuals who were walking at a normal pace.

Repeated 2015 investigation [ edit ]

A review of the 1959 investigation's evidence completed in 2015–2019 by experienced investigators from the Investigative Committee of the Russian Federation (ICRF) on request of the families confirmed the avalanche with several important details added. First of all, the ICRF investigators (one of them an experienced alpinist ) confirmed that the weather on the night of the tragedy was very harsh, with wind speeds up to hurricane force,(45–67 mph, a snowstorm and temperatures reaching −40 °C. These factors weren't considered by the 1959 investigators who arrived at the scene of the accident three weeks later when the weather had much improved and any remains of the snow slide had settled and been covered with fresh snowfall. The harsh weather at the same time played a critical role in the events of the tragic night, which have been reconstructed as follows:

On 1 February the group arrives at the Kholat Syakhl mountain and erects a large, 9-person tent on an open slope, without any natural barriers such as forests. On the day and a few preceding days, a heavy snowfall continued, with strong wind and frost.

The group traversing the slope and digging a tent site into the snow weakens the snow base. During the night the snowfield above the tent starts to slide down slowly under the weight of the new snow, gradually pushing on the tent fabric, starting from the entrance. The group wakes up and starts evacuation in panic, with only some able to put on warm clothes. With the entrance blocked, the group escapes through a hole cut in the tent fabric and descends the slope to find a place perceived as safe from the avalanche only 1500 m down, at the forest border.

Because some of the members have only incomplete clothing, the group splits. Two of the group, only in their underwear and pajamas, were found at the Siberian pine tree, near a fire pit. Their bodies were found first and confirmed to have died from hypothermia.

Three hikers, including Dyatlov, attempted to climb back to the tent, possibly to get sleeping bags. They had better clothes than those at the fire pit, but still quite light and with inadequate footwear. Their bodies were found at various distances 300–600 m from the campfire, in poses suggesting that they had fallen exhausted while trying to climb in deep snow in extremely cold weather.

The remaining four, equipped with warm clothing and footwear, were trying to find or build a better camping place in the forest further down the slope. Their bodies were found 70 m from the fireplace, under several meters of snow and with traumas indicating that they had fallen into a snow hole formed above a stream. These bodies were found only after two months.

According to the ICRF investigators, the factors contributing to the tragedy were extremely bad weather and lack of experience of the group leader in such conditions, which led to the selection of a dangerous camping place. After the snow slide, another mistake of the group was to split up, rather than building a temporary camp down in the forest and trying to survive through the night. Negligence of the 1959 investigators contributed to their report creating more questions than answers and inspiring numerous conspiracy theories.

In 2021 a team of physicists and engineers led by Alexander Puzrin published a new model that demonstrated how even a relatively small slide of snow slab on the Kholat Syakhl slope could cause tent damage and injuries consistent with those suffered by Dyatlov team.

Ok, what about the Katabatic wind that I mentioned earlier?

In 2019, a Swedish-Russian expedition was made to the site, and after investigations, they proposed that a violent katabatic wind was a plausible explanation for the incident. Katabatic winds are a drainage wind, a wind that carries high-density air from a higher elevation down a slope under the force of gravity. They are somewhat rare events and can be extremely violent. They were implicated in a 1978 case at Anaris Mountain in Sweden, where eight hikers were killed and one was severely injured in the aftermath of katabatic wind. The topography of these locations were noted to be very similar according to the expedition.

A sudden katabatic wind would have made it impossible to remain in the tent, and the most rational course of action would have been for the hikers to cover the tent with snow and seek shelter behind the treeline. On top of the tent, there was also a torch left turned on, possibly left there intentionally so that the hikers could find their way back to the tent once the winds subsided. The expedition proposed that the group of hikers constructed two bivouac shelters , or just makeshift shelters, one of which collapsed, leaving four of the hikers buried with the severe injuries observed.

Another hypothesis popularised by Donnie Eichar 's 2013 book Dead Mountain is that wind going around Kholat Syakal created a Kármán vortex street , a repeating pattern of swirling vortices , caused by a process known as vortex shedding , which is responsible for the unsteady separation of flow of a fluid around blunt bodies. which can produce infrasound capable of inducing panic attacks in humans. According to Eichar's theory, the infrasound generated by the wind as it passed over the top of the Holatchahl mountain was responsible for causing physical discomfort and mental distress in the hikers. Eichar claims that, because of their panic, the hikers were driven to leave the tent by whatever means necessary, and fled down the slope. By the time they were further down the hill, they would have been out of the infrasound's path and would have regained their composure, but in the darkness would have been unable to return to their shelter. The traumatic injuries suffered by three of the victims were the result of their stumbling over the edge of a ravine in the darkness and landing on the rocks at the bottom. Hmmm...plausible.

Military tests

In another theory, the campsite fell within the path of a Soviet parachute mine exercise. This theory alleges that the hikers, woken up by loud explosions, fled the tent in a shoeless panic and found themselves unable to return for their shit. After some members froze to death attempting to endure the bombardment, others commandeered their clothing only to be fatally injured by subsequent parachute mine concussions. There are in fact records of parachute mines being tested by the Soviet military in the area around the time the hikers were out there, fuckin’ around. Parachute mines detonate while still in the air rather than upon striking the Earth's surface and produce signature injuries similar to those experienced by the hikers: heavy internal damage with relatively little external trauma. The theory coincides with reported sightings of glowing, orange orbs floating or falling in the sky within the general vicinity of the hikers and allegedly photographed by them, potentially military aircraft or descending parachute mines. (remember the camera they found? HUH? Yeah?)

This theory (among others) uses scavenging animals to explain Dubinina's injuries. Some speculate that the bodies were unnaturally manipulated, on the basis of characteristic livor mortis markings discovered during an autopsy, as well as burns to hair and skin. Photographs of the tent allegedly show that it was erected incorrectly, something the experienced hikers were unlikely to have done.

A similar theory alleges the testing of radiological weapons and is based partly on the discovery of radioactivity on some of the clothing as well as the descriptions of the bodies by relatives as having orange skin and grey hair. However, radioactive dispersal would have affected all, not just some, of the hikers and equipment, and the skin and hair discoloration can be explained by a natural process of mummification after three months of exposure to the cold and wind. The initial suppression by Soviet authorities of files describing the group's disappearance is sometimes mentioned as evidence of a cover-up, but the concealment of information about domestic incidents was standard procedure in the USSR and thus nothing strange.. And by the late 1980s, all Dyatlov files had been released in some manner.

Let’s talk about Paradoxical undressing

International Science Times proposed that the hikers' deaths were caused by hypothermia, which can induce a behavior known as paradoxical undressing in which hypothermic subjects remove their clothes in response to perceived feelings of burning warmth. It is undisputed that six of the nine hikers died of hypothermia. However, others in the group appear to have acquired additional clothing (from those who had already died), which suggests that they were of a sound enough mind to try to add layers.

Keith McCloskey, who has researched the incident for many years and has appeared in several TV documentaries on the subject, traveled to the Dyatlov Pass in 2015 with Yury Kuntsevich of the Dyatlov Foundation and a group. At the Dyatlov Pass he noted:

There were wide discrepancies in distances quoted between the two possible locations of the snow shelter where Dubinina, Kolevatov, Zolotarev, and Thibault-Brignolles were found. One location was approximately 80 to 100 meters from the pine tree where the bodies of Doroshenko and Krivonischenko were found and the other suggested location was so close to the tree that anyone in the snow shelter could have spoken to those at the tree without raising their voices to be heard. This second location also has a rock in the stream where Dubinina's body was found and is the more likely location of the two. However, the second suggested location of the two has a topography that is closer to the photos taken at the time of the search in 1959.

The location of the tent near the ridge was found to be too close to the spur of the ridge for any significant build-up of snow to cause an avalanche. Furthermore, the prevailing wind blowing over the ridge had the effect of blowing snow away from the edge of the ridge on the side where the tent was. This further reduced any build-up of snow to cause an avalanche. This aspect of the lack of snow on the top and near the top of the ridge was pointed out by Sergey Sogrin in 2010.

McCloskey also noted:

Lev Ivanov's boss, Evgeny Okishev (Deputy Head of the Investigative Department of the Sverdlovsk Oblast Prosecution Office), was still alive in 2015 and had given an interview to former Kemerovo prosecutor Leonid Proshkin in which Okishev stated that he was arranging another trip to the Pass to fully investigate the strange deaths of the last four bodies when Deputy Prosecutor General Urakov arrived from Moscow and ordered the case shut down.

Evgeny Okishev also stated in his interview with Leonid Proshkin that Klinov, head of the Sverdlovsk Prosecutor's Office, was present at the first post mortems in the morgue and spent three days there, something Okishev regarded as highly unusual and the only time, in his experience, it had happened.

Donnie Eichar , who investigated and made a documentary about the incident, evaluated several other theories that are deemed unlikely or have been discredited:

They were attacked by Mansi or other local tribesmen. The local tribesmen were known to be peaceful and there was no track evidence of anyone approaching the tent.

They were attacked and chased by animal wildlife. There were no animal tracks and the group would not have abandoned the relative security of the tent.

High winds blew one member away, and the others attempted to rescue the person. A large experienced group would not have behaved like that, and winds strong enough to blow away people with such force would have also blown away the tent.

An argument, possibly related to a romantic encounter that left some of them only partially clothed, led to a violent dispute. About this, Eichar states that it is "highly implausible. By all indications, the group was largely harmonious, and sexual tension was confined to platonic flirtation and crushes. There were no drugs present and the only alcohol was a small flask of medicinal alcohol, found intact at the scene. The group had even sworn off cigarettes for the expedition." Furthermore, a fight could not have left the massive injuries that one body had suffered.

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Yekaterinburg

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Yekaterinburg , city and administrative center of Sverdlovsk oblast (region), west-central Russia . The city lies along the Iset River, which is a tributary of the Tobol River , and on the eastern slope of the Ural Mountains , slightly east of the border between Europe and Asia . Yekaterinburg is situated 1,036 miles (1,667 km) east of Moscow .

Near the village of Shartash, which was founded in 1672 by members of the Russian sect of Old Believers, an ironworks was established in 1721 and a fortress in 1722. In 1723 the new settlement was named Yekaterinburg in honor of Catherine I , the wife of Peter I the Great . The town grew as the administrative center for all the ironworks of the Urals region, and its importance increased after 1783, when the Great Siberian Highway was built through it. After 1878 the Trans-Siberian Railroad linked the city with Siberia. After the Russian Revolution of 1917 (October), Yekaterinburg achieved notoriety as the scene of the execution of the last tsar , Nicholas II , and his family in July 1918. In 1924 it was renamed Sverdlovsk in honor of the Bolshevik leader Yakov M. Sverdlov, but the city reverted to its original name in 1991.

Modern Yekaterinburg is one of the major industrial centers of Russia, especially for heavy engineering. The Uralmash produces heavy machinery and is the city’s largest enterprise; it once employed some 50,000 workers, though it now has a small fraction of that number. Engineering products manufactured in the city include metallurgical and chemical machinery, turbines, diesels, and ball bearings . During the Soviet period the city was a major center of biological and chemical warfare research and development . There is a range of light industries, including a traditional one of gem cutting. Food processing is also important. The city, laid out on a regular gridiron pattern, sprawls across the valley of the Iset—there dammed to form a series of small lakes—and the low surrounding hills.

Yekaterinburg is an important railway junction, with lines radiating from it to all parts of the Urals and the rest of Russia. The city is the leading cultural center of the Urals and has numerous institutions of higher education , including the Urals A.M. Gorky State University (founded 1920), a conservatory, and polytechnic, mining, forestry, agricultural, law, medical, and teacher-training institutes. The Urals branch of the Russian Academy of Sciences and many scientific-research establishments are also located there. Boris Yeltsin , the first democratically elected president of Russia, was educated and spent much of his political career in the city. Pop. (2005 est.) 1,304,251.

Blood tests for Alzheimer's may be coming to your doctor's office. Here's what to know

But there is still little data to guide doctors about which kind to order and when, by lauran neergaard | the associated press • published july 28, 2024 • updated on july 28, 2024 at 10:33 am.

New blood tests could help doctors diagnose Alzheimer’s disease faster and more accurately, researchers reported Sunday – but some appear to work far better than others.

It’s tricky to tell if memory problems are caused by Alzheimer’s. That requires confirming one of the disease’s hallmark signs — buildup of a sticky protein called beta-amyloid — with a hard-to-get brain scan or uncomfortable spinal tap. Many patients instead are diagnosed based on symptoms and cognitive exams.

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Labs have begun offering a variety of tests that can detect certain signs of Alzheimer's in blood. Scientists are excited by their potential but the tests aren't widely used yet because there's little data to guide doctors about which kind to order and when. The U.S. Food and Drug Administration hasn't formally approved any of them and there's little insurance coverage.

“What tests can we trust?” asked Dr. Suzanne Schindler, a neurologist at Washington University in St. Louis who’s part of a research project examining that. While some are very accurate, “other tests are not much better than a flip of a coin.”

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More than 6 million people in the United States and millions more around the world have Alzheimer’s, the most common form of dementia. Its telltale “biomarkers” are brain-clogging amyloid plaques and abnormal tau protein that leads to neuron-killing tangles.

New drugs, Leqembi and Kisunla, can modestly slow worsening symptoms by removing gunky amyloid from the brain. But they only work in the earliest stages of Alzheimer’s and proving patients qualify in time can be difficult. Measuring amyloid in spinal fluid is invasive. A special PET scan to spot plaques is costly and getting an appointment can take months.

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Even specialists can struggle to tell if Alzheimer’s or something else is to blame for a patient’s symptoms.

“I have patients not infrequently who I am convinced have Alzheimer’s disease and I do testing and it’s negative,” Schindler said.

Blood tests so far have been used mostly in carefully controlled research settings. But a new study of about 1,200 patients in Sweden shows they also can work in the real-world bustle of doctors' offices — especially primary care doctors who see far more people with memory problems than specialists but have fewer tools to evaluate them.

In the study, patients who visited either a primary care doctor or a specialist for memory complaints got an initial diagnosis using traditional exams, gave blood for testing and were sent for a confirmatory spinal tap or brain scan.

Blood testing was far more accurate, Lund University researchers reported Sunday at the Alzheimer's Association International Conference in Philadelphia. The primary care doctors' initial diagnosis was 61% accurate and the specialists' 73% — but the blood test was 91% accurate, according to the findings, which also were published in the Journal of the American Medical Association.

There’s almost “a wild West” in the variety being offered, said Dr. John Hsiao of the National Institute on Aging. They measure different biomarkers, in different ways.

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Doctors and researchers should only use blood tests proven to have a greater than 90% accuracy rate, said Alzheimer’s Association chief science officer Maria Carrillo.

Today's tests most likely to meet that benchmark measure what’s called p-tau217, Carrillo and Hsiao agreed. Schindler helped lead an unusual direct comparison of several kinds of blood tests, funded by the Foundation for the National Institutes of Health, that came to the same conclusion.

That type of test measures a form of tau that correlates with how much plaque buildup someone has, Schindler explained. A high level signals a strong likelihood the person has Alzheimer’s while a low level indicates that’s probably not the cause of memory loss.

Several companies are developing p-tau217 tests including ALZpath Inc., Roche, Eli Lilly and C2N Diagnostics, which supplied the version used in the Swedish study.

Only doctors can order them from labs. The Alzheimer’s Association is working on guidelines and several companies plan to seek FDA approval, which would clarify proper use.

For now, Carrillo said doctors should use blood testing only in people with memory problems, after checking the accuracy of the type they order.

Especially for primary care physicians, “it really has great potential to help them in sorting out who to give a reassuring message and who to send on to memory specialists,” said Dr. Sebastian Palmqvist of Lund University, who led the Swedish study with Lund’s Dr. Oskar Hansson.

The tests aren't yet for people who don't have symptoms but worry about Alzheimer's in the family — unless it's part of enrollment in research studies, Schindler stressed.

That's partly because amyloid buildup can begin two decades before the first sign of memory problems, and so far there are no preventive steps other than basic advice to eat healthy, exercise and get enough sleep. But there are studies underway testing possible therapies for people at high risk of Alzheimer's, and some include blood testing.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Notice of Special Interest (NOSI): Women’s Health Research

In coordination with the White House Initiative on Women’s Health Research , ORWH and several NIH institutes and centers issued a Notice of Special Interest (NOSI) to highlight interest in receiving research applications focused on diseases and health conditions that predominantly affect women (e.g., autoimmune diseases, depressive disorders, Alzheimer’s disease and Alzheimer’s disease-related dementias, gender-based violence), present and progress differently in women (e.g., cardiovascular disease, HIV, reproductive aging and its implications), or are female specific (e.g., uterine fibroids, endometriosis, menopause).

Applications should have a central focus on the health of women, as demonstrated through specific aims that either explicitly address a particular condition in women or focus on one of the following high-priority topics:

• Projects that investigate the influence of sex-linked biology, gender-related factors, or their intersections on health  
• Projects that investigate how physical, mental, and psychological health outcomes interact with structural factors to either mitigate or exacerbate health disparities, and aim to create behavioral interventions to address these issues
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• Research to increase public awareness of the need for greater investment in and attention to women’s health research, as well as women’s health outcomes across the lifespan
• Projects that advance research to reduce health disparities and inequities affecting women’s health, including those related to race, ethnicity, age, socioeconomic status, disability, and exposure to environmental factors and contaminants that can directly affect health
• Dissemination and implementation research to increase uptake of evidence-based interventions that advance women’s health
• Projects addressing topics identified in the Women’s Health Innovation Opportunity Map

In each of these potential areas of focus, intersectional and/or multidimensional approaches to gender-related social and structural variables—including race , ethnicity , socioeconomic status , and state and federal policies—are strongly encouraged.

The NOSI expires November 5, 2027 . Check the individual Notice of Funding Opportunities for applicable receipt dates here .

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