Medical News

Pets can carry the MRSA superbug

Medical News - Thu, 05/22/2014 - 14:17

"Pets can harbour the hospital superbug MRSA and it can pass between pets and their owners," BBC News reports.

New research suggests that as many as 9% of dogs may be carriers, though the risk of transmission is small.

The story comes from a laboratory study which found that cats and dogs can carry the same genetic strain of MRSA found in humans. The results also suggest that the bacteria is likely to have been passed from humans to their pets.

As its name suggests, MRSA (short for methicillin-resistant Staphylococcus aureus) is a type of bacterial infection that is resistant to a number of widely used antibiotics. This means it can be more difficult to treat than other bacterial infections. 

However, while many pets may carry MRSA on their fur, it is rare for them to develop an active infection. Following good hygiene practices when handling and washing your pets should significantly reduce any risk of infection.

The study does raise concerns that the widespread use of antibiotics in veterinary medicine may encourage the spread of MRSA in humans.

The researchers highlight the importance of a “one health” view of infections – the health of both animals and humans are “intrinsically linked”.

 

Where did the story come from?

The study was carried out by researchers from the University of Cambridge, the Wellcome Trust Sanger Institute, University of London, University of Hull and the Animal Health Trust, all in the UK. It was funded by the Medical Research Council, the National Institute for Health Research and the Wellcome Trust.

The study was published in mBio, a peer-reviewedopen access medical journal. The article is available to read online.

The study was covered fairly by BBC News.

 

What kind of research was this?

This was a laboratory study in which researchers mapped the DNA sequence of 46 MRSA samples taken from cats and dogs in the UK and compared these to a collection of human MRSA samples.

Researchers point out that MRSA is a major problem in human medicine, with a small number of strains causing most of the problems. They also say that since the late 1990s, the role of both livestock and pets as reservoirs of MRSA infection and also as vectors for transmission, has become clearer.

For example, it is estimated that up to 9% of dogs in the UK are thought to be carriers of MRSA.

 

What did the research involve?

Between 2003 and 2007, the researchers mapped the DNA sequences of 46 MRSA samples from cats and dogs, collected from two large veterinary hospitals and several smaller veterinary practices throughout the UK. Most samples were taken from wound, skin and soft tissue infections, but others came from urine, cerebro-spinal fluid (the fluid that surrounds and supports the brain), nasal discharges, bloodstream, heart valve and joint infections.

Researchers carried out a number of experiments comparing these samples to a collection of human MRSA samples, which had been previously sequenced as part of other studies. They also evaluated the evolution of the different bacteria.

 

What were the basic results?

The researchers found that most of the animal infections were from the same family, called Epidemic MRSA 15 (EMRSA-15) (sequence type ST22). This is a common strain of MRSA first detected in the UK in the 1990s, which subsequently spread throughout Europe.

Nearly all samples were genetically similar to human bacteria, and the bacteria found in the animals were likely to have originated in humans.

Researchers also found that samples from the same veterinary hospitals were very similar genetically.

Analysis of the DNA showed very few genetic changes between bacteria samples from humans and animals.

This indicates that the MRSA bacteria from cats and dogs did not need to undergo extensive adaptation to live on different animals or humans.

They also found that the animal MRSA were significantly less likely than those from humans to have resistance to the antibiotic erythromycin (which they say is rarely used in English veterinary practices).

The MRSA from animals were more likely to contain mutations making them resistant to the antibiotic clindamycin, used widely in veterinary medicine in the United Kingdom.

 

How did the researchers interpret the results?

The researchers say that their study shows that humans and animals share the same strain of MRSA which it also suggests can be passed between the species without the need for the bacteria to adapt.

Companion animals may act as a reservoir for human MRSA infections and vice versa.

Also, as in human hospitals, it appears that MRSA can be readily transmitted in veterinary hospital settings.

In an accompanying press release, senior author Mark Holmes, senior lecturer in preventive medicine at the University of Cambridge, said: “Our study demonstrates that humans and companion animals readily exchange and share MRSA bacteria from the same population.”

“It also furthers the ‘one health’ view of infectious diseases that the pathogens infecting both humans and animals are intrinsically linked, and provides evidence that antibiotic usage in animal medicine is shaping the population of a major human pathogen.”

 

Conclusion

This was a laboratory study looking at genetic similarities between the MRSA samples found in cats and dogs and those in human populations, suggesting that the infection may pass between the two.

Although the results are worrying it should be noted that on an individual level, MRSA in pets is still rare. However it’s important to stick to strict hygiene practices to prevent MRSA in either the human or animal population.

The results may influence future antibiotic prescribing patterns in animals as well encouraging a holistic approach towards treating infections; where we consider both the needs of humans and animals.

Analysis by
Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

MRSA: Hospital superbug 'shared with pets'. BBC News, May 22 2014

Could your PET give you MRSA? Study finds infection can pass between cats, dogs and humans. Mail Online, May 22 2014

Links To Science

Harrison EM, Weinert LA, Holden MTG, et al. A Shared Population of Epidemic Methicillin-Resistant Staphylococcus aureus 15 Circulates in Humans and Companion Animals. mBio. Published online May 13 2014

Categories: Medical News

Prostate cancer linked to common STI

Medical News - Wed, 05/21/2014 - 14:26

“Prostate cancer could be a sexually transmitted disease caused by a common infection,” The Independent reports.

Researchers have found evidence of a link between the cancer and trichomoniasis – a common parasite that is passed on during unprotected sexual contact.

A laboratory study found the parasite produces a protein similar to a human protein that is necessary for the immune system to function. However, the human protein had also been shown to be involved in the growth of cancers, as it causes inflammation.

This is of potential concern as trichomoniasis causes no noticeable symptoms in up to half of men. These men may then be subject to chronic inflammation without realising it.

The study found that in the laboratory setting, the protein from the parasite acted on human blood cells and benign and cancerous prostate cells in a similar way to the human protein. The researchers conclude that infection with the parasite, in combination with other factors, might trigger inflammatory pathways that could lead to cancer growth.

It is important to note that this early study did not involve any men with benign enlargement of the prostate or prostate cancer. Further research will be required to investigate whether there is a clear link between trichomoniasis and prostate cancer.

It could be the case that trichomoniasis is just one of a series of risk factors rather than a single definitive cause.

 

Where did the story come from?

The study was carried out by researchers from the University of California, Los Angeles, the Università degli Sutdi di Sassari, Italy and the Instituto de Investigaciones Biotecnológicas-Instituto Tecnológico de Chascomύs, Argentina. It was funded by the National Institutes of Health Grants, the Microbial Pathogenesis Training Grant, a Warsaw Fellowship, a Graduate Division Dissertation Year Fellowship, a Medical Scientist Training Program Grant, Fondazione Banco di Sardegna Grant and a Regione Autonoma della Sardegna Grant. 

No conflicts of interest were reported.

The study was published in the peer-reviewed medical journal PNAS.

While the general content of the reporting by BBC News and The Independent was accurate, their headlines (“Prostate cancer 'may be a sexually transmitted disease'”) were probably a bit over-the-top given the preliminary nature of the research. Though both organisations included quotes from Cancer Research UK pointing out that it is too early to add prostate cancer to the list of cancers that have been found to have an infectious cause, such as cervical cancer.

We cannot say with any conviction that prostate cancer is a sexually transmitted infection. Other known risk factors for prostate cancer include age, ethnicity and family history. This arguably suggests that the disease may arise due to a combination of complex risk factors.


Links To The Headlines

Prostate cancer 'may be a sexually transmitted disease'. BBC News, May 20 2014

Prostate cancer ‘could be a sexually transmitted disease’, scientists say. The Independent, May 20 2014

Links To Science

Twu O, Dessi D, Vu A, et al. Trichomonas vaginalis homolog of macrophage migration inhibitory factor induces prostate cell growth, invasiveness, and inflammatory responses. PNAS. Published online May 19 2014

Categories: Medical News

E-cigs 'better than patches and gum' as quitting aid

Medical News - Wed, 05/21/2014 - 14:00

“E-cigarettes more effective than patches to help quit smoking, says study,” The Guardian reports. A UK study has found that people who use the aids are 60% more likely to quit than those who try nicotine replacement therapy (NRT) patches or gum, or willpower alone.

This was a “real world” study that surveyed a representative sample of the English population about their smoking habits.

The results of this study, whilst interesting, should be viewed with caution, as there are numerous limitations. This includes the fact it was not a randomised controlled trial (RCT), which is the best way to assess the effectiveness of treatments.

It also relied on people reporting quitting, but they may not have actually done so; self-reporting is not the most reliable of methods.

Finally, it did not compare e-cigarettes against medications, such as champix (varenicline), and psychological interventions. This makes it unclear how e-cigarettes compare to these methods.

Current evidence suggests that getting professional help through the NHS stop smoking service is the most effective way to quit.

E-cigarettes, however, are growing increasingly popular, so policymakers may need to decide whether or not they should be used by NHS smoking cessation services.

 

Where did the story come from?

The study was carried out by researchers from University College London and was funded largely by Cancer Research UK and the Department of Health.

Funding was also received from Pfizer, GlaxoSmithKline and Johnson and Johnson –  pharmaceutical companies that produce and sell NRT products.

The researchers say they received no funding from any e-cigarette manufacturers.

The study was published in the peer-reviewed journal Addiction.

It was covered fairly in most of the UK media, although little mention was made of the study’s limitations.

One of the authors, Professor Robert West, has complained that he has been misquoted by The Sun newspaper.

He has released a statement saying: “I was not calling for e-cigarettes to be made available on the NHS. All I said was that as and when an e-cigarette receives a medical license, it should be theoretically possible for them to be prescribed.”

 

What kind of research was this?

This was a cross-sectional survey of 5,863 adults in England, who had made at least one attempt to quit smoking in the previous 12 months, either using e-cigarettes, NRT bought over the counter or with willpower alone. Its aim was to assess the effectiveness of the three different approaches in helping people to quit.

Cross-sectional surveys look at all data at one specific point in time. They provide a useful snapshot of links between people’s health and their lifestyle, but they cannot see if one thing follows another.

The authors point out that e-cigarettes are increasingly popular. Two RCTs have suggested they can aid smoking cessation, but there are many factors that could influence their effectiveness in the real world, such as who chooses to use them.

They also say it's important to know how e-cigarettes compare with licenced NRT products bought over the counter as an aid to quitting. 

 

What did the research involve?

The study involved a survey of 5,863 adult smokers between 2009 and 2014, who had attempted to quit smoking at least once, without the aid of prescription medication or professional support.

It is part of an ongoing Smoking Toolkit Study, which is designed to provide information about smoking prevalence and behaviour in England. In this study, a new sample of about 1,800 adults aged 16 and above are selected randomly each month and asked to complete a face-to-face computer assisted survey with a trained interviewer.

The sample discussed here comprised adults who had made at least one attempt to quit in the 12 months prior to their interview.

They included people who had used e-cigarettes, NRT bought over the counter and those who had not used any treatment or support.

The researchers excluded those who had used a combination of methods, a prescription stop-smoking medication or face-to-face professional support.

To find out about quitting rates, people were asked how long their most serious attempts lasted before they begun smoking again. Those that said they were still not smoking at the time of the interview were defined as “non-smokers”.

The researchers adjusted their results for potential confounders, including degree of nicotine dependence, age, sex and social grade. They used standard statistical techniques to analyse their results.

 

What were the basic results?

The study found that of the 5,863 eligible adults who had made an attempt to quit in the previous year:

  • 464 (7.9%) had used e-cigarettes
  • 1,922 (32.8%) had used NRT bought over the counter
  • 3,477 (59.3%) had used no aid

Non-smoking was reported in:

  • 93/464 (20%) of those using e-cigarettes
  • 194/1,922 (10.1%) of those using NRT bought over the counter
  • 535/3,477 (15.4%) of those who had used no aid

E-cigarette users were more likely to report smoking abstinence than either those who used NRT bought over the counter (adjusted odds ratio 1.63 (95% confidence interval 1.17 to 2.27) or those using no aid (adjusted odds ratio 1.61, 95% confidence interval 1.19 to 2.18).

 

How did the researchers interpret the results?

The researchers concluded that e-cigarettes may be an effective aid to smoking cessation and, given their popularity, substantially improve public health. They also point out that NRT products bought over the counter did not appear to give better results than not using any aid in this study.

 

Conclusion

This was a useful “real world” survey, which involved a large nationally representative sample of adults in England.

Researchers adjusted their results for a large number of potential confounders, including the degree of nicotine dependence and the time elapsed since participants’ attempt to quit begun.

However, as the authors point out, this was not an RCT, which is the best method of determining the effectiveness of treatments. This means that measured and unmeasured confounders could have affected the results. 

Another important limitation is the study’s reliance on adults self-reporting whether they had quit.

This could make the results unreliable, especially since participants had to recall their smoking over the previous 12 months. The study would be more reliable had smoking abstinence been verified biochemically.

The results of this survey seem to agree with the conclusion of a recent report by Public Health England (the NHS body responsible for public health) into e-cigarettes:

"Electronic cigarettes, and other nicotine devices...offer vast potential health benefits, but maximising those benefits while minimising harms and risks to society requires appropriate regulation, careful monitoring, and risk management.

However, the opportunity to harness this potential into public health policy, complementing existing comprehensive tobacco control policies, should not be missed."

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

E-cigarettes more effective than patches to help quit smoking, says study. The Guardian, May 20 2014

E-cigarettes 'help smokers to quit'. BBC News, May 20 2014

NHS could start prescribing e-cigarettes as study finds them 60% more effective than gum or patches. The Daily Telegraph, May 20 2014

E-cigarettes CAN help people kick the habit: Study finds they are 60% more effective than nicotine patches or gum. Mail Online, May 21 2014

E-Cigarette Users '60% More Likely To Quit'. Sky News, May 20 2014

Links To Science

Brown J, Beard E, Kotz D, et al. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. Study not yet available online.

Categories: Medical News

Vaccines not linked with autism, study finds

Medical News - Tue, 05/20/2014 - 15:00

"There is no evidence whatsoever linking the development of autism to childhood vaccines," The Guardian reports.

A new study involving more than a million children found no evidence of a link between childhood vaccines and autism or autism spectrum disorder.

Researchers pooled the results of studies that have assessed the relationship between vaccine administration and the subsequent development of autism spectrum disorder. No significant associations were found between vaccinations and the development of the condition.

The results of this study therefore suggest that there is no reason that parents should avoid having their child vaccinated because of fears that their child will develop autism after they are immunised.

As a result of the success of the NHS childhood vaccination programme, many parents think that childhood diseases such as mumps and measles are a thing of the past and not a threat to health. But this couldn't be further from the truth.

Because of a decline in vaccine uptake, there was a measles outbreak in Wales in 2012 involving 800 confirmed cases of measles, including one death.

The potential complications of conditions such as mumps and measles are serious, and include meningitisencephalitis (brain infection), loss of vision, infertility, and even death.

 

Where did the story come from?

The study was carried out by researchers from the University of Sydney.

The source of funding was not reported. The authors reported that they had no conflicts of interest.

It was published in the peer-reviewed medical journal, Vaccine.

The results of this study were covered well by the UK media.

 

What kind of research was this?

This was a systematic review and meta-analysis of case-control and cohort studies that assessed the relationship between vaccine administration and the subsequent development of autism or autism spectrum disorder.

A systematic review is an overview of primary studies. Systematic reviews use explicit and reproducible methods to search for and assess studies for inclusion in the review.

A meta-analysis is a mathematical synthesis of the results of the studies included.

This is an appropriate way of pooling and studying the body of available evidence on a specific topic. 

 

What did the research involve?

The researchers searched databases of published literature to identify case-control and cohort studies that have assessed the relationship between vaccine administration and the subsequent development of autism or autism spectrum disorder.

Studies were included that looked at measles, mumps and rubella (MMR) vaccination, cumulative mercury, or cumulative thimerosal dosage from vaccinations. Thimerosal is a mercury-containing chemical that acts as a preservative. It is present in the diphtheria, tetanus and pertussis (whooping cough) vaccines.

Once the studies were identified, the researchers assessed the quality of the study to see if there was any bias, and extracted data about the study characteristics (study design, the number of participants, the type, timing and dose of vaccine, and outcome) and its results.

The researchers then performed a meta-analysis to combine the results of the studies included in the review. 

                            

What were the basic results?

The researchers included five cohort studies involving 1,256,407 children, and five case-control studies involving 9,920 children.

None of the five cohort studies found an association between vaccination and autism or other autism spectrum disorder. When the results of the five cohort studies were combined, there was no increased risk of developing autism or autism spectrum disorder after MMR, mercury or thimerosal exposure (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.92 to 1.04).

The researchers performed subgroup analyses looking at autism and autism spectrum disorder separately. There was no increased risk of developing autism (OR 0.99; 95% CI 0.92 to 1.06) or autism spectrum disorder (OR 0.91; 95% CI 0.68 to 1.20).

They then performed subgroup analyses looking at the different exposures separately. There was no increased risk of developing autism or autism spectrum disorder after MMR vaccination (OR 0.84; 95% CI 0.70 to 1.01), thimerosal exposure (OR 1.00; 95%CI 0.77 to 1.31), or mercury exposure (OR 1.00; 95% CI 0.93 to 1.07).

The researchers also looked at whether there was any evidence of publication bias, a bias that can occur if the publication of research results depends on the nature and direction of the results. Typically, positive results tend to get published while negative results get shelved. If this occurs, it can distort the results of systematic reviews and meta-analyses.

The researchers analysed the results of the cohort studies using statistical tools and found no evidence of publication bias.

Similarly, none of the five case-control studies found an association between vaccination and autism or autism spectrum disorder individually or when combined, and none of the subgroup analyses found any associations.

 

How did the researchers interpret the results?

The researchers concluded that, "The findings of this meta-analysis suggest that vaccinations are not associated with the development of autism or autism spectrum disorder.

"Furthermore, the components of the vaccines (thimerosal or mercury) or multiple vaccines (MMR) are not associated with the development of autism or autism spectrum disorder."

 

Conclusion

This systematic review and meta-analysis has found no association between vaccination and the development of autism or autism spectrum disorder. The cohort studies included in the systematic review had information on more than a million children from four different countries. 

This was a valuable and rigorous piece of research that will hopefully reassure parents who have any concerns about getting their children vaccinated against childhood diseases.

As with all studies, this research has limitations. It excluded data from the Vaccine Adverse Event Reporting System (VAERS) in the United States, a system similar to the Yellow Card scheme in the UK.

This was because researchers say that VAERS data has many limitations and a high risk of bias because of unverified reports, under-reporting, inconsistent data quality, absence of an unvaccinated control group, and many reports being filed in connection with litigation.

It is unclear what effect including these studies would have had on the results of the meta-analysis.

Overall, however, this study adds to the body of evidence that proves that the benefits of vaccination far outweigh any risk.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Autism link to vaccines dismissed by studies of more than a million children. The Guardian, May 20 2014

There is NO link between autism and childhood vaccines, a major new study finds. Mail Online, May 19 2014

Links To Science

Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccines. Published online May 9 2014

Categories: Medical News

Study discovers secret of the Mediterranean diet

Medical News - Tue, 05/20/2014 - 14:00

“The combination of olive oil and leafy salad or vegetables is what gives the Mediterranean diet its healthy edge,” BBC News reports.

The Mediterranean diet – a diet rich in vegetables, fruits, beans, whole grains, olive oil and fish – has long been associated with improved heart health. Though why this is the case is not fully understood.

A new study, on mice, examined a type of chemical called nitro fatty acids.

The researchers state that nitro fatty acids could be produced from foods consumed as part of the Mediterranean diet, as chemicals in olive oil and fish could combine with chemicals in vegetables.

In this study, nitro fatty acids were found to inhibit (block the action of) an enzyme called soluble epoxide hydrolase, and this in turn lowered blood pressure. They went on to show that the enzyme was also inhibited when mice were fed components of the Mediterranean diet.

High blood pressure is a major risk factor for cardiovascular diseases such as heart attacks. So the actions of nitro fatty acids may explain why the Mediterranean diet is associated with improved health.

Future research will be required to determine whether the same processes occur in humans and whether it is possible to harness the benefits of nitro fatty acids in some form of medication.

 

Where did the story come from?

The study was carried out by researchers from King's College London, the University of California and the University of Pittsburgh School of Medicine. It was funded by the British Heart Foundation (BHF), King’s BHF Centre of Research Excellence, the UK Medical Research Council, Fondation Leducq, the European Research Council, the Department of Health, and the US National Institutes of Health (NIH) and National Institute on Environmental Health Sciences.

One of the authors reported a financial interest in Complexa Inc, a pharmaceutical company with a stated interest in developing new drugs.

The study was published in the peer-reviewed journal PNAS.

The research was well-covered by the UK media.

 

What kind of research was this?

This was a mouse study. It aimed to determine the impact of a group of chemicals called “nitro fatty acids” on the activity of an enzyme called soluble epoxide hydrolase and the knock on effects on blood pressure.

Inhibition of soluble epoxide hydrolase is thought to lower blood pressure.

The researchers state that nitro fatty acids could be produced from foods consumed as part of the Mediterranean diet, as chemicals in olive oil and fish could combine with chemicals in vegetables to produce nitro fatty acids.

Previous research has suggested that nitro fatty acids lower blood pressure, and can inhibit soluble epoxide hydrolase by binding to it.

This study aimed to determine whether nitro fatty acids lower blood pressure in mice by inhibiting soluble epoxide hydrolase.

Animal research is needed to address this sort of question. However, it remains to be seen whether the same processes occur in humans.

 

What did the research involve?

The researchers performed a series of experiments on mice to determine whether nitro fatty acids lower blood pressure in mice by inhibiting soluble epoxide hydrolase.

To do this, the researchers made genetically modified mice carrying a version of the enzyme without the binding site for nitro fatty acids and then performed a series of experiments comparing normal and genetically modified mice.

 

What were the basic results?

The researchers found that the enzyme from the genetically modified mice could not be bound or inhibited by a lipid nitro fatty acid.

The mice were given a hormone to make them have high blood pressure. Giving the mice a lipid nitro fatty acid reduced the blood pressure of normal mice but not the genetically modified mice.

After giving the mice the hormone to make them have high blood pressure, the size of their hearts increased. Giving the mice a lipid nitro fatty acid reduced the size of the heart of normal mice but not the genetically modified mice.

The researchers also fed the mice conjugated linoleic acid and sodium nitrate, which they say mimics aspects of the Mediterranean diet. They found that the enzyme was inhibited in normal mice but not the genetically modified mice.  

 

How did the researchers interpret the results?

The researchers concluded that their "observations reveal that nitro fatty acids mediate antihypertensive signalling actions by inhibiting soluble epoxide hydrolase". Or in laypersons’ terms, blocking the actions of the soluble epoxide hydrolase enzyme triggers a series of reactions leading to a fall in blood pressure. And that this suggests “a mechanism accounting for protection from hypertension afforded by the Mediterranean diet.” 

 

Conclusion

By comparing normal and genetically modified mice this study has found that a type of chemical called lipid nitro fatty acids inhibits an enzyme called soluble epoxide hydrolase. This in turn lowers blood pressure.

The research also found that the enzyme was inhibited when normal mice were fed components of the Mediterranean diet. The researchers state that nitro fatty acids could be produced from foods consumed as part of the Mediterranean diet, as chemicals in olive oil and fish could combine with chemicals in vegetables to produce nitro fatty acids.

This interesting research suggests a mechanism for the benefits of the Mediterranean diet.

It is also possible that both nitro fatty acids and the Mediterranean diet could affect different processes as well. 

Future research will be required to determine whether the same processes occur in humans.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Olive oil and salad combined 'explain' Med diet success. BBC News, May 20 2014

The salad that could lower your blood pressure: Tossing lettuce in olive oil with a sprinkling of nuts and avocado boosts heart health. Daily Mail, May 20 2014

Olive oil on salad may save your life. The Daily Telegraph, May 20 2014

Why a Mediterranean diet is good for your health. Daily Express, May 20 2014

Links To Science

Charles RL, Rudyk O, Prysyazhna O, et al. Protection from hypertension in mice by the Mediterranean diet is mediated by nitro fatty acid inhibition of soluble epoxide hydrolase. PNAS. Published online May 19 2014

Categories: Medical News

Could a single booze binge harm your health?

Medical News - Mon, 05/19/2014 - 18:19

“Four glasses of wine is enough to harm your health, scientists say,” reports The Independent. A study has found that just a small amount of alcohol can cause harmful bacteria to leak from the gut into the blood.

The research aimed to see whether binge drinking affects the ease that bacterial substances move through the lining of the gut and into the blood stream. It included 25 healthy adults and gave them alcoholic drinks, then measured the levels of alcohol, bacterial molecules called endotoxins and markers of inflammation in their blood for the next 24 hours.

Endotoxins are produced from the cell wall of certain types of gut bacteria, including E. coli, and can trigger immune responses, such as inflammation.

The study found that bacterial endotoxin levels increased after drinking alcohol, with the increase more noticeable in women.

This small and short-term study tells us little else, however, as the researchers did not find out what effects the inflammatory markers have on the body. We also don’t know if the same results would be obtained in larger samples of people of different ages, health statuses or habitual alcohol intakes.

Despite the limitations of this small study, the adverse effects of drinking too much alcohol are still well known.

 

Where did the story come from?

The study was carried out by researchers from the University of Massachusetts Medical School in the US and was funded by the National Institutes of Health.

The study was published in the peer-reviewedopen access scientific journal PLoS One, meaning it is free to access online.

The UK media’s reporting of the study is generally accurate, though none of the coverage acknowledges that only partial conclusions can be drawn, due to the study's limitations.

That said, the dangers of binge drinking have been well-established in previous studies.

 

What kind of research was this?

This was a controlled study that aimed to examine one potential effect of binge drinking on the body. The authors reported that chronic alcohol consumption makes the wall of the gut more “leaky”.

This makes it easier for molecules from the bacteria living in the gut, such as endotoxins, to enter circulation. It is thought that this contributes to the effects of alcohol on the liver. Sustained alcohol-related liver damage can lead to alcohol-related liver disease.

In this particular study, they wanted to see if a single episode of binge drinking had the same effect on levels of endotoxin in the blood. Endotoxin is part of the cell wall of certain types of gut bacteria, such as E. coli, and can prompt the body to mount an immune response.

While including a control group is important in this type of experiment, unless the two groups are well balanced, it is difficult to ascertain whether any changes seen are due to the exposure being tested (in this case alcohol). The best way to avoid this is to randomly assign people into the groups being compared, but it was unclear if that happened in this study.

 

What did the research involve?

The researchers gave volunteers either alcoholic drinks or a similar drink without alcohol, and compared the effects on the levels of various substances in the blood over 24 hours.

The study included 25 healthy adults (14 female, 11 male) aged 21 to 56. To be eligible, men had to drink fewer than 12 alcoholic drinks per week and women fewer than 9. They abstained from alcohol for at least 2 days before the tests.

The participants were given either 2ml vodka (40% ethanol) per kg body weight in a total volume of 300ml orange/strawberry juice, or the fruit juice without alcohol. It was unclear how participants were allocated to the alcohol or control groups, or if the same participants drank the alcoholic and non-alcoholic drinks at different times. The study defined binge drinking as “more than 4 drinks”, but they did not report exactly how much the participants drank.

They had blood samples taken at the start of the study, every 30 minutes during the first 4 hours after drinking, then 24 hours later. The blood samples were used to measure blood alcohol levels, endotoxin, inflammatory markers and bacterial DNA.

 

What were the basic results?

Drinking alcohol increased blood alcohol levels, which reached a maximum an hour after drinking. Women showed a slower decline then men in blood alcohol levels over the next few hours.

Blood endotoxin levels also rapidly increased up to 30 minutes after drinking, stayed level for 3 hours, then returned to baseline levels at the 24-hour mark. Endotoxin levels were also significantly higher in women.

The study also found increases in certain inflammation-related proteins, and an increase in bacterial DNA in the blood.

In the laboratory, they tested what effects the observed concentrations of endotoxin in the blood would have on other inflammatory markers. They discovered that this led to increases in certain other inflammatory markers.

 

How did the researchers interpret the results?

The researchers conclude that just a single alcohol binge increases the level of blood endotoxin, which leads to an increase in blood inflammatory markers. They went on to say that this “can contribute to the deleterious effects of binge drinking”.

 

Conclusion

This experimental study in 25 healthy adults informs us of some of the possible biological effects that a binge drinking session can have upon the human body – namely, an increase in bacterial endotoxin levels and a corresponding increase in blood inflammatory markers.

However, it was a very small study, including just 14 women and 11 men, meaning that reliable conclusions cannot be drawn. The study does not report its methods clearly, and it is unclear if the volunteers also acted as the controls. The optimum test conditions would have been to randomly allocate which drink they received first, to make sure that the order in which they drank the drinks did not effect the results. 

We also don't know what results would be obtained from larger samples of people, including those of different ages, health and habitual drinking patterns.

The study also does not tell us what effects the increase in inflammatory markers seen would actually have on the body.

Nevertheless, despite the limited information that can be obtained from this small study, the effects of excess alcohol consumption are well known and include an increased risk of liver disease, certain types of cancer, high blood pressure and obesity.

Alcohol is also associated with mental health problems, including depression.

Read more about the risks of drinking too much.

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

Four glasses of wine is enough to harm your health, scientists say. The Independent, May 17 2014

Harm begins with fourth glass of wine. The Times, May 17 2014

How four glasses of wine can harm a woman’s health: Binge drinking more harmful than previously thought, research suggests. Mail Online, May 17 2014

Drinking four glasses of wine in one night can harm your health says scientists. Daily Express, May 17 2014

Links To Science

Bala S, Marcos M, Gattu A, et al. Acute Binge Drinking Increases Serum Endotoxin and Bacterial DNA Levels in Healthy Individuals. PLoS One. Published online May 14 2014

Categories: Medical News

Scientists predict dengue risk for Brazil World Cup

Medical News - Mon, 05/19/2014 - 14:17

"Scientists have developed an 'early warning system' to alert authorities to the risk of dengue fever outbreaks in Brazil during the World Cup," BBC News reports.

England fans planning to travel to Brazil are being warned about the risk of dengue fever after Brazilian researchers have developed a statistical model based on known risk factors for the condition. The model is designed to assess the risk of dengue infection in the main host cities in Brazil.

Dengue fever is a viral infection passed onto humans through a bite from an infected mosquito. In most cases it causes flu-like symptoms such as fever, headaches and muscle pain. However, in rarer cases it can progress to a severe condition called dengue haemorrhagic fever, which can be fatal.

One prediction that England fans may want to pay attention to is that the city of Recife has been designated as high risk for dengue (greater than 300 cases per 100,000 inhabitants). If England come top of their group, they will play in the city on June 29.

You can avoid contracting dengue and other mosquito-borne infections such as malaria and yellow fever by using insect repellent and sleeping under a mosquito net.

 

Where did the story come from?

The study was carried out by researchers from Institut Català de Ciències del Clima, Spain and other global institutions, and was published in The Lancet.

Funding was provided by the European Commission's Seventh Framework Programme projects DENFREE, EUPORIAS and SPECS, and the Conselho Nacional de Desenvolvimento Científico e Tecnológico and Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro.

It was published in the peer-reviewed medical journal, The Lancet Infectious Diseases.

BBC News' reporting of the study was accurate.

 

What kind of research was this?

This was a modelling study that, using incidence rates for June 2000-13, aimed to forecast the risk for dengue fever during the Brazil World Cup in June to July this year. The researchers aimed to identify "trigger alert" thresholds for medium to high risk.

Dengue fever is a viral disease that is passed onto humans by a bite from an infected mosquito. It can cause symptoms of high temperature, headache, and aches and pains in the body, though many people infected with dengue can be asymptomatic.

The main risk is that it can progress to a severe illness called dengue haemorrhagic fever, where the person can get severe abdominal pain, vomiting, breathing problems, and the small blood vessels in the body start to leak fluid. This can lead to failure of the heart and blood circulation, and death.

The Lancet paper reports that 5% of people with dengue have more severe illness and 1% have a life-threatening infection.

There is no specific treatment for dengue fever. Treatment centres on supportive care to help the person recover, including treatment to bring down the fever, control pain and replace fluids, and hopefully prevent the progression of the infection. There is no preventative vaccine.

Outbreaks of dengue fever can occur in tropical regions around Southeast Asia, the Pacific region and the Americas. Outbreaks tend to follow a seasonal pattern, influenced by the effects of climate and rainfall on mosquito numbers and distribution.

This Lancet study reports how with more than one million spectators expected to travel to 12 different cities in Brazil during the football World Cup, the risk of dengue fever is a concern.

The researchers therefore aimed to address the potential for a dengue epidemic during the World Cup using a probabilistic forecast of dengue risk for 553 "micro-regions" in Brazil, with risk level warnings for the 12 cities where matches will be played. Micro-regions were defined as one large city and surrounding municipalities (suburbs).

 

What did the research involve?

The researchers used the Notifiable Diseases Information System (SINAN) organised by the Brazilian Ministry of Health to obtain information on confirmed cases of dengue fever, including mild infections and dengue haemorrhagic fever, from 2000-13. These were summarised by month and micro-region.

They used several international sources to obtain seasonal climate forecasts, including the European Centre for Medium-Range Weather Forecasts (ECMWF), the Met Office, Météo-France and Centro de Previsão de Tempo e Estudos Climáticos (CPTEC). 

Using these two sources of information together, the researchers formed a statistical model to allow dengue warnings to be made three months ahead. The model took into account factors such as population density, altitude, precipitation and temperature (averaged over the preceding three months), as well as dengue relative risk lagged by four months.

To produce the forecast for June 2014, they input into the model real-time seasonal precipitation and temperature forecasts for March to May (produced in February 2014) and the dengue forecast for February 2014 collated in March.

They looked at past performance of the forecasting system using observed dengue incidence rates for June from 2000-13. They then tried to identify the best trigger alert thresholds for scenarios of medium risk and high risk of dengue.

 

What were the basic results?

The forecast for June 2014 showed that there is likely to be a low risk of dengue fever in the host cities Brasília, Cuiabá, Curitiba, Porto Alegre and São Paulo (low risk being defined as fewer than 100 cases per 100,000 inhabitants).

However, there is a possibility of medium risk in Rio de Janeiro, Belo Horizonte, Salvador and Manaus (between 100 and 300 cases per 100,000 inhabitants).

High-risk alerts (greater than 300 cases per 100,000 inhabitants) were predicted for the northeastern cities of Recife, Fortaleza and Natal.

When looking at the reliability of the model for forecasting in previous years, the researchers found that the accuracy varied widely. However, the system was accurate for correctly predicting high-risk areas in all previous years (June 2000–13).

 

How did the researchers interpret the results?

The researchers conclude that, "This timely dengue early warning permits the Ministry of Health and local authorities to implement appropriate, city-specific mitigation and control actions ahead of the World Cup."

 

Conclusion

This is a valuable study that predicts the likely risk of dengue fever in Brazil during the 2014 World Cup. In general, it predicts there is a low risk of dengue in the main host cities (fewer than 100 cases predicted per 100,000 inhabitants).

However, it is important to remember that this model can give estimates only and the quality of the model relies on the existing dengue dataset.

As the researchers say, this depends on surveillance systems in every geographic area to detect, report, investigate and perform specific laboratory tests to confirm the diagnosis of dengue cases. There could be under-reporting, particularly for mild and moderate infections.

Similarly, in some epidemics there could have been overestimation as a result of increased public and health service awareness. As such, the researchers say that the dataset will contain some errors regarding the exact size and timing of epidemics.

As the researchers say, the susceptibility of spectators attending the World Cup will also vary widely depending on their country of origin, its sociodemographic profile, and the duration of visits to each city. They mention that visitors are not expected to stay in the same city for much longer than two to three weeks. 

An epidemic would therefore need to already be in progress among the host population to allow enough time for large numbers of virus-carrying mosquitoes to bite susceptible visitors. In other words, visitors are expected to be at low risk unless there is an epidemic.

The model also cannot make predictions for individual cases or assess what protective behaviours might be suitable for travellers, bearing in mind there is no vaccination or specific treatment for dengue fever.

Nevertheless, the model provides a useful estimation of likely dengue risk levels in different regions of Brazil during the World Cup, and will be valuable for public health authorities.

You can reduce your risk of contracting dengue fever and other mosquito-borne infections by taking some commonsense precautions, such as using insect repellent, wearing light-coloured, loose, long layers of clothing, and sleeping under a  mosquito net.

Read more about reducing the risk of contracting dengue fever.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Brazil 2014: World Cup dengue fever risk predicted. BBC News, May 17 2014

Links To Science

Lowe R, Barcellos C, Coelho CAS, et al. Dengue outlook for the World Cup in Brazil: an early warning model framework driven by real-time seasonal climate forecasts. The Lancet Infectious Diseases. Published online May 17 2014

Categories: Medical News

Measles virus used to treat bone marrow cancer

Medical News - Fri, 05/16/2014 - 14:26

“Massive dose of measles virus kills cancer cells,” The Daily Telegraph reports.

The paper has reported on a new study in the growing field of virotherapy – a treatment where viruses are used to attack diseases.

The study was a proof of concept study, involving people with multiple myeloma – a type of cancer that affects plasma cells, which are made in bone marrow. The cancerous cells are usually spread throughout the bone marrow, but can also form tumours.

The article reports on two women who were given an infusion of a high dose of a modified measles virus that could specifically recognise the myeloma cells. The researchers wanted the virus to infect and kill the cancerous cells, but leave the normal cells untouched.

Six weeks after treatment, both women had no cancerous cells. One of the women also had all of the solid tumour clumps in her body shrink within six weeks of starting the treatment, with the effect appearing to last over a nine-month period. One of her tumours showed some signs of growth at nine months, meaning that more treatment (radiotherapy) was required. 

The other woman showed some improvement in her tumours at six weeks, but not as much.

Both women experienced quite severe side effects in the immediate aftermath of the treatment, such as a rapid heartbeat, but these abated within a week.

The researchers are now planning a phase II trial, involving a larger group of patients.

 

Where did the story come from?

The study was carried out by researchers from the Mayo Clinic in the US. It was funded by the National Institutes of Health and National Cancer Institute, alongside other individuals and charitable foundations. The Mayo Clinic and some of the researchers declared a financial interest in the technology being tested.

The study was published in the peer-reviewed medical journal Mayo Clinic Proceedings.

While the overall reporting of the study was accurate, the Daily Mirror and the Mail Online don’t appear to know the difference between a “cure” and “remission”.

Complete remission means that any signs and symptoms of the cancer are undetectable; however, the cancer can return.

While one of the woman did experience complete remission for nine months, she did require some additional treatment. Patients in remission still need to be monitored long term to see if the cancer returns.

 

What kind of research was this?

This was a preliminary report of two patients taking part in a phase I clinical trial, which aimed to test the effects of a modified measles virus created to treat multiple myeloma – a type of blood cancer. There has been increasing interest in using the process of modifying viruses as a form of cancer treatment. Preliminary research has shown some effect in solid tumours, such as malignant melanoma (the most serious type of skin cancer), but this method hasn’t been tested in patients with blood cancer.

Phase I trials are used to test the maximum safe dose of a new treatment, and is done on a small number of patients. They also allow researchers to get an idea of what effect the treatment has on the disease. If the treatment is safe and shows signs of being effective, it will then go on to larger-scale trials to confirm these effects, and to see what proportion of patients could experience these.

 

What did the research involve?

The researchers gave the two female patients with multiple myeloma the modified measles virus through a gradual infusion into their blood stream, over the course of an hour. They then monitored the women in various ways to see the effects.

The researchers used a modified form of the measles virus, which was developed from the weakened strain of the virus that is used in measles vaccines. The virus was also genetically modified to take up a radioactive form of the chemical iodine, which allowed the researchers to monitor its spread in the body. The modified virus recognises and binds to a protein that is found at high levels on the surface of human myeloma cells. This allows the virus to enter these cells and kill them.

The two patients tested received the highest dose of the modified virus. They were both women, aged 49 and 65. Their disease had not responded to multiple rounds of chemotherapy, and therefore had a high risk of dying. Neither woman had been exposed to the natural measles virus before.

After receiving the virus, the women were monitored to see if they experienced any adverse effects. The researchers also monitored how much the virus had spread through the body. Finally, they looked at what effect it had on the cancerous cells in bone marrow and the clumps of cancerous tissue throughout the body.

 

What were the basic results?

During and shortly after the infusion, the women experienced various side effects, including fever, low blood pressure and a rapid heartbeat. One woman also experienced a severe headache, nausea and vomiting. The side effects were treated and went away within a week, and both women developed antibodies against the measles virus. When tracking the virus, the researchers saw that it was concentrated in the clumps of cancerous tissue (lesions) and not spreading to the normal tissues.

Six weeks after the treatment, biopsies found no abnormal (cancerous) cells in the bone marrow of either woman. Both women also showed a reduction in proteins in the blood that are normally raised in people with multiple myeloma. In one woman, this reduction was maintained over a six-week period, but the levels seen in the other woman increased again six weeks after the treatment.

Six weeks after the treatment, there was substantial shrinkage of the five known lesions found in one of the women's bodies – some of the lesions had almost disappeared. Six months after treatment, scans suggested that only one of the lesions might be growing, and this was still the case at the nine-month mark. The woman had radiotherapy to treat just this lesion, as her bone marrow biopsies still appeared normal.

The second woman showed that some of her lesions had shrunk six weeks after treatment, with one disappearing. However, most of the lesions continued to grow.

 

How did the researchers interpret the results?

The researchers concluded that both patients showed a response to the modified measles virus treatment, and one patient showed lasting, complete remission at all disease sites. They suggest that this type of virus treatment offers a promising new way to target and destroy blood cancers that are spread throughout the body.

 

Conclusion

This research has shown that a modified measles virus can produce a long-term remission of cancerous lesions in a person with multiple myeloma that has not responded to chemotherapy.

Patients such as this have limited remaining treatment options, so a new treatment would offer an important development.

The article describes the response of two women in a phase I trial who received the highest dose of the virus. One of the women had a lasting response; the other woman showed some signs of an early response, but these were not as good and were not as long-lasting.

As yet, we don’t know what proportion of patients might respond to this treatment, or if certain types of patients benefit more than others. The report focuses on two women with a disease that is particularly hard to treat and who received the highest doses.

It does not describe what happened to the remaining people in the phase I trial, in terms of either the side effects or effects on the disease. The full results will be published elsewhere.

The other patients may not have had responses that were as impressive, particularly as some of them received lower doses of the virus.

Phase I trials focus on safety of different doses of a treatment and allow an early glimpse of what beneficial effects patients might have. This study shows that the modified measles virus treatment seemed acceptably safe and can produce a response in multiple myeloma.

The researchers now plan to go on to a larger phase II trial, which will allow them to better assess what proportion of patients might benefit, what these benefits are and how long this effect might last.

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

Massive dose of measles virus kills cancer cells. The Daily Telegraph, May 15 2014

Could measles cure cancer? Experimental virus treatment leaves 49 year old woman in complete remission. Mail Online, May 16 2014

Mother cured of cancer after being injected with enough measles vaccine for 10 MILLION people. Daily Mirror, May 15 2014

Woman's cancer in remission after measles virus. CNN, May 15 2014

Links To Science

Russell SJ, Federspiel MJ, Peng K, et al. Remission of Disseminated Cancer After Systemic Oncolytic Virotherapy. Mayo Clinic Proceedings. Published online May 13 2014

Categories: Medical News

Two big meals 'better' than six snacks for diabetics

Medical News - Fri, 05/16/2014 - 14:17

“Only eating breakfast and lunch may be more effective at managing type 2 diabetes than eating smaller, more regular meals,” BBC News reports.

The report focuses on a small study which found that when people with type 2 diabetes ate two meals a day they lost more weight and had lower blood sugar levels at the end of 12 weeks than when they ate six smaller meals a day.

The study involved 54 overweight and obese people with type 2 diabetes who followed the two diet regimens, one after the other, over the course of 12 weeks.

Both diets were designed to provide the same amount of calories – 500kcal less than each individual needed in a day.

The study was relatively small and short term, and in a very select group of people with type 2 diabetes who were willing to make considerable changes to their lifestyle. It’s also important to note that people in the study continued to take their usual diabetes medications during the study.

Results need confirmation in larger and longer-term studies in broader groups of people with type 2 diabetes. Whether the results apply to people without diabetes (as some reporting suggested) is also not clear.

If you do have poorly controlled diabetes you should not make radical changes to your eating habits without first consulting with the doctor in charge of your care.

 

Where did the story come from?

The study was carried out by researchers from Charles University in Prague and other research centres in Prague and Italy. It was funded by the Ministry of Health of the Czech Republic and the Agency of Charles University.

The study was published in the peer-reviewed medical journal Diabetologia which has been made available as an open access, free of charge PDF (233kb).

The Mail Online suggests the results may apply to anyone, rather than just those with type 2 diabetes, which is unproven.

The Mail’s photo of a massive breakfast including pancakes slathered in butter and syrup and use of the term “big platefuls” may mislead people into thinking that they can eat anything for breakfast and lunch and still lose weight. This is not the case. Both diets in this study were calorie restricted and provided 500kcal (roughly equivalent to a “Big Mac” hamburger) less than the individual needed in a day.

Consuming more calories than you burn off during the day, in any pattern, is likely to result in weight gain.

 

What kind of research was this?

This was a crossover randomised controlled trial comparing the effect of having two versus six meals a day in people with type 2 diabetes.

Diet is an important part of controlling type 2 diabetes.

The researchers report that some observational studies, but not all, have suggested that more frequent eating may increase energy intake and risk of overweight or obesity. Another study suggested that eating one larger meal may be better than two smaller meals for controlling blood sugar levels in people with diabetes.

However, the effect of meal frequency in people with type 2 diabetes has not been tested in a randomised controlled trial (RCT).

An RCT is the best way to compare the effects of different interventions (in this case different meal patterns). This is because randomly allocating people into groups is the best way of ensuring that the groups are similar in their characteristics. This means that any differences seen in their outcome are due to the interventions received.

In a crossover RCT, both groups received both interventions, but in a different order.

 

What did the research involve?

The researchers compared a six meal regimen with a two meal regimen in 54 people with type 2 diabetes over 12 weeks. They looked at changes in body weight, liver fat content, insulin resistance, and pancreatic cell function when the participants were eating in the different patterns.

All people in the trial were receiving oral medications for their diabetes, and all were overweight or obese.

The nutrient composition and calorie intake for both meal patterns were planned by the researchers.

They both provided 500kcal per day less than the person’s energy expenditure requirements.

The researchers gave tutorials to the participants over four days on how to compose and prepare their diets, and they also followed up with them during the study.

Half of the participants were provided with their meals by the researchers, and the other half prepared them themselves.

The two meal pattern included breakfast and lunch, and the six meal pattern included three main meals (breakfast, lunch, dinner), and three smaller snacks. Participants were randomly allocated to which pattern they tried first.

After 12 weeks of one pattern, they switched to the other pattern.

The participants were asked not to change their normal physical activity patterns during the study. Their medications were also not changed unless medically necessary.

The participants completed a three day dietary food record at the start of the study and at the end of each 12 weeks on the dietary pattern. Their physical activity levels (using a pedometer and questionnaires) and outcomes such as blood glucose, insulin tolerance, and weight were also assessed at these time points.

 

What were the basic results?

Based on their diet diaries, there was no significant difference in calorie intake with the different patterns, or in physical activity (steps per month).

The researchers found that people lost weight with both meal patterns. They lost significantly more weight when they were on the two meal pattern (3.7 kg lost on average) than with the six meal pattern (2.3 kg lost on average). The two meal pattern was associated with better fasting blood glucose levels.

 

How did the researchers interpret the results?

The researchers concluded that for people with type 2 diabetes on a reduced calorie diet, consuming these calories in two larger meals (breakfast and lunch) may be more beneficial than eating six smaller meals during the day. They say that new treatment strategies should consider meal frequency, as well as calorie and nutrient composition. However, they do sound a note of caution that further studies are crucial before making recommendations on what meal frequency is best.

 

Conclusion

This study suggests that different meal frequencies can have an impact on body weight in overweight and obese people with type 2 diabetes. The RCT design used increases our confidence that these effects could truly be down to the meal patterns rather than other factors, but there are some limitations:

  • The study was relatively small and short term, and in a select group of people with type 2 diabetes who were willing to make considerable changes to their lifestyle. Results need confirmation in larger and longer-term studies in broader groups of people with the condition.
  • The researchers only assessed meal intake based on diet diaries at the end of each diet period. They acknowledge that they cannot rule out that the participants did differ in their calorie intake when they ate in the different dietary patterns.
  • Physical activity was assessed as a step count using a pedometer and questionnaires, but this may not have fully captured the participants’ physical activity levels.
  • The diets were highly planned, and provided to some participants. The results may be better than what might be achieved with less supervision and meal provision.

Researchers are not certain why eating the same amount of calories, but in different patterns through the day, might have differing effects. They made various suggestions, including differing effects on resting energy expenditure or on the nervous system and hormones affecting hunger, or an impact on our bodies’ daily rhythms.

This is a complex area and is likely to be studied in further research.

The news has suggested that eating two meals a day may also be beneficial for controlling weight in people without diabetes.

It is not possible to say for certain whether this is the case until there are trials in this group of people.

However, it is important to note that both dietary patterns tested were calorie-restricted, and both resulted in weight loss.

Even if you just consume breakfast and lunch, if you consume more calories in it than you burn off during the day this is likely to result in weight gain and not loss.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Two meals a day 'effective' to treat type 2 diabetes. BBC News, May 16 2014

Two hearty meals each day better for you than 6 snacks: Eating a big breakfast and lunch helps control weight and blood sugar levels. Daily Mail, May 16 2014

Links To Science

Kahleova H, Belinova L, Malinska H, et al. Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study (PDF, 227kb).  Diabetologia. Published online May 15 2014

Categories: Medical News

Audit of NHS care for the dying published

Medical News - Thu, 05/15/2014 - 15:00

“Thousands of patients are “dying badly” in NHS hospitals every year,” The Independent reports. An audit, carried out by the Royal College of Physicians, found some NHS trusts are failing to adhere to agreed guidelines on palliative care.

Other problems, identified by the audit, and picked up by the media include “Sick and elderly patients are not being told they are dying in more than half of cases,” as The Daily Telegraph reports, and how “Only a fifth of hospitals have specialist palliative care workers on duty on Saturdays and Sundays” the Daily Mail reports.

The audit, despite the tone of much of the reporting, did find that some NHS Trust and staff were performing well. For example, 97% of bereaved relatives or friends questioned during the audit reported that they had trust and confidence in some or all of the nurses treating their loved ones.

 

Background

The Telegraph explains that care of the dying in hospitals has been of national concern since campaigners warned that patients were being placed on the controversial Liverpool Care Pathway (LCP).

The Liverpool Care Pathway is intended to allow people with a terminal illness to die with dignity. But there have been a number of high-profile allegations that people have been placed on the Pathway without consent or their friend’s or family’s knowledge.

There have also been allegations that some patients were denied food, water and pain relief as a method of 'hasten[ing] death'.

Around half of all deaths in England happen in hospital. So it is a hospital’s duty to provide appropriate and compassionate care for patients in their final days of life. Equally important is to provide appropriate support to their families, carers and those close to them.

The aim of the new report was to gather information that might help to improve the care of terminally ill patients and those close to them in the hospital setting.

 

Who produced the report?

The report (PDF, 1.5Mb), an audit of care standards, was prepared by the Royal College of Physicians (RCP) and the Marie Curie Palliative Care Institute Liverpool (MCPCIL).

The RCP promotes high quality patient care by setting standards of medical practice and promoting clinical excellence, whereas Marie Curie is a charity providing free care to people with terminal illnesses in their own homes or in hospices. Around 70% of the charity’s income comes from donations and the remaining 30% from the NHS.

 

What did the audit look at?

The audit only looked at end of life care given in hospitals, which account for around a half of all deaths. It did not look at end of life care in the community, in the home, residential care homes or other settings, such as hospices.

The audits assessed three main elements:

  • The quality of care received directly by 6,580 people who died in 149 hospitals in England between May 1 and May 31 2013. This was done by reviewing the case notes of a sample of patients and is not the total number of people who died in hospital during this time. The audit only covered expected deaths.
  • Results from questionnaires completed by 858 bereaved relatives or friends, asking about the treatment of their relative, their involvement in decision making, and the support available to them. The questionnaire was distributed by some hospitals involved in the audit, and the results were aggregated nationally. 
  • The organisation of care including availability of palliative care services, numbers of staff, training, and responsibilities for care.

 

What were the key findings?

Findings on the quality of care

  • For most patients (87%), healthcare professionals had recognised that they were in the last days of life, but had only documented telling less than half (46%) of patients capable of discussing this. This was one of the findings picked up in the media.
  • Communication with family and friends about the imminent death of their relative/friend occurred in 93% of the cases, on average 31 hours before their relative or friend died.
  • Most patients (63-81%) had medication prescribed ‘as required’ for the five key symptoms often experienced near the end of life – pain, agitation, noisy breathing, difficulty in breathing (shortness of breath or dyspnoea), and nausea and vomiting.
  • Not all patients need the medication, and in the last 24 hours of life 44% received pain relief and 17% medication for shortness of breath.
  • An assessment of the need for artificial hydration was recorded in 59% of patients, but a discussion with the patient was only recorded for 17% of patients capable of having the conversation. There was documentation that the situation was discussed with more than twice as many relatives and friends – 36%.
  • Artificial hydration was in place for 29% of patients at the time of death.
  • An assessment of the need for artificial nutrition was documented for 45% of patients, but a discussion with the patient was only recorded for 17% of patients capable of having the conversation. There was documentation that the situation was discussed with 29% of relatives and friends.
  • Artificial nutrition was in place for 7% of patients at the time of death.
  • It was only documented for 21% of patients capable of having the conversation that they were asked about their spiritual needs, and only 25% of relatives/carers asked about their own needs.
  • Most patients – 87%, had documented assessments five or more times in the final 24 hours of life, in line with national guidance.

Findings from the bereaved relatives survey

  • 76% of those completing the questionnaire reported being very or fairly involved in decisions about care and treatment of their family member, and 24% did not feel they were involved in decisions at all.
  • Only 39% of bereaved relatives reported being involved in discussions about whether or not there was a need for artificial hydration in the last two days of the patient’s life. For those for whom the question was applicable, 55% would have found such a discussion helpful. 
  • 63% reported that the overall level of emotional support given to them by the healthcare team was good or excellent, 37% thought it fair or poor.
  • Overall, 76% felt adequately supported during the patient’s last two days of life; 24% did not.
  • Based on their experience, 68% were either likely or extremely likely to recommend their Trust to family and friends, while 8% were extremely unlikely to do so.

Another concern, raised by both the media and highlighted in the audit, was that only 21% of sites has access to face-to-face palliative care services, seven days a week, despite a longstanding national recommendation that this be provided. Most (73%) provided face-to-face services on weekdays only.

 

What are the recommendations?

Based on the evidence from the audit, the report made specific recommendations aiming to improve the quality of care delivered in hospitals for dying people in England. They included:

  • Hospitals should provide a face-to-face specialist palliative care service from at least 9am to 5pm, seven days a week, to support the care of dying patients and their families, carers or advocates.
  • Education and training in care of the dying should be mandatory for all staff caring for dying patients. This should include communication skills training and skills for supporting families and those close to dying patients.
  • All hospitals should undertake local audits of care of the dying, including the assessment of the views of bereaved relatives, at least annually.
  • All Trusts should have a designated Board member and a lay member with specific responsibility for care of the dying. Trust Boards should formally receive and discuss the report of local audits at least annually.
  • The decision that the patient is in the last hours or days of life should be made by the multidisciplinary team and documented by the senior doctor responsible for the patient’s care. This should be discussed with the patient where possible and appropriate, and with family, carers or other advocate.
  • Pain control and other symptoms in dying patients should be assessed at least four hourly and medication given promptly if necessary. Interventions should be discussed with the patient where possible and appropriate, and with family, carers or other advocate.
  • Decisions about the use of clinically assisted (artificial) nutrition and hydration are complex and should be taken by a senior experienced clinician supported by a multidisciplinary team. They should be discussed with the patient where possible and appropriate, and with family, carers or other advocate.
  • Hospitals should have an adequately staffed and accessible pastoral care team to ensure the spiritual needs of dying patients and those close to them are met.

 

What next?

The foreword to the new audit indicated there were “few surprises” and that while the “challenges are broad […] the recommendations are clear”. Furthermore, it indicated many of the issues it identified, and the solutions, had been identified in previous reports. Therefore, it seems we know what needs to improve and how; some argue we already knew this; the challenge now appears to be ensuring these recommendations are delivered and that we are not in the same situation in five years' time.

Unsurprisingly Marie Curie, the major funder of the report and main charity provider of end of life care, is calling on the NHS for continued support of its work in this area and to deliver these recommendations.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Doctors and nurses 'are ill-equipped to help people cope with death'. The Independent, May 15 2014

Care for people dying in hospitals: the data behind the audit results – Data Blog. The Guardian, May 15 2014

Doctors are still not good at talking about dying. The Guardian, May 15 2014

Most terminally ill patients not told they are dying, says damning report. The Daily Telegraph, May 15 2014

Dying patients 'not treated with dignity' and more than half are not told they're nearing end, report finds. Daily Mirror, May 15 2014

How dying NHS patients are forgotten at weekends: Only a fifth of hospitals have specialist palliative care workers on duty on Saturdays and Sundays. Daily Mail, May 15 2014

Categories: Medical News

Brits eating too much salt, sugar and fat

Medical News - Thu, 05/15/2014 - 14:26

“Too much sugar, salt and fat: healthy eating still eluding many Britons,” The Guardian reports, while the Daily Mail rather bizarrely warns of a “fruit juice timebomb”. Both papers are covering a major survey that looked at the nation’s eating habits over recent years.

The survey found that, overall, adults and children are eating too much saturated fat, added sugar and salt. We are also not getting the recommended levels of fruit, vegetables, oily fish and fibre that our bodies need.

 

Who produced the survey?

Public Health England, an agency of the Department of Health, has released data from the National Diet and Nutrition Survey (NDNS) from 2008 to 2012. The NDNS is undertaken by Natcen Social Research, MRC Human Nutrition Research and the University College London Medical School. It is funded by the Food Standards Agency (FSA) and Public Health England.

 

How was the national diet and nutrition survey carried out?

In 2008, 2009, 2011 and 2012, a randomly selected group of people aged 18 months or more, from 799 different postcodes, were invited to take part in the survey, via post. Response rates to the survey were 56% in Year 1, 57% in Year 2, 53% in Year 3 and 55% in Year 4. Up to one adult and one child were selected from each address, and this gave a sample size of 6,828 people over the four years (3,450 adults and 3,378 children).

An interviewer recorded background information during a face-to-face interview with the adult, child or child’s parent or guardian, to determine their socioeconomic status. They also took height and weight measurements, and were then asked to complete a four-day food and drink diary using estimated portion sizes. Those who recorded at least three days of consumption were given a £30 voucher for a high street shop.

Participants were asked to complete a 24-hour urine collection and have a fasting blood sample taken by a nurse, alongside other measures.

About half the participants agreed to this.

Results were split for children of different ages, adults aged 19 to 64 and older adults aged 65 and over. Comparisons were also made when combining results from 2008/9 and 2011/12.

 

What were the main findings of the diet survey?

The survey went into extensive detail about the diets of participants, who were deemed to represent "typical" British people.

 

Fruit and vegetables

Only 30% of adults and 41% of older adults were eating or drinking the recommended five portions of fruit or vegetables a day, and only 10% of boys and 7% of girls aged 11 to 18 got their “5 A Day”. Adults aged between 19 and 64 consumed on average 4.1 portions of fruit or vegetables per day – a portion less than the minimum amount recommended for good health.

 

Salt

Estimated salt intake was based on the amount excreted in the urine. On average, this was higher than the recommended levels for all groups of children and adults, except girls aged 7 to 10 and older adults. Salt intake was estimated to be higher in males than females.

 

Fat

The average intake of total fat met the recommended level (no more than 35% of food energy) in all age groups apart from men over 65, who were just over the recommendation, with 36% of their food energy coming from fat. However, the average (mean) intake of saturated fat exceeded the 11% recommendation in all age groups (coming in at 12.6% for the adults surveyed).

Read more about fat in your diet.

 

Fibre

Non-starch polysaccharide (dietary fibre) for adults and older adults was 13.7-13.9g per day, which is below the recommended minimum of 18g. 

 

Oily fish

Oily fish consumption was less than half the recommended one portion per week in adults.

 

Sugars

Average (mean) intake of non-milk extrinsic sugars (added sugars – such as sugars added to some fruit juices and soft drinks) was higher than the recommended limit of 11% for all ages. The levels came in at 14.7% for children aged 4 to 10 and 15.6% in children aged 11 to 18. The main source of this sugar was soft drinks and fruit juice, which accounted for 30% of the intake for those aged 11 to 18.

Read more about sugar in your diet.

 

Iron and minerals

Average (mean) intake of iron was below the recommended levels for women and girls aged 11 to 18, and intake was below the lowest threshold in 23% of women and 46% of girls in this age group. Intake of calcium, zinc and iodine was also low. The intake of other minerals such as potassium, magnesium and selenium were below recommended levels in all age groups, except children aged under 11. Read more about minerals in your diet.

 

Blood cholesterol levels

A third of adults had cholesterol levels high enough to place them at a marginally higher risk of cardiovascular disease, which is one of the main causes of death in England. A further 10% of adults had cholesterol levels that moderately increased their risk, with a further 2% having a high risk of cardiovascular disease.

 

Vitamin D levels

Low vitamin D was found in a proportion of all age groups, which included 7.5% of children aged 18 months to 3 years, 24.4% for girls aged 11 to 18, 16.9% in men over 65 and 24.1% in women over 65.

 

Comparison between 2008/9 and 2011/12

There were very few changes in food consumption between the two time points; in 2011/12, the average total fat was lower, but there was a higher carbohydrate intake.

 

Were there any limitations to the nutrition survey findings?

The survey asked for food and drink consumption over four days, and weekends were over-represented. This is because eating habits are known to change over the weekend. This means that estimating the overall food consumption based on the four days could be inaccurate.

The survey is also reliant on people’s own assessment of portion size and intake. However, the survey was conducted as a food diary kept over 4 days, which should be more accurate than a commonly used method of relying on consumption recall in the previous 24 hours or past few days. The report suggested there may have been under-reporting of calorie intake.

 

What are the implications of poor diet on people’s health?

The findings are concerning as the risks of a poor diet are quite clear, for example:

 

What does this mean for those trying to improve Britons’ health?

There have been numerous health campaigns stating the benefits of eating at least five portions of fruit and vegetables a day, as well as limiting sugar, salt and saturated fat.

It would seem that, based on this survey's findings, these core messages may not have prompted dietary improvements for many people. However, they may have had impact in preventing people’s health from worsening – there is some evidence that since 2009, obesity rates have stopped rising.

There could be numerous reasons for the public health messages failing to lead to a widespread change in eating patterns. For example, many more people may now be aware they should be eating at least five portions of fruit and vegetables a day, but choose to ignore the message. Some commentators have also argued that some food manufacturers may be “manipulating” the 5 A Day message with confusing labelling.

Complimentary explanations include the fact that people want to eat healthily, but find many barriers to doing so, such as being unable to easily get healthy foods that are cheap and easy to prepare. Another explanation is that people are living in what is known an “obesogenic environment”. This is an environment that “promotes” obesity – such as working in an area that has plenty of takeaway burger and kebab shops, but no fruit and veg sellers.

Public health officials want to make healthy choices easier, so that people who want to eat healthily can do so. Doing so involves raising awareness of what is considered a healthy diet from a medical standpoint, so people can make informed choices about whether their own diet is healthy and make changes to their diet if they want to.

However, some critics argue that as well as employing a “carrot”, it may be necessary to employ a "stick" and “punish” people for unhealthy eating habits. One such idea is the controversial concept of a sugar tax, which would deliberately make foods high in added sugar more expensive.

Changing the eating habits of the British public is possible, but may take some time.

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

Too much sugar, salt and fat: healthy eating still eluding many Britons. The Guardian, May 15 2014

Fruit juice timebomb: Health experts say stick to one glass a day as teenagers' poor diets are blamed for increased diabetes risk. Daily Mail, May 15 2014

Millions of Britons ignore health warnings over sugar, salt and fat. Daily Express, May 15 2014

Fruit juice and cereals push children over sugar limits. The Daily Telegraph, May 15 2014

Links To Science

Public Health England. National Diet and Nutrition Survey: Results from Years 1-4 (combined) of the Rolling Programme (2008/2009 – 2011/12) Executive summary (PDF, 406kb). May 2014

Public Health England. National Diet and Nutrition Survey: Results from Years 1-4 (combined) of the Rolling Programme (2008/2009 – 2011/12) Full Report (PDF, 1.47Mb). May 2014

Categories: Medical News

Study linking brain cancer and mobiles inconclusive

Medical News - Wed, 05/14/2014 - 14:00

“Intensive mobile phone users at higher risk of brain cancers, says study,” The Guardian reports.

The news is based on a French study which identified 447 adults who were diagnosed with the most common types of brain tumour (meningiomas or gliomas) between 2004 and 2006. It matched them with 892 people who hadn’t been diagnosed with cancer, and interviewed both groups on their use of mobile phones.

Researchers found no association between regular mobile phone use (phoning at least once a week for six months or more) and risk of the brain tumour. However, it did find an increased risk of gliomas with the highest cumulative lifetime call duration (above 896 hours).

Not many people actually used their mobiles for above 896 hours – only 37 cases and 31 controls. When conducting analyses involving such small numbers of people there is an increased risk of chance findings.

Importantly, mobile phone use by these middle aged French adults 8-10 years ago is unlikely to reflect use today. Mobile use has become much more widespread (only 50% of adults being regular users in this study), and the extent of mobile use and pattern of use – particularly among younger people – has almost certainly changed.

For example, the study didn’t consider text messaging, which many use rather than calling directly, and this may reduce patterns and levels of exposure. This study also did not include smartphones (launched in 2007) which make use of 3G and Wi-Fi signals. 

Arguably the study only provides information about mobile phone use from a decade ago and contributes little in the way of conclusive answers about the current picture.

 

Where did the story come from?

The study was carried out by researchers from Université Bordeaux Segalen in France, and was supported by grants from various French health and research organisations. The study was published in the peer-reviewed journal of Occupational and Environmental Medicine.

The Guardian and the Mail Online's reporting is generally representative of the findings of this study, although there are important limitations to bear in mind. Not least its relatively small size and the fact it used data from eight to 10 years ago. This is an important point to bear in mind when dealing with such a fast-moving technology as mobile phones. Show a teenager today a mobile phone from 10 years ago and they would consider it to be a museum piece.

The Mail also mentions that there was a significant association between heavy mobile phone use (more than 15 hours per month) and glioma. While this is technically true, in statistical terms the association only involved 29 cases and 22 controls. This greatly reduces the “statistical power” of the association (and there was no association with meningioma).

 

What kind of research was this?

This was a case control study conducted across four areas of France between 2004 and 2006, which looked at the association between mobile phone use in adults, and “primary tumours” of the brain or spinal cord. A primary tumour is one that started in that part of the body – as opposed to “metastatic tumours”, which spread from cancers in other parts of the body.

Principally they were looking at the association with two types of tumours:

  • gliomas, which are the most common type of primary brain tumour and comprise several different types depending on cell type
  • meningiomas which account for around a quarter of all brain tumours and develop from the layers that cover the brain and spinal cord

The researchers say that to date the potential cancer-causing effects of radiofrequency electromagnetic fields have been an area of much debate and controversy.

 

What did the research involve?

In this study, called CERENAT, the researchers identified people diagnosed with brain tumours (“cases”), and matched controls without brain tumours from the electoral role. They then collected information on mobile phone use from face-to-face questionnaires to look at the association.

The researchers identified all people over the age of 16 years, living in one of four French areas, who were diagnosed with a primary cancerous or benign tumour of the central nervous system (gliomas and meningiomas only) between June 2004 and May 2006.

They were identified through medical practitioners and population-based cancer registries. For each “case”, two controls without tumours of the central nervous system were identified, matched for age, sex and place of residence.

The researchers collected information on mobile phone use of the cases and controls using questionnaires administered in person. These questionnaires covered sociodemographic characteristics, medical history, lifestyle and detailed occupational and environmental data.

The questionnaires included a set of questions on mobile use and were completed by all “regular users” – defined as phoning at least once a week for six months or more. They included questions on mobile phone model, start and end dates for use of the phone, average number and duration of calls made and received per month, and whether personal or occupational, shared or individual use, or hands-free.

Potential confounders the researchers considered included level of education, smoking and alcohol consumption, occupation (including exposure to pesticides, electromagnetic fields and ionising radiation).

In their analyses, the researchers then looked at phone use in the year before the date of the tumour diagnosis.

 

What were the basic results?

There were 447 cases (253 gliomas, 194 meningiomas) and 892 controls. The average time between tumour diagnosis and interview was six months. Average age of the “cases” was 56 years for gliomas and 60 for meningiomas.

Half of the study population reported regular mobile use – with a third being occupational users. The average cumulative lifetime duration of calls was 115 hours, and average calling time 2.7 hours per month. It was also reported by the same number of cases and controls – 55% of glioma cases and controls, and 44% for meningioma cases and controls.

Compared with non-use, regular use of mobile phones was not significantly associated with risk of either of the brain tumours (odds ratio [OR] 1.24, 95% confidence interval [CI] 0.86 to 1.77 for gliomas; and OR 0.90, 95% CI 0.61 to 1.34 for meningiomas).

People with the highest cumulative lifetime duration of calls (above 896 hours) were found to be at increased risk of glioma (OR 2.89, 95% CI 1.41 to 5.93) and meningioma (OR 2.57, 95% CI 1.02 to 6.44) compared with never-users. People who made the highest cumulative number of calls (above 18,360) also had increased risk of glioma (OR 2.10, 95% CI 1.03 to 4.31), but there was no significant association between number of calls and meningioma.

 

How did the researchers interpret the results?

The researchers conclude that their data, “supports previous findings concerning a possible association between heavy mobile phone use and brain tumours”.

 

Conclusion

This French case-control study finds no association between regular mobile phone use (defined as phoning at least once a week for six months or more) and risk of the most common types of brain tumour. However, it does find increased risk with the heaviest use (cumulative lifetime call duration above 896 hours).

There are important considerations to bear in mind:

  • This study is only representative of people diagnosed with brain tumour in these four regions of France between 2004 and 2006, and their matched controls. They may not be representative of all mobile phone users in France or elsewhere. The average age of people in this study was 56 to 60, and the study was also conducted eight to 10 years ago. In 2004 to 2006 mobile phones had perhaps been regularly used by the public for at most 10 years or less. The extent of mobile phone use by these middle aged people eight to 10 years ago, may not be comparable to younger people today who have greater cumulative years of mobile phone use now behind them, and now have further decades of use ahead of them.
  • Another point to consider is that the current pattern of use in young people may also have changed. Due to the costs of calls many young people now communicate using texting or messaging apps. Also most smartphones use 3G (or in some cases 4G) and Wi-Fi signals so the pattern of exposure may have significantly changed.
  • No association was found between brain tumour and regular mobile use. However an association was found between cumulative lifetime exposure of above 896 hours and tumours, very few people in this study actually reported this extensive use – only 24 glioma cases and 22 controls, and 13 meningioma cases and nine controls. When conducting analyses involving such small numbers of people there is an increased risk of chance findings. 
  • While the researchers have attempted to adjust for various potential lifestyle and sociodemographic confounders, there may still be other factors involved in this relationship, meaning it is difficult to prove cause and effect.

Overall, this study contributes little in the way of conclusive answers. It tells us more about mobile phone use a decade ago than today, and this may be of questionable value with such rapidly evolving technology.

What is required is an ongoing long-term cohort study into mobile phone use. Thankfully, we have one. The COSMOS study (a cohort study into mobile phone use and health) has now recruited 290,000 participants across five European countries including the UK.

Analysis by
Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Intensive mobile phone users at higher risk of brain cancers, says study. The Guardian, May 13 2014

Spending more than 15 hours on a mobile phone each month leaves you 'three times more likely to develop a brain tumour’. Mail Online, May 13 2014

Links To Science

Coureau G, Bouvier G, Lebailly P, et al. Mobile phone use and brain tumours in the CERENAT case-control study. Occupational and Environmental Medicine. Published online May 9 2014

Categories: Medical News

People with purpose in life 'live longer,' study advises

Medical News - Wed, 05/14/2014 - 03:00

"Sense of purpose 'adds years to life'," BBC News reports, after a new study found that having a purpose in life is linked to living longer, regardless of your age or retirement status. But this weak study can only show an association at best.

The US study asked more than 6,000 people aged 20 to 70 whether they felt they had a strong sense of purpose in life. This was assessed using a scoring system of how strongly people felt about the following statements:

  • "Some people wander aimlessly through life, but I am not one of them."
  • "I live life one day at a time and don't really think about the future."
  • "I sometimes feel as if I've done all there is to do in life."

They were also asked about their social relationships with others.

Death rates were recorded for the next 14 years. The study found that people who died scored lower on purpose in life and positive relations with others.

The study only assessed purpose in life using three questions at one point in time. This type of study could therefore only show an association between purpose in life and mortality rate at best. It did not take most of the other likely factors into account, such as physical activity, diet, smoking, alcohol consumption or illness.

Though this study lacks the power to prove that having a purpose prolongs your life, common sense suggests that it is likely to enrich it.

 

Where did the story come from?

The study was carried out by researchers from Carleton University, Canada and the University of Rochester Medical Centre, US, and was funded by the US National Institute of Mental Health and the National Institute on Aging.

It was published in the peer-reviewed medical journal Psychological Science.

In general the media reported the story accurately, but many failed to point out any of the study's limitations. In particular, the lack of information on the physical health status of the participants or cause of death should have been discussed.

 

What kind of research was this?

This was a retrospective cohort study. It aimed to see if having a purpose in life increased life expectancy.

As it was a retrospective study, it is open to study bias. It can show an association, but it is not able to prove that people who reported a strong purpose in life lived longer, as other factors could be responsible for any gains seen.

 

What did the research involve?

The study used data from 6,163 people that had been collected as part of a US study called MIDUS, a longitudinal study of health and wellbeing.

Participants were between the ages of 20 and 75 at the beginning of the study in 1994-95.

They completed a self-administered written questionnaire at home and also had a phone questionnaire.

Purpose in life was measured by their response on a scale of one (strongly disagree) to seven (strongly agree) to three statements:

  • "Some people wander aimlessly through life, but I am not one of them."
  • "I live life one day at a time and don't really think about the future."
  • "I sometimes feel as if I've done all there is to do in life."

The researchers analysed the responses in relation to mortality by looking at data from the National Death Index in 2010.

Statistical analysis was performed to look at the relationship between purpose in life and risk of death. They also analysed other factors, such as age, sex, ethnicity, educational level, retirement status, positive relationship with others, and feeling happy and positive or sad and negative over the previous 30 days. They then adjusted the results to take age and retirement status into account.

 

What were the basic results?

Over the 14-year period, 569 people died. Those more likely to have died were older, retired, male and with lower educational levels.

People who died scored lower on purpose in life and positive relations with others, meaning that greater purpose in life predicted a lower mortality risk (hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.78 to 0.93).

There was no difference between survivors and those who died in terms of whether they reported feeling positive or negative in the questionnaire.

Further statistical analysis found that a sense of purpose reduced the risk of death by relatively the same amount for younger, middle-aged and older adults. The results remained significant whether or not people were retired.

 

How did the researchers interpret the results?

They concluded that, "This study underscores the potential for purpose to influence healthy aging across adulthood and points to the need for further investigation on why finding a purpose may add years to one's life."

They suggest that further research should look at whether "daily physical activity and goal achievement" are the mechanisms behind their findings.

 

Conclusion

This study found an association between people who felt they had a purposeful life and a reduced risk of death.

Although researchers tried to control for the person's state of wellbeing at the time of the questionnaire – whether the person was feeling happy and positive or sad and negative when they responded to the three questions about purpose in life – the questionnaires were only conducted once. It is likely that people's responses may fluctuate and change over time for numerous reasons.

Determining a person's sense of purpose in life from their response to three questions is a very crude measure. The interpretation of each question could be viewed in a different light.

In this study, agreeing with the question "I live life one day at a time and don't really think about the future" appears to indicate that the person lacks purpose in life. However, this could be viewed as a positive attitude for some people suffering from ill health.

A major limitation of this study is that it did not record whether people had any illnesses, or indeed their cause of death.

Further limitations include the lack of general lifestyle information, which could have confounded the results. This includes information about:

  • physical activity levels
  • diet, alcohol and smoking status
  • employment status – the study only reports whether people had retired, not whether they were employed, unemployed or involved in voluntary work

In conclusion, this weak study suggests that having a purpose in life may improve life expectancy, but either way it is unlikely to reduce it.

There have been anecdotal reports that upon retirement many people suddenly find that their life loses purpose as they no longer have a career to think about (though for some, this is a blessing).

If you are having problems coping with retirement and are feeling increasingly socially isolated, there is a wide range of organisations that can help.

Read more about combating loneliness in older people.

Analysis by
Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

How to live longer: Find your purpose in life. The Independent, May 14 2014

Sense of purpose 'adds years to life'. BBC News, May 14 2014

The secret to longevity? Keeping busy and having 'a purpose in life'. Mail Online, May 13 2014

Links To Science

Hill PL, Turiano NA. Purpose in Life as a Predictor of Mortality Across Adulthood. Psychological Science. Published online May 8 2014

Categories: Medical News

New advice encourages more home births

Medical News - Tue, 05/13/2014 - 18:19

"More women should give birth at home, advice suggests," reports The Guardian after draft guidelines produced by the National Institute for Health and Care Excellence (NICE) recommended that women with a low risk of complications in childbirth should be encouraged to either give birth at home or at a midwife-led unit.

The guidance has been revised after new evidence has become available since its original publication in 2007.

As part of the new guidance, NICE proposes revising its recommendations on the most appropriate place for women to give birth if they are at a low risk of complications. It is this aspect of the recommendations that has received the most media attention.

These draft guidelines about the care of healthy women and their babies during childbirth are open to consultation.

 

What do the draft recommendations say?

The draft recommendations say that low-risk women (women without medical conditions or other factors that put them at increased risk) who have given birth before should be advised to plan to give birth at home or at a midwifery-led unit (freestanding or alongside).

"Alongside" midwifery-led units are based at hospital sites next to traditional obstetric labour wards, while "freestanding" midwifery-led units may not be at a hospital site.

Low-risk women who haven't given birth before should be advised to plan to give birth in a midwifery-led unit (freestanding or alongside). This is because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.

 

How is risk assessed?

NICE has published a number of tables listing factors that may increase the risk of complications during birth and require admission to an obstetric unit.

These include having:

  • a chronic condition such as asthmalupus or epilepsy
  • certain ongoing infections
  • a previous history of pregnancy-related complications, such as pre-eclampsia
  • risk factors that make the pregnancy more likely to develop complications, such as if the mother is expecting twins or the mother is obese

Your midwife should be able to provide more detailed advice about whether your pregnancy is low or high risk and why this is the case.

But the final decision about where to give birth is ultimately yours. You will never be forced to give birth at home or at a midwife unit if that is against your wishes.

 

What are the pros and cons of home birth?

The advantages of giving birth at home include:

  • being in familiar surroundings where you may feel more relaxed and able to cope
  • you don't have to interrupt your labour to go into hospital
  • you will not need to leave your other children, if you have any
  • you will not have to be separated from your partner after the birth
  • you are more likely to be looked after by a midwife you have got to know during your pregnancy
  • you are less likely to have intervention such as forceps or ventouse than women giving birth in hospital

However, there are some things you should think about if you're considering a home birth:

  • You may need to transfer to a hospital if there are complications. The Birthplace Study found that 45 out of 100 women having their first baby were transferred to hospital, compared with only 12 out of 100 women having their second or subsequent baby.
  • For women having their second or subsequent baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit. However, for women having their first baby, home birth slightly increases the risk of a poor outcome for the baby (from 5 in 1,000 for a hospital birth to 9 in 1,000 – almost 1% – for a home birth). Poor outcomes included the death of the baby and problems that might affect the baby's quality of life. 
  • Epidurals are not available at home.

 

How has the guidance been received?

The Royal College of Obstetricians and Gynaecologists said it supported the recommendations as long as issues around emergency back-up options and the assessment of pregnancy risk were resolved.

The Royal College of Midwives welcomed the change in guidance, but said more investment in midwifery is needed to implement these changes.

The National Childbirth Trust (NCT) also welcomed NICE's proposed changes.

However, the Birth Trauma Association has concerns over the research that was the basis for these recommendations, and fears that this guidance could put women at risk.

 

How do I get involved in the consultation?

Consultation is open until June 24 2014. If you wish to take part, you will need to register as an individual stakeholder, or contact the registered stakeholder organisation that most closely represents your interests and pass your comments to them.

Read more about how to take part in NICE's consultation.

Analysis by
Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

More women should give birth at home, advice suggests. The Guardian, May 13 2014

NHS push for home births: Second-time mums are told they only need hospital if high-risk. Daily Mail, May 13 2014

'Labour wards not for straightforward births' says NICE. BBC News, May 13 2014

Mums encouraged to have home births under new NHS proposals. Daily Mirror, May 13 2014

Nice Calls For More Midwife-Led Home Births. Sky News, May 13 2014

More women should give birth on 'midwife-led units'. ITV News, May 13 2014

Categories: Medical News

Resveratrol's health benefits 'overstated'

Medical News - Tue, 05/13/2014 - 14:17

“Red wine health benefits 'overhyped',” BBC News reports. The headline follows a study researching the chemical resveratrol, which is found in red wine and chocolate.

Reveratrol has been reported to have long-term health benefits, such as anti-inflammatory and anti-cancer effects. There has been speculation that it may be responsible for the “French paradox”: the puzzling fact that rates of heart disease are low in France, despite citizens enjoying a rich diet.

This study involved almost 800 people from the Chianti region of Italy. The researchers wanted to see if resveratrol had any links with cancercardiovascular disease and death rates.

The study found that the risk of death during the nine-year follow-up period was no different for people with the highest levels of metabolites (breakdown products) of resveratrol in their urine, compared to people with the lowest levels. There was also no difference in the risk of developing cancer or cardiovascular disease.

However, red wine and chocolate contain more than just resveratrol. They may still be good for you (in moderation), but this study suggests that resveratrol may not be the reason why.

 

Where did the story come from?

The study was carried out by researchers from the John Hopkins University School of Medicine, the National Institute on Aging and the New England Research Institute in the US; the University of Barcelona and Catalan Institute of Oncology in Spain; and the Istituto Nazionale di Riposo e Cura per Anziani V.E.II.–Istituto di Ricovero e Cura a Carattere Scientifico and the Azienda Sanitaria in Italy. It was funded by the US National Institutes of Health and National Institute on Aging, the Italian Ministry of Health and the Spanish Government.

It is unclear why the research focused on an area that is famous for its red wine. However, it must be noted that this was part of the long-running “InCHIANTI” study, which has produced dozens of published research pieces.

The study was published in the peer-reviewed medical journal JAMA Internal Medicine.

This story was widely covered by the press, with most of the headlines focusing on chocolate and red wine. It should be noted that these contain more than just resveratrol – the chemical studied in this research. Resveratrol is also found in a wide range of foods.

Finally, it is somewhat amusing that some newspapers talk dismissively of the “resveratrol myth” – the idea that resveratrol is good for you – as these are the very same newspapers that promoted the idea in the first place.

 

What kind of research was this?

This was a cohort study that aimed to determine if resveratrol levels, measured from the levels of metabolites (breakdown products) in urine, were associated with cancer, cardiovascular disease and death rates.

Cohort studies can show association, but cannot show causation. It should be noted that there were significant differences between people with different resveratrol metabolite levels in their urine. For example, those with the highest metabolite levels were less likely to have cognitive impairments.

Although the researchers tried to adjust for these confounding factors, they could still affect the results of this study.

 

What did the research involve?

In this study, 783 people aged 65 years or older from two villages in the Chianti area in Italy were followed between 1998 and 2009, to see if they:

  • died
  • developed cancer
  • developed cardiovascular disease

The researchers examined whether these outcomes were associated with the level of resveratrol metabolites in urine. Resveratrol metabolites in urine samples collected over 24 hours were measured at the beginning of the study.

The researchers took the following confounders into account:

  • age
  • sex
  • education
  • body mass index (BMI)
  • physical activity
  • total energy intake
  • total cholesterol
  • high density lipoprotein (HDL) cholesterol
  • Mini-Mental State Examination (MMSE) score – a measurement of cognitive ability
  • average arterial blood pressure
  • chronic diseases

 

What were the basic results?

During the nine-year follow-up period, 268 (34.3%) of the people studied died.

The researchers compared the risk of death during follow-up for people with the lowest 25% of resveratrol metabolites in their urine to those with the highest 25%, and found no significant difference in the risk of death.

To confirm this result, the researchers looked at the relationship between the dietary intake of resveratrol (assessed from a food frequency questionnaire) and the level of resveratrol metabolites in urine.

These were correlated, meaning that people with the highest dietary intake had the highest levels of metabolites in their urine.

The researchers also found that people with the lowest 25% of dietary intake of resveratrol did not have a significantly different risk of death during follow-up, compared to people with the highest 25% of intake.

They then studied whether resveratrol metabolite levels in urine were associated with the development of cardiovascular disease and cancer in people who did not have these diseases at the beginning of the study.

Again, resveratrol metabolite levels in urine were not significantly associated with the development of cardiovascular disease or cancer during the study. 

 

How did the researchers interpret the results?

The researchers conclude that “this prospective study of nearly 800 older community-dwelling adults shows no association between urinary resveratrol metabolites and longevity. This study suggests that dietary resveratrol from Western diets in community dwelling older adults does not have a substantial influence on inflammation, cardiovascular disease, cancer or longevity”.

 

Conclusion

This study of almost 800 older adults in Italy found that the risk of death during a nine-year follow-up period was no different for people with the highest levels of metabolites of resveratrol in their urine, compared to people with the lowest levels. There was also no difference in the risk of developing cancer or cardiovascular disease.

Although this was a well-designed study, it should be noted that:

  • cohort studies cannot show causation. There were significant differences between people in the different categories of resveratrol metabolite levels. For example, people with high resveratrol metabolite levels were more likely to be male, smoke and be physically active. They were also less likely to have cognitive impairment. This could complicate matters – while physical activity is linked with better health, smoking may have counteracted the positive effects of resveratrol.
  • resveratrol levels were only measured once, over 24 hours at the beginning of the study. This may not be representative of the participants’ usual pattern of consumption of red wine, berries and chocolate.
  • the study compared people with different resveratrol metabolite levels. It may be the case that there is a threshold level over which resveratrol has an effect, although the researchers say they don't know of one.

It should be noted that red wine and chocolate contain more than just resveratrol. They may still be good for you, but this study suggests that resveratrol may not be the reason why.

Relying on a single substance to keep you healthy is not recommended. The so-called “French Paradox” probably arises from a number of factors, such as the tendency to consume less overall calories, sugar and fried food in comparison to other developed nations.

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

Red wine health benefits 'overhyped'. BBC News, May 13 2014

The resveratrol myth: Supposed health benefits of red wine and chocolate ‘unfounded’, research finds. The Independent, May 13 2014

Chocolate and red wine 'WON'T extend your life': Study reveals antioxidant found in both has no 'substantial influence' on longevity. Mail Online, May 13 2014

Sorry! Red Wine isn't good for you after all - Oh, and neither is chocolate! Daily Express, May 13 2014

Links To Science

Semba RD, Ferrucci L, Bartali B, et al. Resveratrol Levels and All-Cause Mortality in Older Community-Dwelling Adults. JAMA Internal Medicine. Published online May 12 2014

Categories: Medical News

Four rare diseases added to newborn screening

Medical News - Mon, 05/12/2014 - 18:19

"Newborn babies to be tested for rare diseases," reports BBC News online.

The news is based on an announcement by the UK's National Screening Committee (NSC), which has recommended screening every newborn baby in the UK for four additional genetic disorders as part of the existing newborn screening programme.

This means expanding the NHS Newborn Blood Spot Screening programme to include screening for homocystinuria, maple syrup urine disease, glutaric aciduria type 1 and isovaleric acidaemia.

 

What conditions are being screened for? Homocystinuria

Homocystinuria causes a build-up of the amino acid homocysteine in blood and urine. Left untreated it can cause bone damage, visual problems and brain damage. These symptoms can usually be prevented with prompt diagnosis and treatment.

Maple syrup urine disease

Maple syrup urine disease is a rare disorder affecting around 1 in 185,000 children. It disrupts the normal functioning of amino acids inside the body. Symptoms can range from the relatively mild, such as vomiting, to severe, such as seizures and coma. The condition can normally be controlled through a specialist diet.

Glutaric aciduria type 1

Glutaric aciduria type 1 is a genetic condition associated with amino acids dysfunction. Symptoms include muscle spasms and bleeding inside the eyes and the brain. The condition can be treated using a combination of medication and occupational therapy.

Isovaleric acidaemia

Isovaleric acidaemia is another genetic amino acid disorder. Initial symptoms include sweaty feet, but without treatment the condition can rapidly worsen, leading to seizures and, in some cases, coma. The condition can be successfully treated using a diet plan designed to avoid certain proteins.

 

How will the testing work?

Babies currently have a heel prick blood test at five to eight days old to test for five conditions where early detection and treatment will improve the long-term outcome for the child:

A pilot programme was run by Sheffield Children's NHS Foundation Trust in which more than 700,000 babies across the country were screened for the new diseases, as well as the five conditions that every newborn baby is currently screened for. 

The Sheffield programme detected 20 children with serious but treatable conditions. Following the results of this pilot study, the NSC was able to recommend extending the newborn screening programme to also screen for these four conditions.

Professor Jim Bonham, national lead for the pilot project and director for newborn screening at Sheffield Children's NHS Foundation Trust, said: "This is fantastic news and everyone who has been involved in the pilot should be really proud of the part they have played in this development.

"As a result of this study, 20 children with serious but treatable disorders were discovered. We are delighted with the results because it shows how we can make an enormous difference for these children and their families, in some cases giving them the gift of life."

Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Newborn babies to be tested for rare diseases. BBC News, May 9 2014

Categories: Medical News

Electrical brain stimulation may induce dream control

Medical News - Mon, 05/12/2014 - 16:10

“Scientists induce lucid dreams by adding current to sleeping people's brains,” reports the Mail Online.

This headline comes from a study of 27 people indicating that for some, electrical stimulation of the brain at a specific wavelength (25 Hz to 40 Hz) may increase the lucidity of their dreams and their self-awareness during them.

Dream lucidity is when a person has awareness that they are dreaming and this often results in them being able to "control" their dreams.

While this is intriguing research the study was small, so its conclusions are tentative, meaning they could be disproved later. This research will need to be tested using many more people to improve confidence in the findings. 

One of the implications of the findings mentioned in the media was the possibility that people with post-traumatic stress disorder may benefit from such brain stimulation. The theory was that having greater self-awareness during a dream may help people consciously alter the course of their dream experience as it happened. It is important to point out that this was a theory and was not tested in this study.

There may be potential benefits of being able to induce lucid dreams or increase self-awareness, but currently, they are speculative and unproven.

 

Where did the story come from?

The study was carried out by researchers from German Universities and Departments of Psychiatry and was funded by the German Science Foundation.

The study was published in the peer-reviewed medical journal Nature Neuroscience.

The media generally reported the story accurately and indicated a possible implication of the research. It is suggested that being able to create more lucid and controllable dreams might help those with post-traumatic stress disorder change what they remember or experience in their dreams. This theory was mainly speculative and not tested in this study.

Unsurprisingly, most newspapers include a reference to the science fiction thriller Inception. It is currently unclear whether the device in question could help you change the mind of a billionaire by planting ideas in their head (we are guessing not).

 

What kind of research was this?

This was a human study using electrical stimulation to study different levels of consciousness and involved analysing brain activity and dreams.

The study authors say that electrical stimulation in specific areas of the brain (specifically fronto-temporal gamma electroencephalographic (EEG) activity) has been linked to conscious awareness in dreams, but a causal relationship has not yet been established.

The authors describe two forms of consciousness: being awake (primary consciousness) and sleeping (secondary consciousness).

A state of sleep in which primary and secondary states of consciousness coexist is called lucid dreaming, a phenomenon that some think is unique to humans.

In lucid dreams the sleeper becomes aware of the fact that they are dreaming while the dream continues. Sometimes the dreamer gains control over the ongoing dream plot and, for example, is able to put a dream aggressor to flight; such as the classic childhood trope of the monster under the bed.

Scientifically, lucid dreams are an opportunity to watch the brain change conscious states, from primary to secondary consciousness and to arrive at testable predictions about the determinants of these states.

 

What did the research involve?

The research used 27 healthy adult volunteers aged from 18 to 26. Each spent up to four nights in a sleep laboratory in Germany.

Participants went to sleep and two to three minutes into a phase of sleep known as rapid eye movement (REM).

It is thought that the REM phase of sleep is when most people experience dreams. During this phase they had electrical currents of different frequencies applied to the front part of their skulls for 30 seconds to stimulate the brain.

To test it wasn’t a placebo effect, some participants were told they were to receive the electrical stimulation, but unknown to them, received no actual electrical stimulation (a sham stimulation).

Shortly after stimulation or sham (5-10 seconds post stimulation) the volunteers were woken and asked to provide a full dream report (description of their dream) and to complete a 28-item scale on sleep consciousness.

None of the volunteers had prior experience of lucid dreaming before the laboratory testing, and as they were not used to recalling their dreams, reports were described as quite short and often bizarre.

The main analysis compared the dream descriptions and sleep consciousness scales across the different stimulation frequencies.

 

What were the basic results?

The study found that certain frequency electrical stimulation during REM sleep influenced ongoing brain activity and boosted self-reflective awareness during dreams. However, other stimulation frequencies were not effective.

Lucid dreams did not happen for everyone but where they did occur, they were most prominent during stimulation with 25 Hz (58%) and 40 Hz (77%).

How did the researchers interpret the results?

The authors interpreted their results to mean that “higher order consciousness is indeed related to synchronous oscillations around 25 and 40 Hz frequency”.

 

Conclusion

The study suggests that for some people, electrical stimulation of the brain at a specific wavelength (25 Hz to 40 Hz) may increase the lucidity of the dreams they experience and their self-awareness during them.

The study was small (just 27 people) and therefore its conclusions are tentative, meaning they could be disproved later. This research will need to be tested using many more people to improve confidence in the findings. 

One of the implications of the findings mentioned in the media was the possibility that people with post-traumatic stress disorder may benefit somehow. The theory was that having greater self-awareness during a dream may help people experiencing traumatic dreams to consciously alter the course of their dream experience. It is important to point out that this was a theory and was not directly tested in this study.

In summary, the study was too small to be able to give any solid indication of whether brain stimulation can improve self-awareness or lucidity during dreams. Also, while there may be potential benefits to being able to induce lucid dreams or self-awareness, such claims remain unproven at this stage.

Akin to the concept of lucid dreams is mindfulness. This is the idea that paying more attention to the present moment – to your own thoughts and feelings, and to the world around you – can improve your mental wellbeing.

Read more about mindfulness.

Analysis by
Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Lucid dreaming can be induced by electric scalp stimulation, study finds. The Guardian, May 11 2014

Could Inception become a reality? Scientists induce lucid dreams by adding current to sleeping people's brains. Mail Online, May 11 2014

Nightmares? control your dreams... with electric current. The Daily Telegraph, May 11 2014

Sweet dreams: Scientists discover way of preventing nightmares by applying an electric current to the brain. Daily Mirror, May 12 2014

Links To Science

Voss U, Holzmann R, Hobson A, et al. Induction of self awareness in dreams through frontal low current stimulation of gamma activity. Nature Neuroscience. Published online May 11 2014

Categories: Medical News

Fat shaming 'more damaging than racism'

Medical News - Mon, 05/12/2014 - 14:17

“Fat shaming can have a much worse impact on mental and physical health than racism or sexism,” the Mail Online reports, describing “fat shaming” as discrimination against those who are overweight.

In fact, the science behind the headline suggests that all forms of discrimination have a negative impact, although some more so than others.

This was a large study, where older adults reported their health and everyday experiences of discrimination at two time periods, four years apart.

Their responses suggested that the experience of discrimination on the grounds of age, weight, physical disability or appearance was linked to worse self-reported physical or emotional health. Discrimination based on race, sex, ancestry and sexual orientation, on the other hand, appeared to have less of an effect on physical and emotional health.

Although the study was large, it had limitations. One was that it only studied older people, meaning that results may not necessarily be applicable to younger generations.

The study did not investigate how discrimination might lead to poorer physical or emotional outcomes, nor did it detail the type, severity, context and frequency of the perceived discrimination. These unanswered questions could be useful topics for future research.

 

Where did the story come from?

The study was carried out by researchers from Florida State University College of Medicine. No sources of funding have been reported, and the authors declare that they have no disclosures (conflict of interests). 

The study was published in the peer-reviewed American Journal of Geriatric Psychiatry.

The Mail Online’s reporting was broadly accurate, but consistently spun the story to focus on weight discrimination, even though the research covered seven other types.

It is somewhat ironic that the Mail Online – a news site infamous for its “Sidebar of Shame,” in which it discusses celebrities’ body sizes in obsessive detail – should run a story about the negative impact of “fat shaming”.

 

What kind of research was this?

This was a longitudinal study aiming to see whether perceived discrimination affected physical, emotional and cognitive health in older adults. It did this by looking at self-reported questionnaire responses completed at two time points, four years apart. It looked at the impact that perceived discrimination had on a person’s health at the time of assessment (in the first questionnaire) and then again four years later (in the second questionnaire). The study, therefore, included both cross-sectional and longitudinal elements. 

The questionnaires asked the same group of people about their experiences, which is a useful way of following this specific group and identifying possible links. However, this study type cannot prove cause and effect. 

 

What did the research involve?

The study included people who were taking part in the Health and Retirement Study (HRS) in the US: a nationally representative longitudinal study of US citizens aged 50 years and older. It included 7,622 people who completed a “Leave-Behind” Questionnaire as part of the 2006 HRS assessment (with a mean age of 67 years) and 6,450 who completed the same health questionnaire again in 2010.

Using the questionnaires, participants rated their everyday experience of discrimination and attributed those experiences to eight personal characteristics:

  • race (such as African American or Hispanic)
  • ancestry (largely based on nationality, such as Filipino-American or Ukrainian-American)
  • sex
  • age
  • weight
  • physical disability
  • appearance
  • sexual orientation

At both the 2006 and 2010 assessments, participants completed measures of physical health (subjective health, disease burden), emotional health (life satisfaction, loneliness) and cognitive health (memory, mental status).

The study performed many analyses. The main analysis looked for links between the different categories of discrimination and poorer physical, emotional or cognitive health. A secondary analysis adjusted the statistics for the effects of body mass index (BMI) and smoking prevalence – which are both known to reduce physical health.

 

What were the basic results?

In this sample, perceived discrimination based on age was the most prevalent (30.1%), with perceived discrimination based on sexual orientation the least prevalent (1.7%).

Across the entire sample, physical and cognitive health generally declined, while emotional health saw an improvement.

The main findings were that discrimination based on age, weight, physical disability and appearance were associated with worse subjective health, greater disease burden, lower life satisfaction and greater loneliness at both assessments (2006 and 2010), with declines in health seen across the four-year period.

Discrimination based on race, ancestry, sex and sexual orientation was associated with greater loneliness at both time periods, but was not linked to a change over time. Discrimination appeared mostly unrelated to cognitive health.

To view the full impact of discrimination, the study’s authors calculated the added disease burden of experiencing it. For example, out of the 2,294 participants reporting age discrimination over the four-year period, the link between age discrimination and the change in disease translated into approximately 130 additional diseases. As such, at the four-year follow-up, participants who experienced age discrimination had almost 450 more diseases than participants who had not experienced such discrimination.

 

How did the researchers interpret the results?

The researchers conclude that, despite limitations, “the present research suggests that discrimination based on a number of personal characteristics is associated with declines in physical and mental health in older adulthood. This research suggests that the effects of discrimination are not limited to the young; older adults are vulnerable to its harmful effects. In older adulthood, discrimination based on age and other personal characteristics that change with age may have particularly adverse consequences on health and wellbeing.”

The research indicated that “discrimination based on race, sex, ancestry and sexual orientation was largely unrelated to the indices of health. In contrast, perceived discrimination based on age, weight, physical disability or appearance had consistent associations with poor physical and emotional health”.

The researchers indicated that “although seemingly modest, the effect of discrimination on health is clinically meaningful at the population level.”

 

Conclusion

This study suggests that perceived discrimination among older adults on the grounds of age, weight, physical disability or appearance is linked to worse self-reported physical and emotional health. It also indicated that discrimination based on race, sex, ancestry and sexual orientation is largely unrelated to physical and emotional health. Very few links were found between discrimination and cognitive ability, which was the third dimension tested in the study.

The study was large, giving it greater reliability than a smaller study of this type. However, there were still many limitations that should be considered when interpreting the findings, most of which were acknowledged by the study’s authors.

The measure of discrimination used was limited to just one item per characteristic (e.g. age, weight, race, etc) and did not capture whether the discrimination was ongoing, a specific event or whether it was context-specific – such as discrimination at work or if it was more widespread. This meant that detail on the type, severity, context and frequency of discrimination linked to the poorer health and emotional outcomes was missing.

The study did not examine how discrimination might lead to poorer physical or emotional health, although there may be many plausible ideas. Ideally, the mechanism by which discrimination can damage lives would be tested in further research to see if any are amenable to intervention or change.

Though this was a large study sample, it comprised mainly older adults (with an average age of 67) and limited ethnic diversity. This makes it unclear whether the findings can be generalised to younger groups or ethnic minorities in the US or UK.

Finally, the study used subjective measures of physical and emotional health, so may not give a wholly accurate picture of objective health.

The cognitive assessment involved tests that are more objective and, interestingly, was the only domain where very few links were found.

Similarly, the perception of discrimination in this study is unavoidably a subjective measure, and as already mentioned, we don’t have any more information on the context of the perceived discrimination.

With the limited contextual information available from this study (for example, there was no further exploration of the discrimination and medical verification of the reported health problems), it is difficult to exclude the possibility that other factors were influencing the apparent relationship between discrimination and health.

For example, a person with mental health issues may have low self-esteem or feel worthless. Because of this, they may have an altered perception of how other people view them.

Overall, these factors make it very difficult to prove cause and effect in this particular study.

If you are worried about your weight, then joining a weight-loss group, where you are encouraged to lose weight in a supportive environment with like-minded people, may help.

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

Fat shaming can have much worse impact on mental and physical health than racism or sexism. Mail Online, May 9 2014

Links To Science

Sutin AR, Stephan Y, Carretta H, Terracciano A. Perceived Discrimination and Physical, Cognitive, and Emotional Health in Older Adulthood. The American Journal of Geriatric Psychiatry. Published online March 21 2014

Categories: Medical News

Lack of exercise 'highest risk' for women over 30

Medical News - Fri, 05/09/2014 - 14:26

"Heart disease warning: Lack of exercise is worse risk for over-30s women than smoking or obesity," The Independent reports. It is important to stress that this headline is based on a result that is applicable to a population, not to an individual.

The Australian study the headline is reporting on looked at population attributable risk, or PARs. PARs can be used to estimate the proportion of cases of a disease, such as heart disease, that would not occur in a population if the risk factor, such as inactivity, was eliminated.

The researchers wanted to determine the proportion of heart disease that was attributable to four specific risk factors: smoking, physical inactivity, high body mass index, and high blood pressure. They looked at groups of women of different ages.

Two key findings of the study were that:

  • smoking had the greatest PAR in women under 30 – if women aged under 30 gave up smoking, approximately 55-60% of cases of heart disease would be eliminated
  • physical activity had the greatest PAR in women aged 31 and older – if women aged 31 to 36 increased their physical activity, about 51% of cases of heart disease could be eliminated

It pays to emphasise that factors could have the greatest PAR simply because they are the most common, rather than because they are associated with the greatest increase in risk for the individual. In fact, smoking was associated with the greatest increase in risk of heart disease at all ages.

It would be unwise to think you could offset one risk against another. Just because you take regular exercise does not mean that it is safe for you to smoke.

 

Where did the story come from?

The study was carried out by researchers from the University of Sydney and the University of Queensland in Australia.

Some of the data came from the Australian Longitudinal Study on Women's Health, funded by the Australian Department of Health. One of the researchers was supported by the Australian National Health and Medical Research Council.

The study was published in the peer-reviewed British Journal of Sports Medicine.

The results of the study were reported well by BBC News and The Daily Telegraph. However, the Daily Mail has misinterpreted the meaning of the figures reported in the study – specifically, how the population attributable risk tool "works".

It reports that individual women in their thirties who are inactive are almost 50% more likely to develop heart disease. However, the study refers to outcomes at the population level.

The 50% figure actually refers to the proportion of heart disease cases that could be eliminated from the population as a whole if this inactivity was not present.

It could be the case that eliminating a risk factor reduces the number of cases the most because it is the most common risk factor in a population, rather than because it is associated with the greatest increase in risk for the individual.

 

What kind of research was this?

This was an analysis of data from cohort studies. It aimed to determine the proportion of heart disease attributable to four specific risk factors in Australian women of different ages.

The figure the researchers were calculating is called population attributable risk, or PAR. It indicates the proportion of cases of a disease that would not occur in a population if a risk factor was eliminated. PAR depends on how common a risk factor is (its prevalence) and the strength of its association with the disease.

Researchers and policy makers can use these figures to help them decide which risk factors they should be targeting to get the greatest reduction in disease in the population as a whole.

 

What did the research involve?

The researchers calculated population attributable risk for heart disease that was attributable to four risk factors:

To do this, they used relative risks of heart disease associated with high BMI, smoking, high blood pressure and physical activity from the Global Burden of Disease reports.

The relative risks give a measure of the strength of the association between each risk factor and heart disease. The Global Burden of Disease reported relative risks based on pooling of results (meta-analyses) of epidemiological studies.

As the risk associated with risk factors varies by age and with sex, the researchers used relative risks specifically for women and the age groups they were looking at.

Relative risks in the Global Burden of Disease reports compared the risk of heart disease for:

  • high BMI (>23kg/m2) versus low BMI (23kg/m2)
  • current smokers versus non-smokers
  • high blood pressure (>115mmHg average) versus low blood pressure (<115mmHg average)
  • no, low and moderate physical activity versus high physical activity

The latter was assessed using what is known as MET (metabolic equivalents), a calculation of how much energy is burned off over a minute during certain activities. For example, for most people, running at 10 mph is equal to 16 METs.
 
The researchers used estimates of how common each risk factor was (prevalence) in Australian women from the Australian Longitudinal Study on Women's Health between 1999 and 2012. This study surveyed women born from 1973-78 (the younger cohort), 1946-51 (the mid-aged cohort), and 1921-26 (the older cohort) every three years.

The risk factors were defined as:

  • high BMI (>23kg/m2)
  • current smoking
  • high blood pressure (defined as being diagnosed or treated for hypertension)
  • no or low physical activity (defined by the Global Burden of Disease study) – MET minutes per week were calculated from reported time spent walking briskly and in moderate and vigorous leisure time activities

The researchers used the relative risks and prevalence estimates to calculate population attributable risks using standard methods.

 

What were the basic results?

The risk of heart disease associated with each risk factor varied across age groups, as did the prevalence of each risk factor.

Smoking was associated with the greatest increase in risk of heart disease at all ages. Of the four factors assessed, smoking had the highest population attributable risk in women aged 22 to 27 (59%) and 25 to 30 (56.6%).

The population attributable risk associated with smoking was lower in women aged 47 to 64 and in the older cohort, and was 5% in women aged 73 to 78 (the oldest group of women with smoking data available).

In women aged 31 to 90, physical inactivity (no or low physical activity) had the highest population attributable risk of the four factors assessed. The population attributable risk of physical inactivity in women aged 31 to 36 was 50.9%.

On average, the population attributable risk was:

  • 48% in the younger cohort (aged 22 to 39)
  • 33% in the mid-aged cohort (aged 47 to 64)
  • 24% in the older cohort (aged 73 to 90)

 

How did the researchers interpret the results?

The researchers concluded that, "From about age 30, the population risk of heart disease attributable to inactivity outweighs that for other risk factors, including high BMI.

"Programmes for the promotion and maintenance of physical activity deserve to be a much higher public health priority for women than they are now, across the adult lifespan."

 

Conclusion

This study has found that the proportion of heart disease attributable to four risk factors (smoking, high BMI, high blood pressure and physical inactivity) in Australian women changes with age.

The figures calculated in this study – called population attributable risk – indicate the proportion of cases that would not occur in a population if risk factors were eliminated. Population attributable risk depends on the increase in risk of heart disease associated with the factor, and the number of women with the risk factor. 

A risk factor could have the highest population attributable risk if it is the most common risk factor in a population. But this is not necessarily because it is associated with the greatest increase in risk for the individual.

This study has found that smoking had the highest population attributable risk in women under 30. If women in this age group gave up smoking, approximately 55-60% of cases of heart disease would be estimated to be eliminated.

In women aged 30 or over, physical inactivity (low or no physical activity) had the highest population attributable risk of the four factors assessed. If inactive women aged 31 to 36 increased their physical activity, about 51% of cases of heart disease could be eliminated.

The population attributable risk for inactivity was lower in older age groups, but if women aged 47 to 64 increased their physical activity, 33% of heart disease cases could be eliminated. If women aged 73 to 90 did the same, 24% of heart disease cases could be eliminated.

One important factor to note is that these population attributable risk figures are estimates designed to give an indication of the maximum effect that might be achieved by removing these risk factors. Achieving this change may be difficult.

The estimates also do not take into account interactions between these and other risk factors. They therefore may overestimate the impact of each factor individually.

As population attributable factors take into account the prevalence of risk factors, they will also change depending on how common a risk factor is, and will therefore differ across populations with different behaviours and characteristics.

Overall, the findings of this study do not change the message for individuals about the importance of reducing unhealthy behaviours such as smoking, and making sure we stay active.

If you are concerned about your fitness level, why not try the NHS fitness plan, which is designed to get fitness phobes up to speed in 12 weeks.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Heart disease warning: Lack of exercise is worse risk for over-30s women than smoking or obesity. The Independent, May 9 2014

Heart risk for women who shun exercise in their 30s: Inactive almost 50% more likely to develop problems. Daily Mail, May 9 2014

Exercise is more important than smoking for women over 30. The Daily Telegraph, May 9 2014

Links To Science

Brown WJ, Pavey T, Bauman AE. Comparing population attributable risks for heart disease across the adult lifespan in women. British Journal of Sports Medicine. Published online May 8 2014

Categories: Medical News

Claims that men are being 'nagged to death' inflated

Medical News - Fri, 05/09/2014 - 14:00

“Nagging could drive men to an early grave, study suggests,” The Independent reports. A Danish study found that both sexes were adversely affected by constant nagging, but men seemed to be more vulnerable.

A cohort study was conducted with the aim of evaluating the association between stressful social relations and death from any cause.

What the papers labelled as “nagging” was defined by the researchers as (to paraphrase slightly) “people demanding too much of you, seriously worrying you or being a source of conflict”.

Much of the reporting failed to make clear that the researchers did not just study social relationships between partners, but also children, other family members, friends and neighbours.

It found that frequent demands or worries from partners and children increased the risk of death during an 11-year follow-up period, as can conflict with your partner, other family members, friends and neighbours.

As this was a cohort study, there could be other factors (confounders) responsible for the link seen. For example, they corrected for underlying diseases (by measuring hospitalisations), but it is possible that the adjustment may not have fully accounted for any underlying illnesses or risk factors for death.

If you find relationships with your partner (or anyone else) a source of tension and conflict, you may benefit from talking therapy.

 

Where did the story come from?

The study was carried out by researchers from the University of Copenhagen and was funded by the Danish Research Council and the Nordea Denmark Foundation.

The study was published in the peer-reviewed Journal of Epidemiology and Community Health.

This story was widely reported on by the media, which seized on the idea of men being nagged to death by their wives. The tone of the reporting was arguably sexist, as it ignored the negative effects that women in stressful social relations also experienced.

The claim that “men are being nagged to death” was based on a comparison between men with high levels of worries and demands and women with low levels of worries and demands.

It is unclear exactly why the researchers performed this comparison, rather than comparing men with low levels of worries and demands to men with high levels; as the saying goes, it’s like comparing apples with oranges.

 

What kind of research was this?

This was a cohort study that aimed to evaluate the link between stressful social relations (with partners, children, other family members, friends and neighbours, respectively) and death from any cause.

A cohort study did not show that stressful social relations caused people to die. There may be other factors (confounders) that are responsible for the link seen.

For example, people with poor mental health may be more likely to experience relationship problems and die prematurely.

 

What did the research involve?

The researchers used information on 9,870 men and women aged between 36 and 52 from the Danish Longitudinal Study on Work, Unemployment and Health.

To measure stressful social relations, participants were asked: “in your everyday life, do any of the following people demand too much of you or seriously worry you?” and “in your everyday life, do you experience conflicts with any of the following people?” with one item for each of the following social roles: partner, children (their own or a partner’s), other family members, friends and neighbours.

Participants could select “always”, “often”, “sometimes”, “seldom”, “never” or “have none”.

The researchers followed the people for 11 years to see whether they died.

They also looked to see if there was a link between stressful social relations with a partner, children, other family members, friends and neighbours respectively, and death. The researchers compared the risk of death for people who responded “always”, “often”, “sometimes”, and “never” to people who responded “seldom”.

They adjusted their analyses for:

  • age
  • gender
  • cohabitation status
  • occupational social class 
  • hospitalisation with a chronic disorder between 1980 and 2000 (the start of the study)

The researchers then performed additional analyses to see whether the links were different in men and women, and in people who were employed and unemployed.

 

What were the basic results?

During the 11-year follow-up period:

  • “Always” (hazard ratio [HR] 1.93, 95% confidence interval [CI] 1.02 to 3.65) and “often” (HR 1.81, 95% CI 1.23 to 2.67) experiencing worries and demands from a partner was associated with an increased risk of death compared to those who answered with “seldom”.
  • "Always/often" experiencing worries and demands from children was associated with an increased risk of death (HR 1.55, 95% CI 1.08 to 2.20). "Never" experiencing worries and demands from children was associated with a borderline significant increased risk of death (HR 1.30, 95% CI 1.00 to 1.68). 
  • "Always/often" experiencing conflict with a partner was associated with an increased risk of death (HR 2.19, 95% CI 1.49 to 3.21)
  • "Always" (HR 2.64, 95% CI 1.29 to 5.39), "often" (HR 2.31, 95% CI 1.37 to 3.87) and "sometimes" (HR 1.36, 95% CI 1.03 to 1.80) experiencing conflict with other family were all associated with an increased risk of death.
  • "Always/often" (HR 2.63, 95% CI 1.16 to 5.93) and "sometimes" (HR 1.50, 95% CI 1.05 to 2.14) experiencing conflict with friends were both associated with an increased risk of death. 
  • "Always" (HR 3.07, 95% CI 1.49 to 6.32), "often" (HR 2.76, 95% CI 1.12 to 6.80) and "sometimes" (HR 1.78, 95% CI 1.20 to 2.66) experiencing conflict with neighbours were all associated with an increased risk of death. 

In their additional analyses, the researchers found that people exposed to worries/demands (always/often) or conflicts (always/often) from their partner, who were also unemployed, had a higher risk of death than employed people with low stress (sometimes/seldom/never) from their partner.

Compared to women with low stress from their partner, men exposed to worries/demands or conflicts had a higher risk of dying. Women exposed to frequent conflict also had a higher risk of dying compared to women with low levels of conflict with their partner.

 

How did the researchers interpret the results?

The researchers concluded that: “stressful social relations are associated with increased mortality risk among middle-aged and women for a variety of different roles. Those outside the labour force and men seem especially vulnerable to exposure”.

 

Conclusion

This Danish cohort study found that frequent demands or worries from partners and children increased the risk of dying during an 11-year follow-up period, as can conflict with your partner, other family members, friends and neighbours.

These results are not particularly surprising. The harmful effects of sustained stress over a long period of time on both mental and physical health are well-established.

Methods and treatments that may help improve the quality of your relationships include:

If you are on the receiving end of sustained abuse, either physical or psychological, it’s important to seek help.

Read more advice about what to do if you feel unhappy about or frightened by the way your partner treats you.

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

Nagging could drive men to an early grave, study suggests. The Independent, May 9 2014

You really can be nagged to death! 'Excessive demands' from partners can double risk of dying during middle age. Mail Online, May 9 2014

Nagging could cost the lives of hundreds of men. The Daily Telegraph, May 9 2014

Being 'nagged to death' is possible, say researchers. Daily Express, May 9 2014

Links To Science

Lund R, Christensen U, Nilssoon CJ, et al. Stressful social relations and mortality: a prospective cohort study. Journal of Epidemiology and Community Health. Published online May 8 2014

Categories: Medical News