Medical News

NICE: 'Obese should be prescribed slimming clubs'

Medical News - Wed, 05/28/2014 - 14:26

“GPs told to prescribe £100 slimming courses for millions of obese patients,” the Daily Mail reports.

The news is based on new guidelines from the National Institute for Health and Care Excellence (NICE) that aim to encourage sustainable weight loss in the obese; “lose a little, and keep it off”.

The guidance is mainly aimed at commissioners (who plan and agree which services will be provided in the NHS and monitor them), health professionals and groups who provide lifestyle weight management programmes. The recommendations may also be of interest to members of the public, including people who are overweight or obese.

The guidance has been issued because being overweight or obese is a common and important health problem in the UK. In 2012 about a quarter of men and women aged 16 and over in England had a body mass index (BMI) over 30, classified as obese.

In addition, 42% of men and 32% of women were categorised as overweight (BMI of 25 to 30). Life expectancy is estimated to be reduced by an average of two to four years for people with a BMI of 30 to 35, and eight to 10 years for a BMI of 40 to 50.

The cost of obesity to society was estimated to be almost £16 billion in 2007, which is predicted to rise to £50 billion by 2050 if obesity levels continue to rise.

NICE has estimated that across the population, a 12-week weight management programme costing £100 or less for people who are overweight or obese would be cost-effective if they were to lose at least 1kg and keep the weight off for life.

 

What are the main recommendations?

NICE recommends that local authorities and clinical commissioning groups should provide access for people to be referred to a range of lifestyle weight management schemes.

GPs, practice nurses, health visitors, pharmacists and the local adult population should be informed of what services are available locally. And they are advised to use informed advice from the NHS Choices website on weight management.

GPs, health and social care professionals are advised to raise the issue of weight loss for overweight and obese adults in a non-judgemental way. They should consider referring adults of any age to local programmes. They should take the person’s preferences into account. but choose group programmes where possible as they provide better value for money. The programmes should be able to show that at least 60% of people are likely to complete them and that they are likely to lead to an average loss of at least 3% of body weight, with a minimum of 30% of people losing 5% of their initial weight.

People should be referred who have:

  • BMI over 30 (or lower for people from black and minority ethnic groups as they have a higher risk of type 2 diabetes), or people with other risk factors such as already having diabetes
  • BMI between 25 to 30 if there is enough local resource

GPs, health and social care professionals and providers of lifestyle weight management services should be trained to deliver multicomponent programmes, tailored to the individual needs of the person. The programmes should have been developed by a multidisciplinary team including a registered dietician, registered psychologist and qualified physical activity instructor. The programme should be collaborative, and cover:

  • dietary habits
  • safe physical activity
  • strategies to achieve behaviour change
  • prevention of weight regain

Commissioners and local authorities should regularly monitor the provision of services and how effective they have been in helping people to lose weight to ensure that the measures are working and are providing good value for money (are cost effective). This includes collecting outcomes such as:

  • the percentage of people losing more than 3% or 5% of their baseline weight
  • how the weight changes in the 12 months after the programme is completed
  • changes in other outcomes such as blood pressure

 

What are the main benefits of weight loss?

The more weight that is lost, the greater the benefits – especially if a person is able to lose 5% to 10% of their body weight, and maintain it. However, even losing just 3% body weight if obese or overweight can be beneficial.

Weight loss reduces the risk of:

Read more about the complications of obesity.

 

What are the dangers of rapid weight loss?

Setting realistic goals for weight loss is an important part of the NICE recommendations. This is to ensure a steady rate of weight loss within safe limits, and to increase chances that the weight loss can be maintained, rather than having weight regain.

The dangers of rapid weight loss include feeling tired and unwell, as well as the potential for more serious complications such as malnutrition and gallstones. The recommended safe level of weight loss to aim for is between 0.5kg and 1kg per week.

 

How accurate and balanced is the media’s reporting of the guidelines?

The media have accurately described the extent of people being overweight and obese in the UK, and the cost of treating obesity-related illnesses. They have also highlighted the risks of obesity and the benefits of long term weight loss.

Arguably some of the papers have missed the point of NICE’s main arguments. That is while funding weight-loss programmes may cost the NHS money in the short-term (the Daily Mail quotes a figure of a £100 million a year, but it is unclear how it came up with the figure), it could potentially save the NHS billions of pounds in the long-term. This remains to be proven. 

The NHS weight loss plan

NHS Choices provides a downloadable 12 week weight loss plan that:

  • promotes safe and sustainable weight loss
  • helps you learn how to make healthier food choices
  • provides support from our online community
  • offers a weekly progress chart 
  • presents an exercise plan to help you lose weight
  • hopefully allows you to learn skills to prevent regaining weight

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

Links To The Headlines

Weight Watchers free on the NHS: GPs told to prescribe £100 slimming courses for millions of obese patients. Daily Mail, May 28 2014

GPs get new weapon to fight obesity: the prescription diet. The Times, May 28 2014

GPs urged to send obese and overweight to slimming classes. The Guardian, May 28 2014

NHS must follow Weight Watchers' lead and 'treat obesity patients with compassion and dignity'. The Independent, May 28 2014

Most Brits need slimming classes, NHS guidance says. The Daily Telegraph, May 28 2014

Weight loss: NHS backs 'lose a little, keep it off' plans. BBC News, May 28 2014

Weight Watchers free on NHS: Official guidance says slimming clubs should be made available without charge. Daily Mirror, May 28 2014

Weight Watchers free on the NHS? GPs advised to send obese on slimming courses. Metro, May 28 2014

Weight Watchers on the NHS: Guidance says WE should pay for overweight patients to slim. Daily Express, May 28 2014

NHS: Lose 3% of bodyweight for 'significant effects'. ITV News, May 28 2014

Links To Science

National Institute for Health and Clinical Excellence. Managing overweight and obesity in adults – lifestyle weight management services (PDF, 355kb). May 2014

Categories: Medical News

Free radicals may actually be good for us

Medical News - Tue, 05/27/2014 - 15:00

“Antioxidant … supplements may make our bodies age faster,” the Mail Online reports. New research suggests that oxygen containing free radicals – the molecules that antioxidants are designed to target – may actually help cells live longer.

Antioxidants are a type of molecule that can neutralise  free radicals, which are a type of unstable and highly reactive species of molecule. “Fans” of antioxidants have claimed that that reducing free radicals can slow the ageing process.

Due to these perceived properties, antioxidants are now big business. Global sales of antioxidants supplements now rank in the billions of pounds.

But a new study, into nematode worms, suggests that the formation of free radicals (in technical terms, ‘reactive oxygen species’) made the worms live longer.

This research contradicts the theory that free radicals are responsible for ageing.

The researchers suggest that reactive oxygen species might activate a signalling pathway within cells and trigger changes in gene expression altering the cells' sensitivity to stress and promote survival.

Or as the German philosopher, Friedrich Nietzsche, famously said “That which does not kill us makes us stronger.”

However, the researchers point out several differences between vertebrates and worms. Nematode worms have a fixed number of cells, and the researchers suggest that because of this they try and repair rather than eliminate damaged cells.

It is unclear whether reactive oxygen species promote longevity in humans, or that antioxidants will make us age faster. 

If you eat a healthy diet and take regular exercise then you will probably never need to take any supplements.

 

Where did the story come from?

The study was carried out by researchers from McGill University in Montreal and was funded by the Canadian Institutes of Health Research and McGill University.

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

The Mail Online’s reporting of the study was broadly accurate but it arguably overstated the potential implications. The study involved worms (C. elegans), not people.

The researchers say that mitochondrial reactive oxygen species – the species that antioxidants neutralise – are involved in apoptosis (programmed cells death) in vertebrates (which includes humans).

However, rather than being a bad thing, the researchers argue that this is part of a protective program which eliminates defective cells.

However, the nematode worm, C.elegans has a fixed number of cells, and the researchers suggest that because of this they try and repair rather than eliminate damaged cells.

Because of the differences between C. elegans and vertebrates it is unclear whether reactive oxygen species promote longevity in humans. 

 

What kind of research was this?

This was animal research using the nematode C.elegans.

 

What did the research involve?

The researchers looked at mutants of the nematode worm C. elegans which had mutations in their mitochondria (the ‘power plant’ of the cell), normal (wild-type) C. elegans treated with a chemical called paraquat and wild-type C.elegans. Both the mutants and paraquat are thought to generate superoxide, a reactive oxygen species.

The mitochondrial mutants and C.elegans treated with paraquat have increased lifespan compared to the wild-type C.elegans.

The researchers performed a series of experiments to see how the increased production of reactive oxygen species increased lifespan.

 

What were the basic results?

The researchers found that changes in the apoptosis signalling pathway was required for the mitochondrial mutants and C. elegans treated with paraquat to have increased lifespan.

This pathway is involved in apoptosis, also known as programmed cell death, a process by which a cell dies in a controlled manner.

However, the researchers found that apoptosis was not required for longevity, suggesting that the pathway was doing something else.

The researchers also found that the genes that were made were altered in the mitochondrial mutants and C. elegans treated with paraquat compared to wild-type C. elegan. And some of these changes were required for increased lifespan.

The researchers suggest that reactive oxygen species produced by the mitochondria might activate the apoptosis signalling pathway and trigger changes in gene expression. This in turn may alter stress sensitivity and promote survival.

 

How did the researchers interpret the results?

The researchers conclude that “these findings clarify the relationships between mitochondria, [reactive oxygen species], apoptosis, and ageing.”

 

Conclusion

This study on nematode worms (C. elegans) has found that reactive oxygen species made the worms live longer. The researchers suggest that reactive oxygen species might activate a signalling pathway and trigger changes in gene expression that alter stress sensitivity and promote survival.

However, the researchers point out several differences between vertebrates and worms; especially a vertebrate as complex as a human being. C.elegans has a fixed number of cells, and the researchers suggest that because of this they try and repair rather than eliminate damaged cells.

Because of the differences between C. elegans and vertebrates it is unclear whether reactive oxygen species promote longevity in humans, or that antioxidants will make us age faster. 

For more information about supplements and whether you actually need them read the Behind the Headline’s special report: Supplements: Who needs them?

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

Links To The Headlines

Think antioxidants will make you live longer? Think again: We spend millions on them but now researchers say supplements may make our bodies age FASTER. Mail Online, May 27 2014

Links To Science

Yee C, Yang W, Hekimi S. The Intrinsic Apoptosis Pathway Mediates the Pro-Longevity Response to Mitochondrial ROS in C. elegans. Cell. Published online May 8 2014

Categories: Medical News

Could an MS drug 'erase' traumatic memories?

Medical News - Tue, 05/27/2014 - 14:00

"A drug could be re-purposed to erase painful memories from people who have suffered trauma and pain," The Independent reports. The news comes from a study involving mice which measured their response to a series of electric shocks.

The mice were either fed the drug fingolimod, which is used to treat multiple sclerosis, or a saline placebo daily. The researchers then performed their experiment over the course of three days. 

On the first day, the mice were given a mild electric shock when they were put in an experimental chamber. The next day they were put in the chamber and no shock was given, but the mice expected to have a shock and still froze in fear. 

The researchers found that the fingolimod mice were no longer scared of being in the chamber and did not freeze. However, the placebo mice were still scared and froze. This suggests that fingolimod may help "erase" memories associated with fear, pain and trauma when they are no longer needed.

Most of us have memories that we would rather forget, such as an embarrassing incident at an office party. But some incidents can be so traumatic that they become lodged in the mind and trigger conditions such as post-traumatic stress disorder. A drug that could help erase such memories could prove very useful.

This is interesting early-stage research, but much more research is required before fingolimod can be considered for use as a treatment for post-traumatic stress disorder or other anxiety disorders.

 

Where did the story come from?

The study was carried out by researchers from Virginia Commonwealth University School of Medicine in the US and the Chinese Academy of Sciences. It was funded by the US National Institutes of Health and the National Natural Science Foundation of China.

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

While The Independent and the Mail Online's reporting of the study was accurate, both organisations chose to only focus on the experiment involving electric shocks. Other aspects of the study were ignored.

 

What kind of research was this?

This was laboratory and animal-based research into a drug called fingolimod, which is used in the treatment of multiple sclerosis.

NICE recommends its use in the treatment of some people with relapsing-remitting multiple sclerosis. This form of multiple sclerosis is where patients have an unchanged or increased relapse rate, or ongoing severe relapses in comparison with the previous year, despite taking drugs called beta interferons.

The researchers say that fingolimod has potential central nervous system benefits that are not yet fully understood.

 

What did the research involve?

The researchers performed a series of experiments on cells they cultured (grew) in the laboratory, as well as on mice.

The news coverage concentrated on one experiment the researchers performed, which aimed to see whether fingolimod affected contextual fear conditioning and fear extinction.

Contextual fear conditioning is a process by which an organism learns to associate a neutral context – in this case an experimental chamber – with an adverse event, such as an electric shock.

Essentially, the experiment made use of the classic Pavlovian response, where behaviour is conditioned in response to an external stimulus. In this case, the response to the electric shock caused the mice to "freeze", where they don't move other than to breathe.

The researchers fed the mice fingolimod or saline (placebo) and monitored their freezing behaviour before and after placing them in an experimental chamber and giving them an electrical shock. They then returned the mice to their normal cages.

Two days later, the mice were returned to the experimental chamber and the freezing behaviour was monitored again to see if mice receiving fingolimod or saline froze for different amounts of time.  

The researchers performed all of these experiments on mice that had been genetically modified so that they lacked part of their immune system. This is because fingolimod is known to affect the immune system, and the immune system has an effect on memory and learning.

 

What were the basic results?

The researchers performed a series of laboratory experiments and found that fingolimod becomes modified when it enters the cell. This modified form inhibits the activity of a class of enzymes, which in turn has multiple effects on gene expression (gene activity).

The researchers also discovered that fingolimod accumulates in the brains of mice, including part of the brain called the hippocampus, which is involved in memory formation.

They found that there was no significant difference in fear contextual conditioning between mice receiving fingolimod or saline – in other words, both sets of mice did not forget the association between the experimental chamber and the electric shock.

Mice receiving fingolimod or saline did have a significant difference in contextual fear extinction. The mice had similar freezing behaviour when they received the electric shock on the first day. They also had similar freezing behaviour on the second day, when they were put into the experimental chamber without receiving a shock, with both groups of mice gradually freezing less.

However, when they were put into the chamber on the third day, the mice fed fingolimod maintained low levels of freezing, showing that they were no longer afraid of being in the chamber, while mice fed the placebo froze.

 

How did the researchers interpret the results?

The researchers concluded that fingolimod "may be a useful adjuvant therapy to facilitate extinction of aversive memories".

 

Conclusion

Despite what the media has reported, the evidence from this study does not prove that it is possible to "erase" painful memories in humans. All we can safely say is that this study has found that the drug fingolimod can reduce fear-related behaviour in genetically modified mice with defects in their immune system.

These mice are known to have impaired acquisition and ability to perform cognitive tasks. Whether fingolimod would have a similar effect on humans who did not have an impaired immune system or cognitive function is unknown.

Changes in memory and anxiety levels were not reported in any of the human clinical trials of fingolimod used in the treatment of multiple sclerosis. There were many listed side effects, including headaches affecting 1 in 10 people, and depression affecting between 1 in 10 and 1 in 100 people. This means that the risks of taking fingolimod solely as an anti-anxiety drug may well outweigh any benefits.

If you are troubled by traumatic events in your past, ask your GP for advice. Many people with post-traumatic stress disorder respond well to a combination of medication and talking therapies such as cognitive behavioural therapy.

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

Links To The Headlines

Drug could rid people of bad memories and trauma. The Independent, May 26 2014

Could pill wipe out our bad memories? Drug used to treat multiple sclerosis found to help us forget experiences that caused pain. Mail Online, May 26 2014

Links To Science

Hait NC, Wise LE, Allegood JC, et al. Active, phosphorylated fingolimod inhibits histone deacetylases and facilitates fear extinction memory. Nature Neuroscience. Published online May 25 2014

Categories: Medical News

Fresh hope in hunt for malaria vaccine

Medical News - Fri, 05/23/2014 - 18:19

“A group of children… naturally immune to malaria are helping scientists to develop a new vaccine,” BBC News reports.

Researchers hope the children could be key to developing a viable vaccine for malaria, which kills more than half a million people every year, many of them children.

Researchers are attempting to develop a new type of malaria vaccine based on proteins found in the blood of children who have a natural resistance to the disease. 

The prototype vaccine has been found to partially reduce malaria infection in mice.

The vaccine stops the malaria parasite from leaving red blood cells so it is trapped inside and cannot cause further infection and damage.

A word of caution though; some candidate vaccines in the past have shown promise in animals but turned out not to work in people. However, encouragingly, the vaccine appeared to mimic the natural resistance to malaria infection found in some children and adolescents living in malaria endemic regions of Africa.

The next steps for the research, outlined by the study authors in The Independent, include “active vaccination trial in monkeys, followed by phase-one trials in humans. We’d like to roll this out as quickly as we can”.

 

Where did the story come from?

The study was led by researchers from the US Center for International Health Research, Rhode Island Hospital in collaboration with other US universities and institutions. It was funded by grants from the US National Institutes of Health, the Bill & Melinda Gates Foundation, and the Intramural Research Program of the National Institute of Allergy and Infectious Diseases.

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

The UK media’s reporting was generally balanced and accurate. It stressed the fact that while the research was promising, there were still many developmental hurdles (trials in monkeys and in humans) to pass through before the vaccine would be fully developed and available for use.

 

What kind of research was this?

This was a laboratory study in mice looking for new targets in the malaria infection cycle on which to develop a new vaccine.

Malaria is a serious infectious disease spread by mosquitos that can cause death if not diagnosed and treated quickly. It is caused by plasmodia parasites, of which five types are known to cause malaria in humans. Once a person is bitten by a plasmodia carrying mosquito, the parasite enters the bloodstream where it replicates and spreads. Around seven to 18 days after infection symptoms appear including fever, headaches, vomiting, muscle pains and others.

The World Health Organization estimated 627,000 people died of malaria in 2012; 90% in Africa, and mostly children under five years old. The range of uncertainty around the estimate was from 473,000 to 789,000 deaths.

The aim of a vaccine is to interrupt the malaria infection process which has many stages and potential target points. Many attempts at a malaria vaccine have been made already but the researchers indicate around 60% of these focus on just four main targets in the malaria infection cycle as the basis of how they work. They say that new targets are needed and new vaccines must be developed to take advantage of these targets.

 

What did the research involve?

The research had four phases.

Phase one

The first aimed to identify new vaccine targets using a group of young Tanzanian children who showed natural resistance to malaria infection. The researchers performed blood tests and DNA analysis on 12 resistant and 11 susceptible two year old children to look for clues as to why some were naturally more resilient to the infection than others. This process identified the plasmodium falciparum schizont egress antigen-1 (PfSEA-1) protein. The PfSEA-1 protein was involved in enabling the malaria parasite to exit infected red blood cells to spread and infect other cells.

Phase two

Having identified the new target, the researchers developed a prototype vaccine designed to disrupt the PfSEA-1 protein, trapping the parasite in the blood cells. They gave the prototype vaccine to mice before infecting them with a lethal dose of malaria parasite. The vaccine reduced the amount of parasite measured in the blood (how infected they were), and delayed the death of the mice from malaria.

Phase three

The researchers tested whether any of the Tanzanian children (453 tested, aged between 1.5 and 3.5 years) had an immune response to the PfSEA-1 protein. This would indicate whether a natural version of the vaccine, targeting the PfSEA-1 protein, was in their bodies and responsible for some of their natural resistance to malaria.

Phase four

The final stage aimed to test for the presence of an immune response to the PfSEA-1 protein in a completely separate group of people – a group of 138 male Kenyans aged between 12 and 35 living in villages with endemic malaria. They were looking to see if natural immunity to the PfSEA-1 protein in this group was linked to more favourable malaria infection outcomes such as lower levels of parasite in the body.

 

What were the basic results?

The main results of the research were:

  • The identification of a new vaccine target – the PfSEA-1 protein.
  • The development of a vaccine that disrupted the function of this protein.
  • Testing the vaccine in mice revealed significantly less malaria parasite infection in the blood in those given the vaccine. Infected vaccinated mice also lived 80% longer before eventual death than those infected but not given the vaccine. Both measures indicated the vaccine was partially protective against malaria.
  • Natural immune response to the PfSEA-1 protein was found in 6% of the Tanzanian children tested and this significantly decreased their risk of developing severe malaria. Natural immune responses to other existing malaria vaccines were not related to risk of severe malaria. 
  • In an unrelated adolescent Kenyan group, 77 of 138 adolescents had immunity related to the PfSEA-1 protein and this gave them 50% lower densities of parasite in their bodies compared with people with no detectable immunity to the protein. This analysis adjusted for age, week of follow-up, exposure to Anopheles mosquitoes, and blood haemoglobin phenotype.

 

How did the researchers interpret the results?

The researchers concluded “our data validate our field-to-lab-to -field-based strategy for the rational identification of vaccine candidates and support PfSEA-1 as a candidate for pediatric falciparum malaria. By blocking schizont egress [the infection being released from the red blood cell], PfSEA-1 may synergize with other vaccines targeting hepatocyte and RBC [red blood cell] invasion”.

In other words, although this vaccine appears to have a partial response, it might be highly effective if it was combined with additional vaccines that had other targets in the lifecycle of the plasmodia infection.

 

Conclusion

Using a combination of laboratory protein experiments, mouse infection studies, and human susceptibility cohorts, this research developed a new prototype vaccine targeting the PfSEA-1 protein.

This approach shows promise in partially reducing malaria infection in mice.

The vaccine appeared to mimic the natural resistance to malaria infection found in some children and adolescents living in malaria endemic regions of Tanzania and Kenya.

It is important to note that the vaccine was not 100% effective but, if developed successfully, it may still be useful if used in combination with other vaccines.

Though this looks hopeful, some candidate vaccines in the past have shown promise in animals such as mice and monkeys, but turned out not to work in humans.

This is a risk for this new vaccine as it hasn’t been tested in humans yet. There also may be side effects that mean the vaccine is not suitable for humans.

However, the new vaccine comes from a protein that has been shown to give naturally higher levels of malaria resistance in children. So this gives it a tentatively higher prospect of working in humans.

The likely next steps for the research were outlined by the study authors in the Independent, “our next destination is an active vaccination trial in monkeys, followed by phase-one trials in humans. We’d like to roll this out as quickly as we can”. This will provide the next stage of proof into whether it will work in high order mammals and humans.

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

Links To The Headlines

Immune children aid malaria vaccine hunt. BBC News, May 22 2014

High hopes for new malaria vaccine based on blood protein. The Independent, May 22 2014

New research brings hope for a malaria vaccine. Daily Express, May 23 2014

Malaria vaccine to be tested within four to six weeks. ITV News, May 23 2014

Links To Science

Raj DK, Nixon CP, Nixon CE, et al. Antibodies to PfSEA-1 block parasite egress from RBCs and protect against malaria infection. Science. Published online May 23 2014

Categories: Medical News

Could a compound found in cannabis treat epilepsy?

Medical News - Fri, 05/23/2014 - 15:00

"Cannabis could be used to help treat epilepsy," the Mail Online reports. A leading epilepsy medical journal has published a critical review summarising the evidence of the benefits of cannabis – specifically the compound cannabidiols – in preventing seizures. The review highlighted one thing: the evidence does not point to any clear answers.

The summary of evidence had a significant risk of bias because it did not employ systematic methods to identify all the relevant information on the topic. It is unclear whether important evidence was overlooked or ignored.

Nonetheless, it reached cautious conclusions. The review included tentative evidence that components of cannabis may help convulsions in humans and mice, but this evidence was patchy and very weak, so may be wrong. There were also reports of the compound making convulsions worse, as well as other negative side effects. 

The Mail Online referred to a recent example where cannabis extracts were used successfully to reduce seizures associated with SCN1A-confirmed Dravet syndrome in a young girl called Charlotte.

But individual successful cases don't provide strong enough evidence to expose large amounts of people to unknown risks. 

There are a range of health concerns associated with cannabis use, especially in the young, so any potential harms related to its medical use need to be considered carefully and cautiously.

 

Where did the story come from?

The summary of evidence was produced by researchers from the Comprehensive Epilepsy Center at the New York University School of Medicine.

The review was adapted from a conference called "Cannabidiols: Potential use in epilepsy and other neurological disorders" sponsored by GW Pharmaceuticals, a company described as having a "commercial interest in developing cannabidiols for the treatment of epilepsy and other conditions".

Some researchers involved in the review also declared funding links with GW Pharmaceuticals and other drug companies, as well as academic funding grants.

The review was published in the peer-reviewed medical journal, Epilepsia.

The Mail Online covered the story as if something new had been discovered. This appears to be linked to a case report about a girl who used cannabis successfully to reduce her epileptic seizures.

However, the main body of the research published in Epilepsia was a more general summary of the current evidence on cannabinoids and their potential relevance to epilepsy or other neuropsychiatric disorders.

 

What kind of research was this?

This was a critical review and commentary that attempted to present a summary of the current scientific evidence about the cannabinoid cannabidiol (CBD) regarding its use in the treatment of epilepsy and other neuropsychiatric disorders.

D9-Tetrahydrocannabinol (D9-THC) is the major psychoactive ingredient in cannabis and CBD is the major non-psychoactive ingredient in cannabis.

Epilepsy is a condition that affects the brain and causes repeated seizures, also known as fits. It affects more than 500,000 people in the UK, meaning that almost 1 in 100 people have the condition. Epilepsy usually begins during childhood, although it can start at any age. 

This research does not report to be a systematic review, meaning there is potential that key research (published or unpublished) may have been missed out. This represents a bias that may have affected the conclusions drawn.

systematic review would be a methodological improvement on this method, and is the most thorough and comprehensive way of reviewing a topic.

 

What did the research involve?

The report stated it was a summary of presentations from a conference where participants were invited to review relevant aspects of the physiology, mechanisms of action, pharmacology and data from studies with animal models and human subjects.

It was not clear if or how any additional evidence was compiled for the summary report. There was no description of the methods by which relevant literature on cannabis and epilepsy was searched or identified, and there was no mention of inclusion or exclusion criteria. As such, the summary appears to have been based solely on the conference presentations.

Because there was no systematic search of the literature available on the subject, there is a high risk of selection bias (cherry picking). This means relevant literature may have been missed, which could potentially lead to false conclusions.

 

What were the basic results?

The main points from the summary of the evidence included:

  • Cannabis and D9-THC appear to help stop convulsions (uncontrolled shaking of the body caused by muscle spasms) in most animal studies, but can make convulsions worse in some healthy animals.
  • In animal studies, CBD appears to help stop convulsions in the short term, but there haven't been many studies looking at its longer term use or effects.
  • The biological mechanism by which CBD reduces seizures is not known, although there are many theories.
  • CBD has neuroprotective and anti-inflammatory effects and appears to be well tolerated in humans, but small and methodologically limited studies of CBD in human epilepsy have been inconclusive.
  • Recent anecdotal reports of high-ratio CBD:D9-THC medical cannabis have claimed to work, but these studies were not controlled. This means they did not have a comparison group, so other non-cannabis effects may have accounted for the benefits, or they may have got better on their own.

 

How did the researchers interpret the results?

The researchers concluded that, "CBD bears investigation in epilepsy and other neuropsychiatric disorders, including anxiety, schizophrenia, addiction, and neonatal hypoxic-ischaemic encephalopathy."

But they went on to state that, "We lack data from well-powered double-blind randomised, controlled studies on the efficacy of pure CBD for any disorder."

 

Conclusion

The summary of evidence on the potential use of the active ingredients in cannabis to reduce epileptic seizures highlights one thing: the evidence does not point to any clear answers.

This summary also has a significant risk of bias because it did not employ systematic methods to identify all the relevant information on the topic.

Nonetheless, it reached cautious conclusions, highlighting the need for more robust information from randomised controlled trials (RCT) to inform the debate.

Some of the media reports were less cautious, but still reported the unclear picture around whether cannabis could be used medically to help people with epilepsy and whether it would be safe to do so.

The review included tentative evidence that components of cannabis may help convulsions in humans and mice, but this evidence is patchy and very weak. There were also reports of it making convulsions worse and having other negative side effects. 

Aside from the risk of bias, the evidence presented by the summary suggests that it is a compound found in cannabis that may have a protective effect against seizures, rather than cannabis itself.

The use of recreational drugs, especially stimulants such as cocaine and amphetamine, is not recommended for people living with epilepsy, as they can trigger the onset of seizures.

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

Links To The Headlines

Another medical use for cannabis as scientists find it helps reduce seizures in people with severe epilepsy. Mail Online, May 22 2014

Links To Science

Devinsky O, Cilio MR, Cross H, et al. Cannabidiol: Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. Published online May 22 2014

Categories: Medical News

Premature ejaculation 'doesn't just upset men'

Medical News - Thu, 05/22/2014 - 18:19

"Women suffer during premature ejaculation too," the Mail Online reports after a new study has assessed the psychological impact of premature ejaculation on women and how this may influence their perception of their relationship.

The website reports on a survey that investigated a group of almost 1,500 women aged 20 to 50 years old on their perceptions of and attitudes towards premature ejaculation.

A series of online questionnaires given to the women found that around 40% considered "ejaculatory control" to be extremely or very important. The study also found a significant relationship between the importance of ejaculatory control and the women's "distress".

Lack of attention to women's other sexual needs, such as caressing or kissing, was the most frequently reported (47.6%) reason for sexual distress. This suggests that penetrative sex is not the be-all and end-all of mutually satisfactory sexual relationships.

But this study's findings may not be representative of how women in the UK feel about premature ejaculation – only women from Mexico, Italy and South Korea were surveyed.

There is also a potential conflict of interest in this study, as it was funded by a pharmaceutical company that manufactures three drugs for premature ejaculation.

 

Where did the story come from?

The study was carried out by researchers from the University of Zurich in Switzerland, Versailles-Saint Quentin en Yvelines University in France, and other institutions in Australia and Germany.

The funding of the study was not clear, but some of the researchers are reported to have had research and advisory ties to Menarini, an Italian pharmaceutical company, and the lead researcher is a board member of the company.

This therefore represents a conflict of interest, as Menarini manufactures the drugs ranolazine, dapoxetine and avanafil, which are all used for erectile dysfunction.

The online survey was carried out by a market research company called GfK Eurisko. It is not clear if the women were paid for their participation, which could be a further conflict of interest as they could have been more likely to report that their partner had premature ejaculation if they were being paid for their time.

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

It was covered appropriately by the Mail Online, although the potential conflicts of interest were not outlined in the story.

 

What kind of research was this?

This was a cross-sectional study that involved surveying a group of women between April and June 2013 about their perceptions of ejaculation. 

A cross-sectional study looks at the characteristics of a population at a given point in time. This type of study is useful for finding out how common a particular condition is in a population or recording information in a population. For example, this could be studying perceptions about premature ejaculation in a select population.

Because this study only looks at one point in time, it cannot establish whether there is a cause and effect relationship between factors as it does not show which of them came first.

The authors report that to date, most studies that have explored attitudes and behaviours about premature ejaculation have focused on men and few have focused on the satisfaction of women.

They say evidence has shown a strong association between premature ejaculation and sexual dissatisfaction in both partners, but that it is not known what exactly causes this distress.

For example, is it the lack of ejaculatory control or the consequential factor that the man is distressed and therefore less focused on the sexual needs of the woman? Or possibly a combination of both?

 

What did the research involve?

The researchers surveyed 1,463 women from three countries (Mexico, Italy and South Korea) that belonged to a web-based consumer group from a market research company.

The women were all aged between 20 and 50 years. The researchers say three countries were selected to capture cultural differences.

To be included in the survey, women had to meet the following criteria:

  • be sexually active
  • have engaged in sexual intercourse with a man
  • consider themselves heterosexual or bisexual
  • have had sexual relationships predominantly with men or with both men and women equally

The women also had to answer yes to one of the following questions:

  • Are you currently with a man who ejaculates earlier than you would like him to?
  • Are you currently with a man who has been given the clinical diagnosis of premature ejaculation?
  • Are you currently with a man whose time from penetration until ejaculation is on average less than two minutes most of the time?
  • Has your current partner ever reported the wish to have more control over his ejaculation?

Premature ejaculation was considered if the man had self-reported it or through subjective assessment by the woman. No objective data was available for the diagnosis of premature ejaculation.

Validated and self-constructed online questionnaires were used to assess the women's perception of premature ejaculation, relationship satisfaction and quality, and sexual functioning and satisfaction.

Some of the questionnaires used a Likert-type scale to rank their response – when asked about feeling distressed by premature ejaculation, the response was ranked from "extremely" to "not at all".

Statistical methods were then used to analyse the survey data. Analyses were carried out on the whole group of women as well as the individual groups of women, depending on how they reported which of the four questions they answered yes to.

 

What were the basic results?

The average age of the women was 34 years and the average relationship status was 86 months (about seven years).

The majority of women included in the study (63.1%) reported that their partner had expressed the desire to have more control over his ejaculation, with 53.7% reporting they were with a man who ejaculates earlier than they would like.

Fewer than 10% of women reported being with a partner who had a clinical diagnosis of premature ejaculation.

The study's main findings were:

  • Around 40% of women considered ejaculatory control to be extremely or very important.
  • There was a significant relationship found between the importance of ejaculatory control and women's distress.
  • Women reporting fewer sexual problems considered ejaculatory control more important and reported more premature ejaculatory-related distress.
  • The man's lack of attention to her other sexual needs, such as caressing or kissing, was the most frequently reported (47.6%) reason for women's sexual distress, followed by the reported short time between premature ejaculation (39.9%) and lack of ejaculatory control (24.1%).
  • Almost a quarter of women reported that the man's ejaculatory problem had previously led to relationship break-ups.
  • Women who considered duration to be important were more likely to report relationship break-ups.
  • About half of the women (49.8%) reported having a sexual problem such as low libido, with 41.4% reporting sexual dissatisfaction. Of the women with a self-reported sexual problem, 78.6% stated they experienced these problems while being with a man who ejaculated prematurely.
  • When asked what their ideal sexual intercourse duration would be (not including foreplay), the pooled average response was about 23 minutes, ranging from 1 to 200 minutes.

 

How did the researchers interpret the results?

In their conclusions, the researchers say the study highlights the detrimental effects of premature ejaculation on relationships and a woman's sexual satisfaction. The effect can sometimes lead to termination of the relationship.

They say this is the first study to report that important sources of female stress are not only factors relating to performance, such as control or duration of sexual intercourse, but rather inappropriate attention focus and the negligence of other forms of sexual activity.

 

Conclusion

This type of study has investigated the attitudes and perceptions of premature ejaculation, surveying a relatively small number of women from three countries. The study included which aspects of premature ejaculation are most distressing to women.

Overall, the study shows that among this group of women, there was a significant relationship between the importance of ejaculatory control and their distress. 

As the study surveyed women from Mexico, Italy and South Korea, the findings may not be representative of how UK women feel about premature ejaculation.

There are other limitations of the study worth considering, including:

  • Premature ejaculation status was self-reported by the women, so not all of the women's partners may have met the clinical criteria for a diagnosis of premature ejaculation. That said, the researchers did ask the women if their partner had received a clinical diagnosis and less than 10% reported this was the case. The researchers also note that previous studies have shown that men over-report premature ejaculation and say this may be the case for women as well.
  • As this was a cross-sectional study, it cannot establish cause and effect, so the effect of premature ejaculation on female sexual functioning and relationship status cannot be determined. The study only highlights that there is an association, but other factors may be at play in this association.
  • It is not clear why – and is rather surprising – that the researchers from Switzerland, France, Australia and Germany did not survey women from any of these countries.
  • The potential conflict of interest that this study was funded by a pharmaceutical company that manufactures three drugs for premature ejaculation should not be ignored.

If you are troubled by premature ejaculation, the sensible first step is to ask your GP for advice. Aside from any difficulties that premature ejaculation causes your sex life, the condition can often be a symptom of a serious underlying health condition, such as type 2 diabeteshigh blood pressure or prostate disease, so further diagnosis is recommended.

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

Links To The Headlines

'Women suffer during premature ejaculation too': Psychologist reveals the frustration of the partners of men who are 'too tied up in their own (short-lived) pleasure'. Mail Online, May 21 2014

Links To Science

Burri A, Giuliano F, McMahon C, Porst H. Female Partner's Perception of Premature Ejaculation and Its Impact on Relationship Breakups, Relationship Quality, and Sexual Satisfaction. The Journal of Sexual Medicine. Published online April 29 2014

Categories: 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