Health in the News

Measles: Greater Manchester Reports Recent Spike in Confirmed Cases

2019-03-08T07:18:00.003-05:00

Doctors have urged people in Greater Manchester to make sure they and their children are vaccinated against measles after a sharp recent increase in cases.

Public Health England said there had been 32 confirmed cases across Greater Manchester so far this year.

At the end of January there had only been five confirmed cases.

"The majority of the cases are in unvaccinated children," said Dr Kristina Poole, from Public Health England North West.

Experts have warned in recent years that a rise in the number of measles cases may be linked to the controversy surrounding the MMR vaccine used to immunise people against it.

In 2018 there were 144 cases in Greater Manchester, up from 127 in 2017.

The government's chief medical advisor Prof Dame Sally Davies has insisted the MMR vaccine is safe.

She said uptake was "not good enough" and urged parents to ignore "social media fake news".

Dr Poole said the MMR vaccine both protected individuals against the measles virus and also limited its spread throughout the community.

"MMR is a highly effective and safe vaccine," she said.

According to data from the World Health Organization (WHO), the number of measles cases in Europe tripled between 2017 and 2018 to 82,596.

Measles is a highly contagious disease that in severe cases can lead to complications including blindness, pneumonia and infection and swelling of the brain.

The UK, which was declared free of the disease for the first time by the WHO in 2017, experienced small outbreaks last year.

Satisfaction With NHS 'Hits 11-Year Low'

2019-03-08T07:16:00.002-05:00

Public satisfaction with the NHS has fallen to its lowest level for over a decade, a long-running survey suggests.

The British Social Attitudes poll of nearly 3,000 people found 53% of in England, Scotland and Wales were satisfied with services last year.

That is a three percentage point drop since 2017 and the lowest level since 2007. A peak of 70% was seen in 2010.

Experts said waiting times and a lack of staff were major concerns as ratings for GPs dropped to an all-time low.

The findings of the survey have been released by the Nuffield Trust and King's Fund think tanks, which helped to provide analysis around the figures.

Ruth Robertson, from the King's Fund, said the issues identified by the public were "long-standing" problems that the government had not yet managed to deal with.

She pointed out the findings were even more interesting considering the public had been polled in the summer after the 70th anniversary of the creation of the NHS and at a time when the government had announced extra funding for the health service.

"There was no birthday bounce," she added.

Of those who were not satisfied last year, 30% said they were actively dissatisfied, with virtually all the rest being neither satisfied or dissatisfied. Less than 1% said they could not answer.

Being free at the point of use, the quality of care and the range of services and treatments available were the main reasons people expressed satisfaction.

Despite the drop in satisfaction, the rating was still well above the all-time low of 34%, which was recorded in 1997. The survey started in 1983.

How individual services compare
The poll also provided breakdowns for individual services.

It showed satisfaction with GPs was at it lowest level ever, at 63%, but that was still higher than dentistry and accident and emergency.

Prof Helen Stokes-Lampard, of the Royal College of GPs, said GPs always wanted to provide the best care they could, so it was "disappointing" to see the drop.

"We know that general practice is currently facing intense resource and workforce pressures and while GPs are working incredibly hard to combat these, we understand that many patients are still waiting too long to see their doctor - something we find just as frustrating," she added.

There were some encouraging signs, however, that when people did get to access hospital care, they were happy - as satisfaction ratings for outpatient services hit their highest levels ever, at 70%.

Meanwhile, satisfaction levels with social care, which is run by councils not the health service, were down, at 26%.

Although researchers said significant numbers - about one in 10 - did not express an opinion, suggesting people did not use these services or did not know what they were.

Niall Dickson, chief executive of the NHS Confederation, which represents health services, said: "These findings show the inevitable consequence of starving the NHS of funding for the best part of a decade.

"We should be under no illusions about the scale of the task we face to restore public confidence in the health service."

A spokeswoman for England's Department of Health and Social Care said the recently announced long-term plan coupled with the extra money would "safeguard" the future of the NHS.

Meanwhile, a Welsh government spokesman said other polling there showed satisfaction in Wales was higher- but, he added, there was "always more to be done".

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Being a Couch Potato is 'Bad for the Memory of Over-50s'

2019-03-04T14:32:00.001-05:00

Watching television for more than three-and-a-half hours a day could leave adults with a deteriorating memory, a study suggests.

Tests on 3,500 adults over 50 found that verbal memory decline was twice as bad in couch potatoes, compared to lesser TV watchers, over six years.

Our memory naturally gets worse as part of the ageing process.

But this happened faster the more TV was watched, University College London research found.

The researchers cannot be sure that TV was the cause of more rapid memory decline, but they say it could be that watching it for long periods stopped people from doing other more stimulating activities such as reading, and exercising.

The study, in Scientific Reports, found that those who watched television for more than three-and-a-half hours a day experienced, on average, an 8% to 10% decrease in verbal memory.

For those watching less than that per day, it was around 4% to 5%.

There was no evidence of TV having an impact on language fluency.

Puzzle solving 'won't stop mental decline'
Exercise 'benefits next generation'

Dr Daisy Fancourt, from the UCL Institute of Epidemiology and Health Care, said that while watching television may have educational and relaxation benefits, "overall this suggests that adults over the age of 50 should try and ensure television viewing is balanced with other contrasting activities".

Study participants, from England, were tested on how well they could remember a list of 10 common words and asked to list as many words in a particular category in one minute.

They were asked how much TV they watched each day and monitored from 2008-09 to 2014-15.

The research took into account other potential explanations for memory decline including lifestyle factors, and other behaviours, such as time spent sitting, and exercising.

Although the study did not ask people what they were watching on TV, some types of television could have a greater effect on cognitive decline, it said.

"Older people tend to like watching more soap operas, which can be stressful because they identify closely with the characters," says Prof Andrew Steptoe, from UCL.

"This may create cognitive stress which could contribute to memory decline."

Don't Panic

Prof Dame Til Wykes, professor of clinical psychology and rehabilitation from King's College London, said being a passive TV observer may be a potential explanation for the study findings.

"There is still a lot we don't know, such as whether memory reductions are affected by what we watch, whether we watch alone or whether you interact with the TV like those on Gogglebox. We also don't know whether changing behaviour would improve memory.

"Although this result will cause us to think carefully about screen time, a lot more research is needed before we panic and closely measure TV time like a step counter."

Dr Bob Patton, lecturer in clinical psychology, University of Surrey, said older adults (and their carers) should be mindful of too much time spent watching TV.

"While TV may not rot the brain as traditional wisdom may suggest, even moderate watching is associated with some very real changes among viewers aged over 50."

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Adolescent Health: Teens 'More Depressed And Sleeping Less'

2019-03-04T14:26:00.003-05:00

Adolescents are more likely to feel depressed and self-harm, and are less likely to get a full night's sleep, than 10 years ago, a study suggests.

Yet smoking, alcohol and anti-social behaviour - often linked to mental health problems - were less common for 14-year-olds in 2015 than in 2005.

Factors behind mental health problems may be changing, the University College London researchers said.

The rise in depressive symptoms was "deeply worrying", a charity said.

Researchers from London and Liverpool analysed data from two large cohorts of 14-year-olds - the first group from around Bristol, born in 1991-92, and the second from across the UK, born in 2000-01.

There were 5,600 young people surveyed in the first group and 11,000 in the second.

In 10 years, based on a standard questionnaire on mood and feelings, levels of depression in this age group rose from 9% to 15%.

Adolescents who said they had hurt themselves on purpose rose from 12% to 14%. The rate of increase was similar for boys and girls, although girls are more likely to self-harm.

How the health and behaviour of teenagers has changed over 10 years, 2005-15

Study based on two surveys of 14-year-olds

While obesity and poor body image also rose, fewer 14-year-olds in 2015 had tried alcohol, binge drinking, smoking and having sex - compared with those surveyed a decade before.

They were also less likely to have tried cannabis or other drugs - 4.3%, down from 5%.

When it came to sleeping, the 2015 cohort were more likely to go to bed later and wake up earlier, meaning that more of them slept less than the recommended eight hours for teenagers.

Dr Praveetha Patalay, associate professor at UCL and co-author of the study in the International Journal of Epidemiology, said the research gave a bigger picture of adolescent health, not only mental health in isolation.

"It's a holistic view, with some things getting worse and some improving.

"We have to remember that lots of things are changing for young people - in different directions."

She said that although the study could not pinpoint causes of mental health difficulties, it could be valuable in identifying what the risk factors are for mental health problems.

In her early teenage years Lauren Nicole Coppin Campbell, now 21, began to suffer with body image and low self-esteem.

For her, the images of people she was seeing on social media and in popular culture had a negative impact.

"I didn't feel like the people I was seeing on my feed we're representative of me.

"You rarely saw curvy, chubby, black women or girls who were being portrayed as beautiful or intelligent.

"On social media or other media you often see stereotypes - the bigger woman is the comedian, the funny person you laugh at or who you feel sorry for."

Before she was 16, she began forcing herself to be sick in a bid to obtain what she calls a "twisted image of perfection."

At times it felt like there was no escape.

"It isn't just online," she added.

"You can go to school or see friends on the weekend and they might start talking about Kylie Jenner or whoever else who may make you feel you're lesser than."

Lauren is now working as a plus size model and is an ambassador for The Be Real Campaign.

Emma Thomas, chief executive of charity YoungMinds, said the rise in 14-year-olds self-harming or experiencing depressive symptoms was "deeply worrying".

"The factors behind mental health problems are often complex, but we know that stress at school, bullying, concerns about body image, and the pressures associated with social media can all have a big impact," she said.

"To make matters worse, it's often far too difficult for young people to get mental health support, which means that their problems can escalate unnecessarily."

Dr Bernadka Dubicka, chair of the child and adolescent faculty at the Royal College of Psychiatrists, said: "This study provides further confirmation that young people today are struggling with mental health problems more than their 90s counterparts.

"The sharp rise in levels of depression and the increase in self-harm are worrying, as are the concerns our young people have around their body image."

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'Tiniest Baby Boy' Ever Sent Home Leaves Tokyo Hospital

2019-03-04T14:20:00.002-05:00

A baby boy who weighed just 268g (9.45oz) at birth has been released from hospital in Japan, and is believed to be the smallest boy in the world to have been successfully treated.

The baby was born by emergency C-section in August, and was so small he could fit into a pair of cupped hands.

The infant was nurtured in intensive care until he was released last week, two months after his due date.

He had grown to a weight of 3.2kg, and is now feeding normally.

Born at 24 weeks, the tiny boy spent five months in hospital.

"I can only say I'm happy that he has grown this big because honestly, I wasn't sure he could survive," the boy's mother said, according to Tokyo's Keio University Hospital.

Doctor Takeshi Arimitsu, who treated the extraordinary baby, told the BBC he was the smallest infant born (on record) to be discharged from a hospital, according to a database of the world's littlest babies held by the University of Iowa.

He said he wanted to show that "there is a possibility that babies will be able to leave the hospital in good health, even though they are born small".

The previous record-holder was a boy born in Germany, weighing 274g. The smallest surviving baby girl in that same database was also born in Germany, in 2015, and reportedly weighed 252g.

'I didn't think she would see Christmas'
Parents' care 'can help' premature babies

Keio University Hospital said the survival rate of babies born weighing less than a kilogram is about 90% in Japan. But for those born under 300g, that falls to around 50%.

Among the very smallest babies, the survival rate is much lower for boys than girls. Medical experts are unsure why, though some believe it could be linked to the slower development of male babies' lungs.

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Pesticides, Other Environmental Pollutants Advance Progression of ALS

2019-03-02T19:21:00.001-05:00

While exact causes of amyotrophic lateral sclerosis (ALS) remain unknown, new research shows pesticides and other environmental pollutants advance the progression of the neurodegenerative disease.

The latest study from the University of Michigan ALS Center of Excellence, recently published in the Journal of Neurology, Neurosurgery Psychiatry (a BMJ journal), supports the group's 2016 research that found increased levels of numerous pesticides in blood tests of people with ALS, says senior author Eva Feldman, M.D., Ph.D., director of U-M's ALS Center of Excellence.

"Our latest publication shows that other toxins like polychlorinated biphenyls, known as PCBs, are also elevated in ALS patients and correlate with poor survival," says Feldman, a Michigan Medicine neurologist. "Our research shows that environmental pollution is a public health risk that we believe must be addressed." ALS, also known as Lou Gehrig's disease, is a rapidly progressive disease that causes people to lose their ability to move their limbs and body.

For the study, each of the 167 U-M patients had blood drawn shortly after being diagnosed with ALS. They were then divided into quartiles based on the concentration of pollutants in their bloodstream. The quartile with the highest amount of pollutants had a median survival time of 1 year and 11 months from the initial date of ALS diagnosis. Meanwhile, the quartile with the lowest concentration of pollutants had a months-longer median survival time at 2 years, 6 months.

"Our concern is that not only are these factors influencing a person's likelihood to get ALS, but also speeding up disease once they have it," says Michigan Medicine neurologist Stephen Goutman, M.D., M.S., the study's primary author and the director of U-M's ALS clinic.

High Rate of Disease in Michigan

Michigan Medicine researchers are uniquely poised to study the origins of ALS in the search for more effective treatments and, eventually, a cure. Feldman says Michigan has one of the highest rates of ALS in the country, according to the Centers for Disease Control and Prevention.

"'Why us? Why Michigan?' We believe the answer may lie in the fact that Michigan is both an industrial and agricultural state," says Feldman, who founded Michigan Medicine's ALS Center of Excellence in 1998.

Throughout Michigan's farming history, a variety of persistent environmental chemicals have been used in pesticides. These chemicals are absorbed into the ground and can potentially reach water supplies. While harmful pesticides have been identified and banned, such as DDT in 1972, their consequences persist, taking decades to degrade in some cases. These chemicals can accumulate in the sediments of rivers and the Great Lakes, as well as in the fish that populate them.

Michigan's industrial activities have placed the state among the top five generators of hazardous waste in the U.S., with 69 designated Superfund sites. PCBs, which are non-flammable, man-made chemicals used in electrical and hydraulic equipment, were in use until 1979. Similar to pesticides, these industrial chemicals degrade slowly, can leech into the ground and may affect the environment for decades to come.

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"If these chemicals are getting into the water bodies, such as lakes and rivers, in Michigan, this could be a source of exposure for everybody," Goutman says. "These persistent environmental chemicals take a long time to break down, sometimes decades. Once you're exposed they may accumulate in your body. They get into the fat and can be released into the blood. We're particularly concerned about ALS patients who have been exposed to higher amounts of these chemicals."

"As pollution changes the environment, we are being exposed to more and more toxins. We don't yet know how this is going to contribute to human disease over time. As we look at more toxins, we want to identify those that are of greater significance in terms of disease onset or progression," Goutman adds.

"If we can determine what these chemicals are doing to our organs, brains and motor neurons, then we can develop drugs to counteract those effects."

Improve Quality of Life, Advance the Research

ALS has no cure, but two FDA-approved medications, riluzole (also known as Rilutek) and edaravone (also known as Radicava), are shown to have modest effects in slowing disease. Goutman says using non-invasive ventilation - a ventilator that's connected to a mask that covers the nose, nose and mouth, or entire face - is an extremely effective therapy for ALS. It's reported to increase survival by 13 months on average. Also, it is important to not overlook other related symptoms in ALS and treat these to improve quality of life and to address mobility and safety, which Goutman discussed in a recent Facebook Live presentation.

Feldman says future research will continue to address the question her patients most frequently ask: "Why did I get this disease?" A clear understanding of the development of ALS will help researchers work toward a cure.

Next, the team plans to study a new cohort of patients in U-M's clinic. Repeating similar results would further validate their findings, they say, establishing the framework for a national study. The scientific team has also received funding from the Center for Disease Control to understand the metabolism and interactions of pesticides and pollutants in ALS patients, and how specific metabolites correlate with disease onset, progression and survival. Feldman says understanding the metabolism of pesticides will lead to drug discovery.

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Prenatal Vitamins May Reduce the Risk of Autism in High-Risk Families

2019-03-02T19:17:00.004-05:00

Researchers at the University of California have found that mothers of children with autism spectrum disorder (ASD) may be able to reduce the risk of autism in further offspring by taking prenatal vitamins during their first month of pregnancy.

Study author Rebecca Schmidt and colleagues believe this is the first study to suggest that maternal use of prenatal vitamins may reduce ASD recurrence in siblings of children with ASD in high-risk families.

According to the Public Health Agency of Canada, about one in every 66 Canadian children and adolescents aged 5 to 17 years has ASD.

Previous studies have shown that younger siblings of children with ASD are up to 13 times more likely to be diagnosed with the condition than the general population.

For the current research, Schmidt and team recruited participants from the Markers of Autism Risk in Babies: Learning Early Signs (MARBLES) cohort study and evaluated 241 children whose older siblings had ASD.

As reported in the journal JAMA Psychiatry, the prevalence of ASD among children of mothers who took prenatal vitamins during the first month of pregnancy was 14.1%, compared with a prevalence of 32.7% among children whose mothers did not take the vitamins during that time.

Schmidt says scientist still need to find out how prenatal vitamins may be reducing the risk of ASD, but that it is already known that vitamins such as folic acid are essential for brain development and many of the pathways that may influence autism risk.

"It's recommended already that moms take prenatal vitamins, or folic acid supplements, starting before pregnancy to catch this early developmental window," she says.

Pediatrics professor Lonnie Zwaigenbaum from the University of Alberta called the findings "remarkable."

For the growing number of families who have a child with autism and are looking ahead to future pregnancies, they're really demonstrating that the potential reduction in absolute risk is really quite significant." - Lonnie Zwaigenbaum.

Schmidt and colleagues say that additional research is now needed to confirm and investigate the findings in order to inform public health recommendations for ASD prevention in affected families.

Schmidt, R., J., et al. 2019. Association of Maternal Prenatal Vitamin Use With Risk for Autism Spectrum Disorder Recurrence in Young Siblings. Jama Psychiatry.

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Sustained Smoking Cessation Can Lower Risk of Seropositive RA

2019-02-27T12:39:00.001-05:00

Analysis of data demonstrates first time that behaviour change can delay or prevent most severe form of rheumatoid arthritis.

Smoking is an important risk factor for developing the most common form of rheumatoid arthritis (RA) and other inflammatory diseases, but a critical question remains: Can those who quit smoking delay or prevent RA or have they permanently and irrevocably altered their risk of the disease?

A new study by investigators from Brigham and Women's Hospital leverages data from the Nurses' Health Studies to find out. Their findings, which appear in Arthritis Care & Research, demonstrate for the first time that changing behaviour - in this case, sustained smoking cessation - can reduce risk of developing seropositive RA, the more severe form of the disease.

"Ours is the first study to show that a behaviour change can reduce risk for seropositive RA. Risk isn't just about genes and bad luck - there's a modifiable environmental component to the onset of this disease and a chance for some people to reduce their risk or even prevent RA," said corresponding author Jeffrey Sparks, MD, MMSc, of the Division of Rheumatology, Immunology and Allergy at the Brigham.

To conduct their study, Sparks and colleagues used data from the original Nurses' Health Study, established in 1976, and Nurses' Health Study II, a second cohort established in 1989. Both groups include registered nurses from across the U.S. who filled out health surveys every two years with questions that included information about smoking and health status.

Among more than 230,000 participants in this analysis, the researchers identified 1,528 who developed RA. The research team was especially interested in the 969 "seropositive" as opposed to "sero-negative" cases. Patients with seropositive RA have auto-antibodies related to RA, and generally have more severe disease manifestations, including joint deformities and disability.

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For seropositive RA, risk began to go down about five years after women quit smoking and continued to decrease the longer they stayed non-smokers. Participants who quit for good reduced their risk of seropositive RA by 37 per cent after 30 years. The team did not find any association between sero-negative RA and smoking, adding further evidence to the theory that sero-negative and seropositive RA may be two distinct diseases with distinct risk factors.

"One of the lessons here is that it takes sustained smoking cessation to reap the full benefit," said Sparks. "Whereas for other diseases, such as cardiovascular disease, quitting smoking can provide a more immediate effect, here we're seeing benefits decades later for those who quit smoking permanently."

While the biological mechanisms that link smoking and the development of RA are unclear, Sparks and others think that smoking may affect a preclinical disease process that leads to the formation of RA-related auto-antibodies and increases inflammation.

In addition to further studying the biology of RA, Sparks and colleagues want to extend their investigations to include men and interventional trials among active smokers to see if it is possible to prospectively prevent the formation of RA-related auto-antibodies and the progression of the disease among those at increased risk.

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Autism-Anorexia Link 'Must Be Acted On'

2019-02-27T12:32:00.005-05:00

The NHS must change the way it assesses eating disorders to take account of a link with autism, a research charity has said.

Autistica said findings suggested one in five women presenting to UK clinics with anorexia may also have autism and tailored therapy was vital.

One woman said her autism had made her "obsessed" with counting calories, even though she did not want to lose weight.

Health watchdog NICE said more research was required.

Sophie McInnes, 24, told the BBC's Victoria Derbyshire programme her anorexia had developed not from issues surrounding body image or weight but because she had developed a set of rules for herself about how many calories she could eat.

She said she had wanted to put on weight but her autism - at that stage undiagnosed - had meant she would not let herself.

"It was all about the calories, all about the numbers," she said, having begun to write down what she was eating aged 19.

"I actually admitted myself into the eating disorder unit because I had started exercising a lot and I wasn't eating anything.

"They put me in a wheelchair and said my weight was so low that if I didn't eat, I would need to be sectioned."

Eventually, Sophie left the unit but she continued to struggle to gain weight.

It was only several years later, in 2018, that she was diagnosed with autism.

Had the link been spotted sooner, she said, it would have helped her recovery.

"It's just taken away a big chunk of my life so far, and I want to move on," she said.

More Research Needed

Autistica's director of science, Dr James Cusack, said is calling for new guidelines from the National Institute for Health and Clinical Excellence (NICE) to reflect this.

Currently, the guidelines do not contain any mention of autism.

"We also need more NHS services involved in research," Dr Cusack said, "both informing studies and carrying out trials in eating-disorder care settings."

His proposal has the backing of former Health Minister Norman Lamb.

The Lib Dem MP told the Victoria Derbyshire programme it was "vital" that practice caught up with research.

"We may well be applying inappropriate care to women with both conditions," he added.

NICE said in a statement that it recognised factors such as autism needed to be taken into account with regards to eating disorders, but there was currently "very little" evidence on whether the intervention of health professionals needed to be modified in such cases.

NHS England has been approached for comment.

Will Mandy, a leading autism researcher, from University College London, said part of the issue was that women and girls were much less likely than men to be recognised as having autism in the first place.

And he believes that the "high levels of stress and anxiety" caused by the condition going undiagnosed in childhood and adolescence can contribute to people experiencing severe mental health conditions, such as eating disorders.

Recognition among health professionals of the autism-anxiety link was key, he said.

"If you don't know somebody is autistic, it becomes quite hard to help them and to adapt treatment to being autistic," Mr. Mandy said.

A tailored approach can include simple changes, such as making communication easier and the environment friendlier.

Caroline Norton, from South London and Maudsley NHS Trust's Eating Disorder Service, said its autistic patients might have one-to-one sessions - to remove the noise of others in the same space - where they learned to make food with a dietician.

Healthcare professionals can also try to make patients more comfortable.

One of the service's former patients, Ms Norton said, would hardly communicate with the therapist face-to-face but would instead send a long response via email shortly after the session - so they learned from this.

"It's about meeting the individual at the level that they need," she added.

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Cannabis Use in Teens Linked to Depression

2019-02-27T12:28:00.002-05:00

Parents should not be complacent about the risks of teenagers using cannabis, experts are warning.

UK and Canada researchers said they had found "robust" evidence showing using the drug in adolescence increased the risk of developing depression in adulthood by 37%.

They said the findings should act as a warning to families who saw cannabis use as part of the growing-up process.

The team added that the developing brain was particularly susceptible.

The researchers - from University of Oxford and Montreal's McGill University - said cannabis use in the young was an "important public health issue", particularly given that cannabis available today tends to be much stronger than it was previously.

Around one in nine young adults and teenagers use the drug each year in England and Wales.

Report author Prof Andrea Cipriani conceded some parents had a relaxed attitude to the drug, but added the evidence was clear.

"This is important information for parents and teenagers. The risk is modest, but it can have a devastating impact."

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How Risky is Cannabis?

This is the first time the actual risk has been quantified in this way.

The team looked at 11 previous studies, covering more than 23,000 young people, the journal JAMA Psychiatry reported.

Young people who had already shown signs of depression or had a family history of the condition were excluded.

It found cannabis use before 18 increased the chance of an individual developing depression in young adulthood - defined as before the age of 35 - by 37%.

In terms of numbers that means around one in 14 cases of depression in that age group - around 60,000 in the UK - could be attributed to drug use in the teenage years.

The study also looked at whether there was an association with anxiety and suicide attempts.

There was an increased risk of anxiety developing in young adulthood, but it was not considered statistically significant.

Meanwhile, those who used cannabis in their teenage years were three times more likely to try to kill themselves - although the data on that trend was not considered robust enough to draw a firm conclusion.

So is This Proof?

No. The researchers were unable to prove cannabis use was definitively causing depression.

Instead, they could only say it looked to be a strong link.

This is because of the figures they found, but also what is known about the impact cannabis has on the developing brain.

Evidence has suggested that the drug affects the parts of brain that govern rational and emotional thinking as well as serotonin levels that influence mood.

To prove the link, trials would have to be conducted on young people - something that will never be done because it is unethical.

King's College London psychiatrist Prof Sir Robin Murray said the research could not be considered conclusive, but acknowledged the findings were "probably correct".

He said the risk of developing depression was smaller than what has already been established for schizophrenia-like psychosis.

He also said it was likely that any risk would be also down to the amounts of cannabis consumed and the strength - something this study was unable to unpick.

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Onions and Garlic Could Protect Against Cancer

2019-02-24T21:21:00.002-05:00

Aside from their ability to inject deep flavour into almost any meal, onions and garlic might also protect against cancer, according to a recent study.

A recent study adds to the evidence that allium vegetables reduce cancer risk.

Garlic, onions, leeks, chives, and shallots are classed as allium vegetables.

They are grown throughout much of the world and form the bedrock of family meals far and wide.

Earlier studies have shown that certain compounds in allium vegetables - including flavanols and organosulfur compounds - are bioactive.

Some have been shown to hinder the development of cancer.

Scientists from the First Hospital of China Medical University recently set out to understand whether consuming greater amounts of these vegetables might prevent people from developing colorectal cancer. They recently published their results in the Asia-Pacific Journal of Clinical Oncology.

Not counting skin cancers, colorectal cancer, also called bowel cancer, is the third most common cancer diagnosed in men and women in the United States.

Researchers are aware of certain dietary risk factors, such as consuming high levels of red or processed meats. However, they know less about foods that might protect against bowel cancer.

Unpeeling the Onion

Scientists have already investigated whether allium vegetables could reduce bowel cancer risk. Although some have identified a significant effect, others have found either a small interaction or none at all.

The authors of the latest study believe that the variation in results is partly due to how data was collected. For instance, some studies combined all allium vegetables into one group for analysis, and others did not include data from some, less common, types of allium vegetable.

With this in mind, the researchers designed a study that would more faithfully capture the impact of allium vegetables on colorectal cancer risk.

To investigate, they matched 833 individuals with colorectal cancer with 833 control participants without it, who were similar in age and sex and who lived in similar locations.

Each participant was interviewed, and their dietary habits were recorded using a validated food frequency questionnaire.

The Benefits of Allium Vegetables

The researchers found that, as theorized, there was a significant relationship between the level of allium vegetables that an individual consumes and their risk of colorectal cancer.

Specifically, in adults who consumed the highest levels of allium vegetables, the risk of developing colorectal cancer was 79 percent lower than those who consumed the lowest levels.

"It is worth noting that in our research there seems to be a trend: the greater the amount of allium vegetables, the better the protection." - Senior author Dr. Zhi Li.

The inverse relationship was seen in the overall consumption of allium vegetables, as well as in specific types, namely garlic, garlic stalks, leeks, onions, and spring onions.

The correlation was also significant in both men and women. This is interesting because, in some earlier studies, differences were seen between the sexes. For instance, one study found a weakly protective effect in women and a slight increase in colorectal cancer risk in men.

As previously mentioned, past research into allium vegetables and colorectal cancer risk produced conflicting results. However, evidence in favor of the relationship is now growing.

For instance, a study with Southern European participants found "an inverse association between the frequency of use of allium vegetables and the risk of several common cancers."

Similarly, a meta-analysis assessed links between allium vegetable intake and the presence of adenomatous polyps, which are precursors of colorectal cancer.

The authors concluded that "high intake of total allium vegetables may be associated with a risk reduction of colorectal adenomatous polyps."

A Simple Dietary Change

Dr. Li believes that this group of vegetables provides a simple lifestyle change that could help reduce the risk of colorectal cancer.

Of course, consuming these vegetables alone will not reduce risk in a meaningful way, but used in conjunction with other dietary changes, they might make a difference.

The debate is likely to continue for some time; there is a dizzying array of reasons why allium-rich diets may seem (or not seem) to impact cancer risk. For example, how a vegetable is cooked can significantly alter its chemical composition.

This might help explain why studies conducted among different global populations had differing results; future studies would do well to take this into account.

Conclusions cannot yet be drawn, but, if the results are replicated, adding extra onions and garlic to our dishes may be a tasty way to reduce colorectal cancer risk.

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Blueberries May Lower Cardiovascular Risk By Up to 20 Percent

2019-02-23T21:40:00.001-05:00

The phytochemicals that give blueberries their blue color can significantly improve cardiovascular health, finds a new two-part study.

The positive effect that blueberries can have on blood pressure is comparable to that of hypertension drugs.

Dubbed "the silent killer" because it has no visible symptoms in its early stages, hypertension affects approximately 1 in 3 adults in the United States.

The condition puts a strain on the cardiovascular system, which in the long run may contribute to heart failure, stroke, and kidney failure.

The National Institutes of Health (NIH) recommend that people with high blood pressure stay in control of the condition by eating healthfully, exercising, not smoking, and maintaining a healthy weight.

But should you eat anything in particular to keep your arteries healthy? In a previous Spotlight feature, we rounded up 16 foods that studies have suggested can improve cardiovascular health.

Along with broccoli, spinach, pulses, and fish, berries may also reduce heart disease, due to their antioxidant polyphenols.

New research zooms in on the cardiovascular effects of blueberries and finds that anthocyanins - the phytochemicals that give blueberries their color - mediate the beneficial effects that this fruit has on the cardiovascular system.

The lead author of the study is Ana Rodriguez-Mateos, Ph.D., from the Department of Nutritional Sciences at King's College London, in the United Kingdom. The researchers published their findings in The Journals of Gerontology: Series A.

Anthocyanins and Blood Pressure

Rodriguez-Mateos and her colleagues recruited 40 study participants who were in perfect health and randomly divided them into two groups: One received a daily drink consisting of 200 grams (g) of blueberries, and another group received a control drink.

To examine the effects of the blueberries, the researchers took the participants' blood pressure and measured the flow-mediated dilation (FMD) of their brachial arteries.

FMD is a standard indicator of cardiovascular risk; it measures how much the brachial artery widens when blood flows at a higher rate.

In the second part of the study, the researchers compared drinking blueberries with drinking purified anthocyanins or control drinks that had concentrations of fiber, minerals, or vitamins equivalent to those in blueberries.

Blood pressure decreases by 5 mm Hg

The scientists noticed the beneficial effects of the blueberry drinks only 2 hours after the participants had consumed them.

"Purified anthocyanins exerted a dose-dependent improvement of endothelial function in healthy humans, as measured by [FMD]," report the authors.

The endothelium is a type of membrane inside the heart and blood vessels. It contains endothelial cells that help control the dilation and contraction of the arteries.

Endothelial cells also help keep blood pressure in check and play a key role in blood clotting.

The authors continue, "[t]he effects were similar to those of blueberries containing similar amounts of anthocyanins, while control drinks containing fiber, minerals, or vitamins had no significant effect."

After a month of having 200 g of blueberries each day, the participants' blood pressure decreased by 5 millimeters of mercury (mm Hg), on average. The researchers note that such a decrease is usually obtained with medication.

"Our results identify anthocyanin metabolites as major mediators of vascular bioactivities of blueberries and changes of cellular gene programs," conclude the researchers.

Rodriguez-Mateos comments on the findings, saying, "although it is best to eat the whole blueberry to get the full benefit, our study finds that the majority of the effects can be explained by anthocyanins."

The scientists explain that anthocyanins "circulate in [the] blood as phenolic acid metabolites."

"If the changes we saw in blood vessel function after eating blueberries every day could be sustained for a person's whole life, it could reduce their risk of developing cardiovascular disease by up to 20 percent." - Ana Rodriguez-Mateos.

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Flu Vaccine 'Working Better for Children'

2019-02-22T22:27:00.002-05:00

The flu vaccine is so far proving more effective in children than in adults in the UK, mid-season figures suggest.

The nasal spray flu vaccine is 87% effective in children aged two to 17 against the main circulating flu strain, influenza A(H1N1)pmd09, Public Health England data indicates.

Meanwhile, the flu vaccine is 39% effective against the same strain in adults aged 18 to 64.

No data is yet available for the over-65s or for other flu strains.

The data shows that more children than ever are being vaccinated, although take-up is lower in younger age groups.

The figures are preliminary and are subject to being revised by the end of the flu season in May, when more data is available.

Some 43% of two-year-olds have been vaccinated, compared with 45% of three-year-olds.

Among school-aged children, 56% to 64% have been vaccinated, depending on the year group.

Last year's final figures for the whole flu season of 2017-18 showed that the vaccine was only 15% effective among all age groups.

This included effectiveness of about 27% in children aged two to 17, 12% among people in at-risk groups aged 18 to 64, and 10% in those aged 65 and over.

For this latest flu season, a new "booster" vaccine has been brought in to improve effectiveness among the over-65s.

'Super-Spreaders'

Dr Mary Ramsay, head of immunisation at PHE, said: "It is encouraging to see that this year's vaccines are offering a high level of protection against the main circulating strain of flu - particularly for children.

"Children tend to be 'super-spreaders' of flu and so protecting them is crucial for protecting the rest of the population.

"We're pleased that more parents have been taking up the offer of vaccination for their children and encourage anyone who is eligible to do so every winter.

"It's the best defence we have against this unpredictable virus."

Health Secretary Matt Hancock said: "The most basic instinct for any parent is to do whatever they can to protect their child. Vaccinations save countless lives and are absolutely vital.

"More children have been vaccinated this year to protect against flu and it is a positive sign that the vaccine itself appears to be more effective than in previous years.

"Our world-leading vaccination programme saves lives and I urge all parents of young children to make sure their child is vaccinated against flu and other childhood diseases."

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Provide Sanitary Products Free in All Hospitals, Says Doctors' Union

2019-02-22T22:23:00.002-05:00

Two out of five hospital trusts and health boards in the UK do not give sanitary products to patients who need them, or only in emergencies, an investigation by the BMA has found.

The doctors' union says pads and tampons are a basic need and should be available free to inpatients.

But in some trusts, razors and shaving foam were handed out free while sanitary products were not.

The BMA has written to NHS England asking for action to be taken.

The BMA asked a total of 223 trusts and health boards across the UK about the policy towards supplying sanitary products.

Out of 187 who responded, 104 said they did supply them.

But 25 said they did not supply them at all and 54 said they did, but only in emergencies or in small amounts.

None of the trusts and health boards which responded said they had a policy on when sanitary products were handed out.

And at 27 trusts, there was nowhere to buy sanitary products anywhere on site.

The BMA's investigation is part of a wider campaign to end period poverty, which focuses on making sanitary items more affordable.

Eleanor Wilson, a member of the BMA medical students' committee, said: "When patients are under our care in the NHS, we need to make sure that we make them feel as welcome and as looked after as possible.

"By not providing them with something so key to their health and wellbeing, it has a big impact on their sense of self-worth - we are effectively withholding that dignity from them.

"While some hospitals have good provision, in others, patients have had to face embarrassment and hope that relatives can bring them in.

"For some that is not an option, and it can often become more challenging for young and teenage paediatric patients."

She said sanitary products should be part of a basic package including toilet paper, food, razors and shaving foam, made available to patients when they go into hospital.

Tackling Period Poverty

The BMA also says the impact on the wellbeing of a patient far outweighed the relatively small cost to the NHS.

Prof Dame Parveen Kumar, chair of the BMA board of science, said hospitals should provide clear information on how patients can access sanitary products during their stay in hospital.

"Hospitals have an opportunity to lead the way in tackling period poverty and should be a shining example of the progress that can be made on this important issue."

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More Over-75s Should Take Statins, Experts Say

2019-02-01T21:42:00.000-05:00

More people over the age of 75 should be taking statins, scientists have said, following a review of research.

There had been a lack of evidence about how much the cholesterol-lowering drugs benefit this age group.

But the review found they cut the risk of major cardiovascular disease in all ages studied, including the over-75s.

Researchers said thousands of lives could be saved each year if more than the estimated third of UK over-75s who do take statins, were given them.

They also said it could improve quality of life for many people.

Cardiovascular disease kills about 150,000 people in the UK each year, with two-thirds of these occurring in people over the age of 75.

Statins reduce the build-up of fatty plaques that lead to blockages in blood vessels, though reported side effects and the extent of how often they are prescribed has attracted controversy.

Side Effects 'Massively Outweighed'

The review, which looked at 28 randomised controlled trials - often called the "gold standard" of studies - involving nearly 190,000 patients, found statins lowered the risk of major cardiovascular disease in the ages studied, from under-55s to over-75s.

There were similar reductions in risk for stroke and for coronary stenting or bypass surgery.

Authors of the paper said there had until now been an "evidence gap" around how effective the drugs are for the elderly.

They estimate that about a third of the 5.5 million people in the UK over 75 take a statin, when the "vast majority" of these would meet the medicine regulator's guidelines for being prescribed the drug.

Prof Colin Baigent, one of the authors of the paper, said: "One of the issues we have is that very often doctors are unwilling to consider statin therapy for elderly people simply because they're old, and that, I think, is an attitude that is preventing us from making use of the tools we have available to us."

The benefits were strongest in people who have already had vascular disease. There wasn't enough data in people over the age of 75 who haven't had it to show a benefit. Experts have called for more data to guide prescription for these people.

However, the authors said even a smaller reduction in risk was significant because the elderly have a higher baseline risk for cardiovascular disease in the first place.

The more people reduced their low-density lipoprotein (LDL), or "bad" cholesterol, the more the risk of cardiovascular disease was lowered, the study found.

A 1.0 mmol/L reduction in LDL cholesterol lowered the risk of major vascular events by about a fifth and a major coronary event by a quarter, when results from all age groups were combined.

To put this into perspective, about 2.5% of 63-year-olds with no history of vascular disease would be expected to have their first major vascular event per year, compared with 4% of 78-year-olds.

Reducing those risks by a fifth would prevent first major vascular events from occurring each year in 50 people aged 63 and 80 people aged 78 per 10,000 people treated.

Prof Baigent said there was an argument for giving statins to people over the age of 75 who have a "normal" level of LDL cholesterol.

He said: "In many circumstances, the person may be very healthy, they may be able to avoid having a stroke or having a heart attack simply by taking a cheap and safe tablet every day.

"That may be a choice they're willing to take. At the moment I feel we're not taking the opportunity to offer that."

'Reassuring'

There has been controversy about statin side effects and how often they are prescribed, especially in otherwise healthy people.

Common side effects include muscle pain, increased risk of type 2 diabetes and digestive problems.

It is possible to lower cholesterol levels without drugs by making lifestyle changes, such as by cutting down on saturated fat and eating more fruit, vegetables and fibre.

Prof Baigent said side effects were "massively outweighed, both in middle age and the elderly, by the benefits of statin therapy that we already know about".

And he also said he was not calling for people to pick statins over exercise and lifestyle changes.

"I think it's not an either/or," he added.

The Royal College of GPs welcomed the research and said it was "particularly reassuring" to see evidence of the benefit of statins in over-75s.

Prof Martin Marshall, vice-chairman of the college, said some patients would not want to be on long-term medication.

"But GPs are highly trained to prescribe and will only recommend the drugs if they think they will genuinely help the person sitting in front of them, based on their individual circumstances - and after a frank conversation about the potential risks and benefits."

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Health Screening 'Not Meeting Targets', Report Finds

2019-02-01T21:38:00.001-05:00

None of the three main health screening programmes in England - for bowel, breast or cervical cancer - met their targets last year, according to a report by the National Audit Office.

There were also delays in cervical screening results reaching half of women tested, with a backlog of nearly 100,000 samples.

Bowel screening performed best, narrowly missing its 60% target.

A health think tank said the report was "deeply concerning".

But ministers said they were committed to making improvements to keep screening programmes "among the best in the world".

The NAO report comes after two recent incidents with breast and cervical screening raised concerns about about the management and organisation of both programmes.

Smear Result Delays

While bowel and breast screening met their minimum targets in 2017-18, neither met their upper target for the percentage of eligible people screened for signs of cancer.

However, with 72% of women eligible for cervical screening being tested last year, even the lower target of 75% was not met.

NHS screening programme Lower target for coverage Standard target for coverage

Percentage of eligible people screened in 2017-18

Cervical screening 75% 80% 71.7%
Breast screening 70% 80% 72.1%
Bowel screening 55% 60% 59.6%

Many women also experienced delays getting their results after having smear tests, or cervical screening.

According to the Department of Health and Social Care, results should be received within 14 days, but this target has not been met since 2015.

In March 2018, a third of women received their results on time, improving to just over half (55%) by the end of last year.

But in October, 98,628 samples were still waiting to be tested in labs across England, the report said.

It is thought that a change in the way tests are carried out affected staffing in labs, leading to the delays.

The report also highlights variation in the percentage of people screened across the country, with the lowest levels of coverage mostly in London.

And it describes issues with complex, ageing IT systems, with the cervical screening programme relying on an estimated 350 different systems to make it work.

Complicated IT problems are reported to have resulted in 5,000 women not being invited for breast screening.

The report also raises questions about the way screening programmes are governed and monitored.

However, the report says NHS England and Public Health England have succeeded in introducing bowel scope screening, although only half of GP practices were linked to a screening centre delivering the service in 2016-17.

By September 2018, 166,000 people had been invited for this type of screening against a target of nearly 500,000.

'Unacceptable'

Rebecca Fisher, a GP and policy fellow at the Health Foundation, said the report painted "a deeply concerning picture of the state of screening programmes in England, with missed targets, inconsistent coverage, and ageing IT systems".

She said screening saved lives but the public must be able to trust the quality of the services being offered.

"Today's report highlights an urgent need for investment in the IT and equipment required to make improvements," she said.

"Policymakers must also consider how to most efficiently run screening programmes to ensure that these potentially lifesaving services are equally available right across the country."

Meg Hillier, chairwoman of the MPs' committee of public accounts, said: "Those responsible for screening programmes are not always capable of picking up when people are not invited for a screening appointment, or ensuring that people receive their test results on time.

"It is unacceptable that these important screening programmes are being let down by complex and ageing IT. The Department of Health and Social Care, NHS England and Public Health England need to get this fixed."

A Department of Health and Social Care spokesperson said: "Our screening programmes are widely recognised as among the best in the world, and we are committed to making any improvements needed to keep our offer to patients world-class.

"Prevention and early diagnosis of cancer are key priorities for this government, and we are already working closely with NHS England and Public Health England to address the issues this useful report highlights."

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US Doctor Gave Boy, 4, Cannabis Cookies for Temper

2019-01-29T09:50:00.000-05:00

A California doctor is fighting for his licence after he prescribed cannabis cookies to a four-year-old boy.

Dr William Eidelman, a natural medicine physician, said small doses of marijuana would help control the child's temper tantrums.

The doctor misdiagnosed the child with bipolar disorder and attention deficit disorder (ADD).

A board of state regulators labelled him "grossly negligent" for failing to consult a psychiatrist.

The boy's father consulted Dr Eidelman in September 2012 because his son was misbehaving at school.

The doctor recommended small amounts of the drug, which was revealed when the school nurse was asked to give the boy his cannabis cookies at lunchtime.

The board did not seek to revoke the doctor's licence because he prescribed cannabis to a child, but because he was "negligent in his care and treatment".

Dr Eidelman has appealed against the ruling, made on 4 January, and said he will continue to practise. His lawyers said he had won a suspension of the revocation, pending a future hearing.

Medicinal cannabis usage has been legal in California since 1996, and Dr Eidelman estimates that he has recommended the drug to thousands of patients.

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Fitness Trackers 'Overestimate' Calorie Burning

2019-01-29T09:48:00.000-05:00

Popular brands of fitness trackers can overestimate the number of calories burned while walking by more than 50%, tests have found.

Researchers at Aberystwyth University found all products - ranging from £20 to £80 in price - were inaccurate during walking and running tests.

Dr Rhys Thatcher said devices had an "inherent tendency" to over-measure.

Fitbit said its product was based on "extensive research", but others said theirs were "not medical devices".

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The tests, carried out for the BBC X-Ray programme, measured the amount of oxygen a volunteer used during ten minute walking and running sessions on a treadmill, before comparing it to the various fitness trackers.

The Fitbit Charge 2, which is the best selling fitness tracker on the market, was very accurate in testing calories burned while running, underestimating by 4%. But when measuring walking, it overestimated by more than 50%.

Cheaper devices - the Letscom HR and the Letsfit - underestimated the number of calories burned while running by 33% and 40% respectively.

But both were far more accurate in the walking test. The Letscom overestimated by 15.7% while the Letsfit was only 2% above the official measurement.

"If you want to know the exact number of calories that you are burning during an exercise session then it doesn't matter which device you use, you have to interpret the data with some caution," Dr Thatcher said.

He added the inaccuracies were not important if they were being used as a motivational tool or to track progress.

Fitbit said it was confident about the performance of its product.

Letscom and Letsfit said their devices depend on data such as height and stride for accuracy and are not scientific devices, giving only estimations.

X-Ray is on BBC One Wales at 19:30 GMT on Monday 28 January.

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Video: Keeping Your Family Healthy During Flu Season

2019-01-29T09:36:00.000-05:00

Flu season may not be here yet, but there are preventive measures you can take now. Always wash your hands with soap and water; cough or sneeze into your upper sleeve, not your hands; eat well and get plenty of rest.

And most important, before flu season even starts, get a flu shot. Remember, you can't get the flu from the flu shot. Watch this public service announcement to learn more.

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Differences in GP Access Across England 'Shocking'

2019-01-23T12:03:00.002-05:00

The variation in the availability of GPs in different parts of England is shocking, doctors' leaders say.

A BBC analysis has found close to a threefold difference between the areas with the most and fewest doctors.

In one area - Swale in Kent - there is only one GP for every 3,300 patients, while in Rushcliffe in Nottinghamshire it is just under one for every 1,200.

The Royal College of GPs said the shortages put care at risk, but NHS chiefs said issues were being tackled.

More doctors are being trained and community services have been made a priority for investment under the 10-year plan announced earlier this month.

Millions miss out on seven-day GP access.

Have waits for GP appointments got longer?

However, RCGP chairwoman Prof Helen Stokes-Lampard said none of that addressed the urgent problems the profession was facing.

She said the differences in the number of GPs was "shocking" and "surprising".

"It suggests there are areas of the country that are really struggling to get the GPs they need.

"Over the past decade, general practice has not received the investment it needs."

She believes the health service in England is 6,000 doctors short of what it needs - it currently has just over 34,000 - and the problems meant care was "not safe" in some places.

Patients Association chief executive Rachel Power said the findings were "worrying".

She said as well as risking safety, shortages also meant "increased difficulty in securing an appointment, and longer waits".

Which areas have the fewest GPs?

The analysis looks at the number of patients per GP in each local NHS area - known as clinical commissioning groups.

It shows a threefold difference between the areas with the most GPs and least.

Worst areas (patients per GP)

Swale: 3,342
Horsham and Mid Sussex: 2,997
Bradford City: 2,587
Thanet: 2,520
Bexley: 2,479
Best areas (patients per GP)
Rushcliffe: 1,192
Camden: 1,227
Liverpool: 1,283
North Derbyshire: 1,286
Corby: 1,369

Could there be valid reasons for the differences?

There is no official recommendation for how many patients a GP should have.

That is because the demand each patient places on their GP is different.

Older patients, young children or people with long-term conditions, such as diabetes, will need to see their GPs more than others.

If a doctor has a lot of these patients on their books, they will not be able to cope with as many patients.

That could be behind some of the differences that are being seen, but not all, the RCGP said.

Is the situation getting worse?

The data provided by NHS Digital only goes back to 2015.

In that time it shows the number of GPs being employed has fallen slightly while their patient population has increased.

For the average GP this means their caseload has increased by nearly 80 patients to 1,734.

NHS bosses believe that will improve in the coming years.

What is being done to tackle the problem?

NHS England is increasing the proportion of the budget spent on general practice in a bid to recruit 5,000 more GPs.

There are signs that is beginning to have an impact. A few years ago one in 10 training places were going unfilled.

But last year they were all filled - in fact extra places were opened up as 3,400 people went into training.

The RCGP warned this will take some time to have an impact, given the number of years it takes to train a doctor.

The college would like to see more incentives to encourage doctors to work in areas where there are shortages.

In the past, "golden hellos" worth £20,000 have been used to attract GPs to some areas.

A spokesman for NHS England also pointed out that there were thousands of nurses, pharmacists and other health staff working alongside GPs and, with the extra investment being made in the NHS, these staff would help "free up extra resource for GP services in every community".

Data analysis by Clara Guibourg.

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Have Researchers Found a New Risk Factor for Schizophrenia?

2019-01-23T11:56:00.002-05:00

Scientists have located an intriguing link between schizophrenia and the Epstein-Barr virus, a type of herpes virus. Now, they need to determine which way the risk lies.

A new study may have found another environmental risk factor linked to schizophrenia. Schizophrenia, a condition characterized by a confused perception of reality, delusions, and altered behavior, affects more than 21 million people globally.

In a new study, specialists from Johns Hopkins Medicine in Baltimore, MD, and the Sheppard Pratt Health System in Townson, MD, found evidence that links schizophrenia with the Epstein-Barr virus.

This is a herpes virus that causes infectious mononucleosis, or glandular fever.

As the scientists report in a paper published in the Schizophrenia Bulletin, they saw higher levels of antibodies against the Epstein-Barr virus in the bodies of those with schizophrenia than in those of people without any mental health conditions.

The higher level of antibodies suggests exposure to the virus, but it is unclear which way the risk runs - that is, whether infection with the Epstein-Barr virus renders people more vulnerable to schizophrenia, or whether schizophrenia impacts the immune system and exposes people to infections.

"We are interested in the role of infectious agents such as Epstein-Barr virus in schizophrenia and other serious psychiatric disorders, so we did this study to look at the associations," says senior study author Dr. Robert Yolken.

A link between schizophrenia and infection?

Research has identified certain genetic risk factors for schizophrenia, but it has also recognized the possibility that some environmental factors - including exposure to infections - can raise schizophrenia risk.

In the new study, the scientists worked with 743 participants, of whom 432 had schizophrenia and 311 had no mental health problems (the control group). Around 55 percent of the cohort was male.

Dr. Yolken and colleagues compared the levels of antibodies against the Epstein-Barr virus in the participants with schizophrenia with those of participants in the control group.

They saw that people with schizophrenia were 1.7–2.3 times more likely than controls to have higher antibody levels against this herpes virus.

These participants did not have higher antibody levels against other types of infections, such as varicella (or chickenpox) or the herpes simplex type 1 virus, which is mainly transmitted orally (through kissing, for example).

'Unusal response to Epstein-Barr virus'

However, the researchers found that people with high genetic risk of schizophrenia and who also presented high levels of Epstein-Barr virus antibodies had an increased probability to pertain to the schizophrenia group - more than eight times higher, to be precise.

Also, among participants with schizophrenia, around 10 percent had both high levels of antibodies against this type of herpes virus and a higher genetic risk for schizophrenia, compared with only a little over 1 percent of the participants in the control group.

"We found that individuals with schizophrenia had an unusual response to Epstein-Barr virus. This indicated that the prevention and treatment of Epstein-Barr virus might represent an approach for the prevention and treatment of serious psychiatric disorders such as schizophrenia." - Dr. Robert Yolken

The study did not seek to establish cause and effect relationships, but the researchers suggest that preventing infection with the Epstein-Barr virus may be helpful in the context of schizophrenia risk.

However, the United States Food and Drug Administration (FDA) have not yet approved any drugs for the treatment of this type of herpes virus. That said, researchers are currently studying some drugs with therapeutic potential.

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Mental Health: Tougher Checks Before Superdrug Botox

2019-01-23T11:52:00.002-05:00

High street retailer Superdrug is to introduce tougher mental health checks before performing cosmetic procedures, following criticism by the NHS.

Prof Stephen Powis, the medical director of NHS England, said the injections risked fuelling mental health disorders - and the health service was left to pick up the pieces.

Superdrug started offering Botox and dermal fillers last year.

The retailer said it was "fully committed" to the issue.

High Street procedures

Botox is an injection of Botulinum toxin that relaxes muscles to temporarily hide lines and wrinkles.

Dermal fillers are injections under the skin that can fill skin creases or lead to bigger lips

NHS Choices: Botox and Dermal fillers

Superdrug's Skin Renew Service offers the cosmetic procedures to people over the age of 25, surgeons have criticised the company for treating Botox and fillers as "casual beauty treatments" on a par with having a wax.

The NHS is concerned about the impact on people who are mentally ill, including with Body Dysmorphic Disorder (BDD), in which people are fixated on what they think are flaws in their appearance.

The BDD Foundation says body dysmorphia can be a crippling illness and severely impair someone's life.

Woman's Botox party warning after lip filler swelling

Prof Powis wrote to Superdrug's chief executive, saying the company could do more to protect people who were seeking treatment because they were mentally unwell, or might have a mental health disorder triggered by treatment.

Prof Powis said: "Pressures on young people's mental health are greater than they ever have been, with families and the health service too often left to pick up the pieces.

"The lack of tough checks on cosmetic surgery means that the public is dependent on businesses taking voluntary steps to get their house in order, leaving people avoidably exposed to dangerous practices."

Superdrug said it already performs an hour-long consultation before cosmetic procedures take place and these include a mental health assessment.

The company said it would now ask specific questions about Body Dysmorphic Disorder:

"We remain fully committed to including recommended protections for mental health. We met with the NHS to ensure we have the highest safety standards and quality of patient care."

People fixate

Alana, who has BDD, told Radio 4's Today programme that prior to being treated for the condition she would "beg and plead" with her parents to access plastic surgery and cosmetic procedures.

The 22-year-old believes that it would have been a "real issue" for her if these procedures had been available on the high street at the time.

Kitty Wallace, a trustee with the BDD Foundation, said fewer than 10% of patients with BDD were satisfied with the results of their cosmetic procedures.

She said: "It is important that these measures are in place to protect such individuals from potentially damaging and unnecessary procedures.

"Although their anxiety might reduce temporarily, they will often find themselves fixating on another part of their body that they want to change.

"We commend that Superdrug will be screening for the disorder, and referring people who are positive to their GP and Mind."

The foundation has its own questionnaire, which asks questions about how much people fixate on their appearance and how much it affects their day-to-day life.

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Study Shows How Herpes Viruses and Tumours Have Learned to Manipulate the Same Ancient RNA

2019-01-16T07:46:00.001-05:00

Findings Could Have Implications for Drugs and Insight Into Diseases Like Alzheimer's

Herpes viral infections use the ancient genetic material found in the human genome to proliferate, mimicking the same process tumours have been found to manipulate, Mount Sinai researchers have shown for the first time. These observations provide further insight about how herpes viruses can manipulate the immune system in ways that may drive neurodegenerative diseases like Alzheimer's, according to the study, published in Nature Communications in January.

The researchers found that herpes viruses appear to manipulate an ancient RNA species that originated several million years ago, called human satellite II RNA (HSATII RNA). HSATII RNA is normally inactive, but both herpes viruses and cancer cells have essentially learned to activate it, using this RNA to manipulate their environment to help them invade the body and grow.

The researchers believe that both viruses and cancer cells figured out how to use this RNA because they both rapidly evolve to test out different strategies to multiply and spread within the body over time. Researchers have yet to understand whether herpes and cancer came upon this strategy coincidentally or whether they work hand in hand in some cases. Several researchers involved in this work pioneered the study of how a different type of RNA affects tumor evolution.

"The evolution of tumours can teach us about viruses and vice versa, and understanding one system may help us treat the other," said one of the study's senior authors, Benjamin Greenbaum, PhD, Assistant Professor of Oncological Sciences, Pathology, and Medicine (Hematology and Medical Oncology) at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai. "The HSATII RNA induction seen in herpes infections and cancer cells suggests possible convergence upon common mechanisms in these seemingly disparate diseases."

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The study potentially gives further insight into how herpes viruses might play a role in developing colitis and neurodegenerative diseases like Alzheimer's. It is the first step toward potentially developing diagnostic tools that look for these types of RNAs in cancer and herpes patients and using the ancient RNAs as targets for drugs in the future, said Dr. Greenbaum.

The lead author of the study was Maciej Nogalski, PhD, Postdoctoral Research Fellow in the laboratory of co-senior author Thomas Shenk, PhD, James A. Elkins Professor of Life Sciences in the Department of Molecular Biology at Princeton University.

"Herpes viruses have been extensively studied for many years, but once again by investigating host-virus interactions at the cellular level we were privileged to get insights into novel regulatory mechanisms of human cells. Our virus-centered studies not only uncovered interesting aspects of viral infection, but also provided an inducible system that could accelerate investigations about possible roles HSATII RNA plays in other diseases," Dr. Nogalski says.

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Researchers Identify Multiple New Subtypes of Most Common Childhood Cancer

2019-01-16T07:40:00.001-05:00

Like cartographers completing a map, investigators have identified multiple new subtypes of the most common childhood cancer - research that will likely improve the diagnosis and treatment of high-risk patients. St. Jude Children's Research Hospital scientists led the study, which appears as an advance online publication today in the journal Nature Genetics.

Researchers used integrated genomic analysis, including RNA sequencing, to define the genomic landscape of B-cell acute lymphoblastic leukemia (B-ALL) in almost 2,000 children and adults. B-ALL is the most common form of ALL and the most common cancer in children. B-ALL remains the leading cause of pediatric cancer death.

Investigators identified 23 subtypes of B-ALL, including eight new subtypes, with distinct genomic and clinical features as well as outcomes. Subtype prevalence often varies with age. More than 90 percent of B-ALL cases can now be categorized by subtype compared with 70 percent a few years ago.

"B-ALL has remarkable molecular diversity, which we and others have used to refine classification and drive the development of precision medicines to improve B-ALL treatment and outcomes," said corresponding author Charles Mullighan, MBBS, M.D., a member of the St. Jude Department of Pathology. "Part of precision medicine is an accurate molecular diagnosis, which this study provides to more patients."

A novel subtype-defining alteration

Alterations of the transcription factor gene PAX5 defined two new subtypes, including PAX5 P80R, as the first lymphoblastic leukemia initiated by a point mutation. "While secondary mutations are necessary and often involve kinase signaling, we show this point mutation impairs development of B lymphoid cells and promotes development of B-ALL in mice," Mullighan said.

The other PAX5 subtype, PAX5-altered, was defined by diverse alterations in the gene, including sequence mutations or rearrangements with one of 24 other genes. Together the PAX5 subtypes accounted for almost 10 percent of the previously uncategorized cases of B-ALL.

The new subtypes include a high-risk variety of B-ALL that occurs primarily in adults. It is defined by rearrangement of the transcription factors BCL2 with MYC or BCL6. "This subtype has a dismal diagnosis," Mullighan said. "Recognition of this subtype-defining rearrangement may lead to alternative therapy for patients." In contrast, a subtype defined by rearrangement of the gene DUX4 was associated with a good prognosis in adults, as had previously been observed in children.

Tracking gene expression

The study demonstrated the capability of RNA sequencing to identify multiple types of genomic alterations, highlighting the utility of this technique for leukemia diagnosis, particularly when whole-genome sequencing is not available. Examples in this study included chromosomal rearrangements resulting in fusion genes, gene-expression profiles and other alterations.

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"Through this study, two-thirds of the previous uncharacterized B-ALL patients could be classified into different subtypes with distinct genetic alteration profiles and clinical features," said co-first author Zhaohui Gu, Ph.D., a postdoctoral fellow in the Mullighan laboratory. "That may substantially speed up the development of customized treatments for these patients.

"We also established a robust B-ALL classification pipeline based mainly on RNA sequencing data that may be integrated into clinical diagnosis of ALL," Gu said.

"As a clinician, these data describing the diversity of subtypes of B-ALL will allow us to refine our prognostic abilities for individual patients, and ultimately, will lead to the development of new targeted therapies that will more effectively treat the leukemia with fewer side effects," said co-author Mark Litzow, M.D., professor of medicine at the Mayo Clinic and chair of the Leukemia Committee, Eastern Cooperative Oncology Group and the American College of Radiology Imaging Network, which contributed to the study.

Additional subtypes revealed

The other newly identified subtypes include:

* NUTM1 gene rearrangement with different partner genes that researchers believe may be vulnerable to treatment

* HLF gene rearrangement to multiple genes, including TCF4 as well as the previously recognized partner TCF3.

* Three subtypes that share patterns of gene expression similar to those of established B-ALL subtypes. The classification suggests that the new subtypes, ETV6-RUNX1-like, KMT2A-like and ZNF384-like, have risk profiles and prognoses similar to the established subtype for which they are named.

* Additional subtypes driven by sequence mutations, including IKZF1 N159Y.

Previous work from St. Jude and the Children's Oncology Group TARGET initiative have shown IKZF1 (Ikaros) mutations to be a marker of high risk B-ALL.

The study included patients from St. Jude, the COG and adult cancer cooperative studies.

Patient samples of many of the B-ALL subtypes are available to the international scientific community through the St. Jude data portal PROPEL (Public Resource of Patient-derived and Expanded Leukemias). PROPEL makes patient-derived leukemia xenograft samples available free of charge to researchers with no obligation to collaborate.

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Overstretched 'Sandwich Carers' Trying to Help Parents and Children

2019-01-16T07:35:00.002-05:00

An exhausted, overstretched generation of carers, are in need of emotional support themselves, say researchers. A report from the Office for National Statistics (ONS) says more than a quarter of such "sandwich carers" are suffering from depression or stress.

"Sandwich carers" look after their elderly parents and their children.

There are 1.3 million people in the UK with such multi-generational caring responsibilities, say researchers, with many feeling ignored and undervalued.

The ONS says the numbers in this "sandwich" generation, often in their 40s and 50s, are being increased by a combination of longer life expectancy and women tending to have children later in life.

But the report warns of the hidden pressures being carried by these mid-life carers - with warnings that they can be worn down emotionally, physically and financially.

The majority of carers in this "sandwich generation" are women - and almost half of these women feel that they cannot work as many hours as they would like.

One in three sandwich carers say that financially they are "just about getting by".

For those with more than 20 hours per week of caring, the ONS says a third are experiencing some kind of mental health problems, which might be stretched out over many years.

They risk becoming isolated, running out of money and being constantly under pressure - while trying to juggle between responsibilities of care, work and their own relationships.

What's it like?

Sarah, a 52-year-old mother of five children, lives in London, where she looks after her mother-in-law, who has dementia.

The work of carers is "completely undervalued," she says.

In fact, she says it makes her angry when in questionnaires carers are categorised as "not working", when they never stop working, often to the detriment of their own health.

Even though this affects a "massive number of people", Sarah says much of this huge and unrelenting responsibility goes by without being recognised.

"There is no spare time at all and you can get very tired," she says.

Sarah says she has a good network of support around her, but there is still a residual sense of guilt about whether she is spending enough time with her children or her mother-in-law, as she tries to stretch herself across helping all of them.

'Lose touch with friends'

The people who are often most neglected are the carers themselves, and she says it would be easy for someone to get "unwell".

"You can lose touch with friends, when it's hard to see people," she says.

Going out together as a family becomes difficult and holidays become limited, at a time in life when people might be expecting to enjoy some travelling.

Sarah says it is important to resist the "feeling of horizons being limited".

"You could easily feel that your life is getting narrower."

Her mother-in-law had previously lived alone in Dorset, and Sarah says that created another set of pressures, needing hours of travel, sometimes at short notice.

But she says it is worth it and feels that it is the right thing to do - but Sarah says that there needs to be much more openness about the stress and struggles facing so many people in her generation.

'So exhausted'

Catherine, aged 61, living in Cheshire, helps her 89-year-old mother at the same time as caring for her daughter, who has cerebral palsy.

The emotions can be a "roller coaster", she says, with some very low dips, such as if there are problems with navigating the care system.

A big practical problem, she says, is the shortage of reliable carers and the difficulties created when there are interruptions and gaps in staff available.

Catherine says she has sometimes spent a fortnight as the sole carer, through nights and days.

"I couldn't speak in full sentences, I was so exhausted," she said.

She says that other people are not "heartless", but they fail to see the extent to which carers can be trapped and unable even to get out of their house.

Even simple things like going for a walk have to be planned, Catherine says.

Carers find their own release from stress, she says, and in her own case she says that she "knits, knits, knits", as a hobby.

"Good friendships" have been very important to her, she says, otherwise people can become very isolated and feel all the weight on their shoulders.

But she warns that carers can sometimes feel excluded and neglected by neighbours who might be "afraid of saying the wrong thing".

She says that caring has its own lessons - and she has learned to "live in the moment" and enjoy what she can.

"How many other people get pleasure from getting out to the supermarket?" says Catherine.

'Time-poor and stressed'

This is a growing problem for a "time-poor and stressed" generation, says Helen Walker, chief executive of the Carers UK charity.

As well putting pressure on health and wellbeing, it is also tough on those balancing being a carer with their own jobs.

The charity estimates that about two million people have left work as a result, with consequences for their finances and careers.

Both Sarah and Catherine spoke of the difficulties in having to negotiate the care and health support system for their relatives, and Carers UK says getting the right care for the elderly is often tougher than getting childcare.

"With the social care system under extreme pressure, additional stress is being placed on families who are trying to juggle children, work and older relatives," says Ms Walker.

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