"Meningitis vaccine may also cut risk of 'untreatable' gonorrhoea, study says," is the headline in The Guardian.

The news comes from the results of a study in New Zealand that found people who'd been given an old version of the meningitis B vaccine were less likely to be diagnosed with gonorrhoea.

But no protective effect was found for chlamydia, which is often diagnosed at the same time as gonorrhoea.

The publication of the study is timely – just last week the World Health Organization issued a warning about the rise in antibiotic-resistant strains of gonorrhoea.

The researchers claim this is the first vaccine to show any protective effect against gonorrhoea, but the vaccine in question is no longer in use.

A variant of the vaccine is currently given to babies in the UK as part of the routine NHS vaccination schedule. As the New Scientist magazine speculates, if the biological mechanism is discovered, we may see a sudden drop in gonorrhoea cases in 20 years' time.

But it's unlikely that a dedicated vaccine against gonorrhoea will be available for at least a few years. And that prospect is not a certainty by any means.

For now, the most effective way to prevent gonorrhoea is to always use a condom during sex, including oral and anal sex.

Where did the story come from?

The study was carried out by researchers from Sexual Health Services, Waikato District Health Board, and the University of Auckland in New Zealand, and Cincinnati Children's Hospital in the US.

The research was funded by GSK Vaccines, a pharmaceutical company, and Auckland UniServices, a branch of the university that partners academics with industry. No conflicts of interest were declared.

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

The UK media's reporting was generally accurate – but the headlines weren't.

The Guardian's headline talks about "untreatable" gonorrhoea, but the study didn't look at whether any of the people had drug-resistant gonorrhoea or not. The research looked at data captured between 2004 and 2016, when drug-resistant gonorrhoea was less of a concern.

The Independent's headline – "World first as scientists develop vaccine that reduces chance of catching gonorrhoea" – is also inaccurate. The vaccine in question already existed, and it hasn't definitely been proven to reduce the chances of catching gonorrhoea.

What kind of research was this?

This case-control study looked at people with a gonorrhoea diagnosis and whether or not they'd had a meningitis vaccination in the past to see if there was an association. 

Gonorrhoea is a sexually transmitted infection caused by Neisseria gonorrhoeae bacteria, and is associated with multiple issues, including pelvic inflammatory disease, infertility and chronic pain.

Antimicrobial resistance has increased in recent years, and some strains of the infection are now resistant to drugs.

Researchers previously noted a decline in gonorrhoea diagnoses in New Zealand after a mass vaccination programme for meningococcal B, a serious cause of life-threatening infections such as meningitis and blood poisoning.

Meningitis B is caused by Neisseria meningitides, a bacteria similar to the one that causes gonorrhoea, so experts thought the MeNZB vaccine may be able to protect against both.

This type of research is useful for looking at a large population of people and examining trends and associations – but it can only show a link, not prove cause and effect.

A randomised controlled trial would be needed to do this, where the vaccine is offered to some people and not others, but this would be unethical.

What did the research involve?

Researchers looked at 14,730 people aged between 15 and 30 who received a positive diagnosis of gonorrhoea or chlamydia at a sexual health clinic between 2004 and 2016.

They wanted to see if having the meningococcal B vaccine decreased the risk of getting gonorrhoea.

Of those involved, 1,241 people had a gonorrhoea-only diagnosis. Chlamydia-only diagnoses were used as the control group, which included 12,487 people.

Coinfection with both gonorrhoea and chlamydia is relatively common in sexually active adults who don't use condoms.

This means someone being diagnosed with chlamydia but not gonorrhoea could be the result of the meningococcal B vaccine.

Further analysis was done to include the 1,002 people who had both infections.

The researchers looked back over records from the New Zealand National Immunisation Register to identify which participants had received the MeNZB vaccine between 2004 and 2006.

They were able to link people diagnosed with gonorrhoea or chlamydia to their vaccine history through unique National Health Index numbers. They then adjusted the results for ethnicity, deprivation levels, geographical area and sex.

What were the basic results?

The researchers found 41% of the participants diagnosed with gonorrhoea only had been vaccinated against meningitis B, compared with 51% of the chlamydia-only group.

They also found:

• People who had been vaccinated were 31% less likely to have a gonorrhoea diagnosis than a chlamydia diagnosis (adjusted odds ratio [aOR] 0.69, 95% confidence interval [CI] 0.61 to 0.79).
• The effect of vaccination appeared to decrease over time. Subgroup analyses found the effectiveness of the vaccine was 20% in the period immediately after the vaccination programme from 2004-09 (95% CI 2% to 34%) compared with 9% from 2010-14 (95% CI 0% to 25%).
• When people with coinfection were included in the gonorrhoea group, the effectiveness of the vaccine reduced to 23% (95% CI 15 to 30).

How did the researchers interpret the results?

The authors concluded that, "Exposure to [the] MeNZB [vaccine] was associated with reduced rates of gonorrhoea diagnosis – the first time a vaccine has shown any protection against gonorrhoea.

"These results provide a proof of principle that can inform prospective vaccine development not only for gonorrhoea but also for meningococcal vaccines." 

Conclusion

This large study found an association between having the MeNZB vaccine and a reduced likelihood of being diagnosed with gonorrhoea.

But it's difficult to form any firm conclusions because of the nature of the case and control groups.

For example, given that both groups were sexually active, we don't know why the majority of people with gonorrhoea didn't also have a chlamydia infection, and how this may have affected the results.

It could just be down to pure chance and have nothing to do with the vaccine.

So before we celebrate the alleged "cure of gonorrhoea", there are many things to consider:

• The vaccine in question is no longer in use as a vaccine against meningococcal B. The Men4C jab is now used in the UK. Though it does have many similar components, we don't know if these are useful in protecting against gonorrhoea. Research now needs to focus on whether the association still exists with the new jab.
• Although the authors adjusted for some variables, other factors might be at play that may have affected the results, such as people's education, diet, and immune system strength.
• No new vaccine has actually been developed. The indication that something in the MeNZB vaccine might increase protection against gonorrhoea requires further research to pinpoint how it does so.
• The research was only conducted on people who were diagnosed at a sexual health clinic, and didn't include data from GP surgeries. Many cases in the community could have been missed, and these people could have different immunisation trends.
• We don't know how long the potential protective effect lasts for, as it seemed to decrease over time.

It's very much a case of "if" rather than "when" a gonorrhoea vaccine is developed. For now, the best way to protect yourself against gonorrhoea, chlamydia and other STIs is to always use a condom during vaginal, oral and anal sex.

Read more about how to have safe sex.

Links To The Headlines

Meningitis vaccine may also cut risk of 'untreatable' gonorrhoea, study says. The Guardian, July 10 2017

World first as scientists develop vaccine that reduces chance of catching gonorrhoea. The Independent, July 11 2017

First vaccine shows gonorrhoea protection. BBC News, July 11 2017

Links To Science

Petousis-Harris H, Paynter J. Morgan J, et al. Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: a retrospective case-control study. The Lancet. Published online July 10 2017

"Sense of purpose aids sleep, US scientists find," The Guardian reports on a new study that explored the relationship between having a sense of purpose in life and quality of sleep in older adults.

The study analysed data from 800 older adults with an average age of 80 in the US.

Researchers found that generally, having a greater sense of purpose in life was associated with better quality of sleep, as well as a decreased likelihood of sleep disorders such as sleep apnoea and restless leg syndrome. 

Although these are interesting findings, it's not possible to rule out the influence of other factors.

The fairly abstract concept of "sense of purpose" may be influenced by various health and lifestyle factors, such as levels of physical activity and mental health problems, and these may all in turn affect quality of sleep.

But this study wasn't able to pull out all of the intricacies of this complex relationship.

Problems with sleep are more common in the UK than most people realise, but there are proven ways to help combat insomnia.

As for having a "sense of purpose", research has shown that volunteering your time for a cause or charity you believe in can help improve your mental wellbeing.

Read more about how giving can improve your wellbeing. 

Where did the story come from?

The study was carried out by researchers from Northwestern University in the US, and was funded by the National Institute on Aging Grant Numbers and the Illinois Department of Health.

It was published in the peer-reviewed journal Sleep Science and Practice. It's available on an open access basis and is free to read online.

The UK media coverage around this research was generally balanced and well reported.

What kind of research was this?

This analysis of data from two cohort studies set out to explore the relationship between having a sense of purpose in life and quality of sleep.

Previous research has suggested that having a sense of purpose in life could protect against several negative health outcomes, one being sleep disturbances. Sleep disturbance is known to be more common among older adults.

Studies have also observed the prevalence of sleep disturbance to be higher among African Americans than white people. The researchers wanted to investigate this further.

Cohort studies are useful for looking at an association between an exposure and an outcome. But the study design means it isn't possible to fully rule out the influence of other confounding factors and prove that a purpose in life directly leads to better sleep.

What did the research involve?

The data sample for this analysis was taken from two ongoing Chicago-based cohort studies: the Minority Aging Research Study (MARS) and the Rush Memory and Aging Project (MAP).

MARS is a study of risk factors for cognitive decline that recruits older African Americans who haven't had a diagnosis of dementia.

MAP aims to look at the brain changes associated with ageing and cognitive decline. It recruited older adults of mostly white ethnicity (88%) without a diagnosis of dementia who agreed to annual clinical assessments, as well as brain autopsy after they died.

The analysis included 825 older adults with an average age of 79.

Purpose in life was measured at the start of the studies using a modified 10-item assessment derived from the Ryff and Keyes' Scales of Psychological Well-Being, a tool used to assess sense of purpose.

As part of the assessment, individuals were asked to respond to statements like "I feel good when I think of what I've done in the past and what I hope to do in the future", and "Some people wander aimlessly through life, but I am not one of them".

Participants used a five-point scale for their responses, ranging from 1 strongly disagree to 5 strongly agree. Higher scores were used to indicate higher levels of purpose in life.

Sleep quality and symptoms of potential sleep disorders were assessed using a 32-step questionnaire derived from the Pittsburgh Sleep Quality Index (PSQI), the Berlin Questionnaire, and the Mayo Sleep Questionnaire (MSQ). The questionnaire was given to participants at the end of each annual visit.

The PSQI assessed sleep quality, specifically looking at how long it takes to fall asleep, sleep duration, and how much you actually sleep during the night.

The Berlin questionnaire assessed risk of sleep apnoea, and the MSQ assessed the presence of restless leg syndrome and REM behaviour disorder, where dreams are acted out (for example, through sleepwalking or shouting out).

Sleep data was collected at baseline and follow-up points at the end of the first, second and third year.

The researchers analysed any links with purpose in life, adjusting for potential confounders like age, sex, race and years of education.

Changes in quality of sleep over the course of the two-year study were also taken into account.

What were the basic results?

• Out of all the 825 respondents, at the beginning of the study 42% were at high risk of sleep apnoea, 23.6% were exhibiting symptoms of restless leg syndrome, and 7% had symptoms of REM behaviour disorder.
• Higher levels of purpose in life were associated with better sleep quality. Over a one-year period, improved sleep quality was reported in people with a higher "purpose of life".
• Increased levels of purpose in life were associated with a decreased risk of sleep apnoea (odds ratio [OR] 0.630, 95% confidence interval [CI] 0.454 to 0.875). This association continued during the first and second follow-up assessment.
• Purpose in life wasn't significantly associated with symptoms of restless leg syndrome. But at year one of follow-up, it was associated with a decreased likelihood of having possible restless leg syndrome (OR 0.524, 95% CI 0.361 to 0.762).
• Purpose in life wasn't significantly associated with REM behaviour disorder at baseline or years one, two and three of follow-up.

How did the researchers interpret the results?

The researchers concluded that, "In a biracial sample of over 800 older adults, the present findings provide support for the hypothesis that purpose in life is related to sleep quality, with indications that it could be a potentially useful clinical tool for assessing older adults."

They added: "We found that higher levels of purpose in life at baseline predicted better sleep quality at baseline, as well as increased change in sleep quality over a one-year period, a finding that is consistent with previous studies." 

Conclusion

This study explored the relationship between having a sense of purpose in life and sleep quality and sleep disorders.

Researchers found generally, having a greater sense of purpose in life was associated with better quality of sleep and a decreased likelihood of sleep disorders like sleep apnoea and restless leg syndrome.

The researchers suggest this may be down to people having better overall physical and mental health.

Although these are plausible hypotheses, there are a few points to note. As with the majority of cohort studies, it isn't possible to prove cause and effect and fully rule out the influence of other health, lifestyle and personal factors in the associations.

For example, having a healthy lifestyle can have an impact on quality of sleep. Drinking too much alcohol, smoking, not getting enough exercise, and mental health problems may reduce the chances of having a good night's sleep.

And it's difficult to know the exact impact of having less of a sense of purpose in life on sleep quality. This is a fairly abstract concept that may have various external influences this study wasn't able to fully explore.

The length of time a person has felt a particular way may also have an effect. For example, the effect on sleep may not be the same in someone who's felt they have no purpose in life for a long time compared with someone who's recently been under acute stress.

It would be interesting to conduct this study in young adults to see if the findings are similar. There may also be different possible influences on sleep, such as different dietary factors (like sugary drink consumption) or increased screen use, in other populations.

Learn about different ways to get a better night's sleep.

Links To The Headlines

Sense of purpose aids sleep, US scientists find. The Guardian, July 10 2017

How a sense of purpose helps you sleep well: Study finds those who feel their lives have meaning are less likely to suffer insomnia. Mail Online, July 9 2017

The secret of a good night's sleep has finally been found by scientists. The Daily Telegraph, July 10 2017

Links To Science

Turner AD, Smith CE, Ong JC. Is purpose in life associated with less sleep disturbance in older adults? Sleep Science and Practice. Published online July 10 2017

"Gonorrhoea fast becoming 'untreatable', WHO experts warn," reports Sky News.

Analysis of data from 77 countries by the World Health Organization (WHO) found antibiotic resistance exists against almost all antibiotics currently used to treat the sexually transmitted infection (STI) gonorrhoea.

In the past, gonorrhoea infections were treated effectively with a one-off dose of antibiotics.

Nowadays, gonorrhoea needs to be treated with both an antibiotic injection and a dose of antibiotic tablets.

And increased resistance to antibiotics, coupled with a lack of new treatments in the pipeline, raises concerns that the infection could be untreatable in the future.

This is concerning, as untreated gonorrhoea in women can cause complications that can lead to infertility and miscarriage. 

In this study, a WHO group outlined a new strategy to support the research and development of new treatments for gonorrhoea. Preventing the spread of the STI is also of paramount importance.

What is gonorrhoea?

Gonorrhoea is the second most common STI in the UK.

It's caused by the bacteria Neisseria gonorrhoeae, and can be transmitted easily through unprotected vaginal, oral or anal sex, infecting the genitals, back passage, and sometimes the eyes or throat.

Usual symptoms include an abnormal discharge from the vagina or penis, pain when passing urine, and bleeding in between periods in women.

Treatment involves an antibiotic injection and a single dose of antibiotic tablets.

But many people get no symptoms, so gonorrhoea can go unnoticed and untreated, which can lead to serious complications.

Around 10-20% of women can get pelvic inflammatory disease from gonorrhoea, which can then affect their fertility.

Gonorrhoea in pregnancy can also be transmitted to the infant, which can lead to newborn conjunctivitis and even threaten a baby's eyesight.

Where did the study come from?

The study was produced by the WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP), a group of researchers responsible for monitoring trends in drug-resistant gonorrhoea.

What is the new evidence?

The group analysed data from 77 countries, and found there is increasing resistance to all the drugs currently used to treat gonorrhoea – to both the first-choice antibiotic, and to the second-choice antibiotic used when the first one fails.

Bacteria have the ability to respond and adapt to antibiotics, with the potential to become effectively immune to the antibiotic's effects.

Even more worryingly, they can develop resistance to many different antibiotics, which now seems to be the case for the bacteria that causes gonorrhoea.

There also aren't many drugs currently being developed for the treatment of gonorrhoea. This raises the concern that the spread of drug-resistant gonorrhoea could outpace the development of new drugs, and may even result in doctors not being able to treat the STI.

In order to address this, the Global Antibiotic Research and Development Partnership (GARDP) initiative was launched in 2016 by the World Health Organization and Drugs for Neglected Disease (DNDi).

GARDP is a not-for-profit research organisation that sets up programmes around the world that aim to develop short- and long-term treatments for STIs, among other things.

As part of their initiative to improve research and development for new treatments for gonorrhoea, GARDP convened a panel of international experts from various institutions in different regions, including India, South Africa and China.

Together, they have outlined a research and development strategy that could help target the development of new treatments for gonorrhoea.

Recommendations

GARDP seeks to work with various experts to bring one new treatment for gonorrhoea to the market by 2023.

This is discussed in the research and development strategy, which outlines four components.

• component 1: accelerate the development of a new chemical entity
• component 2: evaluate the potential of existing antibiotics and their combinations
• component 3: explore co-packaging and development of fixed dose combinations
• component 4: support the development of simplified treatment guidelines and foster conservation

Explained simply, this means that GARDP hopes to:

• Accelerate the development and registration of new molecules and drugs for the treatment of gonorrhoea, particularly those in the later stages of clinical trials that may be close to entering the market.
• Conduct further research through randomised controlled trials to test whether the drugs currently used have the ability to treat gonorrhoea effectively. The drugs will be tested in populations with high numbers of sexually transmitted infections, as well as countries known to have various forms of antibiotic resistance.
• Explore the use of combinations of antibiotics in fixed doses, which will help reduce costs and hopefully lead to more people taking the drugs as prescribed.
• Support the development of evidence-based guidelines to ensure any new treatments are globally accessible, but mainly to make sure they're used and prescribed in an appropriate manner to reduce the emergence of more antimicrobial resistance to the drugs – it would be counterproductive to produce a new antibiotic to which gonorrhoea then becomes resistant.

Conclusion

The increase in antimicrobial resistance towards drugs used to treat gonorrhoea is reaching a critical stage, especially given how common the infection is worldwide, with an estimated 78 million new cases in 2012.

This study raises concerns around an important topic while also proposing strategies to help address the slow pace of research and development of new drugs.

The prevention of gonorrhoea is equally, if not more, important. The most effective way to prevent gonorrhoea is to always use a condom during sex, including anal and oral sex.

Read more advice about sexually transmitted infections and how to prevent them.

Links To The Headlines

Gonorrhoea fast becoming 'untreatable', WHO experts warn. Sky News, July 7 2017

Oral sex spreading unstoppable bacteria. BBC News, July 7 2017

Gonorrhoea becoming 'untreatable', experts warn. ITV News, July 7 2017

Untreatable gonorrhoea 'superbug' spreading around world, WHO warns. The Guardian, July 7 2017

Links To Science

Global Antibiotics Research and Development Partnership. Multi-drug-resistant gonorrhoea: a research and development roadmap to discover new medicines. July 2017 (PDF, 230kb)

"Ejaculating at least 21 times a month significantly reduces a man's risk of prostate cancer," is the headline on the Mail Online. This is based on research from the US that asked men how often they ejaculated per month and subsequent reporting of prostate cancer.

They found that men who ejaculated 21 times or more a month were less likely to report prostate cancer at follow-up than those ejaculating four to seven times per month.

However, it does not prove that ejaculating more frequently prevents cancer, only that it is associated with a reduction in risk. It might be that a range of other factors such as genetics, lifestyle, number of children, diet, nature of sexual activity and education contribute to this risk, but we cannot say for sure what factors might increase the risk.

The researchers offer a number of hypotheses why ejaculation may help reduce prostate cancer risk, such as reducing stress or keeping cell metabolism well regulated. But these suggestions remain in the realm of speculation.

Despite any lurid tales you may have heard growing up, masturbation is entirely safe. So if you want to do it as a preventative method then it wouldn't pose any health risks.

Initial signs of prostate cancer usually involve problems with urination, such as needing to urinate more frequently, due to the prostate getting larger. While prostate enlargement can occur as men grow older, it is important to check symptoms like these with your GP.

Where did the story come from?

The study was carried out by researchers from Boston University School of Public Health, Harvard T.H. Chan School of Public Health, and Harvard Medical School, all in the US. It was funded by the National Cancer Institute and grants from the Prostate Cancer Foundation Young Investigator Award.

The study was published in the peer-reviewed medical journal European Urology on an open-access basis, making it freely accessible online.

The UK media reporting was generally accurate and, as you would imagine, some of the coverage, and the associated photos, were a little tongue in cheek.

The Sun's claim that "having 21 orgasms a month could be the key to preventing CANCER in men because it helps the prostate 'flush out toxins'" is unsupported. The claim that it flushes out toxins was not studied in this research and it is not proven that ejaculation is a "key to preventing cancer". 

What kind of research was this?

This was a cohort study following up male health professionals from 1992 for 18 years. It was designed to look at multiple health outcomes. In this particular analysis, the researchers aimed to determine their ejaculation frequency at different ages and whether it was associated with likelihood of getting prostate cancer.

A cohort study is best for this type of research as it allows reporting of people's habits and lifestyles without interfering and means a lot of people can be followed over a long period of time to see long-term health outcomes. However, a cohort study cannot control for other factors that may affect outcomes, a randomised controlled trial would be needed for that – but they are very time consuming, expensive, and intrusive on people's lives.

What did the research involve?

Researchers took data from the Health Professionals Follow-up Study, a study that began in 1986 aiming to look at links between men's lifestyles and health outcomes. They took 31,925 men's answers to a questionnaire about ejaculation frequency and looked to see if there was an association with developing prostate cancer.

The men were aged between 40 and 75 at baseline in 1986 and were all health professionals. They were asked questions about medical history and lifestyle every two years. Ejaculation frequency was assessed in the 1992 questionnaire.

The specific question asked was: "On average, how many ejaculations did you have per month during these ages?: age 20-29; age 40-49; past year."

The frequency of ejaculation per month was recorded in the following categories:

• none
• 1-3
• 4-7
• 8-12
• 13-20
• over 20

Follow-up was complete for 96% of the men still alive.

For men reporting they had prostate cancer, medical records were obtained to determine age at diagnosis; prostate specific antigen (PSA) level – PSA is a hormone associated with prostate enlargement; and tumour stage and grade.

To see if the link between ejaculation frequency and prostate cancer differed according to the specific characteristics of the cancer, clinical information was used to group prostate cancer into four risk categories:

• Low risk = T1/T2 tumour, PSA<10 nanograms (ng) per millilitre (ml), Gleason score 6 (the Gleason score is a measurement of how likely the cancer is to spread out of the prostate into surrounding tissue)
• Intermediate risk = T1/T2 tumour, PSA 10-20 ng/ml, Gleason score 7
• High risk = T3 tumour, PSA 20-50 ng/ml, Gleason score 8
  Regional or distant metastases =
• T4/N1/M1 tumour, PSA ≥50 ng/ml

Analyses were adjusted for a range of potentially confounding factors, including:

• race
• family history of prostate cancer
• vigorous physical activity
• body mass index
• diabetes
• marital status
• diet
• smoking
• history of vasectomy
• history of PSA testing

What were the basic results?

Over follow-up, a total of 3,839 cases of prostate cancer were diagnosed. Frequency of ejaculation per month decreased with age. The proportion of men reporting average frequency of 13 or more ejaculations per month was 57% aged 20-29 but dropped to 32% at age 40-49.

Excluding men with erectile dysfunction, compared with men who ejaculated four to seven times per month:

• There was a 20% decreased risk of prostate cancer for those who ejaculated 21 times or more per month aged 20-29, (adjusted hazard ratio (aHR) 0.80, 95% confidence interval (CI) 0.69 to 0.92).
• There was an 18% decreased risk of prostate cancer in ages 40-49 for those who ejaculated 21 times or more per month, (aHR 0.82, 95% CI 0.70 to 0.96).
• There was a 26% reduction in risk of prostate cancer for men aged over 50 who had ejaculated 21 times or more per month in the previous year, (aHR 0.74, 95% CI 0.58 to 0.94).
• There was also a decreased risk of prostate cancer in ages 40-49 for those who ejaculated 13-20 times per month (aHR 0.81, 95% CI 0.72 to 0.90).
• There were similar yet smaller reductions in risk at all ages for men ejaculating 13 or more times per month.

For men ejaculating over 13 times per month compared with four to seven times per month:

• For ejaculation while aged 20-29, there was a 25% lower risk of getting "low risk" prostate cancer, (aHR 0.75, 95% CI 0.63 to 0.89).
• For ejaculation while aged 40-49, there was a 28% lower risk of getting "low risk" prostate cancer, (aHR 0.72, 95% CI 0.61 to 0.83).
• For ejaculation in the year before the questionnaire, while aged over 50, there was a 25% lower risk of getting "low risk" prostate cancer, (aHR 0.75, 95% CI 0.62 to 0.92).
• For ejaculation aged 20-29, there was a 27% lower risk of getting "intermediate risk" prostate cancer (aHR 0.73, 95% CI 0.61 to 0.88).
• No significant differences were found for ejaculation frequency at older ages and "intermediate risk" cancer, or for any age and "high risk" prostate cancer.

How did the researchers interpret the results?

The researchers concluded that "this large prospective study provides the strongest evidence to date of a beneficial role of ejaculation in prevention of prostate cancer".

They add that "more frequent ejaculation in the absence of risky sexual behaviours could represent an important means of reducing the profound medical costs and physical and psychological side effects of unnecessary diagnosis and treatment of low-risk tumours, even though it appears to be less strongly associated with aggressive disease".

Conclusion

This research showed an association between ejaculating more frequently and a lower chance of getting prostate cancer in three different age groups.

Before too much is read into these findings, there are some limitations of the research to consider:

• Three age groups were looked at; ages 20-29, 40-49 and 50 and over. It is not known what the differences are within these groups and it is not known what the outcomes would be if ejaculation was measured in different age categories.
• Although the authors adjusted for some variables, there are still some factors that might have influenced the results, such as sociodemographic background, education level and whether the men had children.
• The circumstances of ejaculation were not considered – in other words whether the occurrences were mostly through masturbation or with a sexual partner. This might have had an influence on the results.
• The questionnaire relied on self-reporting and considering past history, which may have led to recall bias where participants inaccurately reported their ejaculation history.
• Prostate cancer was self-reported through medical history and not specifically screened for. It might be that men who are more sexually active are less likely to seek cancer screening and therefore may be unaware of the presence of prostate cancer.
• The study was conducted on mostly white health professionals in the US and might not be generalisable to the entire UK male population – especially as prostate cancer tends to be more common in men of African-Caribbean or African descent.

Aside from ejaculating frequently, other methods that may help reduce your risk of prostate cancer include achieving or maintaining a healthy weight, and regular exercise. 

Links To The Headlines

Ejaculating at least 21 times a month significantly reduces a man's risk of prostate cancer. Mail Online, July 5 2017

Having 21 orgasms a month could be the key to preventing CANCER in men because it helps the prostate ‘flush out toxins’. The Sun, July 5 2017

Links To Science

Rider JR, Wilson KM, Sinnott JA, et al. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up. European Urology. Published online March 28 2016

"Abnormal deposits that build up in the brain during Alzheimer's have been pictured in unprecedented detail by UK scientists," reports BBC News.

Alzheimer's disease is characterised by two proteins that take abnormal forms and build up in the brain: beta amyloid plaques and tangles of tau protein, both of which are thought to contribute to the symptoms of Alzheimer's.

Recent drug research has focused on amyloid plaques, but without much success. Interest is now shifting to tau tangles.

Researchers used a new ultra-magnifying technique called cryo-electron microscopy to picture tangles of tau protein in detail.

Cryo-electron microscopy involves freezing a tissue sample (which helps preserve it) and then using powerful microscopes to study the sample at a molecular level.

From this, researchers produced models of the molecules in the protein fibres. Eventually, this work may lead to therapies that can prevent the fibres spreading.

But that's not going to be easy. Brain cells need tau protein to function. The key will be to prevent overgrowth of tau protein fibres without stopping tau carrying out its vital work.

Any drug that targets tau would need to get inside brain cells. One expert estimates it may take 10-15 years before new drugs could be developed from this starting point.

So, this is just the start – but it's a good start. As well as Alzheimer's disease, tau is implicated in several neurological diseases, including Parkinson's disease, so other patients may also benefit from this advance.

Where did the story come from?

The study was carried out by researchers from the Medical Research Council Laboratory of Molecular Biology in Cambridge in the UK, and Indiana University School of Medicine in the US.

It was funded by the UK Medical Research Council, the European Union, the US National Institutes of Health, and Indiana University School of Medicine.

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

BBC News carried a balanced and accurate report of the study findings, but failed to spell out how much work now needs to be done before any new treatments can be developed.

What kind of research was this?

This pathology study used donated brain tissue, which was processed and underwent imaging to examine its protein structure.

This type of study is important for advancing our understanding of disease. It doesn't automatically lead to a cure.

What did the research involve?

Researchers used brain tissue donated by the family of a woman who died of Alzheimer's disease 10 years after diagnosis, aged 74. The tissue was processed to extract fibres of purified tau protein.

These were spread across a carbon grid, frozen, and hundreds of images taken using an electron microscope.

The researchers used the images to describe the molecular structure of the protein fibres and create 3-D molecular models of them.

They also carried out other analysis of the tau fibres, such as checking whether they could "seed" growth of the protein fibres in cultured cells, and compared them with other Alzheimer's disease brain cell samples.

What were the basic results?

Researchers found two types of tau fibres: a straight filament and a paired helical (spiral-shaped) filament.

The detailed molecular maps of the filaments show an ordered c-shaped core, common to both types of fibre. This core seemed to be necessary to seed the fibres through cultured brain cells.

The core is attached to what researchers describe as a "fuzzy coat", which doesn't have any clear molecular order and may grow randomly from the core.

The results were corroborated by other tests, which they said were "in good agreement" with proteins found in earlier research and mass spectrometry imaging of 10 other cases of Alzheimer's disease.

How did the researchers interpret the results?

The researchers said the structures they identified "establish a basis for understanding the differences between molecular conformers of tau aggregates [build-ups]".

They say the research "opens up new possibilities for studying the molecular mechanisms underlying a wide range of neurodegenerative disease". 

Conclusion

There's a tendency when scientists announce a breakthrough in our understanding of a disease to immediately start thinking about whether this could lead to a cure.

While the ultimate aim of research into Alzheimer's disease is of course to be able to prevent or treat it, early research like this is more about understanding the disease mechanisms.

This piece of research demonstrates how a new technique can be used to identify the molecular structure of abnormal protein deposits in the brain. That's a big step forward for use of this technology, which may be useful for other diseases, too.

The causes of Alzheimer's disease still aren't well understood. The brain is complex. Tangles of tau protein may be an important part of the development of Alzheimer's disease – but we don't know whether stopping the spread of tau tangles would halt the memory problems and mental decline characteristic of the disease.

While we can celebrate this advance as a scientific breakthrough in our understanding of Alzheimer's disease, we need to be patient about the chances of a cure.

Until then, while there's no guaranteed way of preventing Alzheimer's, the following may help lower your risk of developing the condition:

• stopping smoking
• not drinking large amounts of alcohol
• eating a healthy, balanced diet, including at least five portions of fruit and vegetables every day
• exercising for at least 150 minutes (2.5 hours) every week
• staying mentally active

Read more about how to prevent Alzheimer's.

Links To The Headlines

Sharp focus on Alzheimer's may help target drugs. BBC News, July 5 2017

Links To Science

Fitzpatrick AWP, Falcon N, He S, et al. Cryo-EM structures of tau filaments from Alzheimer's disease. Nature. Published online July 5 2017

"A common ingredient of soap and toothpaste could be causing antibiotic resistance and fuelling the spread of superbugs," the Mail Online reports.

This news follows the results of a study that looked at whether there could be a common reason why some gut bacteria have resistance to both the quinolone class of antibiotics and the chemical triclosan.

Triclosan has antibacterial properties and is found in a wide range of products, ranging from soap to cleaning products to children's toys. It's also found in some brands of toothpaste as it protects against gum disease. Quinolones are antibiotics often used to treat digestive infections such as E. coli and salmonella.

This study found E. coli and salmonella bacteria with mutations to a particular gene (gyrA) had some degree of resistance to both triclosan and quinolones. The mechanism of resistance was slightly different for the two substances.

The researchers also found that when certain mutant E. coli strains were exposed to low levels of triclosan, they became more dominant (grew more) than other bacteria, but only if they were already present.

Reassuringly, triclosan exposure didn't lead to new mutations developing in previously normal E. coli bacteria. But this doesn't rule out the possibility that triclosan could contribute to bacterial resistance in other ways.

In an accompanying press release, the researchers point out that traditional cleaning methods, such as soap, water and bleach, can be just as effective as antimicrobial branded products – and they don't contribute to the increasing threat of antibiotic resistance. 

Where did the story come from?

The study was carried out by researchers from the Institute of Microbiology and Infection at the University of Birmingham, and the Quadram Institute and John Innes Centre at Norwich Research Park.

It was supported by training grants received by individual researchers, and published in the peer-reviewed Journal of Antimicrobial Chemotherapy.

The Mail Online's coverage was accurate, and included some useful background information on how the US Food and Drug Agency has recently banned triclosan from personal cleaning products such as soap and body gel because of concerns about safety and antibiotic resistance.

The chemical is still used in some brands of toothpaste, both in the US and the UK, and has not been banned in the UK.

What kind of research was this?

This laboratory study aimed to see whether there could be a common link between bacterial resistance to quinolone antibiotics and resistance to triclosan.

Antimicrobial resistance is a global public health problem. As bacteria develop resistance to increasingly stronger antibiotics, we're reaching a point where this is overtaking the rate at which new antibiotics can be developed.

A world without effective antibiotics would see a return to a situation where routine surgeries become far riskier, and some conditions become untreatable.

Triclosan is a biocide – a chemical that can destroy micro-organisms. It's found in many household and cosmetic products like antiseptic soaps, body washes and toothpastes.

Quinolones are a group of commonly used antibiotics, including drugs like ciprofloxacin. Drugs in this group are used to treat a wide range of digestive tract infections, such as salmonella, as well as various respiratory, skin and urinary tract infections.

Quinolones mainly destroy bacteria by targeting a particular bacterial enzyme called DNA gyrase. The gyrA gene codes for this enzyme, and bacteria with mutations to this gene are resistant to quinolones because the antibiotics can no longer bind to this site.

A recent study has shown that salmonella bacteria with gyrA mutations were also less susceptible to triclosan.

The researchers aimed to investigate what mechanism could be causing the bacteria to become more tolerant to quinolone after being exposed to triclosan (a process known as "cross resistance"). 

What did the research involve?

This study involved normal (wild type) strains of E. coli and salmonella bacteria, as well as those with gyrA gene mutations.

Researchers looked at how well the bacteria were able to grow in the presence of quinolones and triclosan, and the minimum concentration of each drug or chemical needed to prevent bacterial growth.

They used laboratory methods to introduce new gyrA mutations and see how drug resistance differed by specific mutation.

As triclosan isn't known to directly target DNA gyrase in the same way as quinolones, they investigated the mechanism by which gyrA mutations could influence triclosan resistance.

The researchers finally tested the possibility that a suboptimal concentration of triclosan – below the level normally needed to stop bacterial growth – might support the growth of bacteria with gyrA mutations.

What were the basic results?

The research showed that both E. coli and salmonella bacteria with gyrA mutations were resistant to some degree to both the quinolone ciprofloxacin and to triclosan.

Eight times the ciprofloxacin concentration was needed to prevent bacterial growth, and four times the concentration of triclosan.

The researchers showed that there was some difference in the susceptibility of E. coli and salmonella to ciprofloxacin depending on the specific mutation the bacteria carried.

They confirmed that, as expected, triclosan doesn't directly target DNA gyrase. They found gyrA mutations in E. coli bacteria increased activity of the bacteria's main "stress response pathways", and this was how they were resistant to triclosan.

Stress response pathways is a term used to describe molecular "defences" that protect against environmental stresses or "threats".

The mechanism was slightly different for salmonella. In the "competitive fitness" tests, researchers found that exposure to low concentrations of triclosan led to E. coli bacteria with a specific gyrA mutation (Asp87Gly) becoming more dominant than other bacteria. The same effect wasn't seen with salmonella.

However, a promising finding was that previous exposure to low-concentration triclosan didn't lead to new quinolone-resistant mutations developing among the wild type bacteria. 

How did the researchers interpret the results?

The researchers concluded that, "Our data suggest gyrA mutants are less susceptible to triclosan due to up-regulation of stress responses. The impact of the gyrA mutation differs between E. coli and Salmonella."

They went on to say that, "The impacts of the gyrA mutation beyond quinolone resistance have implications for the fitness and selection of gyrA mutants in the presence of non-quinolone antimicrobials." 

Conclusion

This study mainly explored why bacterial resistance could be common for both quinolone antibiotics like ciprofloxacin and the antibacterial triclosan.

It confirmed previous findings that one cause seems to be bacteria developing mutations in the gyrA gene.

In the case of quinolones, the mutation alters the enzyme that they normally bind to. Triclosan resistance is largely because the already-mutant bacteria have boosted stress response pathways, or molecular defences.

The main finding of this research was that small triclosan concentrations led to resistant E. coli bacteria becoming the more dominant strains more likely to survive and reproduce.

This may cause concern that low concentrations in everyday products like toothpastes and body washes could lead to the development of antibiotic-resistant bacteria.

But this study didn't find direct evidence for this. Certain mutant E. coli strains did become more dominant, but only if they were already present.

Importantly, triclosan exposure didn't lead to new mutations developing in previously normal E. coli bacteria. This means that this research didn't demonstrate that triclosan causes the development of drug-resistant bacteria.

Nevertheless, there could be other mechanisms that cause resistance, aside from gyrA gene mutations. And triclosan exposure could also have an effect on the effectiveness of other antimicrobials.

This study will undoubtedly be an important contribution to the body of evidence on triclosan.

In 2016, the US Food and Drug Administration (FDA) banned the sale of antiseptic washes containing triclosan (and other ingredients) because of concerns that exposure could carry risks to human health, including being a possible cause of cancer, as well as potentially contributing to antimicrobial resistance.

The EU is also phasing out its use in domestic products, and European agencies are monitoring evidence on its safety and effectiveness.

Triclosan is still used in some brands of toothpaste, as it's thought to prevent gum disease.

Links To The Headlines

Common disinfectant found in soap and toothpaste could be causing antibiotic resistance. Mail Online, June 4 2017

Links To Science

Webber MA, Buckner MMC, Redgrave LS, et al. Quinolone-resistant gyrase mutants demonstrate decreased susceptibility to triclosan. Journal of Antimicrobial Chemotherapy. Published online July 3 2017

"Millions of people taking common heartburn and indigestion medications could be at an increased risk of death," The Guardian reports after a US study found people taking proton pump inhibitors (PPIs) had a slightly higher risk of death than the control group.

PPIs reduce the amount of acid in the stomach. As well as being used to treat heartburn, they're often given to people as a protective measure if they're thought to be at risk of a stomach ulcer – for example, people who take daily low-dose aspirin, which is known to irritate the lining of the stomach.

This headline is based on research in 350,000 predominantly male US veterans who were prescribed PPIs or H2 blocker drugs to either treat heartburn or protect the stomach. PPIs and H2 blockers both work by reducing stomach acid.

The researchers found people who took PPIs had a greater risk of death from any cause compared with those who took H2 blockers or nothing at all.

But there was no proof that the increased risk of death was directly caused by the PPI drugs. The researchers tried to adjust for underlying health factors, such as cardiovascular disease, which is often treated with daily aspirin, but it's possible the effects of these or other factors could still have influenced the results.

If you've been prescribed PPIs, you shouldn't stop taking them without first consulting your GP. The risk of not taking them (such as a stomach bleed) may be greater than any risk associated with taking them.

Where did the story come from?

The study was carried out by researchers from VA Saint Louis Health Care System, Washington University School of Medicine, and Saint Louis University in the US.

No information on funding was provided, but the data the researchers analysed came from the US Department of Veterans Affairs.

The study was published in the peer-reviewed journal BMJ Open and is open access, so it's free to read on the BMJ website.

The UK media's coverage of the story was generally accurate, but the headlines failed to reflect the inherent limitations of the study – including the fact that the conditions people were taking PPIs for in the first place may also have been one of the main causes of death.

What kind of research was this?

This large cohort study of US veterans aimed to look at whether PPIs or H2 blockers were associated with risk of death.

H2 blockers are drugs like ranitidine (Zantac) that reduce stomach acid, and are commonly used to treat acid reflux or heartburn.

PPIs such as omeprazole work in a slightly different way, but are also used to protect the stomach, often in people who have ulcers or those at risk because they take anti-inflammatories or aspirin long term.

Both types of drugs are available on prescription, and some can be purchased over the counter in pharmacies.

As this was a cohort study, it can't prove that taking one drug directly causes death – it can only show there's an association. It might be the case that other health, sociodemographic or lifestyle factors, such as high body mass index (BMI), contributed to the higher risk of death.

A randomised controlled trial (RCT) would give more reliable evidence on the direct effect of either taking the different drugs or doing nothing (control group) while controlling for other factors.

But RCTs can be expensive and time consuming to carry out. Cohort studies can be useful to assess potential adverse effects, as they're able to follow an extensive number of people (in this case 349,312) over a long period of time.

What did the research involve?

Researchers used the US Department of Veterans Affairs national databases to identify 349,312 people (average age 61, 94% male) who'd been prescribed acid suppression therapy (PPIs or H2 blockers) between 2006 and 2008. They looked at their likelihood of death by any cause over 5.71 years on average.

Information on deaths is routinely gathered by the Veterans Benefit Administration for all US veterans.

The 275,977 participants whose first acid reflux drug was a PPI were placed in the PPI group, while the 73,335 participants who received H2 blockers first were the reference group.

In the H2 blocker group, 33,136 participants were later prescribed a PPI and were placed in the PPI group from the point they started taking PPI drugs.

The main outcome of interest was drug use in relation to death.  The researchers also looked at how long the drugs were prescribed for.

They adjusted their data to take into account a number of things that could have influenced the results, including:

• age
• race
• gender
• kidney function
• number of hospitalisations

They also took into account a range of chronic illnesses, including:

• diabetes
• hypertension
• cardiovascular disease
• peripheral artery disease
• stroke
• chronic lung disease
• hepatitis C
• HIV
• dementia
• cancer
• a range of gastrointestinal illnesses

What were the basic results?

Overall, 23.3% of the entire cohort died over the 5.71-year follow-up. The rate was 12.3% in those using H2 blockers at the start of the study, 24.4% in those using PPIs at the start of the study, and 23.4% in those who'd ever used PPIs.

The researchers found:

• PPI use was associated with increased risk of death compared with H2 blocker use (hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.23 to 1.28)
• PPI use versus no known exposure to acid suppression therapy (PPIs or H2 blockers) was also linked with a similar increased risk of death (HR 1.23, 95% CI 1.22 to 1.24)

Risks were similar when only looking at participants with no known gastrointestinal problems:

• PPI versus H2 blocker use (HR 1.24, 95% CI 1.21 to 1.27)
• PPI versus no known acid suppression therapy (HR 1.22, 95% CI 1.21 to 1.23)

Compared with participants taking PPIs for 30 days or less, risk of death gradually increased with the length of time they were taking them:

• 31-90 days (HR 1.05, 95% CI 1.02 to 1.08)
• 91-180 days (HR 1.17, 95% CI 1.13 to 1.20)
• 181-360 days (HR 1.31, 95% CI 1.29 to 1.34)
• 361-720 days (HR 1.51, 95% CI 1.47 to 1.56)

How did the researchers interpret the results?

The researchers concluded that, "The results suggest excess risk of death among PPI users; risk is also increased among those without gastrointestinal conditions and with prolonged duration of use. Limiting PPI use and duration to instances where it is medically indicated may be warranted." 

Conclusion

This larger set of observational data finds that PPI drugs are associated with an increase in the risk of early death compared with either H2 blockers or no acid suppression drugs. This was the case for participants both with and without gastrointestinal problems.

It also appears as though the longer the PPIs drugs are taken, the greater the risk of death.

Considering that these drugs are widely used in the UK, these findings may cause concern. But the research has a number of important limitations:

• The study was conducted in a population of mostly white, older US male veterans, which might limit the ability to generalise the results to the whole UK population.
• Deaths can't be linked directly to the use of PPIs. The researchers have tried to adjust for many health and other characteristics that could be linked with both PPI use and higher risk of death, such as cardiovascular diseases, but we still can't be certain the influence of the disease has been fully taken into account.
• Many of the deaths occurred in the first year, so could well be linked to underlying causes. There was also no information on cause of death.
• The follow-up period only lasted around five years. Longer term death outcomes weren't examined – it may be that PPIs are associated with better outcomes for participants in the long term, but we can't say for sure either way.
• The length of follow-up in the PPI group was more than two years longer than in the H2 blocker group, so it's unsurprising there was a greater risk of death given the extra two years of data collection.
• The drugs were all prescribed in outpatient settings. Some brands of these drugs are available over the counter in the UK. There might be a difference between the groups of people who have their drugs prescribed and those who buy them over the counter, both in terms of risk and in the dose of the drugs.
• This study can't attribute risk to any individual PPI drug. If there is a direct mortality risk from PPIs, it may differ according to which drug it is – but this study isn't able to tell us this.

Overall, this large study of good-quality data raises a clear link that needs further examination.

But people who have been prescribed PPIs shouldn't stop taking them – the risk of not doing so may be much greater than any risk the drugs pose. For example, a bleeding stomach ulcer can be very serious and potentially life threatening.

If you're concerned about your medication, you should discuss your treatment options with your GP or the doctor in charge of your care.

Links To The Headlines

People taking heartburn drugs could have higher risk of death, study claims. The Guardian, July 4 2017

Heartburn drugs taken by millions may increase risk of early death, study suggests. The Daily Telegraph, July 3 2017

Indigestion pills 'may increase the risk of an early death': People who use one type of treatment for heartburn are 25% more likely to die within six years. Daily Mail, July 4 2017

Acid reflux drugs linked to heightened risk of premature death in new study. The Independent, July 4 2017

Links To Science

Xie Y, Bowe B, Li T, et al. Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans. BMJ Open. Published online July 4 2017

"Brain training games boost the memory and may reduce the risk of dementia, new research suggests," The Daily Telegraph reports.

Researchers used an app called Game Show to treat people with amnestic mild cognitive impairment.

Amnestic mild cognitive impairment, which is characterised by problems with short-term memory worse than expected for a person of that age, can be the first sign of dementia. But not everyone with this condition will go on to develop full-blown dementia.

The app game involved associating different geometric patterns with different locations. The small study, involving 42 adults, found playing games on the app for eight hours over four weeks improved the participants' performance in memory tests.

The participants also reported that they enjoyed playing the games and were motivated to continue using the app after the study ended. This would be important if the game was prescribed to help people with amnestic mild cognitive impairment in real life.

This research is in its very early stages. It's not yet clear whether the game would be able to improve the symptoms of people with this condition in everyday life, or slow the development of dementia.

As one expert commentator has pointed out, this type of training is unlikely to prevent or cure dementia, but may help with symptoms.

Get more advice on activities that may be useful for people with early-stage dementia.

Where did the story come from?

The study was carried out by researchers from the University of Cambridge and the University of East Anglia.

It was funded by a grant from Janssen Pharmaceutica/Johnson & Johnson, and the study's authors received funding from the Wellcome Trust, Eton College, and the Wallitt Foundation.

The authors note that they have consulted for or received grants from various medical companies.

The study was published in the peer-reviewed International Journal of Neuropsychopharmacology. It's open access, so it's free to read online.

Most UK news sources reported on the study using an appropriate degree of caution, given the early stage of the research.

The Times and The Daily Telegraph say that the app "may" reduce the risk of dementia or slow its progression in their headlines, and the Mail Online included a prominent section describing some of the study's limitations.

The Independent refers to the participants as having "early-stage dementia" in its headline, and the Mail Online also refers to them as having "early onset dementia". But this isn't quite correct.

The participants were older adults with mild cognitive impairment, a condition where people have problems with their memory that aren't severe enough to be classed as dementia. 

While people with mild cognitive impairment are at increased risk of developing dementia, not all will go on to develop the condition.

What kind of research was this?

This randomised controlled trial (RCT) assessed whether a new "brain training" app called Game Show might help people with a form of memory impairment with their memory difficulties. This study design is the best way to test treatments to see if they have an impact.

Participants in this study had amnestic mild cognitive impairment (aMCI). People with this condition have problems with memory that are worse than would be expected for a healthy person of that age, but not severe enough to be classed as dementia and don't affect their ability to perform everyday tasks independently.

The condition is more common in older people, and people with the condition are at increased risk of developing dementia.

The Alzheimer's Society reports that different studies have found between about 5 and 15% of people with aMCI develop dementia each year. The charity has published a factsheet on aMCI (PDF, 1.05Mb).

Amnestic mild cognitive impairment may also reduce motivation, which could have an impact on whether or not people with the condition take part in programmes that might help them, or stick with them.

There are no effective drug treatments for aMCI, but cognitive training – essentially a form of "brain training" – has been reported to show benefits.

The study's authors say that existing cognitive training programmes are reported to be boring and repetitive. They developed a cognitive training game and tested it to see if it would help with memory as well as be enjoyable to play.

What did the research involve?

The researchers enrolled 42 adults with aMCI and assigned them at random to either play Game Show for eight hours over four weeks, or just carry on with their usual clinic visits (the control group). They then tested their memory at the end of the four weeks.

The participants, who were about 75 years old on average, took a range of standard memory tests and had their symptoms assessed at the start of the study.

The two groups – game playing and control – were similar at the start of the study.

The participants took the memory tests again at the end of the four-week study.

The main assessment was the Cambridge Neuropsychological Test Automated Battery Paired Associates Learning (PAL), which assessed episodic memory, or the ability to remember locations and events.

This test involves being shown boxes at various positions on a touch-sensitive screen, and opening in a random order.

One or more boxes contain a pattern. The patterns are then shown again in the middle of the screen, and participants are asked to touch the box in which that pattern originally appeared.

The task increases in difficulty, starting with a single pattern, and ending with a series of eight patterns. If the participant makes an error, the patterns are shown again in their original positions, and the participant can try to locate them again.

The Game Show app employed a similar task of pattern and location mapping, but involved appealing and engaging visual displays, music, and a virtual "quiz show" host.

Participants in the group playing the game did so for an hour at a time on an iPad, and were supervised by the researchers while they did it.

After each hour of play, participants rated how much they had enjoyed the game and how much they wanted to continue playing, as well as their self-confidence and memory.

What were the basic results?

Playing the Game Show app improved various aspects of the participants' performance on the PAL test of episodic memory.

Compared with the control group, at the end of the four-week study Game Show players:

• made significantly fewer errors remembering where patterns were located in the two and three-pattern stages, but not at later, more difficult, stages
• took fewer goes to get the two-pattern stage correct, but not in the more difficult stages
• correctly located many patterns in their first go at each stage of the game

The people who played Game Show reported high levels of enjoyment and motivation to continue playing that lasted up to the end of the four-week study.

How did the researchers interpret the results?

The researchers concluded that episodic memory improved in people with aMCI by playing the Game Show cognitive training app.

Turning the training into a game improved motivation, and therefore engagement with the training.

The researchers suggest that the game "could complement [drug] treatments for aMCI and mild Alzheimer's disease", but more controlled trials are needed to confirm these findings and extend them to other groups.

Conclusion

This small trial suggests that an iPad game aimed at training episodic memory – memory of locations and events – can lead to improvements in this aspect of memory in older adults with aMCI.

The fact the study used a control group and an RCT design increases confidence in these findings.

But there are some important things to bear in mind at this very early stage:

• The study was very small – the authors acknowledge that it needs to be repeated in a larger sample of people to confirm the findings.
• The game hasn't been tried in people with dementia, so we don't know if it would help them.
• The study only followed participants for four weeks. More studies are needed to see how long the improvements last, especially if participants stop playing the game, and whether motivation to play the game is maintained in the longer term.
• The researchers largely focused on performance in specific tests of episodic memory. It isn't clear whether the benefits seen in these tests would mean that the participants' memories were better in everyday situations. The participants playing the game did rate their memory as better, but it's unclear if they just meant their memory performance in the game or their memory in general.
• The group that played the game did so under the supervision of research staff. This level of attention may have contributed to their feelings of motivation and confidence. The opposite is true of the control group, who knew they weren't getting to play the game. This could potentially contribute to the memory results seen. Ideally, in future studies the control group would have the same level of interaction with the research staff (an attention control) to make sure this doesn't have an effect.

As one expert commentator pointed out, this type of training is unlikely to prevent or cure dementia – but it may help with the symptoms.

With an ageing population, research like this is increasingly important. The use of technology like computerised touch screen games to deliver this training is very appealing, and could potentially be used in the home without the need for supervision.

Links To The Headlines

Brain training games boost memory and may reduce the risk of dementia, research suggests. The Daily Telegraph, July 3 2017

Could an app reverse the early signs of dementia? Brain training game improves memory in people with mild cognitive impairment. Mail Online, July 3 2017

New brain training app improves memories of people with early-stage dementia. The Independent, July 3 2017

Links To Science

Savulich G, Piercy T, Fox C, et al. Cognitive Training Using a Novel Memory Game on an iPad in Patients with Amnestic Mild Cognitive Impairment (aMCI). International Journal of Neuropsychopharmacology. Published online July 2 2017

"Nearly a quarter of women who don't make cervical screening appointments are unaware that the process even exists, according to a UK survey," BBC News reports.

Cervical cancer is a type of cancer that starts in the cervix, the entrance to the womb. It's responsible for around 900 deaths a year in the UK.

Regular screening appointments to check for abnormal cell growth are offered to all women aged between 25 and 64.

This study found about a quarter of eligible women didn't go for a cervical screening test. Most women who didn't attend either said they were unaware of screening or that they intended to go, but were overdue for their appointment.

Cervical cancer became a high-profile media topic after the untimely death of reality TV star Jade Goody from the disease in 2009. It now seems that almost a decade later, the issue has dropped off the radar for many women.

The researchers suggest that interventions to increase the uptake of cervical screening should focus on three main types of non-participants:

• those who intend to go to screening but don't actually confirm an appointment
• those unaware of screening
• those who actively decide not to be screened

Read more about cervical cancer screening, including why it's offered and who's invited for a screening test.

Where did the story come from?

The study was carried out by researchers from University College London (UCL) in the UK and the National Cancer Institute in the US.

It was funded by a grant from Cancer Research UK.

The study was published in the peer-reviewed European Journal of Cancer. It's available on an open access basis and is free to read online.

BBC News' coverage was balanced and accurate.

What kind of research was this?

This cross-sectional study wanted to assess the prevalence of women who didn't participate in the UK cervical cancer screening programme, and better understand the reasons why they didn't attend.

Cervical screening is used to detect any abnormal changes in cells in the cervix that could potentially develop into cervical cancer.

All women between the ages of 25 and 64 who are registered with a GP are invited for cervical screening.

But the uptake of cervical screening has been decreasing in the UK. The researchers wanted to investigate the reasons behind the fall in attendance.

Cross-sectional studies are useful for analysing data from a population at a specific point in time. But a drawback is that they can't confirm the cause for any observations or explore which factors could be having an influence.

What did the research involve?

Researchers surveyed 3,113 women eligible for screening in the UK using face-to-face computer-assisted personal interviews (CAPIs).

Four questions were asked around past screening behaviour and whether the women intended to attend screening in the future.

The questions were:

• Have you ever heard of cervical screening, also known as the smear test or Pap test?
• Have you ever had a cervical screening test?
• When was the last time you had a cervical screening test?
• Do you intend to go when next invited?

From their responses, the women were categorised as either participants or non-participants.

Non-participants were classified as:

• unaware
• unengaged
• undecided
• decided not to be screened
• intending to be screened

Data was also collected on sociodemographic characteristics, such as:

• age
• marital status
• number and age of children
• occupational status
• ethnicity
• first language spoken

What were the basic results?

Of the 3,113 women, 793 (27%) were classed as non-participants:

• 219 women (28%) were unaware of screening
• 406 women (51%) were overdue for screening but intended to be screened
• 118 women (15%) had decided not to be screened

Women between the ages of 25 and 34 were more likely to be classed as non-participants. They were also the most likely age group to be unaware of screening. Women aged 55-64 were most likely to have decided against screening.

Women from lower socioeconomic groups and who didn't work were more likely to be unaware of screening, overdue for screening, or to have decided against screening.

Single women were more likely to be unaware or to have decided not to be screened compared with married women.

Women from ethnic minority groups were more likely to be unaware of screening. But South Asian and black women were more likely to intend to go to screening than white British women.

When language was adjusted for, there was no difference between white British women and those from different ethnic backgrounds.

How did the researchers interpret the results?

The researchers concluded that, "This work suggests that the vast majority of women in Britain who are not participating in cervical screening as recommended are not making an active decision not to attend.

"Most non-participants are either unaware or would like to be screened but are unable to translate their positive intentions to be screened into action." 

Conclusion

This study presents interesting findings on the proportion of women who don't go for cervical screening tests, and the possible reasons for their non-attendance.

Researchers found most non-participants were either unaware of screening or intended to go to screening but still failed to go. This was most common in single women aged 25-34.

One point to note is that the data was collected through self-reported questionnaires, which carry the risk of inaccurate reporting because of the perceived social stigma around screening and the desire to give the "right" response.

In the case of cervical cancer screening, it's possible women know they should attend screening but for whatever reasons don't want to attend, but feel more comfortable saying that they do in fact plan to attend screening, even when they might not in reality.

Another point is that women who agree to participate in market research screening interviews may be from different socio-demographic groups to those who don't.

This means we can't be completely sure that this sample – despite being large – represents the views and screening participation of the population as a whole. 

The researchers suggest that this study will help focus interventions on three main types of non-participants to increase the uptake of cervical screening:

• those who intend to go to screening but are overdue for the test
• those unaware of screening
• those who actively decide not to be screened

This incredibly useful study highlights the need for further exploration into the reasons why some women don't go for cervical screening – what is the exact reason women are unaware of screening, and why do they choose not to attend?

These questions are important, as cervical cancer is often preventable if abnormal cell changes are detected early.

In England, screening is offered to all women aged 25-64. Teenage girls aged 12-13 are offered the HPV vaccine, which helps protect against cervical cancer, as part of the routine NHS childhood vaccination schedule.

Links To The Headlines

No-show women at cervical screening 'unaware of test'. BBC News, June 30 2017

Links To Science

Marlow LAV, Chorley AJ, Haddrell J, et al. Understanding the heterogeneity of cervical cancer screening non-participants: Data from a national sample of British women. European Journal of Cancer. Published online May 20 2017

"Over-the-counter magnesium tablets significantly improve depression in just two weeks, new research reveals," the Mail Online reports. A small study found that people taking the supplements – on top of their existing treatment – reported an improvement in depression symptoms.

However, because the study wasn't blinded (people knew what they were taking) the improvements could have been down to the placebo effect; people get better just because they expect to get better.

Researchers asked 126 adults with mild or moderate depression to spend six weeks taking magnesium supplements and six weeks without magnesium supplements. People also continued with their usual depression treatment. Researchers monitored people's depression symptoms with phone calls every two weeks.

Half the people took supplements straight away, and half took supplements after waiting six weeks. Depression symptoms improved by an average six points on a scale of 0 to 27 after people took magnesium for six weeks, compared to after six weeks not taking magnesium.

The potentially positive effect of magnesium on depression isn't outside the realms of possibility. The element is thought to play a role in many of the biological processes involved in mood regulation.

It is therefore frustrating that a more rigorous study design wasn't used to rule out the possibility of a placebo effect.

Where did the story come from?

The study was carried out by researchers from the University of Vermont and was funded by the Henry and Carleen Tufo fund of the University of Vermont. The study was published in the peer-reviewed journal PLOS One on an open-access basis, so it's free to read online.

The Mail Online covered the study uncritically, not mentioning that it had no placebo group and was not blinded. They also stated, incorrectly, that people were untreated for depression while not taking magnesium – in fact, everyone in the study took magnesium in addition to continuing with their usual treatment.

What kind of research was this?

This was an open-label randomised cross-over clinical trial, with no placebo group. People knew when they were taking the treatment and when they were not, as did the researchers monitoring their symptoms.

This type of study can show whether people's symptoms improved while they were taking treatment, but it can't tell us whether those improvements were caused by the active ingredient, or whether they would have happened while taking anything – even a sugar pill.

What did the research involve?

Researchers contacted 1,340 adults identified by their primary care doctor as having mild or moderate depression. Of these, 126 people agreed to take part and were eligible for the study. People continued their usual treatment throughout the study.

Half were randomly assigned to start magnesium supplements immediately, followed by a six week 'control period' without magnesium. The other half were assigned to start magnesium after a six week control period. All participants were monitored for symptoms and side effects with phone calls every fortnight, throughout the 12 week study period.

People took four 500mg tablets of magnesium chloride daily.

Researchers looked at the average change in symptom score from start to end of the six weeks of magnesium treatment, and from start to end of the six weeks of control. They calculated the net difference (ie the difference in change in score between the two six week periods) and adjusted the figures to take into account use of SSRI medicines, the order in which people had been randomised, and their response during the control period.

Depression symptoms were measured using the standard Patient Health Questionnaire 9 (PHQ-9) which uses nine questions to diagnose and classify depression. Mild depression is a score of 5 to 9, moderate depression is 10 to 14, moderate to severe depression is 15 to 19 and 20 to 27 indicates severe depression. 

What were the basic results?

People scored on average six points lower on the depression scale while taking magnesium supplements (adjusted net difference -6.0, 95% confidence interval (CI) -7.9 to -4.2). This is seen as clinically important.

Analysis of the figures found that magnesium was effective regardless of age, gender, depression category and depression treatment. Perhaps surprisingly, it also suggested that adherence to treatment (whether people took at least 80% of the tablets) did not make a difference.

The most commonly reported side effect was diarrhoea, reported by eight people, but this was not more common when people were taking magnesium than when they were not taking it.

How did the researchers interpret the results?

The researchers say their results showed that "magnesium supplements may be a fast, safe and easily accessible alternative or adjunct [addition] to starting or increasing the dose of antidepressant medications."

Addressing the issue of the lack of a placebo group, they claim it is "not useful when the research seeks to assess the presence and magnitude of the effect of an intervention."

They add: "Whether magnesium works because it induces a physiological change in the subject, or only because of the placebo effect (or a combination of the two), it remains that subjects do report better levels of depression and anxiety when taking magnesium than when not."

Conclusion

Depression is a serious illness that can cause a great deal of distress to those who have it, as well as to their friends and family. Current treatments – both medication and talking therapies – work well for some people but less well for others.

Antidepressants can have unwanted side effects. So, a new treatment for depression with few side effects would be very welcome.

Despite the researchers' interpretations of their results, however, it's hard to recommend a treatment when we don't know whether a sugar pill would work just as well.

The lack of a placebo group in the study means we cannot be sure whether magnesium is a useful treatment for depression. We know that the placebo effect is real, and that it can bias results of clinical trials if not tested for by a placebo group in the study.

This study was relatively small (only 112 people provided data that could be analysed); lasted only 12 weeks and did not include a placebo group. It's entirely possible that the results shown with magnesium pills are due to the placebo effect, and that they would have worn off with a longer study period.

Although the researchers say that magnesium is "safe", high doses can cause diarrhoea. UK guidelines state that most people should be able to get sufficient magnesium through their diet, such as by eating more green vegetables, and that the effects of high-dose magnesium in the long term are unknown. Also, magnesium supplements are not recommended for people with a history of kidney disease.

This study seems to have been a wasted opportunity to find out whether magnesium is a useful supplement for people with mild to moderate depression.

Links To The Headlines

Over-the-counter magnesium tablets can banish the blues in just TWO WEEKS without the side effects associated with antidepressants. Mail Online, June 28 2017

Links To Science

Tarleton EK, Littenberg B, MacLean CD, et al. Role of magnesium supplementation in the treatment of depression: A randomized clinical trial. PLOS One. Published online June 27 2017