Category Archives: Health

Saving children’s teeth in Sudan – without anaesthetic or drills

Tooth decay is the most common chronic dental disease in the world. It affects 60-90% of children around the world, according to the World Dental Federation. It is 20 times more common than diabetes and five times more common than asthma. If left untreated, it can cause pain and abscesses and may require root treatment or even extraction. This can traumatise children for life.

The usual way to treat tooth decay is to drill out the rot and then cover the tooth with a thin stainless steel cap. This is considered the gold standard treatment, but it requires a local anaesthetic, lots of time, specialist skills and, for the dentist, the patience of a saint. If the child is anxious – and many are – they often have to be admitted to hospital to have the work carried out under a general anaesthetic.

But consider a child living in poverty in East Africa with no running water or electricity, and the nearest dentist a day or two’s walk away. Would you imagine that their care would be similar to a child in the West? And do you think their decayed teeth would be saved?

I work as a dentist in Sudan providing care for children with these exact circumstances. By the age of 12, almost all children in Sudan know what it is like to have had a tooth extracted. For a country of 40m people, we have just eight children’s dentists.

What if I were to tell you that all we need to do to save a child’s tooth is to ignore the rot, seal it by gluing a cap on the bad tooth and do nothing else? And would you believe me if I told you that this is just as effective as the costly standard treatment?

A 2006 analysis of primary care records, showed that this simple technique, known as the Hall technique, was effective in treating children in Scotland. It works by starving the tooth-rotting germs of oxygen.

Even though this technique is supported by scientific evidence, it has been shunned by many dentists around the world as there was no randomised controlled trial proving its effectiveness compared with accepted conventional techniques. So with colleagues at Queen Mary University of London, we set out to conduct just such a trial.

We randomly assigned 164 children to receive one of two treatments. One group received the gold standard of care. The child received a local anaesthetic and the bad tooth was then drilled to remove the decay. The cap was fitted after adjusting it to the right shape and size of the tooth – which is fiddly – and then glued. The other group received the Hall technique. We pushed the metal cap gently onto the tooth and glued it on without any injections or drilling.

Capping and gluing is common to both techniques but requires a considerable adjustment in the conventional technique. None is required for the Hall technique.

The study was done at a time in Sudan when Omar Al-Bashir’s brutal regime was coming to an end. Daily life was, and still is, tough. The situation affected the project on many levels.

While most scientists take the internet for granted, we don’t. Blackouts are common and can last for weeks or months, so a high level of organisation is needed. Even in the capital, Khartoum, electricity and water supplies are not guaranteed and could be out for days.

Writing up this study took a while as we fit research around when we have internet access and are able to collaborate online with partners in Sudan and internationally. But the Sudanese are generally happy people and nothing seems to faze them. The staff were fantastic and did whatever they could to help under these difficult conditions.

Positive results

The results of our study, published in open access journal PLOS ONE, prove that the Hall technique performs as well as the gold standard in all clinical aspects, such as the survival of the tooth, gum health, faulty bite (occlusion) and abscess formation, even when done by less experienced operators.

In addition to saving teeth, the Hall technique performed as well as the gold standard in terms of the caps remaining in place over a two-year follow-up. And the children were much happier just before the treatment, just after it, and a year later. In fact, some children were demanding the caps to be fitted on their brothers and sisters. The only crying we heard in the clinic was when a child’s sibling got a cap and they didn’t.

Keeping costs low is very important for maintaining public health systems around the world, and this technique proved to be much cheaper than conventional techniques of drilling and capping. But changes in healthcare policy must be supported by evidence, and our study goes some way to providing that.

The Hall technique, if widely adopted, could have a big impact on many overstretched public health services around the world, particularly those in developing countries and those with little access to dental services, giving children a better chance of keeping their teeth.

Fadil Elamin does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Source: The Conversation: Health

http://theconversation.com/saving-childrens-teeth-in-sudan-without-anaesthetic-or-drills-119053

Drug-resistant germs found on flies in English hospitals – new study

Hospital-acquired infections are very common and they pose a serious risk to patients who are already weakened by another medical condition. Although hospitals take several steps to avoid these sorts of infections, there is one thing they often overlook: insects.

Scientists have looked at the problem of insects in hospitals before, but research has mainly focused on bugs that can breed inside a hospital, such as ants and cockroaches. Our research suggests that we should be more worried about flying insects because several flies we trapped at English hospitals carried drug-resistant bacteria.

Using ultraviolet-light flytraps, electronic fly killers and sticky traps, we captured about 20,000 flies from seven English hospitals. We placed the traps in areas where food was prepared or stored as well as wards, neonatal units and maternity units.

Most of the insects we collected over the 18 month period were Diptera, or true flies, accounting for the 76% of the flies we caught. The Diptera species includes house flies, bluebottles, drain flies and mosquitoes.

Almost half of the true flies caught in our traps were non-biting midges. These flies are typically outdoor species that don’t breed inside buildings. But non-biting midges were not the only intruders in the hospitals. We also found several other species that live and feed on plants, such as aphids, froghoppers and leafhoppers. This suggests that hospitals could do more to prevent flying insects from entering the building.

Bugs on bugs

We determined how many and which bacteria were on the flies we trapped and whether those bacteria were drug resistant. We analysed several families of true flies and found 86 bacterial strains. Enterobacteriaceae, a family that includes E. coli and Klebsiella, were the most commonly isolated, accounting for 41%, followed by Bacillus (which includes the food poisoning bug B. cereus) at 24% and staphylococci (which includes S. aureus, a cause of skin infections, abscesses and respiratory infections) comprising 19%.

When we tested the bacteria for susceptibility to antibiotics, we found that 53% of the strains were resistant to one or more class of antibiotic. Of these, 19% were resistant to several antibiotics, referred to as multi-drug resistance.

Multi-drug-resistant bacteria are, naturally, harder to treat. And infections caused by multi-drug-resistant Enterobacteriaceae are associated with a high risk of death. Fortunately, the Enterobacteriaceae found on the flies in this study were susceptible to most of the antibiotics tested.

We found penicillin to be the least effective antibiotic, especially in Staphylococcus species, which is not surprising given that penicillin-resistant bugs are widespread. We also found bacteria that were resistant to other commonly used antibiotics, including tetracycline and clindamycin.

The link between flying insects in hospitals and hospital-acquired infections is not yet fully understood, but the ability of certain insects to spread bacteria that are attached to their legs or that are in their faeces has been described before. Even when the number of bacteria on insects is not enough to cause an infection directly, they can still act as a reservoir of pathogenic bacteria. This means that when a fly lands on a surface rich in nutrients for bacterial growth, even if only a few bacteria are delivered, it is a matter of hours before the cells multiply to sufficient level to be able to cause an infection.

The good news is that even though more than half the bacteria found on flies in our study were resistant to at least one antibiotic, they were susceptible to other antibiotics and hence treatable. Still, English hospitals could do more to improve pest control – it might help to reduce the risk of infection in already vulnerable patients.

Federica Boiocchi receives funding from Aston University and Killgerm Chemicals Ltd.

Source: The Conversation: Health

http://theconversation.com/drug-resistant-germs-found-on-flies-in-english-hospitals-new-study-118856

Parkinson’s disease: scientists find the earliest roots in the brain

About 100 people have a rare mutation in a gene called SNCA that puts them at almost certain risk of getting Parkinson’s disease. This makes them ideal subjects for studying the root causes of this debilitating condition. Most of these people live in the northern Peloponnese in Greece, and a handful live in Campania, Italy. We were lucky enough to have 14 of these people agree to travel to London so we could study their brains.

More than 6m people, globally, have Parkinson’s disease; it is the second most common neurodegenerative disorder after Alzheimer disease. The symptoms, which worsen over time, include motor symptoms such as stiffness, slowness and shaking, as well as non-motor symptoms, such as memory problems. Researchers have been trying to find a reliable marker for the disease so that people at risk can be identified before the motor symptoms start.

There are no cures for Parkinson’s disease, but symptoms are treated with drugs that restore a brain chemical called dopamine to normal levels. Dopamine has long been considered a prime culprit in Parkinson’s disease as low levels cause problems with movement. But another brain chemical called serotonin has also been implicated in the disease. But we didn’t know how early and to what extent changes in serotonin occur and if these changes are related to disease onset. To help answer this, we needed to study those Greek and Italian subjects with the SNCA gene mutation.

Studying these gene carriers before they develop Parkinson’s disease is a unique opportunity to understand what comes first in the cascade of events that eventually leads to a diagnosis of Parkinson’s disease. This knowledge is critical so that we can develop sensitive markers to track the progression of the disease.

People with the mutation tend to display symptoms of Parkinson’s disease in their 40s or 50s, so we wanted to study subjects in their 20s and 30s to see if there were any brain changes a decade or more before symptoms started.

Seven of our volunteers, who kindly visited our lab for ten days of brain imaging and neurological tests, had no motor symptoms and seven had been diagnosed with Parkinson’s disease. We also examined 25 patients with sporadic Parkinson’s disease (Parkinson’s disease without a genetic cause) and 25 healthy volunteers.

All participant had three brain scans: one to measure dopamine, one to measure serotonin, and another to study anatomical regions in the brain.

We also carried out a series of clinical tests to investigate motor and non-motor symptoms. The volunteers wore an electronic device on their wrist for seven days to pick up any movements associated with Parkinson’s disease – movement that might be too subtle to be detected by a neurologist with the naked eye. These tests confirmed that the seven subjects with the gene mutation who had no motor symptoms were, indeed, Parkinson’s free.

Early serotonin loss

Comparing data from the different groups allowed us to measure the severity of dopamine and serotonin loss at different stages of the disease, from people without symptoms to people with a diagnosis. It also allowed us to compare changes seen in the gene carriers with changes seen in those with sporadic Parkinson’s disease. This helped us translate our findings in the gene carriers into the more common sporadic form of Parkinson’s disease.

We discovered that gene carriers without symptoms had depleted serotonin, while their dopamine neurons appeared to remain intact. So the changes in the serotonin system that we identified are likely to start very early and precede the onset of motor symptoms by some years.

Our study, published in Lancet Neurology, suggests that changes to the serotonin system come first, occurring many years before patients show symptoms. This important finding could lead to the development of new drugs to slow or even stop disease progression.

Our findings also suggest that brain scans of the serotonin system could be used as a tool for screening and monitoring disease progression. But these scans are expensive, so we need more work to develop affordable technology. We also need more research into genetic forms of Parkinson’s which could further unlock the earliest changes underlying this awful disease.

Heather Wilson receives research support from the CHDI Foundation.

Professor Politis research is supported by Michael J Fox Foundation for Parkinson’s Research, Edmond and Lilly Safra Foundation, CHDI Foundation, Glaxo Wellcome R&D, Life Molecular Imaging, Invicro, Curium, Medical Research Council (UK), AVID radiopharmaceuticals, National Institute for Health Research, Alzheimer’s Research UK, and European Commission IMI2 fund.

Source: The Conversation: Health

http://theconversation.com/parkinsons-disease-scientists-find-the-earliest-roots-in-the-brain-119030

Listeria outbreaks: why they should be much rarer in ten years’ time

A listeria outbreak in the UK has infected nine people and killed five of them in June 2019. The bacteria was transmitted via sandwiches and salads eaten in seven hospitals across England, supplied by the Good Food Chain, a company based in the Midlands. The outbreak came to light after samples from its meat supplier tested positive for the bacteria, which microbiologists refer to as L. monocytogenes.

People who contract listeria risk developing an infection called listeriosis, which can be dangerous to the likes of pregnant women, immunocompromised people and the elderly. The riskiest foods include soft cheeses, unpasteurised milk, salads and certain types of processed meat and fish.

This is the third significant outbreak around the world in the past several years. South Africa experienced the largest ever incidence in 2017-18, when more than 200 people died after eating a contaminated ready-to-eat sausage called polony. The outbreak led to product recalls from some 15 countries in the region.

Between 2015 and 2018, an outbreak in Europe killed ten people and infected more than 50. It was caused after a vegetable processing facility in Hungary contaminated frozen products being shipped to numerous countries, including the UK, Finland and Austria. The bacteria persisted despite the manufacturers following all the regulations on sanitation.

Disasters such as these could probably have been avoided if samples of these factory food products had been pre-tested using the latest genome sequencing technology. This has yet to filter down to industry – because the costs are still too high – so food manufacturers are still relying on standard laboratory bacteria tests. The good news for the future is that this is soon likely to change.

How Listeria spreads

L. monocytogenes lives in soil, water courses and plants as an organism known as a saprophyte, which lives off dead and decaying matter. It also exists in the gut of animals – including humans – often causing no symptoms and then being passed out in faeces. Because fresh vegetables are grown in tight spaces, it is difficult to prevent them being contaminated from these sources – due to the likes of soil splash and interactions with wild animals in the field.

To become a problem for the food industry, there usually needs to be a contaminated “pinch point” in the manufacturing process that can spread bacteria to a large volume of products. In the Hungary outbreak, for instance, L. monocytogenes matching the culprit strain were traced to the floor drain of the processing factory and to spinach from a vegetable grinder.

One reason why listeria bacteria are so good at surviving in the food supply chain is because they form bacterial biofilms, in which the microorganisms stick together in a matrix of polymeric substances that they secrete from their bodies. These biofilms are resilient enough to survive a fair amount of antibacterial punishment, even on man-made surfaces such as stainless steel or polystyrene.

At the same time, recent evidence suggests that L. monocytogenes enter a protective state under stress, such as when a different detergent is used against them. In this state it is harder to eradicate them. They are also able to tolerate fridge temperatures remarkably well. In all, they are much hardier survivors than other bacteria such as E. coli or Salmonella and demand greater cleaning and sanitation in food factories to keep them at bay.

The testing regime

By law, food manufacturers in the UK and many other countries currently have to send food and environmental samples for microbial analysis. If they supply a major supermarket or high street restaurant chain they are probably required to exceed minimum requirements and send more samples to meet more stringent safety policies.

These tests will flag up bacterial contamination, but they are of limited value in relation to listeria. Because listeria is able to live almost anywhere, you can expect to find a certain low level of L. monocytogenes. It only becomes a cause for concern when the level increases over a short period of time.

Yet these standard microbial tests are a hit and miss method of spotting contaminations. The trouble is that it can often be difficult to see whether there is a problem without looking at the genetics of the bacteria: in “safe” food samples, the listeria will be genetically diverse, whereas in an outbreak they will be predominantly the same subtype. Standard tests only tell you whether you have L. monocytogenes or not – to get the genetic information, you need genome sequencing.

Standard lab tests also don’t give you any information about the source of the bacteria. For this reason, investigators have already started using genome sequencing during outbreaks including the ones I mentioned earlier. In a situation such as the pan-European outbreak of 2015-18, without genome sequencing the food suppliers may have had to shut down many more units for intensive cleaning before they could operate again, losing much more money in the process.

Unfortunately, genome sequencing tests can cost something like five times the current going rate for standard tests. This effectively prohibits its use in pretesting – all the more so for small suppliers with shallower pockets.

Ten years from now it could be a very different situation. We have already seen the way that the price to generate the raw data for a bacterial genome has fallen from US$50,000 to US$1 (£39,735 to £0.79) in the past decade. The technology has already become standard for the likes of researchers, which is usually a sign that it will reach industry a few years later. In the meantime, standards are rising anyway – operators in the supply chain are constantly reviewing their safety practices with a focus on consumer safety. These include increased microbial sampling and more sanitation and disinfection programmes.

So while listeria is a tough opponent for the food manufacturing industry, its days as a serious threat could well be numbered. Fairly soon, food manufacturers and their retailers are going to face a choice: pay for genome sequencing technology or save money and risk an outbreak, the result of which is a catastrophic effect on public health and the possible end of your company. In the end, they probably won’t need to think about it for very long.

Alva Smith does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Source: The Conversation: Health

http://theconversation.com/listeria-outbreaks-why-they-should-be-much-rarer-in-ten-years-time-119043

Long hours at the office could be killing you – the case for a shorter working week

UK employees have the longest working week compared to other workers in the European Union. But, despite the long hours, recent studies have shown this does not make the UK a more productive nation.

An analysis by the Trade Union Congress on working hours and productivity found that, while UK full-time staff worked almost two hours more than the EU average, they were not as productive as staff in Denmark who worked fewer hours in the average week.

Such findings have triggered an interest in the relationship between the number of hours worked and productivity – and the results of several studies have suggested the concept of “optimal working time”. This refers to an optimal number of hours spent at work after which productivity begins to decline and acute or chronic health problems begin to arise. Some experts suggest it should be no more than 35 hours a week.

Read more:
The rise of the low-pay workforce – when seven jobs just isn’t enough

So, while the prevalence of flexible working and the use of technologies to facilitate it have brought many benefits to organisations, such changes have also helped to create a 24/7 work culture – and with it that feeling of “always being on” and available to take work calls or emails. And, as research shows, employees working in such environments may actually show lower levels of engagement – which over time could reduce their productivity.

Impact on health and well-being

Several studies have shown that some aspects of work are important predictors of health, happiness, motivation and life satisfaction. For a start, the number of hours people work has a major impact on their physical and psychological health. Evidence also suggests that long working hours are associated with hypertension, heart disease and the risk of injuries and accidents.

Other studies have shown associations between hours of work and stress, anxiety and depression. The propensity to work long hours also has an adverse effect on family and social relationships and can increase family conflict.

But research studying the impact of working hours on health has also recognised how people’s perceptions regarding long working hours and time demands can affect this negative association. Voluntarily opting to work longer hours as opposed to being pressured by one’s employer can translate into big differences in health and well-being. This can help explain why some people who work extended hours may display poorer physical and psychological well-being compared to others.

Motives for working long hours

There are predominantly two motivations for working long hours – both of which have distinctive influences on the relationship with work outcomes and well-being. Some people work long hours, for example, because they find personal fulfilment in their work. These people genuinely enjoy their job and derive a sense of satisfaction from excelling at it.

This is different from working long hours to avoid the threat of job insecurity or negative feedback from supervisors. In the first instance, while there might be pressure to put in long hours, it is ultimately the employee’s choice. Hence, these workers are unlikely to experience the adverse effects of work pressure and stress as much as those who feel forced to put in longer hours.

Nonetheless, there is a lot of cynicism about the benefits of working extended hours. Excessive involvement with work, even if it is enjoyable for the employee, can lead to neglect in other areas of life which can take a toll on health, well-being and interpersonal relationships.

Risks of workaholism

In many cultures, long working hours and workaholism have positive connotations – such as dedication, commitment and perseverance. But when the need for work turns so excessive that it begins to interfere with health, personal happiness and social functioning, it can turn into a potentially fatal disorder.

Employers and co-workers can help colleagues who are prone to overworking by looking out for any warning signs of workaholism. Specific times to take breaks and finish work are vital. And everyone should be taking their holiday allowance so that they have enough time for rest and recovery.

Read more:
Why we have such a love-hate relationship with work

Of course, this all sounds well and good – but job insecurity, work pressures and an overly competitive work atmosphere can compel employees to work extended hours – even when they know it’s damaging their health.

Ultimately, most workers today desire a life beyond work – and research shows people can be more productive if they are able to balance their work and personal lives in more satisfying ways. Companies, for example, that have trialled the four-day work week have found that working fewer hours results in productivity increases due to reduced employee stress and improved focus on work tasks.

Also as working less means employees will spend less time commuting, there are obvious payoffs for the economy (think, more time to recuperate and engage with leisure activities) and the environment of doing away with an overwork culture.

Shainaz Firfiray does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Source: The Conversation: Health

http://theconversation.com/long-hours-at-the-office-could-be-killing-you-the-case-for-a-shorter-working-week-116369

Want to be healthy and happy? Choose a ⁠c⁠o⁠n⁠s⁠c⁠i⁠e⁠n⁠t⁠i⁠o⁠u⁠s⁠ ⁠p⁠a⁠r⁠t⁠n⁠e⁠r⁠

Y⁠o⁠u⁠r⁠ ⁠p⁠a⁠r⁠t⁠n⁠e⁠r⁠’⁠s⁠ ⁠p⁠e⁠r⁠s⁠o⁠n⁠a⁠l⁠i⁠t⁠y⁠ ⁠c⁠a⁠n⁠ ⁠i⁠n⁠f⁠l⁠u⁠e⁠n⁠c⁠e⁠ ⁠y⁠o⁠u⁠r⁠ ⁠l⁠i⁠f⁠e⁠ ⁠i⁠n⁠ ⁠a⁠l⁠l⁠ ⁠s⁠o⁠r⁠t⁠s⁠ ⁠o⁠f⁠ ⁠w⁠a⁠y⁠s⁠. For example, studies have shown that a conscientious partner i⁠s⁠ ⁠g⁠o⁠o⁠d⁠ ⁠f⁠o⁠r⁠ ⁠y⁠o⁠u⁠r⁠ ⁠h⁠e⁠a⁠l⁠t⁠h. Our latest study shows that they are also good for your quality of life.

Personality reflects a person’s characteristic way of thinking, feeling and behaving. Psychologists tend to examine personality across five key traits: extroversion, openness to experiences, conscientiousness, emotional stability and agreeableness. Typically, these traits are measured using questionnaires that help psychologists build up a profile of a person’s personality.

Personality characteristics can have a strong impact on health, even influencing how long you live. Research shows that the more conscientious a person is, the longer they live. Conscientiousness is defined by high levels of self-discipline. Because conscientious people are more organised and careful they are more likely to lead healthier lives than their less conscientious peers. For instance, they may be more likely to follow their doctor’s advice, eat more healthily and do more exercise.

It’s not just your own personality that can strongly influence your health, though – your partner’s can too. A US study examined the relationship between partner conscientiousness and health ratings in 2,203 older couples. They found that husbands’ conscientiousness influenced wives’ health, and wives’ conscientiousness influenced husbands’ health. The same findings were also replicated in a more recent study.

These results showed something particularly interesting: conscientiousness had a compensatory effect, meaning that having a more conscientious spouse predicted better health, even after taking into account a participant’s own conscientiousness. A finding that the researchers described as “compensatory conscientiousness”.

A better quality of life

We recently carried out a study to see if we could find similar effects in younger adults. We also wanted to see if a person’s conscientiousness influenced their partner’s quality of life. The term “quality of life” reflects a person’s satisfaction with their life, including physical health, psychological state and social relationships.

We talked to 182 romantically involved couples, asking each person to complete a questionnaire. The participants were aged from 18 to 78, with an average age of 36. To qualify to take part, couples had to have been in a relationship for at least six months. Just under half the sample was married and most couples lived together. On average, the couples had been together for just over ten years.

Each person completed the questionnaire separately from their partner so that they could not discuss their answers. The survey questions let us measure their personality, using the ten-item personality inventory and ask them questions about their quality of life using questions developed by the World Health Organisation.

Our analysis showed that an individual’s own level of conscientiousness was related to their quality of life, with participants who had higher levels of conscientiousness reporting a better quality of life. We also found that people who had partners with higher levels of conscientiousness also reported having a better quality of life. This finding was true for both men and women.

Our findings raise the question of how a person’s conscientiousness influences their partner’s health. It is likely that partners high in conscientiousness help to create an environment that leads to greater health. For instance, a conscientious partner likes to plan and be organised and so they may provide their partners with useful health reminders, such as to take medication or attend a doctor’s appointment. Conscientious partners are also dependable and so are likely to be good providers of social support for their partner.

These findings show that our partner’s personality is important for our health, so choose your life partner carefully.

Lynn Williams does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Source: The Conversation: Health

http://theconversation.com/want-to-be-healthy-and-happy-choose-a-c-o-n-s-c-i-e-n-t-i-o-u-s-p-a-r-t-n-e-r-114520

Fitness trackers and personalised training programmes – the way to get healthier at work

On average, people spend over 3,500 days (or 84,000 hours) at work over a lifetime. This makes work the ideal place to encourage and support physical activity and exercise. And a new study from Germany shows that doing so can help employees increase their fitness, improve their cardiovascular and mental health, and even increase productivity.

Many jobs today are sedentary, which has a damaging effect on our health, increasing the risk of developing type 2 diabetes and cardiovascular disease. The London bus study in the 1950s showed that workers with sedentary jobs (bus drivers) had much higher levels of heart disease compared with workers with active jobs (bus conductors).

Our work environments can also increase stress, which leads to poor mental health. This is partly because of higher workloads creating increased pressure and also because, through technological advances, work increasingly encroaches on personal time.

Keeping employees healthy is an important consideration for employers, especially with an ageing workforce. Previous research has shown healthier employees are more productive and are less likely to take sick leave.

The results of workplace exercise studies have been mixed, however. Some studies report improvements in total physical activity levels and cardiovascular fitness. Others have reported limited benefits on metabolic health and on work productivity – the latter being important to convince employers of the benefits of these interventions.

The new study, published in The Lancet Public Health, randomly allocated 314 employees to a six-month “lifestyle programme”, focusing on regular exercise, or to a control group where participants were not given any specific lifestyle recommendations.

All the participants had metabolic syndrome – a cluster of conditions, such as high blood pressure, high blood sugar and unhealthy weight, that tend to occur together and increase a person’s risk of type 2 diabetes, heart disease and stroke.

The lifestyle programme group received an individualised package of support to help them achieve the German government’s guidelines for exercise – 150 minutes of moderate intensity exercise per week. The focus of the intervention was on increasing structured exercise, such as gym classes and sport, rather than just increasing overall daily physical activity.

The lifestyle programme group also received behavioural support, such as individualised exercise training schedules, an activity tracker for monitoring progress and revising goals, regular chats with a sports scientist via an app, and monthly face-to-face meetings with the research team.

At the end of the six months, the intervention group showed greater improvements in fitness, fasting blood sugar levels, waist circumference and blood pressure compared with the control group. This suggests that the intervention reduced the severity of their metabolic syndrome. But the observed changes were smaller than would be expected with supervised lab-based exercise training.

The exercise group also improved their productivity, with the greatest improvements observed in employees who showed the highest improvement in fitness. However, this was measured by self-report questionnaire and there are clear limitations to this method.

Scaling it up

Adherence to the exercise programme was high in this trial. On average, participants achieved 147 minutes of the 150-minute physical activity target.

It’s important to consider why this was the case and whether this could be replicated on a much larger scale. But given that it was such a complex multi-component support package, it is difficult to tease out which particular elements – or combinations of elements – contributed to the high adherence and hence the improved health, well-being and productivity of the participants.

A review of workplace interventions using pedometers alone has shown mixed results on physical activity and health. But many of the technology-enabled behaviour change techniques used in this study, such as goal-setting, feedback and self-monitoring, have been shown to be effective for increasing physical activity when used with counselling.

This is not always the case, though. A large study found that adding a wearable physical activity monitor to a counselling-based weight-loss intervention hampered people’s efforts to lose weight. In contrast, another study found that giving people a pedometer increased physical activity regardless of whether further counselling support was provided from a healthcare practitioner.

Complex intervention

Complex interventions might work because different elements of the programme are effective for different people, driving up the overall effect. Put another way, we might expect individual responses for each of the elements. For example, some people may respond well to the activity tracking feedback and goal setting, whereas others may rely on the frequent interactions from a trainer. This is important to consider because achieving the results of the current study on a much larger scale (in thousands of employees rather than hundreds) would be very expensive.

The new study was also conducted on a relatively young and mainly male workforce, and this population probably responds well to the push towards structured exercise rather than increasing total daily physical activity. Other demographics of workers in different industries may not respond as well to this approach.

The study highlights the benefits of promoting exercise at work. Whether this would be replicated on the scale required to improve population health meaningfully is far from certain.

Richard Metcalfe receives funding from The Diabetes Research and Wellness Foundation.

Max Western receives funding from the EPSRC via the GetAMoveOn Network.

Source: The Conversation: Health

http://theconversation.com/fitness-trackers-and-personalised-training-programmes-the-way-to-get-healthier-at-work-118714

Curious Kids: what does it mean to be double jointed?

*What does it mean to be double jointed? – Gen, aged 11, Melbourne, Australia.

If you’re double jointed, it means you have a joint that can bend a lot more than in the average person. This has its upsides and downsides: apart from being a great party trick to show to friends, it might also mean you get injured more easily.

To understand what it means to be double jointed, it’s helpful to know what a joint actually is and why we have joints. Let’s start with the basics: a joint is any place in your body where bones touch each other. As you have more than 200 bones, you have lots of joints too.

Being bendy

Since bones cannot bend, joints give us a way to move our body. Every joint is different, but most joints can only bend a certain amount. For example, your shoulder joint can swivel all the way around so you can move your arm in a circle, while the joints between the 26 bones in your foot only move a small amount.

Curious Kids is a series by The Conversation, which gives children the chance to have their questions about the world answered by experts. All questions are welcome: you or an adult can send them to curiouskids@theconversation.com – along with your name, age and place where you live. We won’t be able to answer every question, but we’ll do our best.

How much each joint can move depends on the shape of the two bones touching each other, and the way they are connected. To see how the shape of the bones makes a difference, you can try an experiment with two tennis balls.

When you try to balance one ball on top of the other, the top ball will roll off easily. Now, try to balance one ball on the palm of your hand – the ball won’t roll off so easily now. And if you make your hand into a cup, and hold the ball in there, it probably won’t roll out at all.

This shows that the shape of the bones matters, because it affects how much a joint can move. So joints with a cup-shaped bone will move a lot less than joints with two round bones. But it also shows that some joints are quite wobbly, and could be quite difficult to control.

Limited by ligaments

That’s where ligaments give our joints extra support. A ligament is a bit like a string or a rubber band, that attaches to both of the bones in a joint, to keep them in the right place and stop you from bending the joint too much. That way, you don’t end up falling forward from your knees, or rolling sideways on your ankle.

Working together, the bones and ligaments limit how much your joints can move. If you are double jointed, it might mean that the bones are round at the end, like two balls, or that the ligaments which help hold the bones in place are loose, or even absent.

Being double jointed might mean you get injured more easily. For one thing, too much bending can dislocate a joint – that means the bones in the joint don’t touch anymore, because the ligaments are too loose. Also, when a joint bends too much, the bones often get more wear and tear, which can cause pain.

You might still be wondering why people call this being “double jointed” – after all, it’s not like the extra bendiness comes from having an extra joint. It actually just means that double jointed people are doubly bendy. That’s why it looks so odd: when you have a double jointed joint, you can bend it in directions and positions most other people can’t.

More Curious Kids articles, written by academic experts:

• How long has gravity existed? – Aine, aged 13, Edinburgh, UK.

• Is global warming heating up the Earth? – Raphael, aged 11, Auckland, New Zealand.

• Does the sky protect the Earth and if yes, then how? – Saskia, aged eight, Estonia.

Marco Arkesteijn does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Source: The Conversation: Health

http://theconversation.com/curious-kids-what-does-it-mean-to-be-double-jointed-118703

Music therapy improves the health of premature babies and boosts parental bonding

Singing and playing music to your baby or young child may seem to be a no-brainer. We all have strong associations with nursery rhymes or childhood ditties sung to us by our parents and grandparents. We associate these with feelings of comfort and security, and it seems like the most natural thing in the world that we would sing to our own children as we cuddle and soothe them, or put them to bed.

Imagine, though, that your baby was born earlier than anticipated, and had to spend time in a neonatal unit in a hospital. Perhaps your baby also has serious medical issues and needs to be constantly monitored, being linked up to a frightening array of medical equipment. Hospital staff are constantly moving around the wards checking everything is OK, and there are alarms on ventilators going off, the hiss of oxygen and all sorts of electric lights flashing and beeping. It can’t be easy to bond with a baby when they are being kept in an incubator and need special medical treatment.

Although hospital staff are trained to support families in these situations, it’s often a very traumatic time for parents. Research into parental experiences in neonatal units shows that feelings of anxiety, guilt and even depression are all common features for many mums and dads. This can prevent or disrupt the natural bonding process that is so important to the healthy development of the baby, and the happiness of the family unit too.

Recent research has shown, however, that music therapy can offer a way for parents to connect with and develop their relationship with their premature baby while they are in hospital. This consists of a music therapist playing a guitar or other instruments, and singing with parents to their baby on the ward. Using melodies and lullabies that the parents choose – including favourite songs, gentle sounds and simple rhythmic structures – the baby can be soothed while parents hold, rock and, if they wish to, sing or hum to their baby.

Music therapy does more than just improve bonding. A large study undertaken in 2013 in the US demonstrated other positive effects for babies who receive music therapy in neonatal units. The study showed improved oxygen saturation, better heartbeat regulation, longer periods of sleep, increased weight gain, and, perhaps most importantly, reduced time spent in hospital. These results have been replicated in other studies too.

Soothing tones

So why is music therapy such a powerful tool for premature babies? Hearing develops from the age of 24 weeks, meaning that babies are accustomed to hearing their mother’s voice, and that of other family members while still inside the womb. They respond more readily to these voices than those of unknown adults, although even then they show a preference for live voices

In addition, researchers think that every baby is born hardwired, as it were, with what has been termed “communicative musicality”. Put simply, babies respond positively to, and have an appreciation of, simple musical structures, melodies and simple vocal sounds. We are all familiar with “baby talk” – the way we instinctively alter the tone of our voices when we talk to babies and young children. This is very calming and soothing for both baby and parent. It not only helps bonding, but lays down the foundations for later cognitive development such as speech and motor skills.

At present music therapy practice is commonly used in neonatal units across the world, including in Australia, the US, Scandinavia, Columbia, and Europe too. UK provision, however, is limited to just a few sites. But, my own preliminary research has found that more and more UK parents are keen to use these techniques, often commenting that “it will give me something to do with my baby”, and “it’s something normal and natural that I can do during this very unnatural beginning to our life together”.

I’ve also found that nurses are also supportive of music therapy. They believe helping parents to explore music with their babies will empower parents and give them the confidence they need to provide the extra attention premature babies require, such as special feeding techniques and potentially administering medication. Consultants are also aware that at the moment, psychological support for parents in neonatal facilities is limited. They believe that the introduction of music therapy will have an important impact on the quality of parental experiences in hospital and the health of the baby.

I am currently part of a team developing a pilot study in South Wales which will offer parents the chance to explore singing to their premature babies. It is hoped that this will be the beginning of an exciting new provision of psychological and medical support for parents and babies in neonatal units in Wales and beyond, but also help ensure these little ones have the best start at life possible.

Elizabeth Coombes receives funding from The Music Therapy Charity to support a music therapy study in a Local Neonatal Unit in south Wales.

Source: The Conversation: Health

http://theconversation.com/music-therapy-improves-the-health-of-premature-babies-and-boosts-parental-bonding-118281

Ebola outbreaks may be more common than we think

The best defence against Ebola outbreaks is early detection. If detected early enough, an outbreak can be prevented with targeted, low-tech interventions, such as isolating infected people and their contacts. But our research suggests that most opportunities for early detection and intervention are missed. In fact, we estimate that most times when Ebola jumps from wildlife to people, it is not detected at all.

Every Ebola outbreak starts with a “spillover event,” where a person becomes infected from an animal – a fruit bat, for example. From there, people can infect other people, and before long an outbreak can become out of control. Once an outbreak has spread to several locations, controlling it is extremely difficult, as epidemics in recent years have shown.

A critical feature of Ebola infections is that a few initial cases infect many other people, but most cases (about 65%) infect no one else. This means any isolated case – such as the first case when an Ebola spillover occurs – is probably the only case. Finding these cases is as important as finding an outbreak early because it is impossible to predict which spillover events will grow into full outbreaks. But since Ebola was first detected in 1976, only eight clusters of five cases or fewer have been detected, compared with 26 clusters of at least six cases.

Only two single-case spillover events have ever been detected (except for accidental laboratory infections), but we expect this to be the most common cluster size. The most plausible reason for this unexpected situation is that many small Ebola clusters have occurred with no one noticing.

Computer simulation

To find out how many of these small clusters have occurred, we simulated thousands of Ebola outbreaks based on published data from previous outbreaks. From these simulations, we determined how often we expect a spillover event to fizzle out early versus how often we expect it to progress into a true outbreak. This allowed us to compare the outbreak sizes we expect to see to those that have been reported. We used these comparisons to estimate detection rates of clusters of different sizes. Across different sets of assumptions, we estimated that less than half of all Ebola clusters, and less than 10% of isolated cases, are detected.

This result suggests that we miss many cases altogether. Because we estimate especially low detection rates for small clusters, it also suggests that we rarely detect outbreaks in their earliest stages.

We rarely find Ebola outbreaks while they are still easy to manage. The main reasons for this are surprisingly simple. Ebola is much rarer than other types of severe fever in the regions of sub-Saharan Africa where it tends to occur. Countries in this region have some of the weakest primary healthcare infrastructure in the world, making them ill-equipped to detect a rare cause of fever among all the common ones.

Many primary health facilities don’t have enough resources to test for even the most common causes of fever, let alone Ebola. Without accurate diagnostics, they must rely on detection based on symptoms. But Ebola is so rare that a single case of severe fever, even with bleeding, is more likely to be caused by malaria, typhoid or yellow fever. Most doctors and public health workers in many regions have never seen a single Ebola case. Therefore, relying on symptoms alone to detect Ebola is unreliable.

Investment in primary healthcare

It is probably impossible to detect outbreaks reliably within the first few cases based on symptoms alone. To find and address outbreaks early, we must invest in primary healthcare and public health capacity.

It is at this local level, mostly in clinics and hospitals, that potential outbreaks are first flagged. It is also at this level, mostly through district health management teams, that measures such as quarantines can be introduced quickly enough to control an early outbreak.

This capacity is not only important for Ebola, improving local healthcare workers’ ability to rapidly diagnose and treat diseases can improve outcomes. More accurately diagnosing bacterial versus viral infections, for example, can help fight growing drug resistance.

Though important, international outbreak responses are often slow, complicated, and expensive. The case of Ebola shows how these types of responses are also not well suited to intervening at the most crucial moments. Instead, it is time we invested more in the kinds of local primary capacity that can find and limit outbreaks at their source.

Emma Glennon receives funding from the Gates-Cambridge Trust.

Freya Jephcott does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Source: The Conversation: Health

http://theconversation.com/ebola-outbreaks-may-be-more-common-than-we-think-114321