Category Archives: Health

Wuhan coronavirus: we still haven’t learned the lessons from SARS

The SARS outbreak in 2002-2003 was the first global pandemic of the 21st century. There were 8,422 reported cases and 11% of those infected with the virus died. Its cause was a newly identified coronavirus (a type of virus that causes respiratory infections): SARS Co-V. Early cases were linked to wildlife markets and restaurants in Guangdong, China, where researchers found SARS-like coronaviruses in animals including masked palm civets and a racoon dog.

A Chinese government team subsequently reported that 66 out of 508 wildlife handlers tested in other markets across Guangdong were positive for antibodies to the SARS virus. The Chinese authorities responded by imposing a temporary ban on the hunting, sale, transportation and export of all wild animals in southern China. They also quarantined or culled civets reared for human consumption in the many civet farms across the area.

We happened to be working on wildlife trade and biodiversity conservation, including rare species of civets in neighbouring Vietnam, and were aware that many different species of animal were kept close to each other.

My colleagues and I suggested that civets testing positive for SARS may have secondary infections rather being than the source of the virus. They were probably infected during the “speed dating” of zoonotic viruses circulating among the jumble of different animal species packed together at markets or while being transported to markets, often in China.

At the Royal Society’s international conference on “Lessons from SARS” in 2004 and in the related publication, we emphasised that wildlife trade was a threat to human health and a primary cause of biodiversity decline in China and South-East Asia.

But here we are again, 17 years later, with another novel zoonotic coronavirus, this time in Wuhan, China. Once again, initial human cases were linked to a market selling a variety of live animals.

A constantly changing range of species have been selected as the culprits in the past few days, including bats and snakes, (the latter results were quickly refuted), and even crickets and wolf cubs.

But, as yet, there is no scientific evidence that the virus has been isolated from any of these, although a recent report stated that “15 environmental specimens collected in the western section (of the Huanan Seafood Wholesale Market) were positive for 2019-nCoV virus through RT-PCR testing and genetic sequencing analysis.” The report continues: “Despite extensive searching, no animal from the market has thus far been identified as a possible source of infection.”

It is not evident what “environmental specimens” refers to here and a complete list of those animals present in, or available from, the market would be appropriate to release together with details of which and how many of these have so far been tested.

Wild rodents, which are often present in these markets, should also have been collected and tested as SARS-like coronaviruses have also been isolated from wild rats in China.

Perfect conditions for pandemics

But we may be chasing our tails, as animals testing positive may not be the source of the current outbreak. We need to step back and learn the broader lessons here.

The perfect conditions for the emergence of human pandemics from previously unknown zoonotic pathogens has been created as a result of three things. First, the shift from subsistence hunting of wildlife to its sale into an international trade network largely driven by demand in China. Second, the extensive cross-exposure within this wildlife trade of species and species populations, which would not mix or be in contact in the wild. And, third, the exploitation of new source populations as areas become depleted of target species.

It is also important to emphasise that these wild animals are typically now more expensive to buy (sometime a status symbol) than domestic livestock, so the demand that perpetuates wildlife trade in the region is a dietary choice and not driven by low income.

The solution is collective action to remove the demand and also the supply chains to these wildlife markets and “farms” (often laundering animals from the wild rather than breeding them). The call to close wildlife markets across China – which started following the SARS outbreak – has also been echoed by experts in China and in external organisations worldwide, such as the Wildlife Conservation Society.

We have to hope that the Wuhan outbreak is a wake-up call for regulation of wildlife trade and animal health, action that is urgently needed to protect human health and the environment.

Diana Bell 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/wuhan-coronavirus-we-still-havent-learned-the-lessons-from-sars-130484

Baby box: child welfare experts say use of sleep boxes could potentially put infants’ lives at risk

Having a baby can be expensive. So it’s maybe not surprising that many retailers around the world have cottoned on to the success of Finland’s baby boxes – a package aimed to set up new parents and their bundle of joy. The Finnish boxes include baby clothing, sleep items, hygiene products and a parenting guide –- as well as a “sleep space” for the baby.

Many retailers around the world are now offering similar boxes for expectant parents. Indeed, research conducted at the University of Tampere in Finland suggests there are variants in over 60 countries. This includes Scotland’s baby box scheme – with all newborn babies getting a free baby box from the Scottish government.

But as a group of child welfare experts, we believe imitations of the Finnish boxes could be placing babies at risk. This is because it has become common to believe that if babies sleep in these boxes, it will help protect them from sudden infant death syndrome (SIDS). Unfortunately, the research does not back this up.

Mother and fathers in Finland are given a baby box from the state that functions a bit like a starter kit. The box includes 64 items and is estimated to cost around €140 (£119). It comes as part of a wider maternity package in Finland, in which parents are also required to register for a health check before the fifth month of pregnancy.

They can opt for a cash alternative of €170 instead of the baby box, although most choose the box. The maternity package has been offered by the Finnish government for over 50 years, and initially arose as a response to poverty and high infant mortality rates.

What’s the problem?

To some extent, retailers in other countries have tried to copy the Finnish model. In the UK, new parents can choose between paying for bigger baby boxes or a free box with some basic items if they engage in an online course. The course doesn’t have much professional oversight, however, and these boxes certainly don’t contain as much as the Finnish version.

But there is a danger that parents might view the boxes as a safe sleep space that will help reduce the risk of SIDS. This sort of belief appears to be based on the fact that the SIDS rate in Finland has fallen over the years – but this does not appear to be because of the boxes.

The same reduction has been found in neighbouring countries such as Norway and Sweden, where baby boxes are not used. The handful of observational SIDS studies conducted in Finland do not mention the box and largely attribute the lower mortality rates to “a reasonably high standard of living, good educational level of mothers, well organised primary maternal and child health services, and the rapid advances in obstetric and neonatal care equally available and regionalised”. All three Scandinavian countries have in place a well supported welfare system that looks after vulnerable families.

As far as we can see, there is no evidence to support a belief that the box can be used as a safe space to reduce infant death. There are also already safe sleep spaces for babies, with cots and Moses baskets that have a safety kite mark readily available.

And with baby boxes being sold by private companies – and public health messaging moving into private hands as a result, the risk is that the impact of government risk reduction campaigns that have saved thousands of young lives in recent decades are forgotten.

What new parents should do

All the evidence-based guidance that has emerged over recent decades delivers clear messages about safe sleeping practices, while also acknowledging that parenting practices can be culturally diverse – in many cultures, for example, co-sleeping is the norm until children are weaned.

The importance of robust evidence must be a key priority. This is why we believe governments and health providers should consider these factors before assuming that baby boxes are the solution to ongoing tragic unexplained deaths of infants.

Crucially, research is needed on the ways in which parents use existing baby boxes, in what circumstances and contexts they might be beneficial, and whether it is the box, or the programmes around them that benefits families.

As a response to this need, we are starting to work with vulnerable parental groups and health providers in Scotland, Finland, Zambia, Vietnam and Kenya to find out whether baby boxes or alternative devices that can be brought into the parental bed can improve infant safety and survival.

The hope is that our combined research should enable low cost, appropriate solutions to be designed with the people who will benefit – and to improve the health and wellbeing of infants and mothers.

Debbie Watson has received funding from AHRC, ESRC and DfE

Helen Ball has received funding from ESRC, NIHR, Lullaby Trust, and the Scottish Government. She is Chair of the Scientific Committee for the Lullaby Trust.

Jim Reid receives funding from Research England through the University of Huddersfield.

Pete Blair 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/baby-box-child-welfare-experts-say-use-of-sleep-boxes-could-potentially-put-infants-lives-at-risk-125512

A&E waiting times worst on record – but using AI to unblock beds could be part of the solution

January is the busiest month of the year for the NHS – with patients often queuing in corridors and ambulances.

In 2019 Emergency Department waiting times in England were the worst on record, with 2000 patients waiting for more than 12 hours for a hospital bed in December. At the same time latest research shows that over the past three years almost 5500 patients have died in emergency departments while waiting for a hospital bed.

Part of the problem is that patients who are admitted as emergencies to hospital can be really sick and unstable. So making the decision as to when they are getting better and are safe to go home (and the bed is free) is complicated and risky.

Indeed for every five patients sent home from hospital, one will be brought back as a medical emergency within a month.
But our research might have found a way to help unblock hospital beds and help doctors and nurses know quickly which patients are safe to go home.

In our latest research, we used machine learning – or artificial intelligence (AI) – to help doctors and nurses be confident as to which patients are ready to leave hospital and which should stay. We used changes in vital signs such as blood pressure and heart rate to highlight those patients who might be well enough to leave hospital.

In the unit in Bangor where we tested this system with 790 seriously ill patients, we found that using AI in this way would have meant 2500 less days in hospital for these patients.

Reading the signs

Vital signs such as blood pressure, heart rate, speed of breathing, temperature, oxygen level, need for additional oxygen and level of consciousness are already commonly used by doctors and nurses to find out how sick someone is. These are taken two to six times a day while patients are in hospital. The more abnormal each measurement is the more likely it is that the patient may need intensive care or die.

Our new study builds on research from our unit at Wrexham Maelor Hospital, published in 2001, which tested a system that summarised all vital signs in a single number. A very similar system is now used in most ambulances and hospitals in the UK, making it easier for doctors and nurses to quickly assess a patient and communicate how seriously a patient is ill.

The system basically gives each vital sign a score between zero and three points – zero points for normal measurements and up to three points for very abnormal measurements. All points are added up: if the total score is zero the patient is likely to be well. If the total score rises the patient is at higher risk – with 20 being the highest score.

For this new study we teamed up with the Bevan Commission and researchers from health electronics company Philips Healthcare. In our study, the computer looked at vital signs of sick patients who were admitted to hospital as emergencies with medical conditions such as asthma, heart failure and stomach ulcers. The computer observed and learned the scores for two days and then started to looks at trends – analysing how often the scores went up and down and how high or low the scores went.

During the study we found that patients with total scores of three or less for more than 96 hours are usually “stable”. They were unlikely to become unwell again during the rest of their hospital stay and could most likely safely leave hospital. We calculated that implementing this simple rule alone would have saved 2143 days in hospital for the 790 patients.

But when the computer used AI it was possible to tell who the “stable” patients were much earlier – after just 12 hours. Working out which patients were ok to go home at this point would have meant 2652 less days in hospital for the patients in our study.

Balancing risks

Deciding whether a patient can go home is complicated – and doctors and nurses often opt to keep patients in hospital longer because they are unsure whether they are really getting better. But the longer patients stay in hospital the more likely they will suffer from complications.

Indeed, it is estimated that 300,000 patients acquire infections in hospital in England alone each year. And being in hospital is particularly risky for elderly patients.

Decisions about discharge from NHS hospitals are usually done by senior hospital specialists, who see patients twice a week – though they might review patients briefly on other days. In contrast our AI system could check whether a patient is getting better several times each day.

The system we developed used data from real patients in a typical UK hospital. The data used by the team in Bangor is available at every hospital bedside in the UK, so could be easily rolled out to all hospitals. This would not only help to make hospital discharges safer but also help to make sure patients are getting the right care. And if the system can stop patients from having to queue for days in Emergency Departments or in ambulances then it might also ultimately help to save lives.

Christian P Subbe has undertaken consultancy work for Philips Healthcare. His employer BCUHB has received funding from the Bevan Commission and Philips Healthcare to undertake the research reported in this article. He is affiliated with Bangor University as a Senior Clinical Lecturer, with Betsi Cadwaladr University Health Board as a Consultant in Acute, Respiratory & Critical Care Medicine and the Health Foundation as an Improvement Science Fellow.

Source: The Conversation: Health

http://theconversation.com/aande-waiting-times-worst-on-record-but-using-ai-to-unblock-beds-could-be-part-of-the-solution-130234

Malnutrition is on the rise in older adults – how to spot the signs

While the obesity crisis is still considered the foremost public health epidemic in the west, one often overlooked condition is quickly becoming a growing concern. Malnutrition, sometimes referred to as under-nutrition, affects an estimated 3 million people in the UK alone. Globally, around 462 million adults are malnourished.

Malnutrition is a condition where a person is deficient in nutrients, such as protein, vitamins and minerals, or not getting enough calories. This has many effects on health and body function, including increased frailty, delayed wound healing, and higher mortality.

Not only that, malnutrition will cost UK health services £13 billion this year alone – and is predicted to cost £15 billion in ten years. Reports also show that it’s also two to three times more expensive to treat someone who is malnourished, compared with someone who is well-nourished. This is because they need more resources to treat them, and a range of health conditions may develop as a result of malnutrition.

But data shows that people aged 65 years and over are more likely to be malnourished compared with any other age group. And this number is on the rise. In the UK, adults over 60 admitted to hospital with malnutrition increased from 1,405 in 2008 to almost 5,000 in 2018.

Spotting the signs

Several things might contribute to malnutrition in the elderly, including swallowing difficulties, poor dentition (such as having missing teeth), mobility issues, acute and chronic illnesses, and not meeting changing nutrient demands – such as not getting enough protein. Another reason might be because almost 93% of people who are malnourished live at home, which means their nutritional health is often not monitored. Loneliness, depression, being unable to cook for themselves, having trouble accessing shops, and low income also contribute to poor nutrition in this age group.

A person is considered malnourished if they have a body mass index (BMI) under 18.5, or have unintentionally lost greater than 10% of their weight in the last three to six months. People with a BMI of less than 20 with an unintentional weight loss greater than 5% within the last three to six months might also be considered malnourished.

But it’s not always easy to spot the signs of malnutrition. Part of this is because it can happen gradually over a long period of time or signs often being considered as a natural part of ageing. But some common signs of malnutrition in older people may include their clothing, jewellery and dentures becoming loose, having a reduced appetite, lack of interest in food and drink, tiredness, altered mood, and weakness.

Healthcare providers in primary care or care homes will use screening tools to identify those at risk of malnutrition, or needing further assessment. These tools look at a person’s BMI, alongside the amount of unplanned weight loss they’ve experienced in the last six months to determine their risk. But for those living on their own, their nutritional status could still be overlooked. As malnutrition numbers continue to grow, friends and family members of older people are being urged to look for possible signs of malnutrition.

The first step in preventing and managing malnutrition is to focus on increasing calories and protein intake using a food-first approach, which aims to improve a person’s nutrition through diet alone. This includes:

• Encouraging people to eat little and often throughout the day, such as having three small meals plus two snacks between meals.
• Drinking more nourishing fluids, such as milk, soups, or having powdered supplements that are high in energy and protein.
• Eating high energy and high-protein foods, such as full-fat milk, yoghurt, and cheese.
• Frozen, ready prepared meals, or home meal delivery services might also ensure better nutrition.

But improving nutrition alone might not be the only solution to malnutrition. People might need help with eating and drinking, they may need better fitting dentures, or they might need foods that are easier to chew and swallow. For those that are lonely, eating in a pleasant environment might also be key to building their appetite. And for those with financial difficulties, they might need help accessing food items.

In some cases, people with disease-related malnutrition might need oral nutrition supplements, which will provide them with energy, protein, and other essential nutrients and mineral. But evidence shows that providing dietary advice, support and guidance with or without an oral nutrient supplement, is effective in increasing nutritional intake and weight. In severe cases, nutrition can also be provided by tube feeding, which is usually done in a hospital or supervised by healthcare professionals.

Identifying those at risk of malnutrition early, understanding how to manage dietary needs and overcoming potential barriers to adequate food intake, is essential, given the serious health and financial consequences linked to malnutrition.

Taibat Ibitoye receives funding from Apetito and the University of Reading.

Source: The Conversation: Health

http://theconversation.com/malnutrition-is-on-the-rise-in-older-adults-how-to-spot-the-signs-129953

Mental health: one in three young people in England are struggling – new report

We have seen a dramatic change in health trends for young people in the last ten years. Across most wealthy countries, such as the UK, Australia and Canada, young people’s participation in health risk behaviours such as regular alcohol consumption and getting drunk has declined. In many ways this can be attributed to successful policy interventions.

However, against this backdrop of largely positive trends in health risks, concern over young people’s mental health has also grown. Worldwide, it is thought that between 10-20% of young people experience mental health disorders. The World Health Organization (WHO) reports that 50% of all mental health illnesses start in childhood (before 14 years), rising to 75% by mid-20s. WHO not only highlights the extent of this mental health issue but also the significant impact of poor mental health on young people’s future life chances.

Our latest report presents findings on the mental health and emotional wellbeing of 11-, 13- and 15-year-olds in England. The data was collected as part of the health behaviour in school-aged children (HBSC) study. HBSC is an international research project that uses a school-based survey to collect information on the health and wellbeing of young people in over 45 countries. We manage the HBSC study in England, and our recently published findings are based on 3,398 young people from secondary schools across the country.

The HBSC study is repeated every four years, which means we can look at how young people’s health, wellbeing and behaviours have changed over time. In England we have collected data from young people aged 11, 13 and 15 years during 2002, 2006, 2010, 2014 and 2018 – so we can examine trends spanning over 15 years.

Life satisfaction

It is important to recognise that most young people surveyed in the latest study reported good mental health and emotional wellbeing. Young people were asked to rate how satisfied they were with their life on a scale from zero to ten (where zero describes the worst possible life and ten describes the best possible life). Three-quarters of young people reported a score between seven and ten, which is thought to suggest high life satisfaction. The proportion of 15-year-old girls reporting high life satisfaction increased from 55% in 2014 to 64% in 2018. We also found that more than half (60%) of young people had a positive body image, stating that they felt their body was “about the right size”.

However, our findings show that a large portion of young people in England are struggling with poor mental health. Over a third (38%) of young people said that they “felt low” at least once a week – this is the highest proportion since the 2006 survey.

The strength and difficulties questionnaire (SDQ) was included in our survey as a measure of young people’s mental health. The SDQ identified over a fifth (22%) of young people were experiencing a high level of emotional problems. We also found that a quarter of 15-year-olds had self-harmed. The proportion of 15-year-old girls who said they had self-harmed increased from 32% in 2014 to 35% in 2018, while a larger increase from 11% to 18% was noted among boys.

Feeling connected

We recognise that health and wellbeing are often influenced by the social environment. Consequently, our survey includes questions about the young person’s social world. For example, we ask young people how they feel about their family relationships, school experiences and their wider neighbourhood. By gathering data on young people’s environment, we can begin to identify factors that protect against poor health and wellbeing.

Self harming was more prevalent among young people who found it difficult to talk to their parents, who felt as though they didn’t belong at school and who said that they didn’t feel connected to their local neighbourhood. Similarly, parental communication – in particular, with a father figure – has been linked to having a positive body image among young people. We have also worked with our colleagues who carry out the HBSC study in Spain and we found that in both countries young people who reported positive relationships with their teachers were more likely to have positive emotional wellbeing.

While most young people in our study reported positive mental health and wellbeing, our data highlights mental health as an area of concern. We compared our most recent survey findings with the results from previous surveys, and it suggests that the number of young people in England who are struggling with mental health is on the rise.

Identifying factors in young people’s lives that may protect against poor mental health can help in the development of interventions to support young people. Our research has consistently found that the family, school and wider neighbourhood can play an important role in relation to young people’s mental health and emotional wellbeing.

Ellen Klemera receives funding from the department of health and social care DHSC

Fiona Brooks receives funding from Department of Health for HBSC England

Kayleigh Chester 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/mental-health-one-in-three-young-people-in-england-are-struggling-new-report-130149

Big Tobacco wants social media influencers to promote its products – can the platforms stop it?

Big Tobacco likes to stay ahead of the curve – it has to in order to survive. Its fundamental problem is that one in two of its long-term users die from tobacco-related diseases. To hook a new generation into addiction, it has to try every advertising and marketing trick in its playbook.

And it has to be innovative. As one ex-marketing consultant remarked: “The problem is how do you sell death?” He said the industry did it with great open spaces, such as mountains and lakes. They did it with healthy young people and iconic images. So the Marlboro Man became a symbol of masculinity and, for women, the industry promoted smoking as a “torch of freedom”.

For years, the industry fought the regulators who slowly and belatedly restricted the places and ways it could advertise and market its products. Then came the internet, which was a dream come true for a tobacco marketeer. The industry could run riot in an unregulated haven. One commentator noted in Wired magazine in 2017 that the internet was a contemporary incarnation of the wild west.

As old rules no longer applied, Big Tobacco began using internet platforms, including Facebook and Instagram, to bypass advertising bans. They began paying social media influencers to promote traditional tobacco products as well as e-cigarettes online. And they were very successful at it.

In August 2018, the New York Times investigated Big Tobacco’s social media and Instagram influences. The paper found 123 hashtags associated with companies’ tobacco products, which had been viewed a staggering 25 billion times. Robert Kozinets, a professor at the University of Southern California, told the newspaper that what the industry was doing was a “really effective way” to get around existing laws to restrict advertising to young people.

Cease and desist

The pressure on the industry to act increased in May 2019 when 125 public health organisations called on Facebook, Instagram, Twitter and Snapchat to immediately end the promotion of cigarettes and e-cigarettes. This included banning the use of social media influencers. The industry ignored the request.

In December 2019, in a landmark decision, the UK Advertising Standards Authority ruled against British American Tobacco and three other firms for promoting their products on Instagram, after a complaint by ASH, Campaign for Tobacco-Free Kids and STOP, of which the Tobacco Control Research Group at the University of Bath is a partner.

In a follow-up statement, Facebook and Instagram announced what many saw as a long-overdue update to their policy on tobacco. It said that branded content that promotes goods such as vaping, tobacco products and weapons “will not be allowed”. The statement made the bold claim that their advertising policies had long “prohibited” the advertisement of these products. The platforms promised that enforcement would begin on this in the coming weeks.

Headlines touting the new policy made it clear that the platforms will ban influencers from promoting e-cigarettes and tobacco products. For example, a BBC headline announced: “Instagram e-cigarette posts banned by ad watchdog.” But they missed three crucial points. First, Facebook’s policies are designed for companies that play by the rules, not for tobacco companies whose playbook is to find ways around them or flout them.

Second, those who track the industry’s activities online say it is notoriously difficult to tell what Facebook calls “branded content”. On Instagram, Big Tobacco’s influencers post glamorised images of vape products with hashtags such as #idareyoutotryit and captions such as “feeling Vype AF”. They don’t post content that simply says “paid promotion of British American Tobacco,” for example.

Finally, serious doubts remain about how any of this will be enforced. The reality is that Big Tobacco needs Instagram to survive and can’t afford to be excluded. A market research company, Klear, recently noted that 96% of all brands have incorporated Instagram into their influencer strategy and that global Instagram influencer marketing activity increased by 48% in 2019.

One of those who has tracked the industry’s use of social media is Caroline Renzulli of Campaign for Tobacco-Free Kids. In an email, she told me: “In the weeks since the announcement that influencers would be banned from promoting tobacco and e-cigarettes, tobacco companies have continued to exploit influencer marketing on Facebook and Instagram to advertise addictive products to young people without consequence.”

She added that: “Facebook and Instagram are uniquely positioned to cut off Big Tobacco’s easiest access point to kids and young people around the world – but without swift enactment and strict enforcement of new policies, the announcement is yet another hollow statement from a company that no longer has any excuse for inaction on this issue.”

Andy Rowell is a freelance writer/investigative journalist and part-time Senior Research Fellow at the University of Bath. He is a spokesperson for the global tobacco industry watchdog, STOP, which is funded by Bloomberg Philanthropies. He recently acquired 10 Imperial Brand shares so he can attend the company's Annual General Meeting to ask questions of the Board.

Source: The Conversation: Health

http://theconversation.com/big-tobacco-wants-social-media-influencers-to-promote-its-products-can-the-platforms-stop-it-129957

Mosquito bites: widely available skin cream found to prevent the spread of deadly viruses – new research

Rising temperatures, increased global travel and trade, and urbanisation are just some of the factors behind the supercharged spread of mosquito-borne viruses worldwide.

Not only was last year the worst on record for severe outbreaks of dengue fever in Asia and South America, southern Europe even had an unprecedented outbreak of West Nile Virus in 2018. And, in 2016, an explosive outbreak of the Zika virus spread throughout South and Central America.

Remarkably, despite the enormous global health burden of viruses spread by mosquitoes – which cause hundreds of millions of infections and thousands of deaths each year – there are no drug treatments available that can stop the virus from spreading and causing disease. There are many reasons why an effective medicine hasn’t been developed, but one of the main challenges is the unpredictability of these often explosive outbreaks. And, with so many distinct viruses, being able to identify which virus might cause the next outbreak is almost impossible.

With few clues showing us what virus we need to prepare against, it’s hard to justify the resources and finances needed to develop virus-specific medicines. Not only that, but many of these infections can be hard to diagnose. Some of the most common mosquito-borne viruses, such as dengue and chikungunya, cause similar symptoms. Without an accurate diagnosis, it would be hard for doctors to prescribe the right medicine even if they were available.

But, our team of researchers has found a different approach that might be able to circumvent many of these issues. This solution is to target a common aspect of every single one of these infections: the body’s immune defence against viruses at the mosquito bite. Our research found that an immune-boosting skin cream can actually prevent infection from a wide range of these dangerous mosquito-borne viruses.

After being bitten by a mosquito, your immune system behaves a bit strangely. The cells in your skin focus mainly on the trauma caused by the puncturing and probing of these pesky insects. This response helps to repair the wounded tissue. However, the body largely ignores the virus – often until it’s too late. We found that the body’s immune defences against the virus failed to keep up with how quickly the virus replicated, which allowed it to spread throughout the body and cause disease.

Our team wondered whether it would be possible to prevent the virus’s attack if we were able to alert the skin’s cells to the lurking viral threat. This is the basis of a new treatment that uses an easily applied topical skin cream. This cream has been used for many years to treat other conditions, such as warts and some skin cancers. It contains an immune boosting agent, imiquimod. When the cream was applied to a mosquito bite, imiquimod alerts the skin’s immune cells, known as macrophages. The macrophages kick-start the immune system’s anti-viral state, stopping the virus in its tracks.

To understand how the cream could activate macrophage cells and whether this might protect the host, we infected mice with two genetically distinct viruses spread by mosquitoes: Semliki forest virus, which can be lethal in mice, and Bunyamwera virus, which causes a fever. Both of these viruses are spread by the Aedes mosquito, which is often the main culprit for transmitting viruses. Worryingly, these insects are rapidly moving from the tropics into more temperate climates.

Half of the infected mice were treated with the cream during the first few hours following infection. In the mice that received treatment, the cream stopped the virus from spreading to the blood and other sensitive tissues, such as the joints and brain. For the mice infected with Semliki forest virus, treatment improved the mice’s chance of survival from 0% to 65%. While for Bunyamwera virus infection, levels of virus in the blood were reduced by up to 10,000 times.

Boosting immune defence also worked for humans. Using skin samples donated by 16 volunteers, we infected them with either Zika or chikungunya virus in the lab. These viruses are also spread by Aedes mosquitoes. Only half of the samples were treated with the cream one hour after infection. In skin samples infected with Zika, the treatment reduced the amount of virus in the skin by more than 70 times. For chikungunya, the virus was reduced more than 600 times. Although more trials will be needed, our research shows that this treatment is effective on several genetically distinct viruses spread by mosquitoes.

Imiquimod-containing creams have been used for many years to treat other skin conditions. So we know it’s well tolerated by patients, and could be repurposed relatively easily compared to new medicines. And, because the cream has already been developed and is readily available, it could be an affordable treatment option in the meantime – until other, more specific, treatments have been developed. The next steps will be for researchers to start testing whether this is safe and effective to be used for routine treatment of these infections.

Steven Bryden previously received funding from Biotechnology and Biological Sciences Research Council.

Clive McKimmie received funding from Medical Research Council and the Wellcome Trust.

Source: The Conversation: Health

http://theconversation.com/mosquito-bites-widely-available-skin-cream-found-to-prevent-the-spread-of-deadly-viruses-new-research-130246

How five short intentions can help people recovering from depression stay on track

About one in six people in England report experiencing anxiety or depression in any given week, and depression is a major cause of disability worldwide.

Some people have experienced very adverse experiences over their lives, leading to low self-esteem and other vulnerabilities which can make people susceptible to depression. Difficult life circumstances, such as financial problems, loneliness, stresses at work, among family or in relationships, poor physical health and genetic vulnerabilities also contribute. Even long-term depression can be treated, but the lifetime risk that the depression returns has been reported as about 50% for those experiencing one episode of major depression, with the likelihood increasing with further episodes.

Greater numbers of people experiencing mental health problems, and greater awareness of effective treatments, has increased demand for services. In recent years this has led to investment through the Improving Access to Psychological Therapies programme, but because of huge demand, waiting times can still be a problem and it’s important that we develop new ways of helping people manage and overcome their mental health problems – to prevent problems occurring in the first place, and to prevent them returning. A lot of this comes down to teaching people to help themselves more effectively.

To some extent this is already happening, for example with increases in self-help support within mental health services, and the use of self-help websites, online support and apps. Working with NHS staff, we have developed the Self-Management after Therapy intervention, or SMArT, designed to help people to stay well after they have recovered from an episode of depression.

Like other relapse-prevention approaches, it assumes that many people continue to remain vulnerable to depression. Recovery is seen as a process that continues after the end of therapy that has its ups and downs. This approach helps prevent someone from feeling they are “back to square one” if they have a setback, a frame of mind that can increase the likelihood of a return to more severe depression.

The approach, first developed by psychologist Peter Gollwitzer in the 1990s, has been found to support changes in behaviour, such as quitting smoking or doing more physical activity, through what are called implementation intentions. It is designed to help people turn an intention to act into a habitual behaviour. We know how hard it can be to make good intentions a reality (such as practically every New Year’s resolution), and when someone’s mood and motivation are low it can be even harder. As one mental health service user said during our research: “I know what to do, but when I’m down I just don’t do it”.

Implementation intentions work by linking a specific situation to a specific response. For example: “Every evening between 7pm and 9pm I will write down all the positive things that have happened that day”, or “Every Thursday evening I will go to the pub quiz with my friend Katy”. They often take the form of “if…, then…” statements, such as: “If I feel down, then I will talk to my partner about why this might be”.

When the situation comes up, the learned response is brought to mind, and is therefore more likely to be acted out. Using our SMArT intervention, people are encouraged to identify up to five of these implementation intentions. It’s important that they are realistic and that they will have an impact on the person’s wellbeing. The best way of thinking about them is to consider five things you do on a regular basis that are important to you. Then, imagine how you would feel if you didn’t do them. That is what tends to happen in depression, or when a person is at risk of a relapse.

The use of the SMArT intervention is supported in mental health services by psychological wellbeing practitioners, and patients are encouraged to share their intentions with friends or family who can support them.

SMArT is just one of a number of ways of helping people who are prone to depression to stay well and we’re carrying out more research to see how effective it is. It provides a bridge between the end of therapy and life without therapy and helps people see the importance of setting plans and having routine in their lives. It also emphasises that recovery is a process that includes learning about oneself and self-management strategies. It is something for the long-term – not just for all-too-soon-abandoned New Year’s resolutions.

Some of the work to develop the SMArT intervention was funded by NHS Research Capability Funding from the West Yorkshire Clinical Commissioning Groups.

Source: The Conversation: Health

http://theconversation.com/how-five-short-intentions-can-help-people-recovering-from-depression-stay-on-track-129046

Autism: stem cell clinics are offering treatments despite lack of evidence it works

The outlook for autistic people today is brighter than it was 50 years ago with many people now living in the community, rather than in institutions. But most low-functioning autistic people are not able to live independently in adulthood, putting them and their families under considerable social and financial pressure. So it’s hardly surprising that some parents of autistic children are keen to find a treatment for the condition. According to a recent BBC Radio 4 report, stem cell clinics in the UK are now offering one.

Before we look at the viability of such a “treatment”, it is worth knowing a bit about stem cells. Stem cells are special cells that can develop into many types of cell, such as liver cells, blood cells or nerve cells. In the early developing embryo, stem cells can develop into any cell type, but stem cells in adults have a much more limited capability.

Adult stem cells can only develop into cell types of the organ they originate from. For example, stem cells originating from the bone marrow can only give rise to closely related cell types, such as fat, cartilage and bone cells, while stem cells in the brain can only differentiate into brain cells.

Read more:
Understanding autism: new research dispels common assumptions

Stem cell therapies aim at regenerating or replacing cells that are affected by disorders and diseases. This can be achieved by isolating stem cells from the patient or a donor and turning them into the desired cells in a laboratory before transplanting them in the patient.

In an alternative approach, stem cells can be transplanted without differentiating them outside of the patient’s body in the hope that the tissue will dictate their fate. This idea is based on the assumption that every tissue contains specific signal molecules telling the stem cells what to become.

A successful stem cell therapy relies on at least two things. First, the tissue and cell type affected by disease or disorder must be known. Second, the right stem adult cell type or early so-called pluripotent cells must be applied. If a disease is caused by degeneration of brain tissue, a cell type able to replace the nerve cells lost due to the condition needs to be used. If the target is bone tissue, a stem cell type that can replace bone cells should be applied. So a one-size-fits-all approach is unlikely to work.

Under-regulated stem cell clinics

The promise of stem cell therapies to tackle disorders with limited conventional treatment options has led to the development of a considerable industry offering stem cell therapies.

Initially limited to developing countries, the number of under-regulated stem cell clinics is growing in developed countries, including the US, Germany, Switzerland and the UK. Most of these businesses are using a loophole in the law which allows the use of stem cells isolated from the patient’s own body (so-called autologous transplantation) for debilitating conditions that cannot be treated with existing drugs. In contrast, all other stem cell therapies must undergo thorough assessments for quality, safety and efficacy.

Read more:
Not all autistic people are good at maths and science – despite the stereotypes

With an autologous approach, most stem cell clinics use cells isolated from the patient’s bone marrow or fat tissue. Although these cells are unable to generate any cell types apart from fat, bone cells or cartilage, many of the stem cell clinics offer treatments for a range of conditions, including dementia, cerebral palsy and autism. These therapies aren’t supported by scientific evidence and they are expensive – around £10,000.

The procedure usually involves isolating cells from the bone marrow or fat tissue of the patient and injecting the cells back into the bloodstream with the hope that the transplanted cells migrate to the organ affected by the disease. Once in the target tissue, stem cells could contribute to regeneration by replacing the faulty cells or by boosting the internal repair capability of the body.

Although some common genetic and environmental factors have been identified in autism, little is known about the exact type of nerve cells affected. Indeed, recent research published in the journal Science suggests that, in addition to nerve cells, microglia (a cell type that fulfils an immune function in the brain) could be affected in people with autism.

This cellular complexity in autism makes designing a stem cell treatment more than challenging. What cell types need to be replaced? Is it enough to boost the patient’s own repair capability? Even if these open questions would be addressed in the future, what stem cell type needs to be used? Is it viable to use adult stem cells or are more potent pluripotent cells needed? So, at least today, autism cannot be treated with stem cells.

An even more fundamental question has been discussed by autism activist groups: does autism need to be cured at all or is it just a form of neurodiversity that society should embrace?

Darius Widera 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/autism-stem-cell-clinics-are-offering-treatments-despite-lack-of-evidence-it-works-129657

The real reason women live longer than men – new study

Ask your smartphone how to drive from Copenhagen to Berlin and it will give you an estimate of how long the trip will take, based on current traffic. If there is a traffic jam in Hamburg, say, the extra time this traffic jam takes will be included in the estimate. But, of course, you are not at all the points of your journey now. Rather, you’ll be in Copenhagen first, then at Odense, then Kolding, and so forth. By the time you get to Hamburg, there may no longer be a traffic jam. The estimate your smartphone gave you will be off. Life expectancy is calculated in much the same way.

Life expectancy in 2019 is calculated using the chances of survival for all ages in 2019: those who turned 70 in 2019, those who turned 69 in 2019, those who turned 71 … you get the point. But nobody actually has all their birthdays in 2019. People have at most one birthday a year (less than one for some of those who died that year and those born on February 29). Since I turned 35 in 2019, why should the 2019 chances of survival for a 70-year-old matter to me? By the time I turn 70, the world will have changed. The estimate will be off.

Read more:
Mortality rates are still rising in the UK – and everyone is ignoring how many more people are dying

But your smartphone also tells you something like “31 minutes extra travel time due to a traffic jam”. With this information, you can guess how long the trip will take assuming that the traffic jam will be resolved by the time you get there: just subtract those 31 minutes. Every part of the journey has a travelling time and you can pick those pieces apart.

Similarly, life expectancy is built up out of many small pieces, one for each age, and demographers can pick those pieces apart. We did that to answer questions such as: “what is the part of life expectancy lived between ages 50 and 85?” (which will be a number between 0 and 35). And “suppose that in 2015 no 70-year-old died of smoking (for example through lung cancer), what would that life expectancy have been?” And “how has the importance of smoking-related deaths been changing, and was that different for men and women?”

Throw all that in the mixer and you get some interesting results, which my colleagues and I – a team from the University of Southern Denmark and University of Groningen – published in BMC Public Health.

Read more:
Improving life expectancy used to be the UK’s forte – now it’s falling behind

We studied the part of life expectancy lived between ages 50 and 85 for high-income North America, high-income Europe and high-income Oceania for the period 1950-2015. Around 1950, males lived about two and a half years less than females. Around 1980, this difference had increased to about four and a half years. Then the difference in life expectancy declined to new lows of about two years in 2015.

All of that increase and subsequent decrease was due to smoking. Remove smoking and you get an almost flat line at only two years, which is what the difference in life expectancy between ages 50 and 85 would have been if nobody had smoked.

Long time coming

If smoking is so bad, why are we seeing all of these early deaths? Why aren’t people smarter? Well, if cigarettes killed you right away, nobody would touch them. The problem is that cigarettes do kill you – only decades later.

Because, historically, men started smoking earlier and heavier than women, any effect of smoking on life expectancy shows in males first. While medical doctors were coming to the conclusion that smoking is bad – basing their conclusions on evidence from men – women decided it was time to take up smoking. Now, decades later, the effect of smoking (death) is declining in males but still increasing for older females who smoked in the past. This gives rise to a four-wave pattern dubbed “the smoking epidemic”: first men smoke, then men start dying from smoking at around the same time women start smoking, then women start dying from smoking.

In the final phase of the smoking epidemic, people get smarter and stop smoking. This last part of the smoking epidemic, however, is the more difficult part. Unfortunately, people keep smoking (big tobacco is doing just fine).

But our study also showed some good news. Recently, there was a big drop in smoking-related deaths for people of around 50 years old. While smoking is certainly not down and out, at least some people seem to get that tobacco is a killer.

Maarten Wensink 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/the-real-reason-women-live-longer-than-men-new-study-130142