Motor learning tied to intelligent control of sensory neurons in muscles

Sensory neurons in human muscles provide important information used for the perception and control of movement. Learning to move in a novel context also relies on the brain’s independent control of these sensors, not just of muscles, according to a new study published in the journal Current Biology.

Each muscle can have tens or hundreds of encapsulated sensory receptors, and these “sensors” are called muscle spindles. Spindles differ from other sensory receptors as they also receive nerve fibers from the central nervous system itself, which acts to control spindle output.

There are more nerve fibers travelling to and from spindles than to the actual muscle tissues generating force and powering movement. Despite more than a hundred years of research on this class of sensory receptors, however, it has been unclear how, why and when the nervous system chooses to independently control spindles.

“The findings strongly point to independent control of these sensors during motor learning,” says Dr. Michael Dimitriou, who conducted the study and is a researcher at the Department of Integrative Medical Biology at Umeå University in Sweden.

In this study, Dr. Dimitriou monitored spindle signals in humans while they learned to control the position of a visual cursor by moving their hand (much like using a computer mouse). Depending on what stage in the learning process, the spindles sent very different signals in response to virtually identical movements.

The research shows that the sensory capability of spindle neurons was adjusted according to the ongoing requirements of the task being learned. In other words, muscle spindle signal patterns were changed during the learning process to become selectively informative about different aspects of movement.

Michael Dimitriou

“It is well-known that effective extraction of information is a major component in good learning performance, and this is true in motor adaptation as well. Richer and more relevant sensory information from spindles allows for efficient update of the computational circuits in our brain that guide movement. Differing levels of skill in controlling muscle sensors is probably a factor defining individual differences in motor learning performance,” says Dr. Dimitriou.

Beyond increased understanding of how human motor learning works, the current findings may also have more practical implications, such as in prosthetic limb and robotics control, argues Michael Dimitriou:

“To use a common example, computer algorithms can easily defeat a human in a game of chess. However, even the most sophisticated robot cannot match the skill and dexterity of a child in moving pieces on the chessboard. Better understanding of human sensory control is a way forward.”

Read a digital publication of the article

About the publication:

Current Biology, article: Enhanced muscle afferent signals during motor learning in humans. Author: Dr. Michael Dimitriou. DOI: 10.1016/j.cub.2016.02.030

For more information, please contact:

Dr. Michael Dimitriou, Department of Integrative Medical Biology (IMB), Umeå University
Telephone: +46 (0)90 786 5273
Email: [email protected]

Photo: Recording of signals from single nerve fibers during motor learning shows that signal patterns from sensory receptors in human muscle change substantially as a function of learning state. (Michael Dimitriou)

Editor: Daniel Harju

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Motor learning tied to intelligent control of sensory neurons in muscles

New insights in cancer therapy from cell death research: Killed cancer cells serve as a potent anti-cancer vaccine

Prof. Peter Vandenabeele (VIB/UGent): “In our research group we investigate the molecular mechanisms of different types of cell death. This is very fundamental research. Recently, more and more evidence is emerging that cell death plays an essential role in cancer and other diseases. This research perfectly illustrates this. It gives a good feeling that a better understanding of mechanisms of cell death on the long run may lead to more efficient cancer immunotherapy”.

Immunogenic cell death – a novel approach to kill cancer cells
Every second, one million cells die by programmed cell death in a healthy human body. Immune cells efficiently clear the body from these dying cells without eliciting an inflammatory response. Elimination of cancer cells by induction of cell death is also one of the main goals in anti-cancer therapy, resulting in the reduction of tumour mass. In the past decade, a number of anti-cancer drugs have been described to not only kill the cancer cells, but also to elicit an immune response in the patient – a phenomenon referred to as immunogenic cell death.

Dr. Dmitri V. Krysko (VIB/UGent): “The great power of immunogenic cell death is that the body’s immune system becomes activated to specifically eliminate the cancer cells. Antigen-presenting cells phagocytize the necroptotic cancer cells and instruct the immune system to trace, recognize and kill any living tumour cells.”

Necroptosis as a new target in cancer therapy
To date, this type of immunogenic cell death has been described only for programmed cell death elicited by a number of cancer drugs. Tania Løve Aaes and Dmitri V. Krysko under the guidance of Peter Vandenabeele, show that another type of regulated cell death program termed necroptosis is also highly immunogenic.

PhD student Tania Løve Aaes (VIB/UGent): “In our research, we developed a system that can elicit necroptosis in cancer cells. We administered these killed cancer cells in mice and found that they have a clear protective effect against tumour growth. We are now studying the findings in other relevant tumour models.”

Prof. Peter Vandenabeele (VIB/UGent): “Many cancer cells develop resistance to the induction of cell death by apoptotic pathways. With this research we hope to provide an alternative way to kill cancer cells by inducing another type of immunogenic cell death, that is necroptosis, to kill cancer cells and to elicit a specific anti-cancer immune response. These results could pave the way for necroptosis as a novel target in cancer immunotherapy.

These findings are published in Cell Reports on March 31, 2016. The work was performed at the Inflammation Research Center (VIB/UGent) and the Cancer Research Institute Ghent (CRIG/UGent).

___________________________________________________________________________________

Publication
Vaccination with Necroptotic Cancer Cells Induces Efficient Anti-Tumor Immunity, Love Aaes et al., Cell Reports 2016

Questions
As this research may raise questions, we want to ask you to list the e-mail address that the VIB has made available for questions in your report or article. Everyone can contact us with questions about this research and other medical research: [email protected].

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Urban health: major opportunities for improving global health outcomes, despite persistent health inequities

WHO | Kobe Centre | UN Habitat

KOBE | GENEVA - New data on the health of city-dwellers in almost 100 countries show that as the world’s urban population continues to grow, health inequities - especially between the richest and poorest urban populations - are a persistent challenge, according to a report by WHO and the United Nations Human Settlements Programme (UN-Habitat).

For example, only half of households in urban areas of 91 countries with comparable data have access to piped water, with the richest 20% of households being 2.7 times more likely to have access to piped water than the poorest 20%. In Africa, this ratio is closer to 17 times.

About 3.7 billion people live in cities today. A further 1 billion people will be added by 2030, with 90% of the growth being in low- and middle-income countries. This intensifies the need to realize the Sustainable Development Goal (SDG) target of ensuring universal health coverage (UHC): that all people obtain the health services they need without suffering financial hardship when paying for them, by 2030.

Health inequalities undermine progress

The report finds that in 79 low- and middle-income countries, children in the poorest one fifth of urban households are twice as likely on average to die before their fifth birthday compared with children in the richest fifth. In nearly 9 of 10 countries for which comparable data was available, the urban poor did not achieve the Millennium Development Goal target for reducing under-five mortality.

The report emphasizes the urgency of addressing health disparities and their determinants in cities as countries strive to achieve the SDGs and identifies innovative ways to achieve UHC that are emerging in such diverse cities as Guangzhou and Lagos, Lima and San Francisco, among many others.

“There is an urgent need to identify and reduce health inequities, particularly for the most vulnerable populations, such as the nearly 1 billion people living in urban slums or informal settlements today,” said Dr Marie-Paule Kieny, WHO Assistant-Director General for Health Systems and Innovation. “This report gives countries and cities practical tools to reduce health inequities and achieve the SDGs.”

While a number of urban areas have improved health coverage, the report finds that coverage for the poor still lags behind. Currently, at least 400 million women, men and children around the world are excluded from what is a basic human right: access to affordable health care. They have little or no access or to health services, and health insurance that is inadequate or non-existent. The report includes a new Urban UHC Dashboard-- an analysis of nine indicators for 94 countries-- which shows that vast inequalities in health service coverage persist, despite urban areas reporting higher coverage of services than their respective national average levels.

Planning cities for people and health

Increasing urbanization poses a unique set of health challenges, including the double burden of non-communicable and infectious diseases, air pollution, access to water and sanitation, and the need to improve nutrition, increase physical activity, and build resilience to health emergencies. Meeting those challenges will require countries and cities to take bold steps towards UHC.

The ways that cities are planned, today and for the future, can profoundly affect the ability of their residents to live long, healthy and productive lives. The report presents solutions for ensuring accessibility to water and sanitation, reducing urban sprawl while developing new transport options, increasing road safety, making cities age-friendly and accessible for persons with disabilities, managing urban health emergencies and increasing resiliency, while also improving healthier homes, particularly for those living in urban slums.

The report further presents a comprehensive set of interventions that can reduce the urban burden of non-communicable diseases. These include smoke-free city ordinances and enforcement; altering the built environment and promoting alternative transport options to foster greater physical activity and reduce air pollution; new approaches to urban food environment to reduce malnutrition and obesity; affordable and healthy housing conditions, and safety-related efforts.

Together, these have tremendous impact on reducing diarrheal diseases, indoor and ambient air pollution, non-communicable diseases, and other diseases saving millions of lives and increasing quality of life. A variety of examples from New York City and China to Mexico City, Barcelona, and South Africa illustrate these impacts, particularly using multiple interventions.

“In cities, progress in health depends not only on the strength of health systems, but also on shaping urban environments. Capitalizing on such interdependent factors leads to efficiency, synergies and co-benefits, and is essential to attaining the SDGs,” said Alex Ross, Director of the WHO Centre for Health Development in Kobe, Japan, which led and wrote the report.

“A healthy population is essential for creating economically competitive and inclusive cities,” said Joan Clos, Executive Director of the United Nations Human Settlements Programme (UN-Habitat). “This new report documents opportunities for joint action to implement the SDGs, and is an important contribution to the Third United Nations Conference on Housing and Sustainable Urban Development to take place in Quito in October 2016 and to the realisation of the New Urban Agenda.”

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Note to editors:

This report:

• Updates the 2010 joint WHO/UN-Habitat global report "Hidden Cities: Unmasking and Overcoming Urban Health Inequities", with the latest evidence on urban health inequity patterns and their social, economic and environmental determinants. Without addressing these issues, the SDGs will not be fully achieved.

• Systematically synthesises evidence for various inter-sectoral actions and impacts on health for issues such as noncommunicable diseases, infectious diseases, health emergencies, nutrition, environmental health (air pollution, water and sanitation), transport, housing, energy and safety.

• Introduces the need for enhanced governance and leadership to realize results, including achieving UHC, and a number of SDG Targets. A healthy population is the basis of a city’s, and ultimately a nation’s and the world’s, sustainable economic growth, social stability, and full realization of human potential.

• Highlights areas for immediate intervention, as well as gaps in knowledge, particularly to document the impact of various interventions on urban health, and means to reduce health inequities.

• Emphasizes health inequities and vulnerable populations, particularly the nearly 1 billion people living in urban slums and informal settlements today, which are projected to double by 2050.

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For more information, please contact:

Gregory Hartl
Coordinator, WHO
Telephone: + 41 22 791 4458
Mobile: + 41 79 203 6715
E-mail: [email protected]

Mamiko Yoshizu
Communications Officer, WHO
Mobile: +81 80 2435 1859
Email: [email protected]

Jeanette Elsworth
Head, Press and Media, UN HABITAT
Telephone: +254 20 762 5518
Email: [email protected]

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Exercise May Enhance Sexual Function in Men

Increased physical activity is associated with better sexual function in men under 40, according to an Emory University study.

The study, published online in the Journal of Sexual Medicine, assessed the association between physical activity and erectile function in young, healthy men ages 18 to 40. Previous studies have suggested that erectile dysfunction in men under 40 is correlated with increased cardiovascular risks.  

“The men in our study who exercised more seemed to experience a protective benefit against erectile dysfunction,” says Wayland Hsiao, MD, co-author of the study and assistant professor of urology, Emory University School of Medicine. “We hope that early screening for ED may be a gateway issue to help motivate young men to live healthily on a consistent basis so that they can possibly avoid health issues associated with a sedentary lifestyle, such as diabetes and cardiovascular disease. We see this as just the beginning.”  

Study participants self-administered two surveys: the Paffenbarger Physical Activity Questionnaire and the International Index of Erectile Function (IIEF). The Paffenburger Physical Activity Questionnaire translates patient-reported physical activity into weekly energy expenditure to determine whether a participant is sedentary or active. The IIEF is a 15-question tool for the measurement of erectile function. The study reported improved erectile function in men under 40 with increased exercise, as well as higher rates of sexual dysfunction in sedentary men under 40.  

“Several studies have evaluated the relationship between exercise and erectile function in older or obese men,” says study co-author Chad W.M. Ritenour, MD, director of the Emory’s Men’s Health Center and associate professor of urology, Emory University School of Medicine. “Our goal with this particular study was to determine if there is a connection between increased exercise and better erectile function in younger men.”  

To view the full study, visit http://ift.tt/1obOoq0

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The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service.

Kerry Ludlam: (404) 727-5692

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Study compares risk of diabetes drugs and medical complications

A study led by academics at The University of Nottingham and published in The BMJ has compared diabetes drugs in their ability to control blood sugar levels and prevent serious complications.

The research, by Professor Julia Hippisley-Cox and Professor Carol Coupland in the University’s Division of Primary Care, found important differences between diabetes drugs, used alone or in combination, and the potential risks of blindness, amputation, severe kidney failure, high blood sugar (hyperglycaemia) and low blood sugar (hypoglycaemia).

Professor Hippisley-Cox said: “This was an observational study so we cannot draw any firm conclusions about cause and effect. However, these results may have implications for prescribing and we would suggest that doctors and patients should be aware when assessing the overall risks and benefits of diabetes drugs.”

The researchers used a large UK primary care database called QResearch to analyse data collected from 469,688 adult patients with type 2 diabetes between 2007 and 2015. The study focussed particularly on glitazones (also called thiazolidinediones) and gliptins used alone or in combination with other diabetes drugs such as metformin and sulphonylureas. When assessing the information, they also took into account influential factors including age, sex, duration of their diabetes, smoking status and deprivation.

New information on risks

Their results found:

• Treatment with gliptins or glitazones on their own was associated with an increased risk of kidney failure compared with treatment with metformin alone

• Dual treatment for glitazones or gliptins with metformin showed reduced risks of high blood sugar compared with the use of metformin alone

• Triple therapy involving metformin, sulphonylureas and glitazones was associated with a significant decrease in the risk of blindness

• Triple therapy using metformin, sulphonylureas and either glitazones or gliptins was associated with significantly increased risks of low blood sugar but these risks were similar to those involving dual therapy with metformin and sulphonylureas.

Although the numbers of patients who were receiving gliptins or glitazones on their own were relatively low, the results appear to support previous reports of safety of gliptins which are excreted by the kidneys.

The findings for glitazones are also consistent with associated increased risks in chronic kidney disease reported in a previous study of almost 4,000 patients in Taiwan between 2003 and 2009. One such glitazone – pioglitazone – has already been withdrawn from use in France and Germany and is used with caution in Switzerland.

Professor Julia Hippisley-Cox added: “Our research adds new information on the potential risks and benefits of different types of medication used to treat type 2 diabetes which may inform future guidelines. However, we would advise patients to continue taking their prescribed medication as normal and to discuss any concerns that they might have with their GP at their next routine appointment.”

— Ends —

Our academics can now be interviewed for broadcast via our Media Hub, which offers a Globelynx fixed camera and ISDN line facilities at University Park campus. For further information please contact a member of the Communications team on +44 (0)115 951 5798, email [email protected] or see the Globelynx website for how to register for this service.

Notes to editors: The University of Nottingham has 43,000 students and is ‘the nearest Britain has to a truly global university, with a “distinct” approach to internationalisation, which rests on those full-scale campuses in China and Malaysia, as well as a large presence in its home city.’ (Times Good University Guide 2016). It is also one of the most popular universities in the UK among graduate employers and the winner of ‘Outstanding Support for Early Career Researchers’ at the Times Higher Education Awards 2015. It is ranked in the world’s top 75 by the QS World University Rankings 2015/16, and 8th in the UK by research power according to the Research Excellence Framework 2014. It has been voted the world’s greenest campus for three years running, according to Greenmetrics Ranking of World Universities.

Impact: The Nottingham Campaign, its biggest-ever fundraising campaign, is delivering the University’s vision to change lives, tackle global issues and shape the future. More news…

QResearch® is a non-profit making venture run by The University of Nottingham in collaboration with EMIS. More than 600 EMIS practices, representing around eight million patients, regularly contribute to the database. The system anonymises and uploads practices’ clinical data to the central database. Then, to protect patient confidentiality, the data are further anonymised and the figures are totalled to produce data that are suitable for research.

EMIS Group is the UK’s leading supplier of healthcare software and related services to GP practices.

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Study compares risk of diabetes drugs and medical complications

Researchers urge arthritis patients to give up smoking to help them live longer

Smoking plays a role in the development of rheumatoid arthritis

Prevalence of smoking is higher in these patients than in the general population 

University of Manchester-led research has found new evidence to suggest that, not only is smoking associated with earlier deaths in those with rheumatoid arthritis, but also those who stop smoking dramatically reduce their risk of earlier death, as published in Arthritis Care and Research journal.

Although there is a lot of evidence to show the association between smoking and increased risk of early death in the general population, researchers at NIHR Manchester Musculoskeletal Biomedical Research Unit were keen to find out the relationship between stopping smoking and subsequent mortality in patients with rheumatoid arthritis.

It has been previously shown that smoking plays a role in the development of rheumatoid arthritis, and so the prevalence of smoking is higher in these patients than in the general population. Those with rheumatoid arthritis also have an increased risk of dying earlier due to developing other health conditions such as cardiovascular disease, cancer, severe infection and respiratory diseases.

The research, led by Rebecca Joseph, Research Assistant at the Centre for Musculoskeletal Research at The University of Manchester, analysed anonymised patient information from an electronic UK-based GP database, which included information on hospital admissions and death certificates.

Researchers found that the risk of death was almost two times higher in patients who smoked compared to those who never smoked, whilst the risk of death for former smokers was similar to that for never smokers. Furthermore in the patients who stopped smoking, the risk of death fell for each additional year they had given up.

“

We hope that this research can be used by public health professionals and rheumatologists to help more people quit smoking and reduce premature deaths, particularly for newly diagnosed patients with rheumatoid arthritis

Professor Deborah Symmons

„

Deborah Symmons, Professor of Rheumatology and Musculoskeletal Epidemiology at The University of Manchester explained: “This research provides important evidence that the risk of early death starts to decline in patients who stop smoking, and continues year on year.

“We hope that this research can be used by public health professionals and rheumatologists to help more people quit smoking and reduce premature deaths, particularly for newly diagnosed patients with rheumatoid arthritis.”

Commenting on the study which was supported by the charity Arthritis Research UK, Stephen Simpson, Director of Research and Programmes said: “Rheumatoid arthritis is a debilitating and painful condition affecting over 400,000 people in the UK, it can begin at any age and is unpredictable - one day you can feel fine and the next day be confined to bed, unable to get up to dress, even go to the toiled unaided.

“As a charity, we are committed to preventing, transforming and curing arthritis and musculoskeletal diseases, and this research shows that cutting out smoking is one intervention which can help this condition from developing.”

The paper, ‘Smoking-related mortality in patients with early rheumatoid arthritis – a retrospective cohort study using the Clinical Practice Research Datalink’ was published in the journal Arthritis Care and Research.

The University of Manchester Oxford Rd Manchester M13 9PL UK

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New drug for the treatment of rheumatoid arthritis shows promising success

(Vienna ) In a clinical phase-3-study, an international research cooperation of MedUni Vienna and Stanford University has achieved significant success with the drug Baricitinib for the treatment of rheumatoid arthritis. The test persons exhibited significantly less symptoms of the disorder. The results are now published in the top scientific journal "New England Journal of Medicine".

The worldwide first clinical phase-3-study with the Baricitinib inoduced significant success in the treatment of rheumatoid arthritis. Baricitinib is an orally administered inhibitor of Janus kinase 1 and 2. This kinase is an inrarcellular enzyme which is activated when extra-cellular messenger molecules, e.g. interferons or interleukin-6, are docking onto cells, thus triggering the events leading to the inflammatory response.

The study which was sponsored by Eli Lilly and was led by MedUni Vienna and Stanford University (USA), was conducted over 24 weeks and comprised a total of 527 persons. The test persons were patients who had previously unsuccessfully undergone many conventional treatment therapies, including one or even several biologic agents. The participants were divided into three groups, one with a daily dosage of 2 mg of baricitinib, one with 4 mg and a control group with placebos.

The result showed that the test persons who had received baricitinib exhibited significant improvements of their symptoms. They suffered of less pain and joint swelling and composite measures of disease activity improved extensively. The group with the 4 mg dose showed even better results than those with the 2 mg dose, compared to the placebo group. The adverse event rates were comparable to those known of biological therapies.

"With Baricitinib, we will have a drug that works even if the currently employed medications are not sufficiently effective", explains study author Joseph Smolen, Manager of the University Clinic for Internal Medicine III of MedUni Vienna in AKH Vienna. "Despite the very long disease duration and the refractory nature of the disease based on the lack of success with a series of other established therapies, almost 10 % of the patients went into full remission, i.e. a cure-like state on drug, within six months, and almost half of the patients demonstrated significant improvement of in disease activity and physical functioning. All this may constitute a new basis for the treatment of rheumatoid arthritis that could become available in the near future."
And there is yet another advantage for the affected people, explains Smolen: "The medication is taken orally once a day and does not have to be administered intravenously or subcutaneously with a needle, unlike other medication. This is significantly more comfortable for the affected people."

The study was developed in cooperation between the company Eli Lilly with MedUni Vienna and the top University of Stanford (USA), as well as other cooperation partners.

Rheumatoid arthritis
Rheumatoid arthritis is a chronic autoimmune deficiency which predominately occurs in women (approx. two thirds of the affected persons) and which strikes most frequently at an age between 40 and 70 years. It causes inflammations in the joints. Swelling, overheating and function limitations are the consequence. Without treatment, it leads to the increased destruction of joints and the bone near the joints, consequently resulting in mal-positioned bones, deformations and increased permanent disability.

Service: New England Journal of Medicine
Baricitinib in Patients with Refractory Rheumatoid Arthritis
Mark C. Genovese, M.D., Joel Kremer, M.D., Omid Zamani, M.D., Charles Ludivico, M.D., Marek Krogulec, M.D., Li Xie, M.S., Scott D. Beattie, Ph.D., Alisa E. Koch, M.D., Tracy E. Cardillo, M.S., Terence P. Rooney, M.D., William L. Macias, M.D., Ph.D., Stephanie de Bono, M.D., Ph.D., Douglas E. Schlichting, M.S., and Josef S. Smolen, M.D.
N Engl J Med 2016;374:1243-52.
DOI: 10.1056/NEJMoa1507247

Five research clusters at MedUni Vienna
In total, five research clusters are established at MedUni Vienna. Here, the emphasis is increasingly on basics as well as clinical research at the MedUni Vienna. The research clusters comprise medical imaging, cancer research/oncology, cardiovascular medicine, medical neuro-sciences and immunology. This research paper is included in the topics of the immunology cluster.

 MedUni Vienna 

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New drug for the treatment of rheumatoid arthritis shows promising success

Barriers to contraception for indigenous Māori teenage mothers

A new study from the University of Otago, Wellington, has found that there are health system barriers for young Māori mothers when trying to access timely contraception.

Associate Professor Dr Beverly Lawton

The study, just published in the Journal of Primary Health Care, looked specifically at contraception before and after pregnancy and aimed to identify any barriers and facilitators to contraception for Māori teenage mothers. The research is part of ‘E Hine’, a longitudinal qualitative Kaupapa Māori study involving Māori women aged 14-19 years old.

Lead author Dr Bev Lawton from the Women’s Health Research Centre at the University of Otago, Wellington says that it’s important for teenage mothers to have timely and equal access to contraception so they can make informed choices about their sexual and reproductive health.

“We found that most women had accessed contraception or advice before pregnancy, but the use was compromised by a lack of information, negative side effects and limited follow up,” Dr Lawton says.

“Our research showed that despite giving considerable thought to post-pregnancy contraception, many study participants experienced clinical and service delays, financial barriers and negative contraceptive side effects.”

We found there was a lack of system focus on contraception initiation and for some a lack of integrated care between midwives and other primary care services, leaving many participants without effective contraception,” says Dr Lawton.

“A lack of integration and limited funding in the New Zealand public-funded system results in multiple missed opportunities to meet these young women’s needs for effective contraception,

“These young women are actively seeking contraception and come up against barriers. We need to urgently address these barriers to meet these young women’s needs”.

Dr Lawton says that the system worked well when there was a contraception plan that included navigation, free access, and providing contraception. Health service funding formulas need to cover provision of contraception and not just contraceptive advice. Other suggested changes could include more funding for training modules for contraceptive implants and intrauterine contraceptive devices, funded General Practice late pregnancy and post birth visits and added funding for insertion of long acting reversible contraception.

For further information contact:

Associate Professor Dr Beverly Lawton
Women’s Health Research Centre,
University of Otago, Wellington.
Tel: 64 4 806 1893

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Barriers to contraception for indigenous Māori teenage mothers

The price of a healthy diet: new study shows divide between rural and metro Victoria

Victoria is probably Australia’s most populated state, with the least number of areas that could be regarded as remote. Yet a new study reveals that Victorians living in non-urban environments pay more for healthy food than their urban counterparts.

Nutritious diets are more expensive and the costs of a healthy diet can increase further for those Victorians who live in rural areas, according to a new study that has broken down the cost of a basket of healthy food available to four different types of Victorian families. Interestingly the study found that eating healthily was more a factor of proximity to towns and cities than socioeconomic status.

The groundbreaking study, led by Dr Claire Palermo, from the Monash Department of Nutrition and Dietetics, has studied how much a basket of nutritious food (fruit, vegetables, meat and meat products, breads and cereals, costs across 26 metro and 76 rural areas, a total of 115 stores in winter and summer of 2012, 2013 and 2014.

The study – published in The Australian and New Zealand Journal of Public Health, looked at the cost of food for four different families for a fortnight (a family of four; single parents; female over 65 years and male 18-50 years). The research team took a random sample of stores in rural and metro areas, collecting data on the price of each item.

The study found that the cost of a healthy food basket for a family of four increased by $27 to a total of $451 from July 2012 to December 2014. According to Dr Palermo, this cost is 32% of for those on the lowest income.

“A healthy diet costs around 30% of government benefits income.  Anything over 30% is classified as unaffordable,” she said. The average Australian spends 20% of their income on food.

For the same period of time the food basket increased in price by $21 to $310 for a single parent family; $7 to $109 for a female over 65 years and $6 to $141 for a male 18-50. All three groups kept the cost of their basket under 30% of the average income for that group.

The data also revealed that the distance of stores from the state capital city predicts differences in food costs, making healthy food options unaffordable for some Victorians.

Significantly, the research team also showed that the further the store is from the city centre, the higher the total cost of the healthy food basket, despite much of Victoria not being considered very remote.

Dr Palermo added that there was no association found between basket cost and the socio-economic index of the town in which the store was located.

“These findings provide new and unique insights into the cost of food as a key determinant of health in a populated state such as Victoria.”

The mean cost of the healthy basket for a typical family represents approximately 31% of household income, and given the rising costs of living pressures and related food stress, eating a healthy diet may be less attainable for those on lower incomes, Dr Palermo added.

The study also found that:

• The cost of fruit and vegetables varied over time more than meats, breads/cereals, dairy foods and non core foods such as margarine.
• The further a store is from the city centre the higher the total cost of a healthy basket of food.
• No association was found between basket cost and the socio-economic index of the town in which store tested was located.

Monash University.

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The price of a healthy diet: new study shows divide between rural and metro Victoria

Longer maternity leave linked to better infant health

McGill, UCLA study of low- and middle-income countries shows paid maternity leave policies could help prevent infant deaths

For each additional month of paid maternity leave offered in low- and middle-income countries (LMICs), infant mortality is reduced by 13%, according to a new study by researchers from McGill University and UCLA Fielding School of Public Health.

The finding, published in the journal PLoS Medicine, marks the first time that research has examined the impact of paid maternity leave on infant mortality in LMICs. Previous work has shown that paid time off is consistently associated with lower mortality of babies under one year old in high-income countries.

“A significant number of countries where the vast majority of maternal and child deaths occur provide less than 12 weeks of paid leave to new mothers,” said lead author Arijit Nandi, an Assistant Professor at McGill’s Institute for Health and Social Policy and the Department of Epidemiology, Biostatistics, and Occupational Health. “Our findings suggest that paid maternity leave policies are a potential instrument for reducing preventable child deaths, even in countries where women are less likely to be working in the formal economy.”

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To carry out their analysis, researchers utilized statistics on approximately 300,000 children born over a period of eight years in 20 LMICs­ across Africa, Asia and Latin America, and combined that data with information on government maternity leave policies in those countries. They teased out the effects of lengthening paid maternity leave by comparing infant mortality rates in countries that expanded benefits with rates in countries where policies remained the same.

After controlling for variables such as gross domestic product and per capita spending on health, the researchers found that adding just one month to the length of paid leave prevents about 8 infant deaths per 1,000 live births, equivalent to a 13% reduction in mortality. The most significant life-saving effect of extending paid maternity leave occurs during the post-neonatal period, when babies range in age from about one month to one year.

The study’s authors theorize that paid and extended maternity leave may help to reduce infant mortality in several ways, including the following:

• Paid maternity leave, with its guarantee of income and job security, may reduce a woman’s stress level, a known risk factor in preterm birth and low birth weight.
• Some policies permit time off as the due date approaches and that may allow expectant mothers easier access to third-trimester care.
• After her child is born, a mother on paid leave may have more time to seek medical attention and care for an ill child.
• A woman who takes time off from work at that point may be more likely to continue breastfeeding and to ensure that her baby receives vaccinations, both of which are important factors in infant health.

One hundred and eighty-eight countries guarantee paid leave of some sort for new mothers. “While this study focuses on low- and middle-income countries, the impact in high-income countries is also well demonstrated. For the health of our children and the well-being of families, the U.S. needs to catch up with most of the world and ensure all new parents have paid parental leave,” said study author Dr. Jody Heymann, formerly of McGill and now dean of the UCLA Fielding School of Public Health and founding director of the WORLD Policy Analysis Center.

In Canada as well as in many European countries, a new mother is entitled to up to one year of paid time off. Only a few countries have no paid maternity leave mandate. They include Papua New Guinea, Suriname, and the United States.

In future work, Nandi said, “We plan to document the effects of paid maternity leave on women’s outcomes, including their labor force participation, health, and well-being, as well as the implications of paternal leave policies.”

Global maps

Is paid leave available to mothers and fathers of infants?

Maternity leave policy

Funding for this research was provided by the Canadian Institutes of Health Research, the Canada Research Chairs program, the Fonds de recherche du Québec -Santé (FRQS), and the Ministére de la Santé et des Services sociaux du Québec.

“Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-

Income Countries: A Quasi-Experimental Study”, Arijit Nandi, Mohammad Hajizadeh, Sam Harper, Alissa Koski, Erin C. Strumpf, Jody Heymann, PLoS Medicine, March 29, 2016. doi:10.1371/journal.pmed.1001985

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Longer maternity leave linked to better infant health

Decades-old mystery disease identified and potential cure found

New research by Adrian Liston (VIB/University of Leuven, Belgium), Seth Masters (Walter and Elisa Hall Institute, Australia), Carine Wouters (University of Leuven, Belgium) has found the genetic mutation causing the disease and also identified an effective treatment. This research was published in the international scientific journal Science Translational Medicine.

For decades, families in Belgium, England, and France have been living with a mysterious disease that results in severe skin lesions, fevers, pain and exhaustion. Every generation, half of the children of the people with this disease develop the same symptoms. Doctors had been previously unable to identify the disease or find any effective treatment. For the first time, this disease has been identified and a treatment found due to an international research team.

Professor Adrian Liston (VIB/University Leuven): “Detailed work by clinicians told us that we were dealing with a genetic disease. Thanks to advances in DNA sequencing technology we were able to sequence the genome of these patients and find the mutation causing the disease”.

The mutation is in the gene called MEFV. This gene was known to cause an inflammatory disease called Familial Mediterranean Fever (FMF) in patients who inherit mutated copies from both mother and father. However, the mutation found in the PAAND patients is different. Only a single copy of the mutation is needed to cause disease, meaning it affects half the children of patients, unlike the mutations that cause FMF, which often skip generations.

Professor Seth Masters (Walter and Elisa Hall Institute): “The PAAND mutation causes the body to respond as if there is a bacterial skin infection. This leads to the skin making the inflammatory protein interleukin-1β, which causes skin lesions, fevers and pain”.

A cure for the new disease?
Understanding the biological basis for this new disease allowed the rational selection of a new treatment. The researchers repurposed an anti-arthritis drug, anakinra (Kineret ®), which targets the same protein that causes PAAND, interleukin-1β. The results in the first volunteer, from an English family, were striking, with a rapid clearance of skin lesions and a complete recovery from fevers and pain. A larger trial is now beginning in the Flemish patients to see if this targeted treatment will act as a complete cure.

Professor Carine Wouters (KU Leuven/UZ Leuven, lead clinical researcher): “This is the synthesis of an intense collaboration between clinicians and scientists trying to understand this disease for almost 10 years.  I am delighted to see how it has increased our understanding of rare mutations, and especially has opened a therapeutic perspective for these patients.”

Quote from one of the patients: “We are happy and very grateful to the doctors and scientists who never gave up their search to understand the disease that affected members of our family for so many years. We are very hopeful that the new treatment will be beneficial to our family. Also we realize that the findings will help other patients to get a correct diagnosis and therapy.3

Professor Adrian Liston (VIB/KU Leuven, lead scientific researcher): “This is an amazing time to be working on genetic diseases. Every month we are solving clinical cases that would have been too hard to work out just a few years ago. Actually, to be honest the research is moving much faster than the healthcare system – we are finding new mutations, new diseases and trialling new treatments faster than the healthcare system is adapting. It creates a difficult situation for patients where the science is in, but the health insurance funds are not ready to reimburse the costs of the advanced diagnostic tests we use or novel treatments that we discover. This is a challenge, but also an opportunity – medical improvements could be rolled out quite quickly with political will.”

Professors Carine Wouters and Adrian Liston have established the Leuven University Fund Ped IMID (Pediatric Immune Inflammatory Diseases) to seek funding for research, diagnosis, and treatment of people living with rare immune disorders not currently covered by the health insurance funds.

___________________________________________________________________________________

Questions
As this research may raise questions, we want to ask you to list the e-mail address that the VIB has made available for questions in your report or article. Everyone can contact us with questions about this research and other medical research: [email protected].

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Sun protection poor for NZ secondary school students: Otago research

A University of Otago study that involved unobtrusively observing the sun-protective practices of students and staff at the sports days of 10 Dunedin secondary schools last summer has found them sorely lacking.

The Otago researchers’ assessment, which also looked at related aspects of the physical environment, found that only 3 per cent of students wore a sun-protective hat while waiting to compete in events. In addition, only 25 per cent of adult supervisors wore such a hat.

Shade was not generally available to students, either when competing or waiting to compete, although sunscreen was provided by half of the schools.

The results of the study, carried out by Cancer Society Social and Behavioural Research Unit staff Bronwen McNoe and Associate Professor Tony Reeder, appear in the April issue of the Australian and New Zealand Journal of Public Health.

The researchers noted that skin cancer prevention recommendations are that students (and staff) should be encouraged to wear sun protective clothing and hats and that broad spectrum SPF30+ sunscreen should always be provided.

They also encouraged sports facilities, such as the Council-owned athletics track where most Dunedin athletics sports days are held, to provide built or portable shade for students (and other athletes) waiting to compete.

Results back up researchers’ other recent findings

The latest findings help to confirm and complement the results of the same researchers’ first national survey of 211 secondary schools, published earlier this month in the US journal Preventive Medicine Reports.

In that survey, school sun protection planning, behavioural expectations, curriculum content and environments were assessed and the researchers allocated a total sun protection “score” to each school. This score included measures of sun protective clothing, shade provision and the management of outdoor school events during peak ultraviolet radiation (UVR) hours. The national mean total score achieved was only 4.6 out of a possible score of 11.

Rather than award schools a “fail” or comment that they “need to do better”, Associate Professor Reeder says that he preferred to say that schools needed better support to help them meet recommended practices. “One principal of a large college commented that their school did not receive sufficient funding for them to pay for the grass to be mowed, let alone build adequate shade for students.”

By investigating associations between scores and school characteristics, the researchers found that the 50 per cent of schools with a sun protection policy scored significantly better than other schools. In addition, schools which included some primary level classes, for which the Cancer Society’s SunSmart programme has been available nationally since 2005, scored better.

Associate Professor Reeder says that having a formal written sun protection policy is an important first step as it signals the expectation of the Board of Trustees that the school intends to provide an environment where students and staff can be safe in the sun.

“The apparent better continuity in these commitments among secondary schools which also included primary level student classes suggests that the SunSmart Schools ‘culture’ gets to become more ingrained,” he says.

Substantial fraction of adolescents’ sun exposure is while at school

Associate Professor Reeder says in New Zealand, where we enjoy unpolluted skies and outdoor lifestyles, the downside is that we have extremely high rates of skin cancer, by far the most common cancer type.

“More than 90 per cent of skin cancers are linked with excessive exposure to UVR, either from sunlight or artificial sources, like sunbeds. Childhood and adolescence are particularly important times to avoid these harmful exposures,” he says.

Mrs McNoe says that adolescents attended school during peak UVR hours (10am–4pm) five days a week, and spent some of that time outdoors.

“So they can receive a substantial fraction of their total UVR while at school, particularly when engaged in outdoor events such as swimming or school sports days and, unfortunately, some get sunburnt.”

At primary school level, the Cancer Society’s SunSmart Schools programme was designed to help prevent that happening. The World Health Organization guidelines on sun protective policies, practices, curriculum content and environments also need to be applied at secondary level, she says.

Although most adolescents were aware that skin cancer is a risk of sun exposure, Mrs McNoe says that this knowledge tends not to be translated into appropriate sun protection behaviour.

“We cannot afford to let teenagers be put in the ‘too hard’ basket. The creation of supportive institutional policies, practices and environmental settings are proven ways to encourage appropriate sun protective behaviours,” she says.

For more information, contact:

Mrs Bronwen McNoe
Cancer Society Social and Behavioural Research Unit
Department of Preventive and Social Medicine
University of Otago
Tel 64 3 479 7177
Email [email protected]

Associate Professor Tony Reeder
Cancer Society Social and Behavioural Research Unit
Department of Preventive and Social Medicine
University of Otago
Tel 64 3 479 7257

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Sun protection poor for NZ secondary school students: Otago research

Psychology graduate uses art and drama therapy to assist people with mental health issues in Sri Lanka

A Kingston University psychology graduate has embarked on a life-changing trip to the Indian Ocean island of Sri Lanka to work with people affected by two events which have shaped the country's recent history.

Charlotte Rose, who graduated in 2015, spent five weeks in South Asia working with people affected by the long-running civil war, which ended in 2009, and the 2004 tsunami. She put into practice the skills developed during her degree working at psychiatric hospitals and leading therapeutic activity sessions at centres for people with variety of mental health needs. The placement was organised by Sri Lanka Volunteers (SLV), an organisation founded by psychology graduates to provide work experience opportunities in their subject field.

"I was based in the capital city of Colombo and lived with a host family in their home, along with 10 other SLV volunteers from around the world," Charlotte said.

A typical day for the 22 year old from Plymouth consisted of spending the morning in an orphanage, followed by the afternoon in a hospital. In a country where knowledge and practice of mental health care is still in its infancy, Charlotte ran a combination of art and drama therapy sessions to help people affected by both the civil war and the tsunami which devastated the country in 2004.

Psychology graduate Charlotte Rose spent five weeks helping people with mental health problems in Sri Lanka "It was a massive cultural eye-opener. We were given a basic language lesson to help us communicate with people, but we ended up using actions and objects to convey our messages most of the time," Charlotte said. "Encouraging children - and adults - to express emotions through drawing pictures and creating crafts was a really useful way to get people to open up and begin to build trust. This allowed me to work with them despite the language barrier."

Charlotte said the profound impact of the civil war and the tsunami resulted in people producing images that sent chills down her spine. In such challenging circumstances, Charlotte insisted keeping her own emotions in check was essential. "Anybody who met the people I did and learnt about their experiences could be forgiven for feeling a sense of despair. But throughout my psychology degree at Kingston University we were constantly taught about the importance of maintaining professional distance - this is vital to be able to provide effective therapy," Charlotte said. "It would have been easy to be very upset by some of the stories I heard - but I was there to assist."

Charlotte credits her time at the University for giving her the strong foundations needed to work with people in Sri Lanka. "Everything I learnt over the three years came rushing back to me. I learn best by putting theory into practice - and my SLV trip was the perfect platform for that."

Charlotte's advice to current students looking to gain experience is simple. "The chance to implement what you learn in the lecture theatre is priceless," she said. However, she acknowledged that the SLV trip was not cheap. "I found out about this scheme in my first year and began saving immediately by doing part-time jobs. Psychology is a very competitive field and if you want to stand out than you need to be prepared to go that extra mile."

With a master's degree in clinical forensic psychology now in her sights, Charlotte remains as focussed as ever. "I am currently working as a healthcare assistant and doing another part time job to save up for a master's. My time in Sri Lanka changed my outlook on life and made me realise that my ultimate goal is to carve out a career in psychology."

• Find out more about studying psychology at Kingston University.

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An alternative route to inflammation

Using a combination of newly developed methods, researchers led by LMU immunologist Veit Hornung have defined a previously unknown pathway that triggers inflammation.

The immune system in vertebrates is capable of distinguishing “self” from “non-self” components, which enables recognition and destruction of invasive pathogens and aberrant cell types such as tumor cells. Adaptive immune reactions, e.g. based on antibodies, are powerful and highly specific, yet require tedious and time-consuming gene rearrangements. For effective immediate defense, intruders must be detected rapidly, and this task is performed by the so-called innate immune system. Innate immune cells express a relatively small set of receptors on their surfaces, which recognize molecular structures that are uniquely associated with pathogens. Binding of these structures triggers an inflammatory response that kills the pathogen or the infected cell. In order to analyze the signal pathways that mediate these processes, researchers led by Veit Hornung, who holds the Chair of Immunobiochemistry at LMU’s Gene Center, combined two different methodologies. They first utilized a novel cell culture system that mimics the function of monocytes, a class of immune cells involved in regulating inflammation. Then they systematically deleted single genes to determine their role in initiation of the inflammatory response – and uncovered a previously unknown signaling pathway. The findings appear in the journal “Immunity”.

Hornung and his group began their study of a protein complex called the NLRP3 inflammasome at Bonn University Hospital before he moved to the LMU in October 2015. This complex is found in monocytes, and plays a key role in inducing inflammation, as well as being implicated in diseases associated with chronic inflammatory reactions, such as gout, Type 2 diabetes and arteriosclerosis. However, our knowledge of its mode of action is primarily based on studies carried out in mouse cells. In mouse monocytes, two stimuli are required to cause the NLRP3 inflammasome to trigger secretion of the pro-inflammatory signal protein interleukin 1beta (IL-1), while freshly isolated human monocytes were found to produce IL-1 in response to a single signal, which acts via a receptor called TLR4. However, no established human monocyte-like cell lines react to this signal. This is why Hornung and his colleagues had to employ the new human monocyte-like cell line in order to understand the basis for the species difference.

“We developed a procedure which allowed us to specifically delete single genes in cultured human immune cells that closely resemble human monocytes. Using this system, we were able to identify, at the genetic level, the components responsible for signal transmission to, and activation of the NLRP3 inflammasome,” explains Moritz Gaidt, a doctoral student in Hornung’s group and first author of the new study. In this way, the team was able to analyze the secretion of IL-1 by human monocytes in unprecedented detail – and to define the mechanism that enables human NLRP3 to be activated in response to a single signal.

The researchers activated the TLR4 receptor by exposing their monocytes to bacterial lipopolysaccharide (LPS) – a complex molecule made up of sugars and fats, which is found on the surface of many pathogenic bacteria. They then showed that binding of LPS triggers the secretion of IL-1 via a previously unrecognized signal relay. “The activation of this new pathway explains why human monocytes do not need a second signal to secrete IL-1. Conversely, in mouse monocytes this particular pathway is not activated, so a second stimulus is required,” Veit Hornung explains. Moreover, while inflammasome activation in the mouse induces programmed inflammatory cell death, the pathway used in human monocytes does not. “We refer to this signal pathway as the alternative inflammasome, in order to distinguish it from previously described pathways,” says Hornung. “We believe that this signal pathway plays a critical role in inflammatory processes in humans.”

The new study underlines the fact that results obtained in mice are not always translatable to humans. So far, only human monocytes have been found to react directly to contact with LPS by releasing interleukin 1, without the need for a second signal. The researchers now intend to analyze the in-vivo function of the TLR4 receptor in other model organisms. Using Hornung’s monocyte-like cells, it should be possible to identify further signal pathways in vitro. “Our results refute some of the classical tenets of inflammasome research. We hope that our new method will also enhance our understanding of the cell biological basis of immune disorders,” Hornung concludes.
(Immunity 2016)

LMU

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Statin use differs among Hispanic adults at risk for heart disease

Study Highlights

• In the United States, adults of different Hispanic or Latino backgrounds who are at high risk for heart disease, varied significantly in their use of cholesterol-lowering medications known as statins.
• Statin use was highest among U.S. adults of Puerto Rican or Dominican heritage and lowest among those of Central American background.
• The difference in statin use depended upon whether study participants had health insurance.

DALLAS — In the United States, adults of different Hispanic/Latino backgrounds, at high risk for heart disease, varied significantly in their use of widely-prescribed cholesterol-lowering medications known as statins, according to new research in the Journal of the American Heart Association. The difference was based on whether or not they had health insurance.

“These findings have important implications for preventing disparities in cardiovascular outcomes within the growing U.S. Hispanic/Latino population,” said study lead author Dima M. Qato, Pharm.D., M.P.H., Ph.D., assistant professor of pharmacy systems, outcomes and policy at the University of Illinois in Chicago. “Efforts to increase the use of statins, particularly targeting individuals that have already suffered a heart attack or stroke, should include expanding health insurance for all Hispanic/Latino adults that currently lack coverage, regardless of their heritage.”

In one of the first studies to document differences in the use of statins and aspirin among diverse Hispanic/Latino populations in the United States, investigators found statin use was highest among high-risk study participants of Puerto-Rican heritage at 33 percent followed by those of Dominican heritage at 28 percent. The range was 22 percent for participants of Cuban and South American heritage and lowest among those of Central American backgrounds at 20 percent. However, lacking health insurance was associated with a lower likelihood of statin use in all groups.

Results were from 4,139 patients at high risk for heart disease enrolled in the larger Hispanic Community Health Study/Study of Latinos, in the Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California between March 2008 and June 2011. All participants (average age 52, about half women) were at high risk for heart disease, defined in the study as ever having had a heart attack, stroke, or diabetes. At enrollment, participants underwent medical examinations and answered questionnaires about medication use and heart disease history.

Overall, researchers noted that one-fourth of study participants took statins and less than half (44 percent) took aspirin. The use of aspirin (available over-the-counter without a prescription) was comparable among all Hispanic/Latino groups.

“Efforts to improve statin prescribing in patients likely to benefit are particularly important in patients with history of heart disease,” Qato said. “Healthcare providers and policy makers should be aware of the role of insurance in the underuse of preventative cardiovascular medications in specific Hispanic/Latino populations.”

Heart disease is the No. 1 killer for all Americans and stroke is the fifth leading cause of death. Hispanics and Latinos, however, face even higher risks of cardiovascular diseases because of high blood pressure, obesity and diabetes. Lifestyle changes outlined in the American Heart Association’s Life’s Simple 7^® — controlling cholesterol, managing blood pressure and blood sugar, getting active, eating better, losing weight, and quitting smoking—can help lower these risks. But when lifestyle changes are not enough, medication also may be necessary.

Co-authors are Todd A. Lee, Pharm.D, Ph.D.; Ramon Durazo-Arvizu, Ph.D.; Donghong Wu, M.S.; Jocelyn Wilder, M.P.H.; Samantha A. Reina, M.S.; Jianwen Cai, Ph.D.; Franklin Gonzalez II, M.S.; Gregory A Talavera, M.D., M.P.H.; Robert Ostfeld, M.D., M.S. and Martha L. Daviglus M.D., Ph.D.

The National Heart, Lung, and Blood Institute; National Institute on Minority Health and Health Disparities; National Institute on Deafness and Other Communication Disorders; National Institute of Dental and Craniofacial Research; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Neurological Disorders and Stroke and the NIH Institution-Office of Dietary Supplements supported the study.

Additional Resources:

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at http://ift.tt/1fEuygG.

For Media Inquiries and AHA/ASA Spokesperson Perspective: (214) 706-1173

Akeem Ranmal: (214) 706-1755; [email protected]  

Julie Del Barto (national broadcast): (214) 706-1330; [email protected]

For Public Inquiries: (800)-AHA-USA1 (242-8721)

heart.org and strokeassociation.org

Life is why, science is how . . .  we help people live longer, healthier lives.

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Statin use differs among Hispanic adults at risk for heart disease

Meningitis vaccine extended to 16 to 18 year olds

The Public Health Agency (PHA) is encouraging all 16 to 18 year olds to get a free vaccination that can help protect against meningococcal disease.

Beginning in April, GPs will invite people born between 2 July 1997 and 1 July 1999 to have the MenACWY vaccine. It will protect against four different causes of meningitis and septicaemia – meningococcal A,C,W and Y diseases.

Dr Lucy Jessop, Consultant in Health Protection at the PHA, said: “Older teenagers are at higher risk of getting Meningococcal W disease (MenW), so you need to get vaccinated to help protect yourself. It will also reduce the risk of you carrying the bacteria, therefore offering better protection to those around you. MenW was generally rare in the UK, but there has been an increase in cases in recent years.

“Even if you have recently had the MenC vaccine, for example in school, you should still get the MenACWY vaccine. It will increase your protection against MenC and provide protection against the three other meningococcal groups.

“The vaccine will be administered in a phased approach so don’t worry if you don’t hear from your GP straight away. We would say, however, that if you are in the eligible age group and have had no communication from you GP by July, contact them and arrange an appointment.”

The MenACWY vaccination programme began in August 2015 for school leavers and first time university students. From January 2016, the vaccination was also made available to 14 and 15 year olds. These groups are still encouraged to get the vaccine, particularly those who are planning to go to university for the first time in the autumn.

Dr Jessop continued: “It is important to receive the vaccine before going to university as those attending for the first time will usually mix with larger groups of people, making them more exposed to various infections or diseases. The best way to protect against meningococcal A, C, W or Y disease is to get the vaccine before you go.”

Meningococcal bacteria can cause meningitis (inflammation of the lining of the brain) and septicaemia (blood poisoning). Both diseases are very serious and, especially if not diagnosed early, they can kill. 

The early symptoms of meningococcal disease are similar to those of flu, so you need to be able to recognise the symptoms very quickly even if you have been vaccinated as the vaccines offered through the routine immunisation programme do not protect against all forms of the disease.

There are five main groups of meningococcal bacteria that can cause meningitis and septicaemia – A, B, C, W and Y. The same bacteria that cause these serious diseases can be carried in the back of the nose and throat, especially in young adults.

Look out for any of these symptoms: 

Fever, cold hands and feet

• Vomiting and diarrhoea
• Drowsiness, difficult to wake up
• Irritability and/or confusion
• Dislike of bright lights
• Severe headache or muscle pains
• Pale, blotchy skin with or without a rash
• Convulsions/seizures
• Stiff neck.

For more information on the MenACWY vaccination programme visit http://pha.site/MenACWY

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Meningitis vaccine extended to 16 to 18 year olds

Change Your Mind about mental health

Health Minister Simon Hamilton today launched Northern Ireland’s new mental health anti-stigma and anti-discrimination campaign.

The “Change Your Mind”, campaign supported by Comic Relief, the Public Health Agency (PHA) and Niamh (The Northern Ireland Association for Mental Health) is the first of its kind in Northern Ireland.

 The campaign brings together the work of the PHA and Niamh to reduce levels of stigma, discrimination, and negative attitudes towards people who experience mental ill-health. It also builds on the PHA’s campaigns to reduce barriers and encourage help-seeking behaviours, and Comic Relief's commitment to supporting mental wellbeing and breaking down the associated stigma and discrimination.

 Health Minister Simon Hamilton said: "Mental health is an issue for everyone and we all need to work at protecting our mental health. The issue is so common, yet unfortunately the stigma associated with mental ill-health still persists, and it is a serious barrier to help-seeking particularly for men. It prevents people from taking that first step to access support before the situation deteriorates to the point that crisis intervention becomes necessary. 

 “I therefore welcome this campaign ‎and I hope that it encourages everyone to treat mental health in the same way as physical health. Taking that first step to seek help must be seen by all as a sign of strength rather than some misguided admission of weakness."

Peter Mc Bride, CEO at Niamh, added: “We in Niamh have long been committed to changing negative attitudes and behaviour towards those with experience of mental illness. Since running our own anti-stigma campaign in 2011 we have been working to deliver this regional campaign and are delighted that Comic Relief and the PHA are the key partners. This grassroots campaign will reach into schools, workplaces and wider society. My call to action today is for people to join us as champions and help make a difference in your own community. The website is now live at http://ift.tt/1UtvbC3  and I would encourage everyone to check it out and see how they can get involved."

In recent years, the PHA has run a number of successful, high-profile media campaigns on mental health such as ‘The Boxer’, ‘The Mask’ and ‘The Fog’. These have tackled the issue of stigma and encouraged people who may have mental health problems to seek support. As a result, people are looking at mental health in a more positive way, providing a strong foundation for the ‘Change Your Mind’ programme to build upon.

Dr Eddie Rooney, Chief Executive of the PHA, explained why this work is so important: "This campaign will build on the positive work across the statutory and the voluntary and community sectors to reduce the levels of stigma, discrimination and negative attitudes towards people who experience mental ill-health.

“We want people to feel more confident in talking about mental health and to remove the myths around this issue so that they will be encouraged to reach out for help.

“We hope this campaign will make a real difference to the lives of people in our community who currently experience mental ill-health.”

Gilly Green of Head of UK Grants at Comic Relief added “we are proud to partner PHA and Niamh to reduce stigma in mental ill-health. We have been supporting similar initiatives in Scotland, Wales and England. Mental ill-health can affect anyone and so reducing stigma is the first step in enabling people to access support and encourage recovery to live a full life”.

Contact

Public Health Agency
Linenhall Street Unit
12-22 Linenhall Street
Belfast
BT2 8BS

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Researchers target intensive care's intensive noise problem

TV presents one picture of an intensive care unit (ICU) – dimmed lights, hushed voices and softly bleeping machines. The reality is that it's more like a busy restaurant and frequently it's noisy enough to compete with a pneumatic drill. That's why Oxford University researchers have been trying to make intensive care noise less intensive.

Professor Duncan Young from Oxford's Kadoorie Centre for Critical Care Research and Education said: 'High levels of noise make it harder to sleep, sleep deprivation leads to confusion, and confusion is thought to complicate the healing process and slow recovery.

'Yet our research found that during the day, noise levels in an ICU are equivalent to those of a busy restaurant. While things are quieter at night, we still found that sounds louder than 85 decibels – around the level of a road drill – were happening up to 16 times an hour.'

Concern that intensive care noise was delaying recovery led to a £280,000 grant from the National Institute for Health Research (NIHR), to understand the noise issues and then work to reduce them.

Professor Young explained: 'Patients may get earplugs and eye masks to help them sleep, but that doesn't deal with the underlying issue. We talked to patients, visitors and staff to find out if particular noises cause more disturbance. We also spent time in an intensive care unit watching and listening to identify the main sources of noise and how patients and staff reacted to them.'

The information was used by a group of staff and patients from the Oxford University Hospitals NHS Foundation Trust to help design a programme of noise-reducing changes. These included replacing noisy metal bins with quieter plastic ones, and introducing new guidelines to ensure the volume settings on equipment are appropriate and that staff try to keep a more normal day and night routine.

Online training for local hospital staff helps show how easily noise levels can rise, and how different noises affect patients. Based on patients’ suggestions, staff can also experience the ICU from the patient perspective. Wearing glasses that simulate the poor vision common in many patients treated in the ICU, they hear a soundtrack of common sounds in the unit while people move around the bed, as staff would do during routine nursing activities.

Professor Young said: 'The experience helps staff understand things from the patient’s point of view, and most of those who have been through the training have said that they will change the way they work.

'The next stage is to develop a noise display, so staff can see and better manage the noise level in the unit. Taken together, we hope all these activities will make intensive care a better environment for patients.'

Oxford University

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Heart and Liver Disease Linked to Antioxidant Shutdown

Rutgers scientists identify a defective protein causing damage and serious illness

By Robin Lally

A protein that should help fight infection and keep us healthy may be targeted for treating devastating illnesses like heart and liver disease, according to a new Rutgers study.

Rutgers scientists have discovered that a protein which is supposed to prevent cell damage is not working efficiently in laboratory mice with heart and liver disease.

In research published in Molecular Cell,Rutgers scientists discovered that a protein (p62), which is supposed to act as an antioxidant to prevent cell damage, was not working efficiently in laboratory mice with liver and heart disease that mimicked these conditions in humans. 

This caused oxidative stress – too much oxygen that damages healthy cells – and allowed the release of harmful molecules, called free radicals, which resulted in serious illness. One of the body’s first lines of defense, the cells antioxidant response system is supposed to prevent these harmful invaders from causing a domino effect and damaging other cells.

Wei-Xing-Zong, a professor in the Department of Chemical Biology in the Ernest Mario School of Pharmacy and leader of the study, said the damage occurred because another protein, (TRIM21) – which should activate the body’s response system to fight off bacteria and virus – did the opposite in these seriously ill mice and shut the antioxidant protein down, preventing it from doing its job.

“The (TRIM21) protein exists naturally in our body; without it, we could easily succumb to other manageable infections,” said Zong. “But this study has shown us that when we run into severe pathological conditions like heart and liver disease it would be more beneficial to inhibit the TRIM21 protein because it is preventing the cell from protecting itself against damage.”

In the Rutgers study, Zong and lead author Ji-An Pan, a scientist in his laboratory, looked at liver and heart damage in laboratory mice and found that the mice in which the TRIM21 gene was inactivated suffered little heart or liver damage when put through the same laboratory procedures used to produce tissue damage in mice with the gene.

“The hearts and livers of the mice without the TRIM21 gene seemed to be well protected which was opposite of the mice with the gene,” said Zong. “We believe this evidence is a truly important step to determining how to effectively treat these conditions in humans.”

Heart disease is the leading cause of death in the United States while one in 10 Americans has some form of liver disease. Rutgers scientists said this study indicates how critical it is to carefully control oxidative stress – which can also lead to neurodegenerative diseases like Parkinson’s and Alzheimer’s, chronic fatigue syndrome, cancers and gene mutations as well as liver and heart disease – so that cell or tissue damage doesn’t occur.

They believe that drugs could be developed that would reduce or stop the activity of the protein that is causing damage and preventing the antioxidant response from occurring.  

“These exciting new results suggest that drugs that reduce the activity of TRIM21 could be highly effective new tools for the treatment of conditions that are driven by high oxidative stress, including liver and heart disease,” Zong said.

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For media inquiries, contact Robin Lally at 848-932-0557 or [email protected]

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Heart and Liver Disease Linked to Antioxidant Shutdown

Bully T cells key to next generation flu vaccine

Associate Professor Katherine Kedzierska is working with a team to unlock the secrets of influenza. They are getting closer to a universal flu shot.

Researchers are one step closer to creating a universal, one-shot influenza vaccine following the discovery that T cells, essential in the immune response to influenza, can recognise and attack emerging, mutant strains of the virus.

An international research collaboration, led by University of Melbourne Associate Professor Katherine Kedzierska from the Peter Doherty Institute for Infection and Immunity and Dr Stephanie Gras from Monash University, used cutting edge single-cell technology, never before used in human influenza investigations, to hone in on human T cells one cell at a time to capture their response to the various strains.

Their four-year study, published in Proceedings of the National Academy of Sciences (PNAS), found how the T cells reacted to new mutant strains of influenza as well as viruses they had previously been exposed to.

The team used crystallography technology at the Australian Synchrotron to scrutinise the structure of the cells to identify how they recognise the mutant strains.

They found that it was their flexibility and ability to adapt that enabled the T cells to essentially bully the new strains into submission.

Associate Professor Kedzierska, senior co-author on the paper, said finding this piece of the puzzle was a major step forward on the path to creating a one-shot, T cell-mediated influenza vaccine for life-long immunity against the virus.

The World Health Organization estimates flu infects between three and five million people globally every year.

“This is a game changer in flu research,” Associate Professor Kedzierska said.

“Previous research has shown us that T cells provide universal, protective immunity to influenza, but we didn’t know why or how until now.

“By using state-of-the-art procedures, this study enabled us to dissect the immune response to understand how this immunity occurs.”

Associate Professor Kedzierska said further research was necessary before a universal vaccine could be created.

“Our past research has shown that only a seventh of the world’s population have the tissue make-up that provides universal immunity to influenza, the difference between a runny nose and being bed ridden,” she said.

“Now we know what to look for, our challenge is to find these receptors in those with a different tissue composition and elicit a similar response.”

Dr Stephanie Gras, also a senior author on the paper, said: "The use of the Australian Synchrotron was absolutely crucial to understanding these fine details of the immune response to influenza."

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Bully T cells key to next generation flu vaccine

New research highlights experiences of ambulance control workers

Staff who coordinate emergency services for 999 calls to the ambulance service require support to reduce stress and sickness absence, new research has found.

A team of experts, including from St George’s, University of London and the University of Surrey, interviewed dispatch staff, who work in ambulance control, sending paramedics to emergencies.

The research uncovered that while dispatchers find the job rewarding, they also report feeling overworked and undervalued compared to those on the ‘front line’. The research was undertaken following concerns that ambulance control staff have levels of sickness leave at twice the national average.

Professor Tom Quinn, of St George’s, University of London and Kingston University, said dispatcher’s work in a highly unpredictable job, where they have no control.

“Dispatchers are faceless compared to the frontline staff, but they are a tribe of unsung heroes working in similar conditions to air traffic controllers and the public don’t understand the importance of their job,” he said.

“They may not be seen as ‘heroes’ like paramedics and firefighters, but they are the ones ensuring that appropriate medical care reaches people in emergencies, which ultimately saves lives.”

The pressures of the role and increasing call volumes, combined with a lack of appropriate support or recovery time after shifts increased the risks of burnout, the research found.

There was also poor interpersonal relationships between dispatch and emergency crews, with a lack of structure to promote team building.

The study recommended implementing more opportunities for dispatchers, paramedics and emergency service crews to understand each other’s job, including shadowing on shifts, to increase team cohesion.

It also recommended higher management support and recognition, as well as training.

The research was published in the Emergency Medicine Journal.

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New research highlights experiences of ambulance control workers

Diagnosing ear infection using smartphone

Researchers at Umeå University in Sweden have developed a method that simplifies the diagnosis of ear infections (otitis media), something which annually affects half a billion children worldwide. The software-based method automatically analyses images from a digital otoscope and enables highly accurate diagnoses. The method is described in the journal EBioMedicine.

“Because of lack of health personnel in many developing countries, ear infections are often misdiagnosed or not diagnosed at all. This may lead to hearing impairments, and even to life-threatening complications,” says Claude Laurent, researcher at the Department of Clinical Sciences at Umeå University and co-author of the article. “Using this method, health personnel can diagnose middle ear infections with the same accuracy as general practitioners and paediatricians. Since the system is cloud-based, meaning that the images can be uploaded and automatically analysed, it provides rapid access to accurate and low-cost diagnoses in developing countries.”

The researchers at Umeå University have collaborated with the University of Pretoria in South Africa in their effort to develop an image-processing technique to classify otitis media. The technique was recently described in the journal EBioMedicine – a new Lancet publication.

The software system consists of a cloud-based analysis of images of the eardrum taken using an otoscope, which is an instrument normally used in the medical examination of ears. Images of eardrums, taken with a digital otoscope connected to a smartphone, were compared to high-resolution images in an archive and automatically categorised according to predefined visual features associated with five diagnostic groups.

Tests showed that the automatically generated diagnoses based on images taken with a commercial video-otoscope had an accuracy of 80.6 per cent, while an accuracy of 78.7 per cent was achieved for images captured on-site with a low cost custom-made video-otoscope. This high accuracy can be compared with the 64–80 per cent accuracy of general practitioners and paediatricians using traditional otoscopes for diagnosis.

Claude Laurent

“This method has great potential to ensure accurate diagnoses of ear infections in countries where such opportunities are not available at present. Since the method is both easy and cheap to use, it enables rapid and reliable diagnoses of a very common childhood illness,” says Claude Laurent.

Read a digital publication of the article in EBioMedicine

About the article:

EBioMedicine, article: Otitis media diagnosis for developing countries using tympanic membrane image-analysis. Authors: Hermanus C. Myburgh, Willemien van Zijl, DeWet Swanepoel, Sten Hellström and Claude Laurent. DOI: http://ift.tt/230ZPUF

For more information, please contact:

Claude Laurent, Department of Clinical Sciences, Umeå University
Phone: +46 90 785 1460
Email: [email protected]
High resolution portrait

Photo: Low cost custom-made video-otoscope that can be connected to a smartphone. Downloadable high resolution version

Editor: Anna Lawrence

Link to news:
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Diagnosing ear infection using smartphone