NHS Choices

Does contraceptive jab make HIV more likely?

NHS Choices - Behind the Headlines - Mon, 12/01/2015 - 11:05

"Contraceptive injections moderately increase a woman's risk of becoming infected with HIV," The Guardian reports.

The headline was prompted by an analysis of 12 studies that looked at whether the use of hormonal contraception, such as the oral contraceptive pill, increases the risk of contracting HIV.

All of the studies involved were conducted in sub-Saharan Africa in low- and middle-income countries.

Researchers found a link between a common injectable form of contraception called depot medroxyprogesterone acetate (Depo-Provera) and the risk of HIV. No link was found with other types of hormonal contraception.

But these results do not prove the depot injection directly increases the risk of HIV. The studies included varied in their design and methods, and have several potential sources of bias.

Any link could be down to behavioural patterns rather than medical reasons. For example, women who know they have an effective long-term contraceptive may forget about the risks of sexually transmitted infections.

Hormonal contraception, including injections or oral tablets, can be an extremely effective form of contraception. But it won't protect you against sexually transmitted infections.

It is worth discussing with your health professional and making sure you are using the method that is most effective, convenient and safest for you, depending on your circumstances.  

 

Where did the story come from?

The study was carried out by researchers from the University of California and received no financial support.

It was published in the peer-reviewed medical journal, The Lancet.

The Mail Online correctly reports the main findings of this study, but would benefit from highlighting that the findings do not prove a causal association between the depot injection and HIV risk, a point clearly made by the researchers in the original publication.

The Guardian's reporting of the study is more measured and highlights how for women in poorer countries, an unwanted pregnancy may pose a greater threat to health and wellbeing than HIV. Rates of maternal death occurring during or shortly after pregnancy remain high in many sub-Saharan countries.

 

What kind of research was this?

This was a systematic review that aimed to search the global literature to find studies examining whether the use of hormonal contraception, such as the oral contraceptive pill or contraceptive injections, increase the risk of contracting HIV.

The researchers say previous study into whether there could be an associated risk has been inconsistent. They pooled the results of different studies in a meta-analysis.

A systematic review and meta-analysis is the best way of identifying and looking at all evidence that has addressed the particular question of interest.

But this type of research is always going to have some limitations reflecting the strength and quality of the underlying studies being reviewed.

It is unlikely a trial would be conducted that would allocate women to hormonal contraception or not, purely to see if this increased their risk of getting HIV.

Instead, the studies are likely to be observational or trials that have primarily been investigating other things.

This means there is potential that associations are being influenced by confounders. In short, other factors linked to contraceptive use, such as lifestyle behaviours, are themselves influencing the risk of HIV, rather than contraceptives directly. 

 

What did the research involve?

The researchers built on the findings of a previous 2012 World Health Organization (WHO) review.

For the current review, they searched one literature database for English-language articles published from December 2011 onwards that included the terms "hormonal contraception", "HIV/acquisition", "injectables", "progestin", and "oral contraceptive pills".

They included studies that assessed hormonal contraceptives, included women without HIV at the study start, and were prospective in nature (following people over time).

Eligible studies were also required to have followed up at least 70% of their participants, have adjusted at least for a woman's age and condom use (to try to minimise confounding from these factors), and been conducted in a low- or middle-income country.

Separate researchers individually assessed the methods and quality of the eligible studies, and extracted data.

 

What were the basic results?

A total of 12 studies met the criteria for being included. All of these studies were conducted in low- or middle-income African countries.

These studies included large numbers of women, from between 400 to more than 8,000, and lasted between one and three years.

What were the studies investigating?

Three of the 12 studies included were observational studies designed specifically to examine any connection between contraception and HIV, while the other studies included women taking part in trials investigating interventions for HIV prevention.

Who was involved in the studies?

Most of the the 12 studies included looked at women aged 25 to 40 in the general population, while two looked specifically at women at high risk of HIV (commercial sex workers or women whose partner was HIV positive).

What contraceptives did the studies examine?

Some of the studies looked at women taking oral hormonal contraception (either combined pill or progestogen only).

In some the women were taking the injectable progestogen depot medroxyprogesterone acetate, and in the remaining studies the women were taking another type of injectable progestogen (norethisterone enanthate).

Most trials compared these hormonal types of contraception with a non-hormonal method of contraception, or with no method of contraception at all.

What were the specific results for the contraceptive injection?

Pooled results of 10 studies of depot medroxyprogesterone acetate found it was associated with a 40% increased risk of HIV (hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.16 to 1.69).

This risk was slightly lower when restricted to only the studies of women in the general population (pooled HR 1.31, 95% CI 1.10 to 1.57) rather than those at high risk of contracting HIV.

There was no evidence of an increased risk of HIV in women taking the other injectable progestogen, norethisterone enanthate (pooled HR 1.10, 0.88 to 1.37); nor was there any increased of HIV risk found from the use of oral contraceptive pills (HR 1.00, 0.86 to 1.16).

 

How did the researchers interpret the results?

The researchers concluded their findings "show a moderate increased risk of HIV acquisition for all women using depot medroxyprogesterone acetate, with a smaller increase in risk for women in the general population.

"Whether the risks of HIV observed in our study would merit complete withdrawal of depot medroxyprogesterone acetate needs to be balanced against the known benefits of a highly effective contraceptive."

 

Conclusion

This is a well-conducted systematic review that tried to identify all studies investigating the possible link between hormonal contraceptive use and HIV.

It did not find an association between HIV risk and oral hormonal contraceptive use, nor with one type of injectable progestogen contraceptive.

But it did find an increased risk of HIV in studies where women used a commonly used injectable form of contraception called depot medroxyprogesterone acetate.

The review had strict inclusion criteria, but the possibility of selection bias and confounding from other factors still cannot be ruled out.

Only three out of the 12 studies directly set out to look at whether hormonal contraceptive use was linked to HIV. And these were still observational studies, meaning the women chose their method of contraception.

The other nine studies were not designed to look for this association.

As women in all of the 12 studies included chose their method of contraception, this could mean there are other differences – such as health and lifestyle – between the women who chose to use this type of contraception and those who chose to use non-hormonal methods. So the contraception may not have been the sole or direct cause of the link.

Two of the studies also included high-risk women, such as commercial sex workers or women whose partner was HIV positive. Exclusion of these studies decreased the association between depot contraceptive injection use and HIV, although the link remained statistically significant.

As the researchers themselves acknowledge, the studies can't say whether the association between hormonal contraception and HIV is "causal". And this is crucial to bear in mind when looking at this review.

Other limitations of this research
  • As the authors also say, it is difficult for them to be sure of the timing of contraception use in relation to subsequent HIV infection.
  • Although the studies included contraceptive methods that are used in the UK, none of these studies were UK-based and all were conducted in sub-Saharan Africa. The prevalence of HIV in these countries is much higher than it is the UK, so the baseline risk of contracting HIV is already much higher than it would be in the UK. The 40% risk increase with the depot injection is a relative increase of what would comparatively be a very small baseline risk in the UK.

Contraceptive injections such as Depo-Provera are extremely effective – estimated to have a failure rate of less than 1 in 330. But they provide no protection against sexually transmitted infections.

Only barrier methods such as condoms protect against HIV and other sexually transmitted infections, such as chlamydia and genital warts.

Talk to your GP if you're unsure you're using the most effective and convenient contraceptive for you. 

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Contraceptive injection raises risk of HIV, research warns. The Guardian, January 9 2015

Women on the contraceptive jab have a greater risk of contracting HIV than those using other forms of birth control or NONE at all. Mail Online, January 9 2015

Links To Science

Ralph LJ, McCoy SI, Shu K, et al. Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies. The Lancet Infectious Diseases. Published online January 9 2015

Categories: NHS Choices

'Bionic' spinal implant helped paralysed rats walk

NHS Choices - Behind the Headlines - Fri, 09/01/2015 - 12:00

"Elastic implant 'restores movement' in paralysed rats," BBC News reports after researchers developed an implant that can be used to treat damaged spinal cords in rats.

The spinal cord, which is present in all mammals, is a bundle of nerves that runs from the brain through the spine, before branching off to different parts of the body.

It is the main "communication route" the brain uses to control the body, so damage usually results in some degree of paralysis or sensory loss, depending on the extent of the injury.

This promising research developed a novel spinal cord implant that has been able to restore movement in paralysed rats. The implant is made of a flexible material that is able to integrate and move with the spinal cord.

This overcomes problems found with previously tested rigid and inflexible implants, which have caused inflammation and quickly stopped working.

The implant works by delivering both electrical and chemical signals, and enabled the rats to walk again for the six weeks of testing.

However, the research is mainly "proof of concept" at this stage, showing the technique works in animals – at least in the short term. It remains to be seen whether implants are safe and effective at restoring movement in people with paralysis. 

 

Where did the story come from?

The study was carried out by researchers from École Polytechnique Fédérale de Lausanne in Switzerland and other institutions in Switzerland, Russia, Italy and the US.

Financial support was provided by various organisations, including the Bertarelli Foundation, the International Paraplegic Foundation, and the European Research Council.

It was published in the peer-reviewed journal, Science Magazine. 

Of all the UK coverage, BBC News reported the research most accurately, and included quotes about the promising nature of the research, but also due caution about the long timeline ahead before it is known whether such implants could be used in people.

Other headlines, such as that in The Times, arguably offer premature hope of a new treatment that can help the paralysed walk again. 

 

What kind of research was this?

This animal research aimed to develop a new flexible spinal implant to restore movement after a spinal cord injury.

Implants are just one of the ways medical science is exploring how to help people who have spine injuries regain sensation and movement.

In the past, electrical implants for the spinal cord encountered problems because spinal cord tissue is soft and flexible, while the implants of old were often rigid and inflexible.

The researchers expected implants with mechanical properties matching those of the host tissue would work better and for longer.

Here, they designed and developed a new soft electrical implant, which has the shape and elasticity of the dura mater, the outermost layer of the protective membranes (meninges) that cover the brain and spinal cord.

The device was tested in paralysed rats. Animal studies are a valuable first step in the development of treatments that may one day be used in people.

However, the road ahead is a long one in terms of developing the treatment for testing in people, hopefully followed by trials of its safety and effectiveness.

 

What did the research involve?

The researchers developed a silicone implant they called electronic dura mater, or e-dura. This implant has interconnecting channels that transmit electrical signals and can also deliver drugs. It was made for surgical insertion just beneath the dura mater layer.

They first tested the long-term functionality of this soft implant compared with conventional stiff implants. Long-term meant testing the device for six weeks.

Each type of implant was inserted into the lower part of the spinal cord of healthy rats. The rats were then assessed using specialised movement recordings, and the rats with the soft spinal implant were able to behave and move as normal.

However, rats with the stiff implants started to demonstrate problems with their movement one to two weeks after surgery, which only deteriorated further up to six weeks.

When examining the rats' spinal cords after the implants were removed at six weeks, the researchers found rats with the stiff implants displayed significant deformity and inflammation in the spinal cord. None of these adverse effects were observed in those who had the soft implant.

They followed this with a series of further tests of the mechanics and functioning of the soft implant, both in the laboratory using a model of spinal cord tissue and in further tests in healthy rats.

The researchers also examined the ability of e-dura to restore movement after spinal cord injury.

The rats received a spinal cord injury that led to permanent paralysis of both hind legs. The e-dura implant was then surgically inserted in the spinal cord, and drug therapy and electrical stimulation were delivered through the electrode to see how it worked. 

 

What were the basic results?

Most of the results in the publication relate to the initial developmental stages of the device. When it came to the paralysed rats, relatively little was said.

However, what the researchers did say is the combination of electrical and chemical stimulation through the implant enabled the paralysed rats to move both of their hind legs again and walk, apparently as normal (though this isn't specifically stated).

The e-dura implant was able to bring about these effects for the six-week period it was tested. 

 

How did the researchers interpret the results?

The researchers concluded they have developed a soft implant that shows long-term biointegration and functioning with the spinal cord.

The implants met the demanding mechanical properties of the spinal tissue, with a limited inflammatory reaction that has been seen with other implants.

When used in paralysed rats, the implant allowed for electrical and chemical stimulation to restore movement deficits over an extended period of time.

 

Conclusion

This is promising research that demonstrates how a new spinal cord implant has been able to restore movement in paralysed rats.

The e-dura implant is a breakthrough in that it overcomes a lot of the problems presented by previous rigid and inflexible implants. Instead, it is made of a flexible material that is able to integrate with spinal cord tissue.

The study demonstrated long-term functionality in rats and few side effects over the six-week testing period.

Rats given a serious spinal cord injury, who were consequently permanently paralysed, were able to walk again after the implant was surgically placed in their spinal cord. The implant works by delivering both electrical and chemical signals.

However, this research is still in the very early stages. While the findings are promising, there is a long way to go before we know whether these implants can be developed to successfully help humans with spinal injuries.

If the implants were developed for human testing, they would need to go through several stages of safety and effectiveness testing to see whether they worked at restoring movement in paralysed people.

It also needs to be seen how they would function in the much longer term, beyond just a few weeks.

Loss of movement is only one of the ways a person can be affected by permanent paralysis of both legs.

We do not know whether this implant would have any effect on loss of bladder, bowel or sexual function, for example.

These effects can have as much of a detrimental effect on quality of life as loss of physical movement.

But, overall, this is promising early-stage research and future developments are awaited with anticipation.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Elastic implant 'restores movement' in paralysed rats. BBC News, January 9 2015

'Cyborg' spinal implant could help paralysed walk again. The Daily Telegraph, January 8 2015

The tiny ribbon that could help the paralysed walk again: 'Cyborg' implant can delivers electric shocks and drugs directly to the spine and even read brain activity. Mail Online, January 9 2015

Links To Science

Minev IR, Musienko P, Hirsch A, et al. Electronic dura mater for long-term multimodal neural interfaces. Science. Published online January 9 2015

Categories: NHS Choices

How 'baby talk' may give infants a cognitive boost

NHS Choices - Behind the Headlines - Fri, 09/01/2015 - 10:30

"Say 'mama'! Talking to babies boosts their ability to make friends and learn,” the Mail Online reports. In a review, two American psychologists argue that even very young infants respond to speech and that "baby talk" is essential for their development.

It is important to stress that a review of this sort is not the same as fresh evidence.

The review must largely be considered to be the authors’ opinion based on the studies they have looked at. The methods and quality of these underlying studies informing this review are also unknown, so we cannot say how solid this evidence is.

That said, the authors’ arguments would chime with most parents’ instinctive beliefs: regularly talking to your baby is a “good thing”. Regularly talking to your baby is likely to have many benefits, not least in helping their understanding of speech and strengthening the bond between parent and baby.

However, whether talking to your baby has greater effects on their learning capacity or ability to make friends in the future is something that cannot be proven by this review.

 

Where did the story come from?

The study was written by two psychologists from New York University and Northwestern University in the US. The work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health, and the National Science Foundation. It was published in the peer-reviewed scientific journal Cell.

The Mail Online reports the review accurately, but doesn’t recognise the important limitations of this review in relation to its absent methods, which means it must largely be considered to be the authors’ opinions.

 

What kind of research was this?

This was a narrative review discussing a selection of evidence about the effects of exposure to human speech during the first year of a baby’s life. They discuss how this affects not only their speech and language development, but potentially their cognitive ability and social capacity as well.

The authors provide no methods for their review. This does not appear to be a systematic review, where the authors have systematically searched the global literature to identify all evidence related to this topic. It is not known how the authors selected the studies they chose to discuss, and whether other relevant evidence was left out. Therefore, this review must largely be considered to be the opinion of the authors.

While we find the possibility highly unlikely, this sort of unsystematic review may have been subject to what is known as “cherry-picking” – where evidence that does not support the authors’ arguments is deliberately ignored.

 

What do the authors discuss?

The researchers say it has been thought that listening to speech is mainly beneficial for infants in helping them to develop language. However, they say that new evidence suggests that benefits lie beyond just language acquisition. 

They say that from the first months of life, listening to speech promotes the acquisition of fundamental psychological processes, including:

  • pattern learning – the ability to recognise both visual and verbal patterns, such as “ma-ma-ma”
  • the formation of object categories – the ability to place external objects into categories, such as being able to tell the difference between a white van and a white sheep
  • identifying people to communicate with
  • acquiring knowledge about social interactions
  • development of social cognition – the ability to interpret, recognise and respond appropriately to other peoples’ feelings and emotions

They also discuss the idea that as babies grow, they specifically favour human speech over other vocalisations, such as laughing or sneezing. They discuss the different nerve cell responses to human speech compared with other sounds, and how speech particularly activates certain areas of the brain. The researchers then go on to discuss the more intricate patterns of how babies learn the rules and patterns of speech as they grow, such as understanding repetitive sequences of different syllables.

The authors present findings of some experiments that aim to see how speech helps babies to learn object categorisation. Babies aged three to 12 months viewed different objects (such as animals) accompanied by listening to either speech or sounds/tones. This found that those listening to speech were better able to categorise similar objects than those who had heard only tones accompanying the objects.

The discussion then turned to how speech may enable babies to identify “potential communicative partners”. That is, they develop the knowledge to treat people and objects differently (for example smiling and making sounds at people). Babies also develop an understanding of how speech conveys information and intentions, even if they cannot understand what is being conveyed. 

 

What do the authors conclude?

The authors conclude: “Before infants begin talking, they are listening to speech. We have proposed that even before infants can understand the meaning of the speech that surrounds them, listening to speech transforms infants’ acquisition of core cognitive capacities […]. What begins as a natural preference for listening to speech actually provides infants with a powerful natural mechanism for learning rapidly about the objects, events and people that populate their world”.

They say that further research is needed into the range of cognitive and social processes that are and are not facilitated by speech, and the mechanisms underlying this.

 

Conclusion

This is an interesting narrative review that challenges the belief that speaking to babies is only beneficial in terms of their own speech and language acquisition. The discussion presents what they describe as new evidence, suggesting that the benefits may extend far beyond this. They argue that speaking to babies may have benefits in terms of developing their cognitive abilities, such as the tests where accompanying speech helped babies better categorise objects. The review suggested that it may enhance their social capacity, such as recognising people to talk to and understanding the nature of speech and how it conveys thoughts and intentions.

Much of this discussion is plausible, but the limitations of this review must be noted. The authors provide no methods on how they have searched for, reviewed and selected the evidence they discuss. We don’t know whether all evidence relevant to the topic has been considered, or whether a biased account has been given. Therefore, this review must largely be considered to be the authors’ opinions based on the studies that they have looked at. The methods and quality of these underlying studies informing this review are also unknown, so we cannot say how solid the evidence is.

It makes sense that regularly talking to your baby is beneficial, not least by helping their understanding of speech and strengthening the bond between the two of you.

There is also evidence that babies born into “speech-poor” environments, where they do not receive regular exposure to spoken language, may have delayed development.

However, whether talking to your baby will turn them into a new Mozart or Einstein, or make them super-popular in later life, cannot be proven by this review.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Say 'mama'! Talking to babies boosts their ability to make friends and learn, psychologists claim. Mail Online, January 8 2015

Links To Science

Vouloumanos A, Waxman SR. Listen up! Speech is for thinking during infancy. Trends in Cognitive Sciences. Published online November 7 2014

Categories: NHS Choices

Can eating like a Viking 'reduce obesity risks'?

NHS Choices - Behind the Headlines - Thu, 08/01/2015 - 12:15

"A Nordic diet could reduce the dangers of being overweight, a study suggests," The Daily Telegraph reports. The headline comes from the results of a small randomised controlled trial.

Half the people in the trial were put on the Nordic diet, which consists of wholegrain products, vegetables, root vegetables, berries, fruit, low-fat dairy products, rapeseed oil, and three servings of fish a week.

The other half acted as a control group and ate a diet of low-fibre grain products, butter-based spreads, and a limited intake of fish.

Researchers found people on the Nordic diet developed reduced activity (expression) in 128 genes associated with inflammation of their abdominal fat compared with controls.

Inflammation may cause some of the adverse health effects associated with being overweight, such as insulin resistance, which is a risk factor for type 2 diabetes.

However, changes in gene expression are not the same as proven changes in clinical outcomes. The study did not find any correlation between these changes in gene expression and clinical measurements of risk factors, such as blood pressure or cholesterol. 

Nevertheless, it is plausible that the Nordic diet has a protective effect – it is relatively similar to the Mediterranean diet (with a bit more herring and a bit less pasta), which has been associated with a reduced risk of chronic diseases.

 

Where did the story come from?

The study was carried out by researchers from a number of academic institutions in Finland, Norway, Sweden, Iceland and Denmark.

Funding came from several sources in these countries, including research foundations and academic institutes. Several commercial companies provided food products for the study participants.

The study was published in the peer-reviewed American Journal of Clinical Nutrition.

The Daily Telegraph and the Mail Online's coverage was accurate, but both overstated the results of the study, failing to point out that research into gene activity alone is not enough to show the health benefits of a diet.

 

What kind of research was this?

This was a randomised controlled trial, which is the best way to determine the effects of an intervention.

The trial was designed to look at whether a Nordic diet had an effect on the activity of genes in abdominal fat just beneath the skin (adipose tissue) in obese people.

It also aimed to see whether any changes in gene expression were associated with clinical and biochemical effects.

In previous research, "dysfunctional adipose tissue" had been proposed as an important link between obesity and its adverse health effects, such as insulin resistance and an unhealthy balance of blood fats.

However, little is known about how diet influences adipose tissue inflammation at the molecular level.

 

What did the research involve?

Researchers recruited 200 adults to the trial, although only 166 completed it. Participants had to be between the ages of 30 and 65, with a body mass index (BMI) of 27 to 38. A BMI of 25 or above is considered overweight, while a BMI of 30 or above is considered obese.

Participants also had to have at least two other features of metabolic syndrome, a condition characterised by symptoms such as high blood pressure, high blood sugar and abnormal blood fat levels, and is often associated with diabetes.

For a period of 18 to 24 weeks, 104 people were put on the Nordic diet, comprising wholegrain products, berries, fruits and vegetables, rapeseed oil, three fish meals a week, and low-fat dairy products. They also avoided sugar-sweetened products.

96 people were put on the control diet, comprising low-fibre cereal products and dairy fat-based spreads, with a limited amount of fish.

A clinical nutritionist or a dietitian gave instructions about the diets. The participants' dietary intake was monitored throughout using regular food records.

To reduce any confounding factors, the study participants were advised to keep their body weight and physical activity unchanged, and to continue their current smoking habits, alcohol consumption and drug treatment during the study.

Researchers took biopsy samples of the participants' adipose tissue at the beginning and end of the study, and extracted RNA, which is used to carry out DNA's genetic instructions.

A test called a transcription analysis was performed to study the expression of genes in the tissue.

Researchers also took various other clinical and biochemical measurements, including levels of blood sugar, cholesterol and triglycerides.

 

What were the basic results?

56 participants were included in the final analysis – 31 from the Nordic diet group and 25 from the control group.

People were excluded if there was a change in their body weight of more than 4kg, and if they started to use statins, had a BMI over 38, or poor adipose tissue samples.

The researchers report differences between the two groups in the activity of 128 genes.

Many of these genes were associated with pathways relating to the immune response, with a slightly reduced activity among people in the Nordic diet group and increased activity among people in the control diet group.

There were no differences between the groups in terms of clinical or biochemical measurements.

 

How did the researchers interpret the results?

The researchers say their study indicates that the Nordic diet reduced the activity of genes associated with inflammation in adipose tissue when compared with the control diet group.

The quality of diet may be an important factor for regulating adipose tissue inflammation independent of weight change, they say.

 

Conclusion

This study found that the activity of certain genes, some of which are associated with inflammation, was different in obese people who ate a Nordic diet compared to those on a control diet.

Yet there was little correlation between these findings and any changes in measurements of risk factors such as participants' cholesterol or blood pressure. The authors concede that the clinical relevance of their findings is unclear.

As the authors say, one limitation is that volunteers in the study may have had healthy eating habits before the study began.

If these volunteers had been randomised to the control diet group, they may have modified their diet to become more unhealthy, and therefore changes in gene expression would seem to be more evident in this group.

Being overweight or obese increases the risk of chronic illness such as diabetes, heart disease and some cancers, so it's important to maintain a healthy weight.

The Nordic diet is being touted as one of the latest trends in healthy eating. Whether it is a proven method to prevent chronic diseases is uncertain, but it does appear to be based on sensible nutritional principles, such as eating lots of wholegrains, fruit and vegetables, while cutting down on saturated fats.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

High blood pressure? Eat like a Viking. The Daily Telegraph, January 7 2015

High blood pressure? Go Nordic: Eating like a Viking can reduce the damaging effects of being overweight - and stave off diabetes. Mail Online, January 7 2015

Links To Science

Kolehmainen M, Ulven SM, Paananen J, et al. Healthy Nordic diet downregulates the expression of genes involved in inflammation in subcutaneous adipose tissue in individuals with features of the metabolic syndrome. The American Journal of Clinical Nutrition. Published online November 19 2014

Categories: NHS Choices

New 'game-changing' antibiotic discovered

NHS Choices - Behind the Headlines - Thu, 08/01/2015 - 11:30

“New class of antibiotic could turn the tables,” on antibiotic resistance, The Guardian reports and is just one of many headlines proclaiming the discovery of a “super-antibiotic”. For once, such enthusiastic headlines might be largely justified.

The study in the spotlight shows the discovery of a new antibiotic, teixobactin, and is exciting for two main reasons.

Firstly, teixobactin proved effective against certain types of drug-resistant bacteria such as MRSA and tuberculosis (TB) in mice models. The way it works, by attacking cell walls rather than proteins, also suggested that bacteria would have a hard time evolving around its effects to develop resistance. This is the first potentially new antibiotic in over 20 years.

Secondly, the mechanism of discovery is potentially revolutionary. The research team used a device known as an iChip to make bacteria in soil “lab-ready” for use. Previously, only 1% of the organisms in soil could be grown and studied in the laboratory. This leaves 99% of bacteria as an untapped source of new antibiotics useful to people. Unlocking this natural reservoir of antibiotic production could potentially lead to the discovery of many more antibiotics in the future.

We now need to wait for tests on humans to make sure that teixobactin works and is safe. Also, teixobactin only appears to be effective against a subset of bacteria (Gram-positive bacteria), so is not a cure-all for Gram-negative bacterial infections, which include E.coli.

This is genuinely exciting news, but only time will tell whether this is a historical moment of similar magnitude to that of Alexander Fleming’s original discovery of penicillin in 1928.

 

Where did the story come from?

The study was carried out by researchers from the US, Germany and the UK, and was funded by the US National Institutes of Health, the Charles A King Trust, German Research Foundation and the German Centre for Infection Research.

Many of the authors declare financial conflicts of interest, as they are employees and consultants of NovoBiotic Pharmaceuticals, a biotech firm with an interest in creating new drugs.

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

The study attracted widespread attention from both the UK and international media. Generally, the media reported the story accurately, with many highlighting that while the study was promising, no human tests had yet taken place.

 

What kind of research was this?

This was a laboratory and mice study looking for new antibiotics.

Antibiotics – chemicals that kill bacteria – were first found in the early 20th century. This led to an explosion of antibiotic discovery that revolutionised medicine, and provided cures for previously incurable diseases. It also led to a marked decrease in complications arising from infection during surgical procedures we now regard as routine and safe, such as caesarean sections.

However, there have been no new antibiotic discoveries for decades. Existing antibiotics are becoming less effective because some bacteria are not killed by them and these bacteria can spread over time; these are so-called "drug-resistant bacteria".

Most people are aware of the "superbugs", such as MRSA and C-difficile, which are a leading cause of hospital-based infections. There are other candidates out there, such as extensively drug-resistant TB, which can take up to two years to treat. Therefore, the problem of drug-resistant bacteria is serious and growing, and could pose one of the greatest threats to public health in the 21st century.

This research sought to identify new bacteria from soil, which is heaving with micro-organisms harbouring naturally occurring antibiotics. Amazingly, the researchers tells us, only 1% of the organisms in soil can be grown and studied in the laboratory. This means the remaining 99% are potentially an untapped source of new antibiotics.

The team sought to devise a new way of growing and studying some of the soil micro-organisms, to screen them for any that display antibiotic properties and could be turned into new drugs.

 

What did the research involve?

The team designed and tested a number of methods to grow (culture) previously un-growable (unculturable) micro-organisms from soil.

This including making a device (iChip) that could be immersed in soil to “trick” the organisms into growing, but still allowed the team to isolate the micro-organisms for further study. This was used alongside a range of chemical growth factors to encourage and maintain growth.

When successful, they screened the newly cultured organisms for any signs that they were producing antibiotics. A number of new chemicals that looked promising were found and then tested in mice, including mice infected with methicillin-resistant Staphylococcus aureus (MRSA).

 

What were the basic results?

The results revealed a number of striking new discoveries:

  • Researchers could successfully grow a range of new organisms from the soil, which had never been done before.
  • Some of these newly grown organisms naturally produced antibiotics.
  • One such antibiotic, named teixobactin, was particularly promising and was subsequently studied intensely in the laboratory and in mice.
  • Tests in mice revealed teixobactin was effective against Gram-positive bacteria including MRSA and the bacteria that cause TB. However, it was not effective against Gram-negative bacteria such as E.coli, which have an extra layer of cell wall protection.
  • Teixobactin inhibited cell wall synthesis via a mechanism that bacteria are unlikely to develop resistance to, as it is so fundamental to their normal survival.
  • Backing this up, when teixobactin was used against bacteria Staphylococcus aureus or Mycobacterium tuberculosis no drug-resistant bacteria were found or developed. This is unusual, as most tests reveal some naturally occurring resistance over time.

 

How did the researchers interpret the results?

The research team simply concluded that: “The properties of this compound [teixobactin] suggest a path towards developing antibiotics that are likely to avoid development of resistance.”

 

Conclusion

This study shows the discovery mechanism of teixobactin and is exciting for two reasons. Teixobactin by itself shows effectiveness against MRSA and TB in mice models and has properties indicating that drug resistance may be unlikely to develop. This is encouraging for the potential future development of it for human diseases caused by Gram-positive bacteria.

Also, the mechanism of discovery shows great promise. The research team devised a completely new way of growing micro-organisms from soil that could not previously be grown. These micro-organisms, 99% of which are unknown to science, have the potential to produce natural antibiotics. Therefore, this discovery opens up the possibility that many more antibiotics can be found in the future. This is encouraging as there has been a lack of new antibiotic discoveries since the 1980s, while at the same time, the problem of drug-resistant bacteria has been growing.

While this discovery is undoubtedly good news, there are a number of moderating factors to bear in mind:

  • We don’t know what proportion of the 99% of currently ungrowable bacteria this new method will help to unleash, and what proportion of them might yield useful antibiotics.
  • Teixobactin has so far only been trialled in the lab and in mice. We need to await tests in humans before we can be sure it works and is safe.
  • Teixobactin looks effective against a subset of bacteria only (Gram-positive bacteria) so is not a cure-all for bacterial diseases.

With these limitations in mind, for once a study matches up to the media hype, as it discovered a promising new antibiotic candidate (teixobactin) and shows us a method that has the potential to lead to many more.

It is early days, but we could potentially be heading into a future where antibiotic-resistance is a thing of the past.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

New class of antibiotic could turn the tables in battle against superbugs. The Guardian, January 8 2015

Antibiotics: US discovery labelled 'game-changer' for medicine. BBC News, January 7 2015

Teixobactin discovery: Scientists create first new antibiotic in 30 years - and say it could be the key to beating superbug resistance. The Independent, January 8 2015

First new antibiotic in 30 years discovered in major breakthrough. The Daily Telegraph, January 8 2015

Is this the answer to doctors' prayers? Super-antibiotic that could wipe out diseases from MRSA to TB is hailed as a 'game-changer' by scientists. Mail Online, January 8 2015

Scientists may have found first new antibiotic in 25 years. The Times, January 8 2015

New antibiotic could work for 30 years – if used right. New Scientist, January 7 2015

Links To Science

Ling LL, Schneider T, People AJ, et al. A new antibiotic kills pathogens without detectable resistance. Nature. Published online January 7 2015

Categories: NHS Choices

Could meal-in-a-pill 'trick' body into losing weight?

NHS Choices - Behind the Headlines - Wed, 07/01/2015 - 12:00

“Weight loss drug fools body into reacting as if it has just eaten,” The Guardian reports. The drug, fexaramine (or Fex), stimulates a protein involved in metabolism that is usually activated when the body begins eating, though it has only been tested in mice.

Researchers found that obese mice given Fex stayed the same weight despite continuing to eat the same amount of a high-fat diet. However, unlike some media claims, they did not actually lose any weight. It had no effect on mice of normal weight.

The protein that is stimulated, FXR (farnesoid X receptor), is present in many organs of the body and plays a complex role in metabolism that is not fully understood. 

Previous drugs developed to activate this protein have shown conflicting results, possibly because they entered the bloodstream and so acted on all of the organs. Fex has been developed so that it appears to be barely absorbed into the blood stream, and so only acts on the FXR in the intestines. This provided better results for obese mice and also reduces the risk of side effects.

Further animal and primate studies will need to be conducted before the drug would be allowed to progress to human trials, but these are promising results. However, even if these trials passed with flying colours, we would estimate that it would take at least 5-10 years before any drug based on this research came to market.

 

Where did the story come from?

The study was carried out by researchers from the Salk Institute for Biological Studies in California and several other institutes in the US, Australia and Switzerland. It was funded by the US National Institutes of Health, the Glen Foundation for Medical Research, the Leona M. and Harry B. Helmsley Charitable Trust, Ipsen/Biomeasure, the California Institute for Regenerative Medicine, the Ellison Medical Foundation, the National Health and Medical Research Council of Australia, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

A financial conflict of interest was reported. Many of the contributing authors “are co-inventors of FXR molecules and methods of use, and may be entitled to royalties from their use”.

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

In general, the media have reported the story accurately, pointing out that it is in the early stages of development and that it has only been tested on mice. However, as mentioned, headlines such as the Daily Mirror’s “'Imaginary meal' diet pill tricks body into losing weight”, or The Daily Telegraph’s assertion that the “pill makes you feel full” are inaccurate. None of the mice lost weight and none of their appetites were suppressed.

 

What kind of research was this?

This was an animal study to test whether a new drug could improve the metabolism of mice. The researchers conducted a variety of experiments of the drug, comparing their response with mice receiving a placebo.

The drug was created to mimic an effect of eating food. Food causes bile acids to be secreted and this activates a protein called FXR (farnesoid X receptor).

FXR plays a complex role in metabolism that is not fully understood. It is present in many organs of the body, including the kidney, stomach, intestines, gall bladder, liver and both white and brown fat cells.

Previously, drugs have been developed to activate FXR, but they have encountered problems because of activating FXR in all of the organs. This gave conflicting outcomes. For example, mice of normal weight given these drugs had improved glucose tolerance, whereas obese mice put on more weight and had even poorer glucose tolerance. It was not clear why this happened, so the researchers wanted to investigate whether just activating FXR in the intestines improved metabolism.

They developed Fex to activate the intestinal FXR drug instead of food, without it being absorbed into the general circulation, to see if this made a difference. They also say that limiting absorption means there would be less potential for side effects.

 

What did the research involve?

The researchers developed a drug called Fex and performed a number of tests using mice.

They first tested the absorption of Fex into the general circulation. They gave mice either a Fex pill by mouth or an injection of Fex into the fluid that surrounds the abdominal organs. The researchers then measured the level of FXR activation in each organ.

The researchers then gave normal weight mice either a Fex pill or a placebo for 35 days. They then compared their weight, metabolic rate and sensitivity to insulin.

Lastly, mice were fed a high-fat diet (60% fat) for 14 weeks to make them obese. The researchers then gave them different doses of the Fex pill or a placebo for five weeks. They compared their weight, metabolic rate, extent of unhealthy white fat and healthy brown fat, and markers of tissue inflammation.

 

What were the basic results?

The oral Fex pill activated FXR in the intestine and did not activate it in the liver or kidneys. The researchers say this shows that it was only minimally absorbed into the general circulation. This was in comparison to the injection of Fex into the abdominal cavity, which stimulated FXR in the intestine as well as the liver and kidneys.

There was no difference between normal weight mice given oral Fex for five weeks in terms of weight gain (small amount) and other metabolic measurements, compared to normal weight mice given placebo.

In obese mice, the Fex pill caused an improvement in metabolism compared to placebo, including:

  • reduced weight gain
  • increased sensitivity to insulin
  • more unhealthy white fat turning into healthy brown fat
  • reduced inflammation

These obese mice were 34 grams at the start of the experiment (normal weight mice would be around 28 grams). They continued on the high-fat diet (60% fat) for five weeks. Those given placebo increased in weight to 44 grams, but those given the highest dose of Fex did not gain any more weight. None of these mice lost weight. The researchers report that there was no change in appetite or food consumption between the mice given Fex and those given placebo.

 

How did the researchers interpret the results?

The researchers concluded that Fex might be a “promising” approach to stimulating FXR, in order to improve metabolism. The say that the “absence of a change in food intake is notable, as failure of appetite control is a major reason for weight gain”. They say that, as this drug appears to improve metabolism without any change in food intake, it “may offer a viable alternative for obesity treatments”. They also point out that as Fex is only minimally absorbed and only stimulates the intestinal FXR, it offers “improved safety profiles” by not circulating around the whole of the body.

 

Conclusion

This animal study has shown that a new drug called Fex prevents obese mice from further weight gain, despite remaining on a high-fat diet. There were also other metabolic improvements, including improved sensitivity to insulin and a reduction of unhealthy white fat cells. There were no differences in measures of metabolism between mice of normal weight given Fex or placebo, although both groups gained a small amount of weight.

This preliminary study appears to show that, unlike previous drugs that have stimulated FXR from the general circulation and shown conflicting results, by targeting intestinal FXR, obese mice benefit. As it has only been tested in mice for five weeks, there is limited information on what these side effects might be in humans.

Further animal and primate studies will need to be conducted before the drug would progress to human trials, but these are promising results.

As the drug appears to improve metabolic function rather than promote weight loss, it could be a candidate to treat diseases of the metabolism, such as type 2 diabetes or metabolic syndrome (where a person has a combination of diabetes, high blood pressure and obesity).

Due to the length of time it takes to bring a drug to market, as well as the chance of a drug proving to be ineffective or unsafe in humans, we can’t envisage Fex (or a variant) appearing in your local pharmacy anytime soon.

In the meantime, tips to help you lose weight can be found here and you can get online support here.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Weight loss drug fools body into reacting as if it has just eaten. The Guardian, January 5 2015

Could an 'imaginary meal' pill solve the obesity crisis? Drug tricks the body into feeling full - AND lowers cholesterol and blood sugar. Mail Online, January 5 2015

Diet pill that makes you feel full proven to keep weight off in mice, scientists say. The Independent, January 5 2015

'Imaginary meal' diet pill tricks body into losing weight. Daily Mirror, January 5 2015

'Imaginary meal' pill makes you feel full and burns fat. The Daily Telegraph, January 5 2015

An 'imaginary meal' pill to lose weight? Scientists reveal latest weapon to battle obesity. Daily Express, January 5 2015

Links To Science

Fang S, Suh JM, Reilly SM, et al. Intestinal FXR agonism promotes adipose tissue browning and reduces obesity and insulin resistance. Nature Medicine. Published online January 5 2015

Categories: NHS Choices

Out-of-character criminal actions linked to dementia

NHS Choices - Behind the Headlines - Wed, 07/01/2015 - 11:00

“Could criminal behaviour be the first sign of dementia?” the Mail Online asks. A US study found an association between sudden, unusual criminal behaviour, such as shoplifting or urinating in public, and various types of dementia.

The study looked at crimes committed by patients suffering from a number of diseases that damage the brain and cause dementia. It found more than 8% of patients had a history of criminal behaviour that first emerged during their illness.

Patients with Alzheimer’s disease, a common form of dementia – were the least likely to commit crimes, while those with a type of uncommon dementia called frontotemporal dementia (FTD) were the most likely to commit crimes including theft, traffic violations, sexual advances and urinating in public. This has long been recognised as an effect of the disorder, as it typically causes a change in personality and can lead to disinhibition.

This study suggests – but cannot prove – that, in older adults, new criminal behaviour could be a sign of brain damage caused by a dementing disorder.

If you are worried about a relative’s behaviour or changes in personality, it is sensible to seek medical advice.

 

Where did the story come from?

The study was carried out by researchers from Lund University in Sweden, the University of California, and the University of Notre Dame in Australia.

It was funded by the Hennerlöfska Foundation for Medical Research, The Swedish Society of Medicine and the Trolle-Wachtmeister Foundation for Medical Research in Sweden, and the National Institutes of Health (NIH), the Consortium for Frontotemporal Dementia Research, the Tau Consortium and the Hillblom Aging Network in the US.

The study was published in the peer-reviewed medical journal JAMA Neurology.

The Mail’s coverage was accurate but uncritical. Its photos of someone handcuffed and an angry-looking older person were unnecessary.

 

What kind of research was this?

This was a retrospective study of patients seen at a memory and ageing centre in the US. It was designed to look at the frequency and type of criminal behaviour that occurred among those diagnosed with a dementing disorder.

Such neurodegenerative diseases can cause brain dysfunction in areas such as judgement, executive function, emotional processing, sexual behaviour, violence and self-awareness, and this can result in antisocial and criminal behaviour.

The crimes committed by people with dementia range from theft, traffic violations and violence to hypersexuality and homicide (but the latter is thought to be rare). The researchers wanted to quantify how often this happens and the extent to which this was the event that led the person to being diagnosed with a form of dementia.

 

What did the research involve?

Researchers reviewed the medical records of 2,397 patients seen at a US memory and ageing centre between 1999 and 2012. These patients had been diagnosed with a variety of neurodegenerative disorders that can cause dementia.

The researchers screened the patients’ medical notes for specific key words to identify criminal behaviour. Keywords were chosen to represent all the criminal behaviours that have been observed in people with dementia. These included court, arrest, criminal, detain, steal, speeding, violation and violence.

The types of criminal behaviour were then stratified according to the following categories:

  • driving under the influence (aka drink driving)
  • hit and run
  • traffic violations
  • speeding
  • insubordination towards legal authorities
  • sexual advances
  • loitering
  • public urination
  • theft
  • trespassing
  • violence (including physical and verbal threats)

Only criminal behaviours that occurred during the patient’s illness were included. The criminal behaviour was considered to be the presenting symptom if the doctor specifically indicated this in the medical record.

Researchers then calculated the frequency of criminal behaviour for the following categories of dementia or dementia-like conditions:

  • Alzheimer’s disease
  • frontotemporal dementia
  • semantic variant of primary progressive aphasia – a type of dementia that effects language and communication, such as speaking, reading and understanding
  • Huntington’s disease – a genetic condition that can cause dementia-like symptoms
  • vascular dementia – dementia caused by reduced blood flow to the brain

 

What were the basic results?

Of the 2,397 patients studied, 204 (8.5%) had a history of criminal behaviour that emerged during their illness.

Of the major diagnostic groups, the following proportions exhibited criminal behaviour:

  • 42 of 545 people (7.7%) with Alzheimer’s disease
  • 64 of 171 people (37.4%) with FTD
  • 24 of 89 people (27.0%) with the semantic variant of primary progressive aphasia
  • six of 30 people (20%) with Huntington’s disease 
  • nine of 61 people (14.8%) with vascular dementia

Criminal behaviour was one of the symptoms that caused 14% of people to be diagnosed with FTD, compared with 2% of patients with Alzheimer’s disease. Of those diagnosed with FTD, 6.4% were more likely to have exhibited violence in this criminal behaviour compared with 2% of people with Alzheimer’s.

Common types of criminal behaviour in the FTD group included theft, traffic violations, sexual advances, trespassing and public urination. In the Alzheimer’s group, the most common crime was traffic violations, often related to memory loss.

 

How did the researchers interpret the results?

The researchers point out that new criminal behaviours are associated with specific dementing disorders such as FTD, but not with others.

"The findings from this study suggest that individuals who care for middle-aged and elderly patients need to be vigilant in the diagnosis of degenerative conditions when behaviour begins to deviate from the patient's norm, and work hard to protect these individuals when they end up in legal settings," they concluded.

 

Conclusion

This study looks at an important issue, but it had several limitations that make the results less reliable:

  • It used data on criminal behaviour taken from patients’ medical notes rather than relying on official criminal records.
  • Patients referred to the centre may have had more behavioural problems than those with dementia in the general population.
  • The study cannot show the criminal behaviour was caused by dementia.
  • The study had no control group, so cannot compare crime rates among healthy adults with those with dementia.

Dementia can lead to changes in behaviour and, in some people, loss of inhibition and aggression.

However, it’s important that people with dementia are not labelled as potential criminals and it should be noted that most are more of a danger to themselves then others.

If you are worried about a relative’s behaviour or changes in personality, it is sensible to seek medical advice.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Could criminal behaviour be the first sign of DEMENTIA? Offending for the first time in old age may be due to brain damage. Mail Online, December 6 2015

Links To Science

Lijegren M, Naasan G, Temlett J, et al. Criminal Behavior in Frontotemporal Dementia and Alzheimer Disease. JAMA Neurology. Published online January 5 2015

Categories: NHS Choices

Wholegrains, not just porridge, may increase life

NHS Choices - Behind the Headlines - Tue, 06/01/2015 - 09:54

"The key to a long and healthy life? A bowl of porridge every day," is the somewhat inaccurate headline in the Daily Mail.

The study it reports on was looking at the health benefits of wholegrains in general, not just porridge.

These headlines are based on a study of more than 110,000 men and women in the US, who were followed up from the 1980s to 2010.

Their diets were assessed every two to four years, and the researchers looked at whether the quantity of wholegrains people ate was related to their likelihood of dying during follow-up.

Fans of wholegrains, which include brown rice and oats, claim they can improve digestion, reduce cholesterol levels and make people feel fuller so they are less likely to snack.

The researchers found people who ate the most wholegrains were about 9% less likely to die during follow-up, and about 15% less likely to die from heart disease specifically, compared with people who ate the least.

We know that people who eat wholegrains also tend to have healthier lifestyles, so researchers tried to take this into account. But, as the authors acknowledge, it is impossible to be certain that other factors aren't contributing.

With that limitation in mind, this is a good-quality study, which supports the benefits of eating more wholegrain foods.

 

Where did the story come from?

This research was carried out by researchers at the Harvard School of Public Health and other research centres in the US and Singapore.

It was funded by the US National Institutes of Health and the National Heart, Lung, and Blood Institute.

It was published in the peer-reviewed Journal of the American Medical Association (JAMA) Internal Medicine. 

While the general content of the stories that appeared in the Daily Mail and The Daily Telegraph was accurate, the headline writers developed a strange obsession with porridge.

While porridge can be a good source of wholegrains, the foodstuff was never actually mentioned in the study. All dietary sources of wholegrains were added together for the analyses, so the study did not show whether one source was better than another.

 

What kind of research was this?

This was an analysis of data from two prospective cohort studies looking at whether eating more wholegrains is associated with living longer.

The researchers note wholegrains have been found to be associated with a reduced risk of diseases such as type 2 diabetes and heart disease.

But while some studies have suggested they are associated with living longer, others have not. The researchers wanted to use a large, good-quality study to assess this question.

This type of study is the best way to assess this question, as it would not be feasible to do a randomised controlled trial where people's diets were controlled over a long period of time.

Collecting data prospectively gives the best chance of getting complete and correct information about people's exposures (such as what they ate) and their outcomes during follow-up (such as whether they died).

As with all studies of this type, people who eat more wholegrains may also have other healthier behaviours or characteristics, such as taking regular exercise, which could affect their risk of death during follow-up.

To try to remove the effect of these other factors (called confounders), researchers need to measure them and take them into account in their analyses.

 

What did the researchers do?

The researchers collected detailed information on the diets and other characteristics of 118,085 adults. They followed them for up to 26 years to find out who died.

They then looked at whether people who ate more wholegrains were less likely to die in this period than those who ate fewer wholegrains.

The researchers analysed data collected in two US studies called the Nurses' Health Study (all-female participants) and the Health Professionals Follow-Up Study (all-male participants) between the 1980s and 2010.

They only included people who did not have heart disease or cancer at the start of the study, and those who had completed full questionnaires on their diets.

The studies collected information on participants' diets using accepted food frequency questionnaires every two to four years.

These questionnaires asked about how often the individual had eaten specified portions of a wide range of foods in the past year.

The researchers used the information collected to estimate each person's wholegrain intake from grain-containing foods such as pasta, rice, bread and breakfast cereal.

The following foods were considered wholegrains:

  • whole wheat and whole wheat flour
  • whole oats and whole oat flour
  • whole cornmeal and whole corn flour
  • whole rye and whole rye flour
  • whole barley
  • bulgur wheat
  • buckwheat
  • brown rice and brown rice flour
  • popcorn
  • amaranth and psyllium (two other types of grains)

This included wholegrains that were intact (such as brown rice) and those where the grain had been broken down, but the food still retained all of the contents of the wholegrain (such as whole wheat flour). The questionnaire also asked how much added bran or wheat germ a person ate.

The researchers identified people who had died through the US National Death Index, the postal service, or through relatives of the participants. They used death certificates to identify the cause of death in each case.

The researchers then analysed whether those people who ate more wholegrains on average were less likely to die during follow-up.

This involved dividing people into five groups according to how many wholegrains they ate, and then comparing the proportion of people who died in each group.

In their analyses, they took into account a wide range of factors that could influence results, such as:

  • total calorie intake
  • age
  • gender
  • ethnicity
  • smoking
  • alcohol
  • body mass index (BMI)
  • physical activity
  • taking multivitamins
  • taking aspirin
  • family history of heart disease, cancer or diabetes
  • medical conditions such as high blood pressure, diabetes or high cholesterol
  • overall healthiness of the diet (using a score based on intake of 10 foods and nutrients linked with a higher or lower risk of chronic diseases, such as red or processed meat and fruit and vegetables)

They also discounted any dietary information collected after a person developed diabetes or heart disease, or had a stroke, as this led to these people changing their diets as a result. They looked at total deaths overall, as well as deaths specifically from heart disease and cancer.

 

What were the results of the study?

Women with the lowest intake of wholegrains ate about four grams of wholegrains per day on average, and this figure was about six grams per day for men.

Women with the highest intake of wholegrains ate about 36 grams per day on average, and this figure was about 53 grams per day for men.

Men and women with higher wholegrain intake also tended to be more physically active, less likely to be current smokers, have lower alcohol intake, and eat healthier diets overall. They were also more likely to have had a high cholesterol level at the beginning of the study.

On average, participants were in their 50s when the study started. In total, the researchers collected more than 2.7 million years of follow-up (the sum of the number of years each person was followed up for). During this time, 26,920 of 118,085 participants (about a quarter) died.

After taking into account potential confounders, the researchers found a significant trend for reduced risk of death during follow-up with increasing wholegrain consumption.

People who had the highest wholegrain consumption were 9% less likely to die during follow-up than those with the lowest wholegrain consumption (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.88 to 0.95).

When looking at death from specific causes, people who had the highest wholegrain consumption were 15% less likely to die from heart disease during follow-up than those with the lowest consumption (HR 0.85, 95% [CI] 0.78 to 0.92). Wholegrain consumption was not linked to risk of death from cancer.

The researchers estimated each additional 28 gram serving of wholegrains per day was associated with a 5% reduction in overall risk of death during follow-up (HR 0.95, 95% CI 0.93 to 0.98) and a 9% reduction in the risk of death from heart disease (HR 0.91, 95% CI 0.87 to 0.96).

 

How did the researchers interpret the results?

The researchers concluded that eating more wholegrains is associated with a reduced risk of death during follow-up, and of death from heart disease specifically, in women and men in the US.

This link remained even after taking other lifestyle factors into account. They say their findings support recommendations to increase wholegrain intake to reduce the risk of chronic diseases.

 

Conclusion

This analysis of two large prospective cohort studies from the US has found an association between higher wholegrain intake and a reduced risk of death during follow-up, particularly from heart disease.

The study benefits from its large size (more than 100,000 participants) and long duration, as well as the thorough collection of information on the participants as the study progressed (prospective data collection).

Our diets and lifestyles are very complex, and it is very difficult to entirely isolate the effect of one dietary component and remove the effect of all other factors.

However, the researchers have assessed and taken into account a wide range of factors in their analyses that could affect the risk of death. This means the results are more likely to reflect the effect of wholegrain foods specifically, rather than other factors.

But the authors themselves acknowledge some factors may still be having an effect. In addition, the study relies on self-reported estimates of dietary intake from the participants, which may not be entirely accurate.

All of the participants in the study were health professionals from the US. The results may not be representative of what would be seen in other groups – for example, those of lower socioeconomic status.

Also, while the study found no reduction in deaths from cancer overall, it did not look at deaths from individual types of cancer, such as bowel cancer.

With these limitations in mind, the researchers have produced a large, useful and good-quality study. The findings reinforce the benefits of including more wholegrains in our diet.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

The key to a long and healthy life? A bowl of porridge every day, say scientists. Daily Mail, January 5 2015

Porridge could be key to a long and healthy life, says Harvard University. The Daily Telegraph, January 5 2015

Links To Science

Wu H, Flint AJ, Qi Q, et al. Association Between Dietary Whole Grain Intake and Risk of Mortality. JAMA Internal Medicine. Published online January 5 2015

Categories: NHS Choices

Why common cold may thrive at low temperatures

NHS Choices - Behind the Headlines - Tue, 06/01/2015 - 09:50

The “common cold 'prefers cold noses',” reports BBC News today, while The Independent recommends that you “heed your mother’s warning: cover up or you’ll catch a cold”.

While these headlines might make you think this study is proof of a link between colder temperatures outside and catching a cold, this isn’t quite what the researchers looked at.

Our nasal passages are naturally a few degrees colder than the core of our body. It has long been known that rhinovirus – the most common cause of the human cold – grows much better at these lower temperatures.

The current study has looked at why this might be. It found that mouse airway cells were less able to mount immune defences against the cold virus at the lower temperature seen in the human nose than at the higher temperature seen at the core of the body.

While this study may suggest a possible explanation for the known effect of temperature on cold viruses, it is very early stage research, testing just one strain of rhinovirus in mouse cells. The experiments will need to be repeated with different strains and ideally with human airway cells.

Also, while the authors speculate about whether this could explain beliefs around the impact of cold environmental temperatures on catching a cold, and wrapping up warm to prevent a cold, this study didn’t actually assess this.

 

Where did the story come from?

This study was carried out by researchers at Yale University. It was funded by the US National Institutes of Health, National Institute of Allergy and Infectious Diseases, and National Science Foundation.

It was published in the peer-reviewed journal Proceedings of the National Academy of Sciences of the United States of America (PNAS).

The media has focused on the potential impact of cold outdoor temperatures on our risk of catching a cold, when this is not what the study assessed. The common cold-causing rhinovirus was already known to grow better at the naturally cooler temperatures in the nose than at higher temperatures found in the centre of the body. This study looked at why this might be the case.

 

What kind of research was this?

This was a laboratory study looking at whether temperature affects how the cells in the airways are able to respond to the cold virus.

The insides of our noses are naturally a few degrees cooler than our core body temperature: 33C – 35C, compared to 37C. The cold virus is already known to be able to reproduce itself better in cells at these cooler temperatures. However, it is not known why this is. Researchers wanted to test whether it could be because the cells in the airways are less able to mount defences against the cold virus at cooler temperatures.

Laboratory research is often the first step to understanding what happens in our bodies. As cells in isolation in the lab may behave differently to when they are in the body, these early experiments usually need to be followed up by studies in animals or humans to confirm their findings.

 

What did the research involve?

The researchers took samples of the cells lining mouse airways and grew them in the lab at either 33C or 37C. They exposed these cells to the rhinovirus – the most common cause of the cold in humans. The virus was selected and grown in a way that allowed it to better infect the mouse cells. They then compared what responses the cells were having to the virus at the different temperatures. In particular, they looked at how well the cells were switching on the production of proteins to help them fight the virus.

 

What were the basic results?

The researchers found that the mouse airway cells were better at switching on the production of proteins to help them fight the cold virus at the warmer (core body) temperature than the cooler (nasal cavity) temperature. The researchers went on to identify some of the proteins involved in prompting this response. They found that if these proteins were not present, then the virus was better able to replicate itself in cells at the warmer temperature. 

 

How did the researchers interpret the results?

The researchers concluded that airway cells are less able to mount defences against the cold virus at the cooler temperatures of the nasal passages than in warmer temperatures at the core of the body. This at least partly explains why the cold virus is able to grow better in the cooler nasal passages than in the warmer lungs. They say that this could be a possible explanation for the “popular but controversial idea that exposure to cool weather conditions can increase susceptibility to common colds”.

 

Conclusion

This laboratory study looked into why the cold virus is able to grow better in the cooler temperatures found in the nasal passages, than in the warmer core body temperature found, for example, in the lungs. The authors note that while this difference has been known since the 1960s, the reasons are still not clear.

Their findings, using cells from mouse airways grown in the laboratory, suggest that at the cooler temperatures these cells are less able to switch on the production of proteins that fight the virus. However, it is important to bear in mind some of the limitations of this early stage research. One limitation was that it tested just one strain of the most common human cold virus (rhinovirus) in mouse cells. The experiments will need to be repeated with different strains of rhinovirus and other cold-causing viruses, and with human airway cells. The authors also note that this might not be the only reason why cold viruses grow better in the nose.

Also, while the authors speculate that this could explain the impact of cold environmental temperatures on colds, this study only really looked at cells at the normal temperature of the human nose, and didn’t assess the impact on nose temperature of it being colder outside.

Regardless of this, it is important to protect your body against the potentially harmful effects of very cold weather. Older people, those who cannot afford heating, and those with long-term health conditions or who are disabled are particularly vulnerable to cold-related illnesses. 

Read more about keeping well in winter

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

You are more likely to get a cold in winter - but keeping your nose warm may be the secret to avoiding it. Mail Online, January 6 2015

Common cold 'prefers cold noses'. BBC News, January 6 2015

Heed your mother’s warning: cover up or you’ll catch a cold. The Independent, January 6 2015

Common cold really is triggered by chilly weather, Yale scientists find. The Daily Telegraph, January 6 2015

Why chilly weather really can give you a cold. The Times, January 6 2015

Links To Science

Foxman EF, Storer JA, Fitzgerald ME, et al. Temperature-dependent innate defense against the common cold virus limits viral replication at warm temperature in mouse airway cells. PNAS. Published online January 5 2015

Categories: NHS Choices

New skin cancer drugs show promise in lab tests

NHS Choices - Behind the Headlines - Mon, 05/01/2015 - 10:29

"New skin cancer drug set for clinical trials," The Guardian reports. In fact, two new compounds designed to treat malignant melanoma are due for trials after promising results in laboratory research.

Both are signalling inhibitors, which work by disrupting the messages a cancer uses to co-ordinate its growth. These have proven effective in the short to medium term, but it is common for the cancer to develop resistance to their effects.

This new research involved two new compounds, both part of a family called panRAF inhibitors, which work using a slightly different mechanism from existing signalling inhibitors.

The findings, involving mice and lab studies, were certainly encouraging, but we should not get ahead of ourselves. The research is barely out of the laboratory, which is the very first phase in the drug discovery timeline.

This means we have no idea whether these new drugs will be safe or effective when used on people.

Clinical trials will provide the answers over the coming years, although there are no guarantees that the drugs will be successful.

Small-scale clinical trials are the next stage in research, and the authors say this is planned.

 

Where did the story come from?

The study was carried out by researchers from the Cancer Research UK Manchester Institute, and the Institute of Cancer Research London.

It was funded by the Cancer Research UK Manchester Institute, Cancer Research UK, the Wellcome Trust and the Division of Cancer Therapeutics at the Institute of Cancer Research.

The study was published in the peer-reviewed science journal Cancer Cell as an open access article. This means that anyone can read the full article online for free.

Generally, The Guardian and the Mail Online reported the story accurately, though it wasn't made clear that the researchers were actually looking at two compounds, not a single drug.

The Mail also claims the research will lead to a "new pill". The study did not use a pill in the mice experiments – rather, the compounds were given orally as a liquid and an injection into a vein. 

It is too early to say with any assurance what form the drug would take if used in people.

The drug was for a resistant form of skin cancer, and these findings are at an early stage of research. 

 

What kind of research was this?

This was a laboratory study investigating biological compounds that have the potential to treat malignant melanoma with specific mutation in the BRAF gene. This is said to account for up to half of people with melanoma.

Melanoma is the most serious type of skin cancer, which can spread rapidly to lymph nodes and other organs in the body if not treated as soon as possible.

The most common sign of melanoma is the appearance of a new mole or a change in an existing mole. This can happen anywhere on the body, but the back, legs, arms and face are most commonly affected.

The study group say existing drug classes called BRAF and MEK inhibitors are initially effective when treating melanoma with the specific BRAF gene mutation.

However, in most people, the cancer comes back as the drugs stop working. In others, the drugs do not work very well to start with.

The team wanted to find new ways of treating this specific drug-resistant form of melanoma and began their investigations in the laboratory.

 

What did the research involve?

The research group designed and synthesised a variety of compounds as part of a drug discovery programme.

They focused their efforts using their understanding of the biological pathways involved in melanoma and, specifically, mechanisms by which current drugs stop working against the BRAF mutation.

The discovery programme led to two promising compounds, which underwent more in-depth biological and chemical experiments to work out exactly how they were working.

None of the experiments involved giving the newly developed drugs to people, although many involved testing the chemical on human cells cultured in the laboratory.

 

What were the basic results?

The discovery programme found two promising compounds. They are called pan-RAF inhibitors, named CCT196969 and CCT241161 respectively.

They were found to inhibit melanoma development through a different biological mechanism from previous drugs.

Because of this, it was hoped there may be less chance that resistance to these drugs will develop, as has happened in the past.

 

How did the researchers interpret the results?

The research team suggested the new chemicals they found, if developed into effective drugs, "could provide first-line treatment for BRAF and NRAS mutant melanomas and second-line treatment for patients who develop resistance".

In other words, these chemicals could potentially be developed into drugs to treat some melanomas in the first instance, and used as a second line of attack for others that have become resistant to existing drugs.

 

Conclusion

This laboratory study discovered two new chemicals, which show anti-cancer properties for melanoma with a specific gene mutation that can make it resistant to existing treatments.

The next stage for research is small-scale, phase I clinical trials to see whether these chemicals could one day be developed into drugs that could be available to treat patients. The authors say this is planned.

These types of trials generally assess whether the drug in development can be safely tolerated in people, and in what doses.

Only after they are deemed safe can further, larger trials be conducted to see whether the drugs work, or are cost-effective, in comparison to other treatments. These trials usually take many years.

There are no guarantees that any new drugs coming out of this research will turn out to be a winner, but there is hope.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

New skin cancer drug set for clinical trials. The Guardian, January 2 2015

Revolutionary new PILL could treat skin cancer: Scientists discover drug could help patients resistant to standard treatments. Mail Online, January 3 2014

Links To Science

Girotti MR, Lopes F, Preece N, et al. Paradox-Breaking RAF Inhibitors that Also Target SRC Are Effective in Drug-Resistant BRAF Mutant Melanoma. Cancer Cell. Published online December 11 2014

Categories: NHS Choices

Are most cancers down to 'bad luck'?

NHS Choices - Behind the Headlines - Mon, 05/01/2015 - 09:54

"Most types of cancer can be put down to bad luck rather than risk factors such as smoking," BBC News reports. A US study estimates around two-thirds of cancer cases are caused by random genetic mutations.

The researchers who carried out the study wanted to see why cancer risk varies so much between different body tissues.

For example, the average lifetime risk of lung cancer is around 1 in 14, whereas brain cancer risk is significantly lower at around 1 in 166.

The study estimates around two-thirds (65%) of cancer risk is a result of chance, based on the number of times stem cells divide in the different tissues.

However, this figure could be anywhere between 39% and 81%. This is quite a large margin of error, reducing the accuracy and reliability of the 65% estimate.

Overall, this gives us a clearer idea of the possible relative effects of chance versus lifestyle, versus genetics on our risk of developing cancer over our lifetimes.

But none of this can predict whether individuals will or will not develop cancer.

Even if the majority of cancers are the result of a bad roll of the dice, there are still proven methods of reducing the risk: namely, eating a healthy balanced diet and leading an active lifestyle free of smoking and excess alcohol.

 

Where did the story come from?

The study was carried out by researchers from Johns Hopkins University in the US, and was funded by The Virginia and D. K. Ludwig Fund for Cancer Research, The Lustgarten Foundation for Pancreatic Cancer Research, The Sol Goldman Center for Pancreatic Cancer Research, and US National Institutes for Health grants.

It was published in the peer-reviewed journal, Science.

Generally, the UK media reported the study facts accurately, but failed to discuss any limitations, such as the breadth of the estimate of the number of cancer cases caused by chance, and so took the findings at face value.

Most news sources stressed that even if some cancers are down to chance, it is still important to take steps to reduce your cancer risk, such as by quitting smoking if you smoke.

 

What kind of research was this?

This was an ecological study exploring what is behind variations in cancer risk. Ecological studies look at the effects of certain factors at the population level.

The researchers say some tissue types give rise to human cancers millions of times more often than other tissue types. Although this has been recognised for a long time, it has never been fully explained.

We know genetics, the number of times the tissue cells divide, and lifestyle factors such as smoking contribute to the risk of cancer in different tissues, but we are unclear what the most important factor is. This study sought to shed more light on this issue.

An ecological study is good for summarising what happens on average to groups of people. However, it cannot tell individuals what their risk of cancer will be, as this is highly variable.

 

What did the research involve?

The study pooled published information on 31 tissue types, estimating the number of times their stem cells (early-stage cells that can develop into different cell types) divided over a lifetime to renew the tissue.

The researchers plotted the total number of stem cell divisions against average lifetime risk for cancer of that tissue type, and looked for a correlation between the two.

The assumption was that more cell divisions over a lifetime would lead to a higher probability of the chance of cancer-causing mutations during this time.  

The second element of the research looked at the contribution environmental factors and inherited mutations were having on lifetime cancer risk.

Cancers were subsequently grouped into those more affected by environmental and genetic factors, and those that were relatively unaffected.

 

What were the basic results?

There was a strong correlation between the number of stem cell divisions and the lifetime risk of cancer across a range of cancers.

The researchers estimated 65% of the differences in cancer risk across tissue types were explained by the number of cell divisions in those tissues (95% confidence interval [CI] 39% to 81%).

This component was described as the "chance element"– the "bad luck", as it cannot be controlled.

In some cancers, environmental factors and inherited genetic factors did compound the risk. In relative terms, the authors indicated the chance elements were playing the biggest role (around 65%), with environmental and genetic components adding to the risk (the remaining 35%).

 

How did the researchers interpret the results?

The authors concluded that, "Only a third of the variation in cancer risk among tissues is attributable to environmental factors or inherited predispositions.

"The majority is down to 'bad luck' – that is, random mutations arising during DNA replication in normal, non-cancerous stem cells. This is important not only for understanding the disease, but also for designing strategies to limit the mortality it causes."

 

Conclusion

This study estimates around two-thirds (65%) of cancer risk is down to chance, based on the number of times stem cells divide in different body tissues. Other factors, including environmental factors and genetics, account for the remaining risk.

However, the estimate was quite variable, with 95% confidence intervals ranging from 39% to 81%. So only 4 out of 10 cancers may be a result of bad luck, or, alternatively, as many as 8 out of 10.

The wide estimate reduces our confidence in its accuracy. Its reliability would be increased if other research groups arrived at similar numbers by a variety of different means.

The estimates put forward in this study were based on previous research estimating the number of stem cell divisions for different tissues, and estimates of lifetime cancer risk. Any error or bias in these two sources will reduce the reliability of calculations based on them.

If the results are confirmed in future studies, they indicate chance does play a significant role in whether a person will develop cancer.

This is not completely new, but allows us to reconsider any implications for public health efforts to reduce death and disease caused by cancer.

For example, one of the effective ways to reduce the risk of developing cancer is through prevention by lifestyle modification.

This research suggests efforts should be targeted at cancer types that have the highest proportion of risk because of environmental and genetic factors.

Focusing on other cancer types that are mainly related to "chance" may be a less effective use of resources.

To some extent this already happens. We know, for example, that lung cancer is increased dramatically by smoking. Lifestyle prevention measures have therefore focused on encouraging people to stop smoking.

There will always be non-smokers who get lung cancer, and smokers who don't. But overall, there is no doubt that non-smokers as a group develop lung cancer far less frequently than smokers.

Professor Bert Vogelstein, from Johns Hopkins University School of Medicine in the US, summed this up by saying: "Cancer-free longevity in people exposed to cancer-causing agents, such as tobacco, is often attributed to their 'good genes', but the truth is that most of them simply had good luck."

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Most cancer types 'just bad luck'. BBC News, January 2 2015

Two-thirds of adult cancers largely ‘down to bad luck’ rather than genes. The Guardian, January 2 2015

Most cancers are caused by bad luck not genes or lifestyle, say scientists. The Daily Telegraph, January 1 2015

Most cancers are 'caused by bad luck - not lifestyle': Scientists claim 65% of cases are down to random mistakes in genes that we can do nothing about. Daily Mail, January 2 2015

Most cancers are caused by bad luck – not bad judgement, says study. The Independent, January 1 2015

Cancer caused by 'bad luck' more than 'lifestyle choices' according to shock new study. Daily Mirror, January 1 2015

Cancer is down to ‘bad luck not lifestyle' Experts claim 65 per cent of cases are random. Daily Express, January 2 2015

Links To Science

Tomasetti C, Vogelstein B. Variation in cancer risk among tissues can be explained by the number of stem cell divisions. Science. Published online January 2 2015

Categories: NHS Choices

Our health news predictions for 2015

NHS Choices - Behind the Headlines - Fri, 02/01/2015 - 11:30

A few days ago we looked at The Guardian’s health news predictions for 2014 to see how accurate, or not, they turned out to be. Of course, it's easy to criticise the work of others (which is pretty much Behind the Headlines’ raison d'être). But we are brave enough to put our money where our mouth is; so here are our own health and medical news predictions for 2015.

One or more successful Ebola vaccine

Multiple research teams are working independently on different strains of a potential vaccine, and initial results from human trials are encouraging. One vaccine being produced by GlaxoSmithKline seems to be effective. Further studies are now required to see if it is also safe.

All being well, the vaccination of high-risk groups, such as healthcare workers, could begin in 2015.

 

First UK "Three-person" IVF baby is born

So-called "three-person IVF" is a technique that could be used to tackle what are known as "mitochondrial diseases". Most of the genetic material in our bodies is inside the nuclei of our cells, which usually contain 23 chromosomes inherited from our mother and 23 inherited from our father. However, there is also genetic material contained in cellular structures called mitochondria, which produce the cells' energy.

Unlike the rest of our DNA, this small amount of genetic material is only passed to the child from the mother. There are a number of rare diseases caused by gene mutations in the mitochondria. Women carrying these mutations will pass them directly to their child, with no influence from the father.

Three-person IVF could prevent these “mitochondrial diseases” by replacing the mother’s mitochondria with healthy mitochondria from a donor, thereby creating a healthy embryo. The child would then have the genetic material of three people – the majority still from the mother and father, but with around 1% of mitochondrial DNA from a donor.

A recent review concluded that the technique appears to be safe. The government is due to bring the regulations around the technology to Parliament, so 2015 could see three-person IVF get the green light in the UK.

This could lead to the first UK three-person IVF baby being born (or at least conceived) in 2015.

 

"Smart watches" found to improve public health

Apple’s much hyped Watch – a smaller, wearable version of a smartphone – is due to be released in 2015.

The device is to carry a number of applications designed to monitor health and promote healthier behaviour. These include a calorie tracker, a pedometer, an alcohol unit tracker and a blood pressure monitor. None of these applications are new, but Apple does have a track record of combining applications into a useful, intuitive package. Or at least, marketing them well.

So "smart watch" early adopters could be inspired to improve their health and fitness by taking part in exercise plans such as NHS Choices' Couch to 5K. Alternatively, you could end up sticking the watch in a drawer as you are fed up with it nagging you.

Other timepieces are available.

 

Someone tries to market a "male pill"

We’ve been told the male pill is just around the corner for decades, so by laws of probability, it has got to be invented eventually. Could 2015 be the year?

There are two main areas of research into male contraception:

  • hormonal contraception – where synthetic (man-made) hormones are used to temporarily stop the development of healthy sperm
  • non-hormonal methods – where other techniques are used to prevent healthy sperm from entering a woman's vagina

A number of studies are ongoing into what has been described as the “holy grail” of contraception research.

We think 2015 could well be the year a pharmaceutical company decides to test the market with a male pill.

 

A renaissance in US stem cell research

Between 2001 and 2009, the US government prohibited federal funding for any research involving human embryonic stem cells.

This meant a generation of US scientists were severely lacking in resources to explore the potentially lifesaving properties of human stem cells. These cells have the ability to develop into other types of specialised cells, such as brain cells.

American scientists are now playing catch-up with their European and Asian counterparts, who had access to government funding.

We are already seeing evidence that research teams based in the US are now producing impressive and exciting work based on stem cell research.

For example, in October 2014, researchers based at Harvard University managed to convert stem cells into cells that are structurally similar to normal pancreatic cells, which had the ability to produce insulin. This could potentially be a first step to a cure for type 1 diabetes – a chronic condition that is caused by the pancreas’ inability to produce insulin in the normal way.

Hopefully, this is the first of many breakthroughs based on stem cell research in the US.

 

A growth in the personal gene screening market

The cost of genome sequencing and DNA screening has fallen exponentially since the landmark work of the Human Genome Project, which was declared complete in 2003. What once cost millions of pounds can now be completed for a few hundred – namely, the screening of individuals' DNA.

This has led to a number of private companies offering individual DNA screening, such as the Google-funded 23andMe, which launched its service in the UK earlier this month.

For £125, the company will run an analysis on DNA from your saliva, and find your genetic risk profile for certain conditions. These can range from the relatively trivial, such as male pattern baldness, to the potentially fatal, such as breast cancer.

Critics of such services have argued that the information provided by these screening tests may be open to misinterpretation and cause undue worry and anxiety.

That said, we think there are enough "worried well" people for gene screening to become big business.

 

If you want to share your predictions for 2015, tweet us @NHSNewsUK or post messages on the Healthy Evidence forum.

Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Categories: NHS Choices

Behind the Headlines Top Five of Top Fives 2014

NHS Choices - Behind the Headlines - Wed, 31/12/2014 - 12:30

As we move towards the end of the year, like all news sources, we fall back on that classic space filler – the list story. So without further ado, here is the official Behind the Headlines Top Five of Top Fives stories of 2014, in which we celebrate the good, highlight the bad, check out the weird and answer some of the burning questions of the year.

The top five 'Good work boffins!' stories of the year

We can often get bogged down in pointing out dodgy sub-group analyses, spurious extrapolations of sample sizes containing just 20 rats and a water maze, and RCTs pointing out the benefits of cherries on dementia prevention that turned out to be funded by Big Cherry. So it's important not to lose sight of the fact that there are many hardworking researchers, producing invaluable, often lifesaving, work, framed in the best traditions of evidence-based medicine, which can make the world a better place.

Here’s our top five of the year:

New weapon found in the war against superbugs

The growing threat of antibiotic resistance is one of the biggest threats to public health. If it continues to develop we could end up living in a world similar to the pre-antibiotic era. What we now consider to be mild infections could spiral out of control and routine surgery would be fraught with danger.

That is why the news in June of the discovery of a new technique to fight bacteria was welcomed. UK researchers have invented a technique to pierce the outer membranes of bacteria, which kills it. The advantage of this approach is that by targeting the membranes, rather than the bacteria themselves, there is less chance of resistance evolving.

Although it is early days, this method could eventually lead to the development of new drugs against multi-drug-resistant bacteria.

'Bionic' pancreas could be used to treat diabetes

The cause of type 1 diabetes is simple. The pancreas doesn’t produce a vital hormone called insulin. The current treatment for type 1 diabetes is far from simple; it involves day-to-day insulin injections and blood sugar monitoring.

Hopefully this may change in the future as researchers in June carried out a small, though successful, trial of what the media described as a “bionic pancreas”.

This is an automated pump/monitoring device, worn on the outside of the body, that continuously measures sugar levels and automatically makes fine adjustments to insulin delivery in response. In effect, it acts like an artificial pancreas.

Studies involving a greater number of people and taking place over a longer duration should be on the way.

Dual vaccine approach could help eradicate polio

Wiping out a disease can be a challenge but it is possible, as we can see with smallpox.

It has longed been hoped that the same could be done with polio; a viral infection that can cause paralysis and death.

Polio vaccination programmes have almost wiped out the disease, though there remain stubborn pockets of resistance in Afghanistan, India and Nigeria. The infection persists in these countries for a number of reasons, including limited access to healthcare and political instability.

Researchers working for the World Health Organization, carrying out field work, found that adding a booster dose to the vaccine schedule increase immunity.

While this may seem a modest accomplishment, just a small increase in overall immunity in a population could successfully eradicated polio once and for all.

Aggressive breast cancer protein discovered

Up to a third of breast cancers are HER2-positive cancers. These are cases of breast cancer where growth is driven by a protein called human epidermal growth factor receptor 2 (HER2). These types of cancer can be particularly aggressive and difficult to treat.

In July researchers identified a protein, integrin αvβ6, that seems to be stimulating the rapid growth of cancerous cells. The good news is that they also identified an antibody called 264RAD that can block the action of the aggressive protein.

The hope is that these discoveries will lead to a new generation of breast cancer drugs.

Removing copper from body could slow cancer

In April an international team of researchers discovered an innovative new technique that could be used to treat certain cancers.

They discovered that copper helped activate a series of biological "pathways" that stimulated the growth of cancerous cells.

So they repurposed existing drugs used to treat a genetic condition called Wilson’s disease, in which copper builds up inside the body.

These drugs did prove successful in reducing copper levels and slowing the growth of tumours in mice, as well as in human cells in a laboratory setting.

It is hoped that similar success will be achieved in human trials.

 

The top five 'Don’t wait up for that call from Stockholm' stories

All medical research is valuable. It's just that some of it is less valuable than others. And to be honest, we cannot see any of the researchers involved in the following studies picking up the Nobel Prize for Medicine anytime soon.

Watching porn associated with male brain shrinkage

A German study found an association between the amount of time men reported watching pornography per week and the size of their brains.

The higher the number of hours of porn watched, the smaller the volume of grey matter.

Though this raises the problem of what we call in the trade a chicken and egg problem. Does watching porn make your brain smaller or do men with smaller brains like watching porn?

To be honest we can think of better ways to use expensive MRI scanners.

'Peeing' in pool may create harmful byproducts

A Chinese study confirmed what most of us always suspected. People who can’t be bothered to get out of a swimming pool to pee are the lowest of the low.

Not only is peeing in a pool deeply disgusting, the study found that compounds found in urine react with chlorinated water, creating a potentially hazardous toxic byproduct called N-DBPs.

While it’s always nice to have your prejudices confirmed, we think there are bigger threats to public health than pool polluters.

Vampire treatment with blood may slow ageing

In a somewhat sinister experiment, American researchers injected blood taken from younger mice into older mice. They found that the injections rejuvenated some communication between nerve cells in the older mice.

While there may be a potential application in humans, we struggle to see a study design involving vampire treatments that would get past an ethics committee.

Headbanging could damage your (Motör)head

A case report in The Lancet was definitely from the “no s**t, Sherlock” school of research. It turns out that repeatedly headbanging to heavy metal music is not ideal for the brain.

Still, the report did provide one of our favourite quotes of the year as The Lancet defined headbanging as: “A contemporary dance form consisting of abrupt flexion-extension movements of the head to the rhythm of rock music, most commonly seen in the heavy metal genre.”

Do short people also have smaller IQs?

No. And the study in question is entirely without merit (average size of the Behind the Headlines team: 5ft 8 inches or 1.72m in new money)

 

The top five 'Call that reporting?' stories

We look at a lot of health journalism. Some of it excellent, some of it good, some of it downright terrible. Here are our top five examples of the latter:

Claims of a universal cure for cancer 'misleading'

The Daily Express hit the ground running in January with the headline: “A cure for all cancers is on the way". The claim, entirely spurious of course, was actually based on laboratory research involving cells taken from blind mole rats.

While the rats do have some intriguing biological properties, claims of a universal cancer cure being imminent was just nonsense. 

Life after death 'is real'

“Life after death is a real phenomenon, British scientists find,” Metro reported. So was it true? Had one of the most significant philosophical and theological questions in human history finally been conclusive answered? No, of course not, stop being so silly.

The researchers actually found that a minority of people reported having out-of-body experiences during cardiopulmonary resuscitation (CPR). It is perfectly plausible that people would continue to have thoughts and experiences while there is still oxygenated blood flowing to the brain.

Earl Grey 'as good as statins'

“A cup of Earl Grey 'as good as statins' at fighting heart disease,” reported The Daily Telegraph on April 1st. We had to double check that it wasn’t an April Fools, but it turned out that this normally sensible newspaper was being serious.

As we are heartily sick of pointing out (all together now) the study involved rats not humans.

And encouraging readers to replaced prescribed statins, used to prevent heart disease, with Earl Grey is profoundly irresponsible.  

Ibuprofen can ‘prolong lifespan’

The Daily Mirror reported, “taking ibuprofen every day could extend your life by up to 12 YEARS”. This was just one of many unproven and irresponsible headlines on research involving yeast, microscopic worms and fruit flies (still, at least it wasn’t rats).

Aside from the lack of evidence, headlines encouraging people to take medication without first seeking medical advice are potentially dangerous. While safe for most people, ibuprofen is not suitable for everyone, such as people with heart failure.

One in three cat bite victims 'end up in hospital'

“One in three people who are bitten [by cats] have to be hospitalised,” the Daily Mail warned us. But before you put your pussy in a Hannibal Lecter style head restraint, the paper was guilty of failing to understand simple health statistics. They confused the number of people who turned up at A&E with a cat bite, with the total number of people bitten by a cat (a much bigger number).

The actual figure of people who require hospitalisation after a cat bite is thought to be less than 1 in 100.

 

The top five 'science is cool' stories

Scientists are cool and the science they practise is even cooler. Here are our five coolest stories of the year:

Nanofibre lined tubes used to 'move' brain tumours

Researchers used tiny "nano-monorails", less than 0.0001mm in width, to pull brain cancer cells out of rats’ brains to an area where they could be safely destroyed.

Electrical brain stimulation may induce dream control

A study found that electrical stimulation of the brain at a specific wavelength (25 Hz to 40 Hz) may increase the lucidity of people’s dreams and their self-awareness during them. So "Inception-style" dream control could become a reality in the future.

Gene therapy could help with inherited blindness

Researchers injected a genetically modified virus into the retina. The virus then modified cells in the retina that are not normally light-sensing (retinal ganglion cells) into light-sensitive cells. This restored some degree of vision in blind mice and dogs.

Lasers used to regenerate damaged teeth

A new laboratory study has found that low-power laser therapy can stimulate dental stem cells (cells that have the ability to form into other specialised tooth cells) to create dentine, the tooth layer under enamel. The hope is that laser therapy could one day replace lengthy and expensive dental operations such as root canal treatments.

'Supercooling' may extend life of transplant organs

US researchers are developing a new "supercooling" technique in which a transplanted organ is frozen while at the same time nutrients are passed through the organ to keep it viable. In animal studies, they have succeeded in keeping an organ “alive” for 72 hours (current techniques can only preserve an organ for around 12 hours).

 

And finally, five burning questions of the year

Can playing Tetris help you lose weight? (maybe)

Is there such a thing as a lazy gene? (probably, but that’s no excuse to let yourself go)

Could watching action films make you fat? (well, if you just do that all day, then yes)

Will watching 'Dad's Army' stop you going blind? (no, stupid boy)

Should schools provide morning-after pills to schoolgirls? (we are not touching that one with a bargepole)

Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Categories: NHS Choices

UK Ebola case confirmed but risk remains low

NHS Choices - Behind the Headlines - Tue, 30/12/2014 - 11:00

A case of Ebola has now been confirmed in the UK, but the risk to the general public remains very low. Ebola can only be transmitted by direct contact with the blood or bodily fluids of an infected person.

The UK case – in a healthcare worker in Scotland who arrived in Glasgow from Sierra Leone on Sunday – has been confirmed by the Scottish government. The patient was placed in isolation at Glasgow's Gartnavel Hospital and has been transferred for specialised care at the Royal Free Hospital in London.

The healthcare worker left Sierra Leone on December 28 and was a passenger on flight AT596 from Freetown to Casablanca and flight AT0800 from Casablanca to London. They then transferred at Heathrow to flight BA1478 to Glasgow. 

The risk of infection to other passengers on the flights is considered extremely low. However, as a precaution, Public Health England is arranging for all passengers and crew on the flight from Casablanca to Heathrow to be provided with health information.

Passengers who were sitting in the vicinity of the healthcare worker on these flights will be contacted and followed up. Health Protection Scotland is carrying out a similar exercise for the passengers on the Heathrow to Glasgow flight.

The Scottish First Minister, Nicola Sturgeon, has reported that a second patient in Scotland is being tested for Ebola.

There are also reports that a patient is being tested for Ebola at Royal Cornwall Hospital in Truro. The patient, who is now in isolation, has recently returned from West Africa and reported to the hospital this morning.

In a joint statement, the hospital and Public Health England said: "A patient has been admitted to Royal Cornwall Hospital and is currently undergoing a series of tests – one of which is for Ebola.

"We do not expect the results to be known for at least 24 hours and in the meantime the patient is being looked after in isolation, following nationally agreed guidelines and protocols to protect the health of our staff and other patients.

"Royal Cornwall Hospitals NHS Trust has been following national guidance around Ebola and made plans in line with advice from Public Health England and NHS England."

The UK has well-established and practised infection control procedures for dealing with cases of imported infectious disease, and these will be strictly followed to minimise the risk of transmission.

Professor Dame Sally Davies, Chief Medical Officer, said: "Our thoughts are with this individual who, along with other NHS and public health colleagues, has been doing a fantastic job saving lives.

"The English and Scottish governments and health authorities are working together to make sure that this individual receives the best possible care. UK hospitals have a proven track record of dealing with imported infectious diseases. 

"It is important to be reassured that although a case has been identified, the overall risk to the public continues to be low. 

"We have robust, well-developed and well-tested NHS systems for managing unusual infectious diseases when they arise, supported by a wide range of experts. The UK system was prepared, and reacted as planned, when this case of Ebola was identified."

More than 19,000 cases of Ebola have been confirmed in West Africa, with over 7,500 deaths – a mortality rate of around 40%.

Outbreaks of Ebola are nothing new, but health professionals are concerned about the size of the outbreak.

 

What is Ebola?

Ebola is a virus that can be spread through blood and bodily fluids. The virus originated in the West African rainforest and is thought to have spread to humans by handling or butchering infected animals.

Once the virus enters the body it can replicate very quickly, causing a range of increasingly harmful symptoms, including internal bleeding. Left untreated, it can have a mortality rate as high as 90%.

 

What are the symptoms of Ebola virus?

An infected person will typically develop a fever, headache, joint and muscle pain, sore throat, and intense muscle weakness. These symptoms start suddenly 2 to 21 days after becoming infected.

Diarrhoea, vomiting, a rash, stomach pain, and impaired kidney and liver function follow. The infected person may then bleed internally, as well as from the ears, eyes and mouth.

 

How is the Ebola virus spread?

People can become infected with the Ebola virus if they come into contact with the blood, body secretions or organs of an infected person.

Some traditional African burial rituals may have played a part in its spread. The Ebola virus can survive for several days outside the body, including on the skin of an infected person.

In parts of Africa, it is common for mourners to touch the skin of the deceased. A person then only needs to touch their mouth to become infected.

Other ways people can catch the virus include:

  • touching the soiled clothing of an infected person and then touching their mouth
  • having sex with an infected person without using a condom – the virus can be present in semen for as long as seven weeks after an infected person has recovered
  • handling unsterilised needles or medical equipment that have been used on the infected person
  • handling infected animals or coming into contact with their bodily fluids

A person is infectious as long as their blood and secretions contain the virus.

Ebola virus is generally not spread through routine social contact, such as shaking hands with patients without symptoms.

The virus is not airborne, so it's not as infectious as diseases such as the flu – you'd need to get close to it to catch it.

 

Who's at risk from Ebola?

Anyone who has close contact with an infected person or handles samples from patients is at risk of becoming infected. Hospital workers, laboratory workers and family members are at greatest risk.

 

How is Ebola diagnosed?

It's difficult to know if a patient is infected with Ebola virus in the early stages. The early symptoms of Ebola, such as fever, headache and muscle pain, are similar to those of many other diseases.

But health workers are on standby to act quickly. If anyone in the UK develops the above symptoms and has potentially been in close contact with the virus, they will be admitted to hospital and will most likely be quarantined.

Samples of blood or body fluid can be sent to a laboratory to be tested for the presence of Ebola virus, and a diagnosis can be made rapidly. If the result is negative, doctors will test for other diseases, such as malaria, typhoid fever and cholera.

 

What are the treatments for Ebola?

There's currently no specific treatment or cure for the Ebola virus, although potential new vaccines and drug therapies are being developed and tested.

Patients need to be treated in isolation in intensive care. Dehydration is common, so fluids may be given intravenously (directly into a vein).

Blood oxygen levels and blood pressure will be maintained at the correct level, and the body organs supported while the patient recovers.

 

What is the risk of Ebola in the UK?

The risk to the UK is thought to be very low, and, while someone with the virus can bring it to the UK, the risk of it spreading is very low.

Ebola virus is not airborne, so there is no credible risk of a swine flu-like global pandemic.

You cannot catch Ebola by travelling on a plane with someone who is infected, unless you come into very close physical contact with them – for example, by kissing them.

 

What precautions are being taken?

Public Health England (PHE), the body responsible for public health in England, has told health professionals about the situation in West Africa and asked for vigilance about unexplained illness in people who have visited the affected area.

PHE has provided advice for humanitarian workers planning to work in affected areas. It is also working with people from Sierra Leone living in England.

Advice has already been issued to immigration removal centres on carrying out health assessments for people who may have been in Ebola outbreak areas within the preceding 21 days.

PHE is also liaising with the UK Border Agency and port health authorities to update guidance for staff working in airports and ports.

Dr Brian McCloskey, PHE's director of global health, said: "The risk to UK travellers and people working in these countries of contracting Ebola is very low.

"People who have returned from affected areas, who have a sudden onset of symptoms such as fever, headache, sore throat and general malaise [sense of feeling unwell] within three weeks of their return should immediately seek medical assistance." 

Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Scottish Ebola patient transferred to London hospital – live updates. The Guardian, December 30 2014

Ebola healthcare worker transferred to London unit. BBC News, December 30 2014

Ebola patient transferred to London's Royal Free Hospital. The Daily Telegraph, December 30 2014

Nurse With Ebola To Arrive At London Hospital. Sky News, December 30 2014

Two more patients being tested for Ebola at UK hospitals. Daily Express, December 30 2014

Race to find hundreds of BA passengers who came into contact with UK nurse who brought Ebola back to Britain – but why did TWO screenings fail to spot her condition? Mail Online, December 30 2014

Categories: NHS Choices

Was The Guardian's 2014 crystal ball accurate?

NHS Choices - Behind the Headlines - Tue, 30/12/2014 - 10:29

In January 2014, The Guardian took the brave, and possibly foolhardy, step of predicting the six big health breakthroughs of 2014.

We're taking a look at just how accurate the paper's crystal ball turned out to be, and gave each our own Behind the Headlines "Mystic Meg" rating for predictive accuracy. 

 

Prediction one: IVF success rates to improve after 20 years of stagnation

The Guardian based this prediction on a technique comprising time-lapse imaging cameras inside IVF embryo incubators. As we discussed back in May 2013, there's nothing new about time-lapse technology, but what is new is how it's being applied to solve a problem.

Embryologists need to check how embryos are progressing to judge their viability for reimplantation. But being moved in and out of the incubator is thought to have a negative effect on the embryos.

Time-lapse cameras can record a series of images at regular intervals without embryologists having to remove the embryos from the incubator.

What actually happened in 2014?

It's hard to know exactly how correct this prediction was, as accurate information on IVF success rates collated by the Human Fertilisation and Embryology Authority only go up to the end of 2012.

It would be surprising if there had been a massive boost to IVF rates in the UK during 2014. While the time-lapse imaging technology can only be a beneficial development, access to the technology remains limited. 

Inevitably, "lab factors" are only part of the complex process of fertility and baby making. Better lab techniques are only likely to have a small, incremental benefit.

Mystic Meg rating: 5 out of 10

We think The Guardian was correct in spotting the potential of time-lapse imaging to increase IVF success rates – it's just too early to tell what impact it may have.

 

Prediction two: Better screening for ovarian cancer

A major study looking at the feasibility of screening for ovarian cancer at the population level (in the same way as had already been done for breast cancer) was launched in 2001.

The screening method made use of a multi-stage process that we looked at in August 2013. A blood test was used to measure levels of a protein called CA125, which is associated with ovarian cancer.

The results of this test were used to assess whether women were at high risk of developing the cancer. Women thought to be at high risk would then be offered an ultrasound scan.

The women were followed up over time to see how accurate their screening information was. Results of the trial were expected to be published in 2014.

What actually happened in 2014?

Publication of the results has been pushed back to 2015, so we can't comment. However, recommendations on ovarian cancer screening from the UK National Screening Committee haven't changed.

Mystic Meg rating: 2 out of 10

A little unfair on the The Guardian perhaps, but they should know better than to expect academics to meet a previously set deadline.

 

Prediction three: New insights into dementia

The prediction is based on a "historic breakthrough" trumpeted back in October 2013. A UK team of researchers were studying the effects of a new drug on a type of neurodegenerative brain disease.

The scientists infected mice with a prion disease. Prion diseases, such as Creutzfeldt-Jakob disease (aka "mad cow" disease), cause a build-up of abnormal proteins in the brain.

This causes brain cells to switch off the production of normal proteins. Without these normal proteins the brain cells die, causing memory and behavioural problems.

This build-up of abnormal proteins is a similar pattern to what occurs in humans with Alzheimer's disease, though there is no evidence that prions are associated with the condition.

Researchers found the new drug prevents this switch turning from "on" to "off", stopping brain cell death. Encouragingly, mice treated with the drug did not develop the memory and behavioural symptoms of prion disease.

This is the first time researchers have prevented brain cell death. Current drugs for Alzheimer's can only reduce the speed at which cell death occurs.

What actually happened in 2014?

The study was warmly welcomed by other experts in the field, with the general consensus being this was innovative research that could lead to new treatments.

However, we've drawn a blank in finding follow-up research. This could be the result of a lack of funding, a painful peer review process, or simply because more long, hard work is needed – we just don't know.

A source close to the research team tells us new research is expected to be published in the first half of 2015.

Mystic Meg rating: 5 out of 10

As with ovarian screening, The Guardian was right in recognising the potential implications of the research, but too optimistic in predicting how quickly a real-world benefit would appear. It can take as long as 15 years to go from proof of concept in mice to a drug that is ready to go on the market.

 

Prediction four: Open-access surgery becomes more widespread

The Guardian's prediction is based on a novel surgical technique known as natural orifice translumenal endoscopic surgery (NOTES).

NOTES is based on a simple idea: rather than creating cuts in the body to gain access to underlying organs, you instead use the natural orifices of the body, such as the mouth, urethra and vagina.

This novel approach has the advantage of potentially reducing postoperative pain and having a lower risk of complications such as infections.

What actually happened in 2014?

While very much in its infancy, NOTES has proved to be a viable, safe and effective technique.

Research published in 2014 suggests it can be used for a wide range of surgical procedures, such as gallbladder removal, hysterectomies and the removal of cancerous colon or rectal tissue.

There are also many ongoing clinical trials comparing the safety and effectiveness of different NOTES procedures, compared with traditional incision-based surgery.

Mystic Meg rating: 8 out of 10 

While the use of NOTES in the NHS remains limited, we wouldn't be surprised if the technique eventually becomes standard practice for some common types of surgery, such as gallbladder removal.

 

Prediction five: Ninja polymers to fight athlete's foot

"Ninja" polymers are a type of synthetic molecule that has been created by a research team at IBM. They are tiny particles a thousand times smaller than a grain of sand.

The particles are given an electrostatic charge, which helps them target fungi and bacteria, essentially causing them to explode. The particles should then dissolve harmlessly in the body.

IBM has commissioned a short animation showing the particles in action.

Researchers say the "ninja" polymers will be the ideal weapon in treating drug-resistant infections – particularly antibiotic-resistant strains of infection, such as MRSA (a so-called "superbug").

As the particles attack bacteria or fungi physically, rather than chemically, there is no risk of them causing drug resistance, which is the pressing concern with our current generations of antibiotics (and, to a lesser extent, antifungals).

What actually happened in 2014?

The research team published new research in 2014, showing a successful proof of concept that ninja polymers can destroy infections such as S. aureus and E. coli.

But this was lab work and not research involving humans. While the lab results are promising, it's unclear whether the particles (made, according to The Guardian, from recycled drinks bottles) are safe for human use.

The lead researcher, Jim Hedrick, estimates it will be at least a decade before drugs based on this technique are available at your local chemist.

Mystic Meg rating: 1 out of 10

The science is good, but The Guardian seriously underestimated how long it will probably take to have workable, effective and safe "ninja drugs".

 

Prediction six: Faecal transplants

It goes without saying that faecal transplants are a pretty off-putting idea, but the concept is simple and less nauseating than you'd imagine.

Faecal matter (or "poo" to us non-medics) containing typical gut bacteria is taken from a healthy volunteer.

It is then placed in a capsule to make a probiotic pill, which is swallowed by a patient (who will usually be being treated for a C. difficile infection).

The bacteria inside the faecal matter helps to change levels of bacteria inside the gut, creating a more healthy environment.

C. difficile is a bacterium that can cause chronic diarrhoea, which can be life threatening in vulnerable people.

What actually happened in 2014?

A small study we covered in October 2014 involved 20 people with C. difficile-associated diarrhoea. Participants were each given 30 capsules of frozen faecal matter containing gut bacteria from four healthy donors.

Results were encouraging. No serious side effects were reported in the small group, and diarrhoea was cured in 14 of the 20 people assessed over an eight-week period.

All six non-responders were re-treated and four were then cured, taking the total to 18 out of 20 that no longer suffered from diarrhoea. Participants' self-reported health scores also improved.

Larger studies are expected to take place in 2015.

Mystic Meg rating: 8 out of 10

While the 2014 study was small, it did have an impressive cure rate of 90% – better than many drugs that are currently on the market.

The biggest challenge of using faecal transplants is probably persuading people to actually take them.

Perhaps a branding exercise could help. Rather than "poo in a pill", they could be marketed as "100% organically natural human-sourced friendly bacteria capsules" – or, in the words of one biologist, "carbon-rich aggregate particles (CRAP)". 

Of course, it's easy to criticise the work of others (which is pretty much Behind the Headlines' raison d'être).

But we are brave enough to put our money where our mouth is, and will shortly be publishing our own health and medical news predictions for 2015.

And if you want to share your predictions for 2015, tweet us at @NHSNewsUK or post messages on the Healthy Evidence forum.

Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Categories: NHS Choices

Find a run near you

NHS Choices - Live Well - Tue, 30/12/2014 - 08:44
Find a run near you

Enter the first part of your postcode in the search box above to find a running event near you.

The box, powered by findarace.com, sorts through thousands of events nationwide to help you find your next challenge.

You can refine your search by selecting your preferred distance, terrain and date, and view results as a list or on a map.

Working towards a goal, such as a running event, is one of the most effective ways to stay motivated for regular exercise.

If you have recently completed the NHS Couch to 5K (C25K) plan, signing up for a running event is one way to keep going.

Whatever your goal, findarace.com’s extensive listings will have an event for you – from family-friendly and fancy dress events, to non-scary triathlons and night-time runs.

Launched in 2012, findarace.com is the brainchild of childhood friends and thrill-seekers Rob Munday, David Wearn and Richard Ward.

As rowers, they had grown weary of 5.30am wake-ups and wanted to explore new ways of enjoying the outdoors.

The next few years were spent falling off mountain bikes in Wiltshire, paddling punctured kayaks in Kent and spraining ankles in Snowdonia.

They found that, as well as being accident prone, it was often hard to find the next challenge. There was no one website where they could look up any sport and enter an event.

“You had to search through a handful of different sport-specific sites, none of which were easy to use or comprehensive,” says Wearn.

This could be done better, they thought.

“We wanted to create a cross-sport listings site with the sole purpose of making it easier to find races and events,” says Wearn.

A few years later, findarace.com was born. The site currently boasts some 5,000 events to choose from across the UK and is used by thousands of people every month.

Categories: NHS Choices

Behind the Headlines 2014 Quiz of the Year

NHS Choices - Behind the Headlines - Mon, 29/12/2014 - 00:00

In 2014, Behind the Headlines covered more than 500 health stories that made it into the mainstream media.

Test your knowledge of 2014's health news with our month-by-month quiz.

If you've been paying attention, you should find this quiz both easy and fun.

Answers are at the foot of the page (no peeking!).

 

In January 2014's health news...

What was said to help make bones stronger?

1) Swimming
2) Marriage
3) Listening to classical music

Warnings were issued about the possible return of what?

1) Swine flu
2) The Black Death
3) Smallpox

 

In February 2014's health news...

What activity was said to lower your sense of wellbeing?

1) "Bingeing" on TV box sets
2) Reading other people's posts on Twitter
3) Commuting

What video game was used to reduce food cravings?

1) Tetris
2) Minecraft
3) Modern Warfare 3

     

    In March 2014's health news...

    What was cited as a potential weapon against the obesity epidemic?

    1) Sunflower seeds
    2) Melons
    3) Seaweed

    What antisocial activity was said to trigger potentially harmful by-products?

    1) Listening to loud music on smartphones
    2) Not cleaning up your dog's poo
    3) Peeing in swimming pools

     

    In April 2014's health news...

    What quintessentially English brand was claimed to be an effective alternative to statins?

    1) Marmite
    2) HP Sauce
    3) Earl Grey tea

    What activity was said to prevent depression in older people?

    1) Sex
    2) Using the internet
    3) Joining a book club

     

    In May 2014's health news...

    England fans were warned about what in the run-up to the World Cup in Brazil?

    1) Sexually transmitted infections
    2) Depression
    3) Dengue fever

    What was said to be better than patches and gum as an aid to quitting smoking?

    1) E-cigarettes
    2) Hypnotherapy
    3) Nicotine inhalers

     

    In June 2014's health news...

    A new invention that can predict strokes was unveiled – what was it?

    1) A smartphone app
    2) A microwave helmet
    3) A retinal scanner

    What was said to damage men's sperm quality?

    1) Wearing Lycra cycling shorts
    2) Smoking cannabis
    3) Drinking energy drinks

     

    In July 2014's health news...

    Which technology company carried out a controversial experiment on some of its users?

    1) Facebook
    2) Apple
    3) Twitter

    What flavouring was said to make people feel fuller?

    1) Garlic
    2) Umami
    3) Curry powder

     

    In August 2014's health news...

    Which NHS service was said to be a waste of time by one team of researchers?

    1) NHS Health Checks
    2) NHS Choices
    3) The NHS Bowel Cancer Screening Programme

    Injections of what kitchen staple were said (wrongly) to be a potential cure for cancer?

    1) Salt
    2) Pepper
    3) Olive oil

     

    In September 2014's health news...

    One newspaper claimed eating a certain food could trigger a stroke within minutes. What food was this?

    1) Kebab
    2) Deep-fried Mars bar
    3) Bacon sandwich

    What old wives' tale may have turned out to be correct?

    1) Going outside with wet hair can give you a cold
    2) Honey can be used to treat infection
    3) Chocolate can help relieve symptoms of premenstrual syndrome (PMS)

     

    In October 2014's health news...

    What "doesn't exist", according to Italian researchers?

    1) The vaginal orgasm
    2) The male midlife crisis
    3) Love at first sight

    What was said to protect against prostate cancer?

    1) Having a cold shower at least once a week
    2) A Norwegian-style diet with lots of fish, game and preserved meat
    3) Multiple sexual partners – at least 21 over the course of a lifetime

     

    In November 2014's health news...

    Watching what classic comedy was said to help prevent vision loss?

    1) Only Fools and Horses
    2) George and Mildred
    3) Dad's Army

    What was reported to spread more than 80 million bacteria?

    1) Drinking somebody else's pint
    2) A French kiss (aka a "snog")
    3) A sneeze

     

    In December 2014's health news...

    What seems to be becoming less deadly over time?

    1) Rabies
    2) Anthrax
    3) HIV

    What could potentially save the NHS millions of pounds a year?

    1) Running operating theatres on a 24-hour-a-day basis
    2) More breastfeeding
    3) Adding fluoride to all of the English water supply

     

    Answers January

    What was said to help make bones stronger?

      2) Marriage – a US study found married men had increased bone mineral density compared with their single or divorced counterparts

        Warnings were issued about the possible return of what?

          2) The Black Death – DNA samples showed there have been multiple strains of the Black Death during human history, suggesting new strains could emerge in the future

             

            February 

            What activity was said to lower your sense of wellbeing?

              3) Commuting – a report compiled by the Office for National Statistics found daily commuting took a toll on most commuters' sense of wellbeing

                What video game was used to reduce food cravings?

                  1) Tetris – a small study found after playing Tetris for three minutes, participants reported a reduction in immediate cravings for food and drink by around 20%

                     

                    March

                    What was cited as a potential weapon against the obesity epidemic?

                      3) Seaweed – lab research suggests alginates, a substance found in seaweed, may reduce the amount of fat the body digests

                        What antisocial activity was said to trigger potentially harmful by-products?

                          3) Peeing in swimming pools – the mixture of urine and chlorinated swimming pool water was shown to produce potentially harmful chemicals known as nitrogen-containing disinfection by-products

                             

                            April

                            What quintessentially English brand was claimed to be an effective alternative to statins? 

                              3) Earl Grey tea – the research involved an extract called HMGF, taken from the bergamot fruit, a citrus fruit used to flavour teas such as Earl Grey; but the results (in rats) were inconclusive

                                What activity was said to prevent depression in older people?

                                  2) Using the internet – a survey of 3,075 retired people found regular internet use was associated with a lower risk of depression

                                     

                                    May

                                    England fans were warned about what in the run-up to the World Cup in Brazil?

                                      3) Dengue fever – prediction models suggested mosquito activity could combine with weather patterns to create the ideal environment for the spread of dengue fever in the city of Recife (but as England failed to come top of their group, they never played in the city)

                                        What was said to be better than patches and gum as a smoking quitting aid?

                                          1) E-cigarettes – a UK study found people who used e-cigs were 60% more likely to quit than those who tried nicotine replacement therapy (NRT) patches or gum, or willpower alone

                                             

                                            June

                                            A new invention that can predict strokes was unveiled. What was it?

                                              2) A microwave helmet – the helmet uses a microwave scattering technique to check if bleeding has occurred inside the brain

                                                What was said to damage men's sperm quality?

                                                  2) Smoking cannabis – researchers found cannabis use was associated with a higher rate of abnormal morphology (the shape of individual sperm)

                                                     

                                                    July

                                                    Which technology company carried out a controversial experiment on some of its users?

                                                      1) Facebook – in a controversial psychological experiment, Facebook filtered the content that appeared on some users' news feeds to see if this could have an emotional effect

                                                        What flavouring was said to make people feel fuller?

                                                          2) Umami – umami, a flavour associated with Japanese food, was found to reduce food cravings

                                                             

                                                            August

                                                            Which NHS service was said to be a waste of time by one team of researchers?

                                                              1) NHS Health Checks – researchers found no difference in the prevalence of diseases such as diabetes in GP practices that offer NHS Health Checks

                                                                Injections of what kitchen staple were said (wrongly) to be a potential cancer cure?

                                                                  1) Salt – while researchers did find a way to use salt to kill cancerous cells (in a lab), this is a long way from a cure for cancer

                                                                     

                                                                    September

                                                                    One newspaper claimed eating a certain food could trigger a stroke within minutes. What food was this?

                                                                      2) Deep-fried Mars bar – this (allegedly) staple Scottish snack was found to slightly reduce the flow of oxygen-rich blood to the brain, an effect highly unlikely to trigger an actual stroke

                                                                        What old wives' tale may have turned out to be correct?

                                                                          2) Honey can be used to treat infection – "friendly" bacteria found in fresh honey was found to be effective in slowing the growth of drug-resistant bacteria such as MRSA

                                                                             

                                                                            October

                                                                            What "doesn't exist", according to Italian researchers?

                                                                              1) The vaginal orgasm – according to two Italian sexologists, the vaginal orgasm, an orgasm that occurs during penetrative sex, "doesn't exist"; they argue female orgasm can only be achieved during oral sex or masturbation

                                                                                What was said to protect against prostate cancer?

                                                                                  3) Multiple sexual partners: at least 21 over the course of a lifetime – a Canadian study came up with the very precise figure of 21 or more sexual partners to reduce prostate cancer risk (20 doesn't count)

                                                                                     

                                                                                    November

                                                                                    Watching what classic comedy was said to help prevent vision loss?

                                                                                      3) Dad's Army – in fact, a clip from Dad's Army was just one of many visual cues used in an experiment to track differences in eye movements in people with glaucoma compared with people with normal vision

                                                                                        What was reported to spread more than 80 million bacteria?

                                                                                          2) A French kiss (aka a "snog") – an intimate kiss lasting at least 10 seconds was estimated to transfer 80 million bacteria between partners

                                                                                             

                                                                                            December

                                                                                            What seems to be becoming less deadly over time?

                                                                                              3) HIV – strains of HIV in South Africa and Botswana were found to be less virulent than other strains; the virus could be adapting as a result of natural selection (viruses that kill all of their host population don't last long in evolutionary terms)

                                                                                                What could potentially save the NHS millions of pounds a year?

                                                                                                  2) More breastfeeding – a modelling study estimated a reduction in childhood diseases, as well as breast cancer rates, would save the NHS millions of pounds

                                                                                                     

                                                                                                    Scores:
                                                                                                    • 0-2: Doctor Leo Spaceman (30 Rock)
                                                                                                    • 3-5: Doctor Douglas "Doogie" Howser (Doogie Howser, M.D.)
                                                                                                    • 6-8: Doctor Harold Legg (Eastenders)
                                                                                                    • 9-11: Doctor Abby Lockhart (ER)
                                                                                                    • 12-15: Doctor Miranda Bailey (Grey's Anatomy)
                                                                                                    • 16-19: Doctor Gregory House (House)
                                                                                                    • 20-23: Doctor Zachary Smith (Lost in Space)
                                                                                                    • 24: Nurse Jackie (Nurse Jackie)

                                                                                                    Thanks for taking part. We hope you had fun and have a happy 2015.

                                                                                                     

                                                                                                    Edited by NHS Choices. Follow Behind the Headlines on Twitter.

                                                                                                    Categories: NHS Choices

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