article_text
stringlengths 294
32.8k
⌀ | topic
stringlengths 3
42
|
|---|---|
After cooking for decades on earthen stoves lit with firewood, women in Sarmathla village in India’s northern Haryana state were excited when they received cooking gas stoves and connections about five years ago.
The gas cylinders which use liquified petroleum gas (LPG) meant that they would not have to collect firewood and breathe in the smoky fumes emitted from stoves called “chullahs.”
They are among millions of poor rural households given subsidized gas connections and cylinders under a government program launched in 2016 to help women move away from using highly polluting sources of cooking such as wood and animal dung to a cleaner cooking fuel.
But in most homes in Sarmathla, the cylinders now lie unused in a corner of the kitchen as many return to lighting their stoves with firewood.
“I am a poor person and everything has become so expensive. As daily wagers, we barely earn four dollars a day,” said Santosh Devi, a village resident. “Tell me, should I buy food for children or buy a gas cylinder?” The cooking gas stoves that were meant to help poor households switch to a clean energy source for cooking lie unused in many homes in Saramthala. (Anjana Pasricha/VOA) A series of price increases in the past year and a half has made cooking gas cylinders unaffordable for many poor households already struggling to cope with soaring food prices and incomes that declined due to the pandemic.
The approximately $13 price tag of a gas cylinder is almost double compared to six years ago when the project was launched. And although the government last month announced a $2.50 subsidy for those with subsidized gas connections, most village residents say they still cannot use it as their primary source of cooking.
Cooking gas prices in India have jumped massively as international crude prices have spiraled — India is heavily dependent on imported natural gas. Santosh Devi says she cannot afford to buy cooking gas cylinders as food prices also soar. (Anjana Pasricha/VOA) The soaring costs pose a challenge to the ambitious program that aimed to tackle the severe health challenges caused by indoor air pollution. Along with building toilets and homes for the rural poor, it was one of the flagship programs of Prime Minister Narendra Modi’s government meant to dramatically improve the lives of poor households in the countryside.
The government subsidies had given more than 80 million rural households access to a clean energy source for cooking until last year, according to government figures. Poonam Devi does most of her cooking on a stove lit with woodfire though she has a cooking gas connection. (Anjana Pasricha/VOA) But Poonam Devi, a resident of Sarmathla, said she uses it sparingly.
“I only cook vegetables on gas but I make everything else on a wood fire,” said Devi as she rolled out Indian bread for the family of seven. “Sometimes I use it when guests come.”
Experts worry that this will set back efforts to address the severe health problems caused by toxic kitchen fumes. While this village depends mostly on firewood, cow dung and agricultural waste are other traditional sources for cooking in India’s vast rural areas.
“The indoor air pollution caused by these solid fuels is equivalent to a person smoking a significant number of cigarettes continuously at the same time,” said Abhishek Jain, director of Powering Livelihoods at the Council on Energy, Environment and Water in New Delhi.
Calling it one of India’s biggest public health challenges, Jain said, “Broad estimates suggest that India loses half a million of its population every year prematurely because of indoor air pollution. That is the scale of the problem we are dealing with.”
The women in this village know the health consequences of the sooty flames only too well.
“I cough and I get congestion and breathing problems due the cooking. So I try to cook on gas when I can,” said Paramwati, a Sarmathla resident whose tiny kitchen traps the fumes. Saramthala village in North India. (Anjana Pasricha/VOA) It is not just poor households that have been affected — even better-off families in this village, who do not benefit from government subsidies, are struggling to cope with the high prices of cooking gas.
“I have to think many times before I can refill this cylinder. I can only do it when I manage to save $13 or I have to wait until my husband gets his salary,” said Manju Chhoker.
That feeling is widely echoed across the village. “It is a huge challenge to cope with inflation and the high prices of gas. When it is time to refill the gas cylinder, I get really worried,” said another resident, Satya Prakash Rajput.
According to studies, the number of households using clean energy as the primary fuel for cooking rose exponentially from about 30 percent to nearly 70 percent between 2011 and 2020. Those gains are now under threat, say experts, as affordability emerges as a huge barrier.
“At the very least this has stalled the progress, at worst this has reversed some of the progress,” says Jain. “So, unless prices would get more affordable through either subsidy support by the government or a decrease in international prices, households may not now shift to liquified petroleum gas for most of their cooking.”
That means women in Sarmathla village may have to continue to lug firewood and cope with the fumes in their kitchens to light their stoves. | Global Health |
Scientists Map the Evolution of Our “Little Brain”
Don’t underestimate the role of the cerebellum in human evolution.
Complete the form below to unlock access to ALL audio articles.
Expansion of the neocortex
The neocortex is the largest and youngest part of the mammalian brain. Human beings’ higher cognitive abilities have long been attributed to the evolution of the neocortex, but a new study suggests we shouldn’t neglect the role of the “little brain” – the cerebellum.
A collaborative team of scientists has explored and mapped the cellular landscape of the cerebellum. “Although the cerebellum, a structure at the back of the skull, contains about 80% of all neurons in the whole human brain, this was long considered a brain region with a rather simple cellular architecture,” explains Professor Henrik Kaessmann, research group leader in the Center for Molecular Biology at Heidelberg University, and the study’s lead author.
Novel technologies such as single-cell sequencing are enabling scientists to map the heterogeneity of cells within tissues. Recent work analyzing the mammalian brain has implied that the cerebellum’s structure might not be so “simple” after all, a notion that is emphasized by Kaessmann and colleagues’ new study published in Nature.
Tracing the evolution of the cerebellum using single-cell sequencing
“In this study, we generated single-nucleus RNA-sequencing data for ~400,000 cells to trace cerebellum development from early neurogenesis to adulthood in human, mouse and the marsupial opossum,” Kaessmann and colleagues describe.
What is RNA sequencing, and why is it used?
RNA-sequencing is a technique that analyzes the quantity and sequences of RNA within a sample, using next-generation sequencing (NGS) approaches. Applying RNA-seq to single cells can identify which genes are “turned on” or “turned off” in a specific cell, creating a clearer picture of the different types of cells and their encoded functions within a sample.
“We established a consensus classification of the cellular diversity in the developing mammalian cerebellum and validated it by spatial mapping in the fetal human cerebellum,” the researchers add.
Human cerebellum has a higher number of Purkinje cells
The human cerebellum comprises a large number of Purkinje cells. Named after the Czech anatomist Jan Evangelista Purkyně – who described them in the 19th century – these cells are large neurons with complex functions in the cerebellum. In the early stages of fetal development, the human cerebellum has almost double the amount of Purkinje cells than mouse and possum brains.
Kaessman and colleagues observed an increase in a particular subtype of Purkinje cell that is created first during development. “It stands to reason that the expansion of these specific types of Purkinje cells during human evolution supports higher cognitive functions in humans,” explains Dr. Mari Sepp, a postdoctoral student in Kaessmann’s lab.
A need to consider alternative animal models in biomedical research
The researchers compared gene expression profiles across the cerebellum cells from humans, mice and the opossum, identifying specific activity programs that have been conserved across species for ~160 million years of evolution. The data implies that these expression patterns – and the cellular programs that underpin them – are key for determining the cell type identities within the mammalian cerebellum.
“However, we also identified many orthologous genes that gained or lost expression in cerebellar neural cell types in one of the species, or evolved new expression trajectories during neuronal differentiation, indicating widespread gene repurposing at the cell type level,” Kaessmann and colleagues say.
“At the level of cell types, it happens fairly frequently that genes obtain new activity profiles,” says Dr. Kevin Leiss, a former doctoral student in Kaessmann’s lab. “This means that ancestral genes, present in all mammals, become active in new cell types during evolution, potentially changing the properties of these cells.”
Several of the gene activity profiles that varied between human and mouse cerebellum samples have been linked to childhood brain cancers and neurodevelopmental disorders. Professor Stefan Pfister, director at the Hopp Children’s Cancer Center Heidelberg and co-author of the study, emphasizes the need to consider a wider variety of models when studying human diseases.
Reference: Sepp M, Leiss K, Murat F, et al. Cellular development and evolution of the mammalian cerebellum. Nature. 2023. doi: 10.1038/s41586-023-06884-x
This article is a rework of a press release issued by Heidelberg University. Material has been edited for length and content. | Disease Research |
After conducting the first scoping review of its kind, researchers at the University of Colorado Anschutz Medical Campus have developed an evidence based interactive mapping tool to assist policymakers as they consider regulating the concentration of THC in cannabis products and as more potent products move into the marketplace.
Their review, funded by the State of Colorado, was released today in the American Journal of Public Health (AJPH).
“We looked at studies that measured adverse or beneficial effects of high concentration cannabis products. From that, we were able to produce an open access, interactive map of the evidence so that anyone looking for research on it can find what is available,” said Lisa Bero, PhD, chief scientist for the Center for Bioethics and Humanities and research professor for the Colorado School of Public Health. “During the review we also discovered that research on cannabis is out of sync with the higher concentrations found in today’s products.”
The review notes that while smoking cannabis has been declining, routes of administration that use higher-concentration THC, such as vaping and dabbing, have been increasing, as well as the THC concentration of smoked products.
As of February 2023, 37 states allowed medical cannabis, and 19 states had legalized recreational cannabis, providing access to these more potent products. Several states have begun to regulate the amount of THC in them due to the risk of harmful effects, but lawmakers have been eager for more accurate and easily accessible data to write appropriate legislation.
“Our map is a public health good that can be used to find the studies that have been done on high concentration cannabis products. For example, they could look for all studies that have been conducted on mental health outcomes,” Bero said.
The map includes 452 studies that meets three criteria: studies involving humans; highly concentrated cannabis exposure; and any health outcomes regardless of whether they were classified as beneficial or adverse.
“While many of these studies need to be expanded to keep up with current trends, it opens up a conversation that could lead to broader research and collaboration between medical experts and state governments as well as close the knowledge gaps about these products,” Bero said. | Drug Discoveries |
The Food and Drug Administration on Thursday approved the nation’s first over-the-counter birth control pill, clearing the way for women and girls to purchase contraceptive medication in the United States without a prescription.
Opill, a once-a-day pill developed by Perrigo, will be moved from behind the pharmacy counter and into drug store aisles some time next year. The Ireland-based company said it would outline pricing and distribution plans in the near future, but noted there will be no age restrictions on sales.
Hormone pills have long been the most common form of birth control in the U.S. since the early 1960s. Despite their popularity — and availability in drug stores in 100 other countries around the world — all of them have required a prescription up until now.
“It’s been around a long time and we have a large amount of data supporting that this pill is safe and effective for over-the-counter use,” said Kelly Blanchard, president of Ibis Reproductive Health, a non-profit group that supported the approval.
While newer birth control pills typically combine two hormones, estrogen and progestin, which can help make periods lighter and more regular, Opill only relies on progestin. It prevents pregnancy by blocking sperm from reaching the cervix and does not come with the same risks associated with the combo pills, such as blood clotting. Current contraceptives are also considered less safe for women at risk of heart problems, including those who smoke and are over 35.
Other women, particularly women and girls of color and those with low incomes, have reported facing significant hurdles in both obtaining prescriptions and safely picking up the pill. Some reported they are unable to set up or afford doctors visits while others said they struggled to take off time from work or school.
“Nonprescription availability of Opill may reduce barriers to access by allowing individuals to obtain an oral contraceptive without the need to first see a health care provider,” the FDA said in a statement issued after Opill’s approval. “Almost half of the 6.1 million pregnancies in the U.S. each year are unintended.”
Perrigo hailed the FDA action as a “milestone” and a “giant leap for women’s empowerment " in a statement to CNN. It added that the company is dedicated to making the pill “accessible and affordable to women and people of all ages.”
The approval also marks a major win for medical experts — including the American Medical Association and the American College of Obstetricians and Gynecologists — which have been pushing for years for an over-the-counter birth control pill. It also comes just more than a year after the Supreme Court’s conservative majority voted to overturn Roe v. Wade, effectively erasing a reproductive right that has been in place for decades.
While Perrigo’s FDA application began years before the Supreme Court decision, the FDA has faced increasing pressure from Democratic politicians, women’s health advocates and medical professionals to ease access to birth control.
With News Wire Services | Drug Discoveries |
As a registered nurse in Colorado, Jennifer Harlan cares for cardiac patients for a living — but in the past five years, she herself has survived three heart attacks.
Last week, Harlan, 53, had the opportunity to meet with the EMS crew who saved her life at HCA Healthcare’s Sky Ridge Medical Center in Denver, Colorado.
"I cannot thank them enough — they are the reason I am here today," she said.
Harlan revealed the details of her heart health journey — along with her prevention tips — to Fox News Digital.
Her first heart attack was in February 2018, when she was just 47 years old, she said.
"I woke up in the middle of the night with distinct symptoms of a heart attack — shooting pain down my left arm, sweating, pale, nauseous," she said.
Harlan went to the emergency department and spent the following night in the hospital, but her tests came back normal — so she was discharged.
"The symptoms returned two days later, but I ignored them, convinced there was no way I was having a heart attack," Harlan said. "By the time I was seen by a cardiologist – three days after the symptoms returned – I had lost blood flow to a large portion of my heart."
Harlan’s left anterior descending artery (LAD) — which is the largest coronary artery that carries blood to the heart — had dissected, clotted and formed scar tissue.
"I had lost 30% of my heart function," she said.
The official diagnosis was SCAD, or spontaneous coronary artery dissection, which is a rare heart condition that happens suddenly with no apparent warning or prior risk factors.
The next occurrence was nearly three years later, in October 2021. Harlan was at work when she felt the same symptoms as with her first heart attack.
"I got immediately to the emergency department, and was diagnosed with a second occurrence of SCAD, this time affecting two different arteries," she told Fox News Digital. "But because I got help quickly, the damage was minimal."
Nearly two years later, in August 2023, Harlan had her most recent episode.
"I again woke up in the middle of the night with the same symptoms and went to the emergency department," she said. "As my symptoms had resolved and my tests were all normal, I was eventually discharged."
Later that night, while watching TV on the couch, Harlan’s husband looked over and saw that she was unconscious and starting to turn blue.
"He pulled me onto the floor, called 911 and immediately started CPR," Harlan said. "I was in full cardiac arrest."
When first responders arrived at Harlan’s house, "I was shocked twice before I got a heartbeat back," she said.
"They transported me to the hospital, where I lost my pulse again and was shocked again. I ended up intubated and with a chest tube."
Harlan spent five days in the ICU.
"This entire experience has taught me that you never know what tomorrow could bring."
After the doctors discovered that she had yet another tear in a small artery that had caused a clot, Harlan received an implanted defibrillator/pacemaker.
She also had several broken ribs and a broken sternum as a result of the CPR.
"That was the most difficult part of my recovery, and it took several weeks for everything to heal," she said. "Additionally, when you get a pacemaker placed, you have very limited mobility in your left arm for several weeks while the pacemaker heals in place."
Harlan was treated at the same hospital where she works — HCA Healthcare’s Sky Ridge Medical Center, a level 2 trauma center.
"We were so honored to care for our colleague as a member of our own family," said David Welcom, director of cardiovascular services at the hospital.
"Our Sky Ridge cardiovascular team is available 24/7 to ensure that we provide that same level of care for our community when minutes make a difference."
What to know about SCAD
Harlan’s condition, SCAD, has no known cause or risk factors.
Most patients who have the condition are women in their 40s and 50s who are otherwise healthy, according to the American Heart Association (AHA).
While there is no specific known cause, "scientists think it’s likely that multiple factors may cause SCAD, such as abnormalities in the arteries, genetics, hormonal influences or inflammatory issues," the AHA’s website states.
External stressors could also elevate risk.
"I just try to live each day with gratitude that three times now, I’ve been given another chance, and I’m trying to be worthy of that gift."
"I have always led a healthy lifestyle," Harlan told Fox News Digital. "I eat well and love to exercise. Yoga and spinning are my favorites."
She went on, "That’s the challenging part — I have no risk factors for heart disease. I’ve got low blood pressure and low cholesterol. Nobody saw this coming."
Harlan doesn’t have any limitations as to what she can and can’t do. Her cardiologist encourages her to be as active as she wants, she said.
She's now made a full recovery and is back to doing yoga and walking for exercise.
Looking ahead, Harlan said she isn’t too worried about future heart attacks.
"I never thought I would have a third occurrence of SCAD — that’s practically unheard of — so, I’d like to think I’m good," she said.
Having the internal defibrillator also adds a level of security.
"If I were to go into cardiac arrest again, the defibrillator would shock me back into a normal rhythm within two minutes," she noted. "That for sure helps me and my husband sleep better at night."
Harlan also received an echocardiogram during her last hospital visit, which showed that her heart had fully regained the 30% that was lost in the first heart attack.
Her next echocardiogram is scheduled for March.
Being a patient gave Harlan a different perspective on how to care for others, she said.
"It’s not enough to just be a strong, intelligent clinical nurse," she said. "You also have to understand all the anxiety that comes with being a patient in the hospital — the unknown and unfamiliar, the worry about what the diagnosis is, the sudden lack of control you have over your most basic functions."
"The longer you wait to seek help for things like heart attack and stroke, the more likely you are to have permanent damage and loss of function."
The nurse believes that the hospital experience was most likely easier for her because she’s familiar with the clinical setting.
"I know the equipment and the tests and the lingo," Harlan said. "For someone who’s never been in the hospital before, it can be very uncomfortable."
Lessons learned
"This entire experience has taught me that you never know what tomorrow could bring," Harlan said.
"I’m not going to live my life in fear, because there’s nothing I can do to prevent another occurrence," she added. "I just try to live each day with gratitude that three times now, I’ve been given another chance, and I’m trying to be worthy of that gift."
While SCAD may have no known risk factors or prevention methods, Harlan said it’s essential for people to pay close attention to the systems.
"Listen to your gut," she advised. "Even if you think you couldn’t possibly be having a heart attack, you can. Get to the hospital and get yourself checked out."
In health care, Harlan said, a common mantra is "time is tissue."
So "the longer you wait to seek help for things like heart attack and stroke, the more likely you are to have permanent damage and loss of function," the nurse said.
"It’s better to go to the emergency department and get diagnosed with indigestion than to talk yourself out of what could be a very serious condition."
Warning signs of SCAD include chest pain or pressure, shortness of breath, and profuse sweating and dizziness, the AHA noted.
Harlan also stressed the importance of getting CPR training.
Immediate CPR can double or triple the chances of someone surviving a heart attack, according to the AHA.
Michael Miller, with South Metro Fire Rescue, was one of the EMS crew members who treated Harlan and was reunited with her last week.
"I would advise everyone to go and get CPR training before anything like this happens," added Miller, according to a local report from CBS Colorado.
"I’m alive today because my husband was trained in CPR and started chest compressions on me almost immediately," Harlan said. "You never know when this could happen to a total stranger, or to someone you love."
She added, "Get trained and save a life." | Women’s Health |
In March 2010, approximately 800 people gathered in Ankeny, Iowa, for a public event hosted by the Departments of Justice (DOJ) and Agriculture (USDA) on competition in agriculture. The meeting followed an outpouring of 15,000 public comments on the topic of consolidation in the seed, livestock, dairy, poultry and food retail industries. At the event, a Missouri farmer stood up and declared, “We’ve waited a long time for justice in the heartland.” There were yips and claps. The energy in the room felt earnest given the questions at hand — for one, who controls the seed market, the foundation of our food supply? In total, the agencies hosted five of these “workshops” across the U.S. that year. Farmers, ranchers, farm advocacy organizations, businesses and consumers showed up in large numbers to listen and provide testimony reflecting their plight: skyrocketing input prices, fewer options in the marketplace, as well as egregious production and licensing contracts. The events were historic, lending to confidence that change was on the horizon. But the hope was short-lived. The public’s investment — in the form of tax dollars, time and courage — resulted in no meaningful action, most notably in the seed trade,one of the most concentrated and privatized industries in agriculture. In the decade that followed, market consolidation only worsened. Today, four transnational firms control more than 60 percent of the global commercial seed market, a concentration ratio that far exceeds the benchmark for healthy competition as established by agricultural economists. Now, with renewed focus on competition concerns in the seed industry, American farmers are once again asking themselves if they should be speaking up to bring fairness back to their fields. Three months ago, the U.S. Department of Agriculture launched an inquiry asking for public comments on competition concerns in the seed industry as they relate to intellectual property rights (IPR). The agency is examining impacts on farmers, plant breeders, independent seed companies, tribal members and other historically underserved growers, as well as society at large. This inquiry stems from President Biden’s July 2021 executive order on promoting competition across the American economy. The comment deadline closes on June 15. That this inquiry was initiated by the executive office is notable, but even more remarkable is the primary focus on seed. A targeted examination of the seed trade through a combined antitrust and IPR lens is long overdue, and we applaud the administration for shining light on this connection. Understanding the tension between antitrust and IP laws is especially relevant to seed. While other agricultural sectors, such as agrochemicals and fertilizers, could also be described as an oligopoly, seed is unique from every other input market: it is a living resource. Seeds are not manufactured in a facility but represent generations of natural evolution both alongside and in absence of human intervention. In this way, grower decisions pertaining to seed are not only economical, but also ethical and cultural. The cultural heritage of our seed supply makes ownership claims via IPR that much more fraught when considering the history of appropriation (stolen land and seeds), not to mention the original intent of IPR laws. As the seed trade continues to consolidate, the diversity of seed in the marketplace decreases. Simultaneously, the pool of plant genetics (“germplasm”) available to plant breeders is receding due to highly restrictive forms of IPR, especially utility patents awarded under the U.S. Patent Act — “patents for invention.” A single patent can cover the plant, seed, future generations, genetic traits, crosses with other varieties and the methods used to produce it. Owners of utility patents, therefore, have far-reaching control over access and use of their protected seed and commonly restrict breeding, research, and seed saving — the very practice that established the diversity of domesticated crops we enjoy today. Hundreds of farmers have been sued for saving patented seed, resulting in million-dollar judgments and bankruptcy. In other words, the entities controlling much of the seed supply are limiting competition from angles beyond their foothold of power in the retail marketplace. You cannot compete in product development if you cannot access the parts. Meanwhile, the Biden administration and Congress have all the parts they need to effect meaningful policy change. Antitrust laws can be enhanced and more strongly enforced, while IPR laws and policies can return to their original intent of incentivizing innovation, not the monopolization of markets. Denying patents on products of nature is also critical. In fact, it was never Congress’s intent to award utility patents for plants. Congress long argued that sexually reproducing plants should not be awarded utility patents for fear of curtailing innovation, threatening the free exchange of genetic resources and increasing market concentration. A 1966 congressional committee report confirms that while its members “acknowledge the valuable contribution of plant and seed breeders, it does not consider the patent system the proper vehicle for the protection of such subject matter.” These conversations led to the passing of the 1970 Plant Variety Protection (PVP) Act. A PVP certificate is not a patent but provides exclusive marketing rights for 20 years to plant breeders for their new varieties. Congress was very deliberate when including two exemptions that protect competition and future innovation. The law requires these varieties to remain accessible for breeding purposes and protects a grower’s right to save PVP-protected seed for re-planting on their own farm. The law served as a compromise between those who wanted full ownership rights of plant varieties and genetics and those who wanted all plant varieties to remain fully accessible without restrictions on breeding, growing or distribution. Everything changed with a Supreme Court decision in 1980, when a five-to-four decision allowed a patent on an “artificially constructed” microorganism. The effect of this decision (and others that followed) has been a Patent and Trademark Office that now views some products of nature as human-made sums of parts, opening the floodgate to patents on seeds, plants and genetic traits. Had the court honored the congressional record on this topic, farmers would be operating within a very different seed system. It’s not too late to change course. The Biden administration can align itself with and support American farmers who are still waiting for justice. There is an urgent need to sow fairness back into our laws and policies as they relate to seed. The administration would be wise to choose that path. Kiki Hubbard is the director of advocacy and communications for Organic Seed Alliance, working toward organic seed systems that are democratic, just as well as support human and environmental health. | Health Policy |
Children’s doctors are calling for an outright ban on disposable vapes to reduce their popularity among young people as the long-term impact on lungs, hearts and brains remains unknown.
The government should ban single-use disposable vapes, which can be bought for just £1.99 and are most popular with young people, the Royal College of Paediatrics and Child Health has said.
This would reduce their environmental impact and discourage children who have never smoked from taking up vaping and risking long-term addiction and lung damage.
Dr Mike McKean, the RCPH vice-president and a paediatric respiratory consultant, said the college had made a “very carefully considered call”, reflecting concerns from its members about the “epidemic” of child vaping, the limited research into the longer-term health impacts, and the small but growing numbers of children with respiratory problems.
“It took decades to understand relationship of cigarette smoking to cancer and respiratory illnesses – my worry is we could be sleepwalking into a similar situation here,” McKean said.
“If you know about lung development, you know that if you inhale potentially noxious, volatile substances there is a huge potential for an inflammatory reaction that could have a minor or a major effect. There is lots of evidence it causes significant coughing and breathlessness. We’re not seeing lots of highly damaged lungs yet, but there are cases reported where the inflammatory response is overwhelming and causes permanent scarring.”
While he though Australia’s approach, where vapes are only available on prescription,
might overburden the NHS, he said England’s permissive approach was “out of step” with neighbouring countries such as Scotland, France, Germany, and Ireland. So far, England has banned free vape samples for under-18s and may prohibit colourful packaging and flavour names that target younger people.
Ministers have the power to “easily” ban disposable vapes, he said, and he hopes they would respond “as fast as possible” to its call for evidence on youth vaping, which closes on 6 June, to avoid the problem getting kicked into the political long grass ahead of the next general election. “If you’re 12 and starting to vape regularly we can’t wait for that 12-year-old to be 13 or 14, we need action now.”
He added he thought there was a “moral imperative” to prevent companies from profiting from long-term addictions by targeting children with colourful packaging and fruity flavours.
The ban would also reduce the environmental harm caused by e-cigarettes, which waste lithium needed for batteries to power electric cars and increase plastic waste, as 1.3 million vapes are thrown away every week in the UK.
The latest NHS Digital data shows that the number of young people vaping is rapidly growing to reach one in five 15-year-olds in 2021, and figures are expected to be significantly higher this year. Action on Smoking and Healthdata also shows that experimental use of e-cigarettes among 11-to-17-year-olds is up 50% on last year.
A Department of Health and Social Care spokesperson said: “It is illegal to sell nicotine vapes to children and we are concerned about the recent rises in youth vaping – particularly because of the unknown long-term harms.
“We are taking bold action to crack down on youth vaping through the £3m illicit vapes enforcement squad to tackle underage sales to children. We have also launched a call for evidence to identify opportunities to reduce the number of children accessing and using vape products and explore where the government can go further.” | Epidemics & Outbreaks |
Clinical depression is considered one of the most treatable mood disorders, but neither the condition nor the drugs used against it are fully understood. First-line SSRI treatments (selective serotonin reuptake inhibitors) likely free up more of the neurotransmitter serotonin to improve communication between neurons. But the question of how SSRIs enduringly change a person’s mood has never returned completely satisfying answers.In fact, SSRIs often don’t work. Scientists estimate that over 30 percent of patients don’t benefit from this class of antidepressants. And even when they do, the mood effects of SSRIs take several weeks to kick in, although chemically, they achieve their goal within a day or two. (SSRIs raise the levels of serotonin in the brain by blocking a “transporter” protein that decreases serotonin levels.) “It's really been a puzzle to many people: Why this long time?” says Gitte Knudsen, a neurobiologist and neurologist at the University of Copenhagen, Denmark. “You take an antibiotic and it starts working immediately. That's not been the case with the SSRIs.”Experts have proposed theories about what causes the delay, but to Knudsen, the most compelling involve our brains’ ability to physically readjust over time: a characteristic called neuroplasticity. In adulthood, brains rarely create new neurons, but they do sprout new interconnections between existing ones, called synapses. Essentially, they adapt by rewiring. “That's exactly what happens when we exercise and learn something,” Knudsen says. This transformation improves cognitive function and emotional processing. Knudsen thinks rewiring could also break someone free from cycles of negative rumination—a hallmark of depressive episodes.Knudsen believes that SSRIs owe their efficacy at least in part to boosting neuroplasticity. Writing in Molecular Psychiatry earlier this month, her team showed how they had tested this theory on people, thanks to a special kind of PET scan developed in the past few years. They recruited 32 people to take the SSRI escitalopram (also known by the brand name Lexapro) or a placebo for one month. Then they asked the people to take a PET scan at the end of the trial, and used radioactive tracers to track where in the brain new synapses were forming.The more time someone spent on the antidepressant before their brain scan, the more synaptic signals the team detected—a proxy for increased connections. “This is one of the first pieces of evidence that these drugs do take time to work, and they do work through increasing the number of synaptic contacts between nerve cells,” Knudsen says.The finding suggests that SSRIs improve neuroplasticity during the first weeks or months of treatments, and that neuroplasticity contributes to the drugs’ benefit—and to the delay before users feel better. “It has been a paradox,” says Jonathan Roiser, a cognitive neuroscientist at University College London who was not involved in the work. Because the drugs’ chemical effects happen on a scale of days, he says, “there needed to be this extra bit of explanation about why the mood change does not happen immediately.”“This is really important not just for general scientific understanding, but for actually improving our ability to treat patients,” says Camilla Nord, a cognitive neuroscientist at the University of Cambridge in the UK, who was not part of Knudsen’s team. “This could help us target the treatment at particular subgroups of patients—or maybe help us understand why it doesn't work in some people.”Since SSRIs were invented about 40 years ago, neuroscientists and psychologists have wanted to know exactly how they work. Studies clarified serotonin’s role about 20 years ago by proving that when serotonin levels rise, the brain veers away from negative biases in processing emotions. But these momentary changes in perception aren’t enough to relieve symptoms. “You need a cumulative exposure to a more positive input over time to break out of the depressive state,” says Roiser. “Previously, this had been the end of the explanation.”One theory for why there’s a lag between the start of SSRI treatment and mood change is that the brain takes weeks to recalibrate serotonin levels. Think of it as a feedback system: Initially, after an SSRI spikes a person’s serotonin levels, their brain responds by pumping the brakes on producing the neurotransmitter. Instead of maintaining a boost, their serotonin levels fall again. “It's like a thermostat,” Knudsen says. It takes a while before the brain adjusts.“It is a fairly simplistic explanation that has helped doctors try to explain to patients why it takes time and what these drugs do,” Knudsen says. But, as a neurologist hoping to improve treatment, Knudsen wasn’t satisfied with this answer, partly because studies in rats suggested that a more complicated story was unfolding. These studies showed that in female rats given daily doses of SSRIs, new synapses formed in their visual cortex and hippocampus, brain areas linked to learning and memory. This indicated that SSRIs induce neuroplasticity.But until about seven years ago, scientists couldn’t replicate these studies in humans, since there was no way to measure synaptic density without cutting out brain tissue. Then in 2016, researchers developed a way to detect synaptic activity in live human brains during PET scans. These scans detect light emitted by radioactive “labels” designed to stick to specific proteins. The patient receives an injection of these radioactive markers, which diffuse to the target proteins in the brain. The scan reveals a map of where exactly those proteins are.Scientists quickly began using the PET method to study disorders like Alzheimer’s and schizophrenia, convincing Knudsen of its power for mental health studies. So her team organized a double-blind, randomized clinical trial in which healthy participants would receive a standard 20-milligram SSRI or a placebo daily. After three to five weeks, the team would collect PET scans of the synapses in each person’s neocortex and hippocampus. In this case, the labels were designed to stick to a protein at the connection between neurons. Tracing them would map out the brain’s synapses, allowing scientists to measure synaptic density.Their hypothesis was simple: The participants who took the drug instead of the placebo would show more synaptic density. That hypothesis was wrong.“At first glance, it seemed slightly disappointing,” Knudsen says. There was no significant difference between synapses in the drug and placebo cohorts. But an imperfection in the study became its life raft. For logistical reasons, each person’s PET scan varied from 24 to 35 days after their first drug dose. This introduced a new variable into the experiment—duration—and it let the researchers perform a new analysis.“It was only when we started to look closer at the timing that we could see they had an increase,” Knudsen says. Participants who spent longer on the drug had more synapses than those who spent less time. And for those on the placebo, timing didn’t matter whatsoever. Knudsen thinks this means that these synaptic changes accumulate during the weeks it takes for SSRIs to ramp up.Nord says that the Danish team’s biological explanation nicely complements the psychological theory that augmenting positive emotions has a cumulative effect on mood. “The two explanations are compatible,” says Nord, whose book The Balanced Brain: The Science of Mental Health was released in September. “They’re explaining it at different levels.”“It's a different perspective to what's come before,” agrees Roiser. “It gives the additional weight to this idea that you need the cumulative changes over time in order to shift the environment to be more positive, which can then explain how people are then going to recover from depression.”Neuroplasticity may be an antidote to the distressing recurring thoughts that are often present in depression. “It's almost as if the brain is fixed in an unhealthy pattern that is reinforcing itself,” Knudsen says. If rumination reinforces negative thinking, then forming new connections offers a way out, she says, “like having a reset button that makes you think differently.”But Mark Rasenick, a neuroscientist at the University of Illinois Chicago, hesitates to draw broad conclusions based on how the healthy individuals in Knudsen’s study responded to SSRIs. Antidepressants affect mood more in a depressed person, he says: “What do they do to healthy people? The answer is not much.”Knudsen agrees that healthy participants may respond less to the neuroplastic effects than people diagnosed with clinical depression, and she says that the project’s next phase, including participants with depression, is ongoing.Rasenick imagines a PET study of only depressed patients, all receiving the same SSRI for the first time. Some participants won’t benefit from the drug, so this setup could compare neuroplasticity in those who benefit versus those who don’t.In 2016, Rasenick’s team proposed another biological explanation for why the effects of antidepressants lag, when they observed that SSRIs gradually accumulate in the membrane of certain brain cells in rats. They may not have an effect until they build up to a critical level. Based on a pilot study Rasenick published last year, this facet of SSRI action may one day allow doctors to use blood tests to quickly measure whether a patient is responding to the drugs. Still, Rasenick believes that neuroplasticity is an important factor too. “To have the evidence from living human brains is critical,” he says.PET scans are becoming an unparalleled resource for measuring wiring in human brains. “It's very rare to have the ability to do an experiment like this,” Nord says. “They're giving us a quite unusual window into the processes that are happening in this treatment.” Knudsen’s team has also used them to investigate psilocybin’s effects, and another team has studied ketamine’s. “What this paper is really showing is that you can detect these new connections being formed,” Roiser adds.The problem is, PET scans and radioactive labels cost researchers thousands of dollars per participant. (About $4,500 per scan in this study, according to Knudsen.) Yet the benefits might pay off if they improve treatment. Nearly one in five adults in the United States have been diagnosed with clinical depression, making it “a major contributor to mortality, morbidity, disability, and economic costs,” according to the CDC.Rosier says this new study suggests it could be beneficial to speed up synapse formation, perhaps with an accelerant drug that could complement SSRIs. “One can imagine encouraging these neuroplastic changes during antidepressant treatment, maybe making them happen faster,” Roiser says. That could help the many people who spend months trying drugs to find the one that works. But there’s still much to uncover about why depression varies from person to person, and how to predict the best treatment. (A fast-acting antidepressant that acts on the neurotransmitter GABA instead of serotonin recently earned approval to treat postpartum depression, but not for general depression.)Knudsen likens treating depression to treating a fever. Antibiotics can’t kill every kind of bacterial infection, and they do nothing if the fever is caused by a virus. So doctors have to know the exact cause of the fever if they want to be confident about the medication they give. Neuroscientists yearn for the same grasp of the biological causes of depression. “To expect that the same kind of medication would be helpful for all patients with depression is perhaps a bit naive,” Knudsen says. “It makes a whole lot of sense to rethink what depression really is and how it should be treated.” | Mental Health Treatments |
The psychedelic drug MDMA can reduce symptoms of post-traumatic stress disorder, researchers reported in a new study published Thursday.
The company sponsoring the research said it plans later this year to seek U.S. approval to market the drug, also known as ecstasy, as a PTSD treatment when combined with talk therapy.
“It’s the first innovation in PTSD treatment in more than two decades. And it’s significant because I think it will also open up other innovation,” said Amy Emerson, CEO of MAPS Public Benefit Corporation, the research sponsor.
Earlier this year, Australia became the first country to allow psychiatrists to prescribe MDMA and psilocybin, the psychoactive ingredient in psychedelic mushrooms. The drugs are gaining wider cultural acceptance in the U.S. in part because of efforts by the nonprofit advocacy group Multidisciplinary Association for Psychedelic Studies.
For the new study, researchers measured symptoms in 104 people with PTSD who were randomly assigned to get either MDMA or a dummy pill during three sessions, one month apart. Both groups received talk therapy.
Common side effects in the MDMA group were muscle tightness, nausea, decreased appetite and sweating. But only one person in the MDMA group dropped out of the study.
After treatment, 86% of the MDMA group improved on a standard PTSD assessment compared to 69% of the placebo group. The assessment measures symptoms such as nightmares, flashbacks and insomnia.
By the study's end, 72% of people in the MDMA group no longer met the diagnostic criteria for PTSD, compared to about 48% of the placebo group.
“The results that they got are very exciting,” said Barbara Rothbaum, who directs the Emory Healthcare Veterans Program in Atlanta. She was not involved in the research, which was published in the journal Nature Medicine.
PTSD also can be treated with other medications or talk therapy.
“They are very effective, but nothing is 100% effective,” Rothbaum said. “So we absolutely need more options for treatment.”
Before MDMA could be prescribed in the U.S., the Food and Drug Administration would need to approve it and the Drug Enforcement Administration would need to change its classification. MDMA is currently classified as Schedule 1, on par with heroin and deemed to have “no currently accepted medical use and a high potential for abuse.”
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. | Mental Health Treatments |
A mom whose 19-yr-old died by suicide has a vital message for parents about marijuana today
"You may be thinking, 'C'mon, Laura, it's no big deal – it's just pot.' 'Pot's legal, so it must be safe.'"
Laura Stack's son Johnny lost his life to suicide three months ago when he was just 19 years old. Though she says the grief of his death is "still fresh," Stack took to Facebook to share something that happened three days before Johnny died, hoping it will help other parents whose kids may be at risk.
She wrote:
"On Sunday, November 17, 2019 around 5:30 PM, he came over for dinner. He lived in our condo a couple miles down the street and would often pop in for a home-cooked meal. This evening, he was a bit agitated but lucid. 'I need to tell you that you were right,' he told me. 'Right about what?' I asked. 'Right about the marijuana and the drugs. You told me weed and drugs would hurt my brain, and it's ruined my mind and my life. You were right all along. I'm sorry, and I love you.' He died by suicide three days later.
Stack explained that Johnny had "dabbed" since he was 15 or 16. "Do you understand the difference between smoking pot (and some edibles) and dabbing high-THC wax, shatter, or butter?" she asked. "Most of my friends look at me blankly when I say these words and say, 'I've never even heard about this.' If you don't know what cannabis extracts are, and you have children, grandchildren, sisters, brothers, nieces and nephews between the ages of 14 and 24, PLEASE keep reading."
"I am NOT talking about those of you who are supporters of legal recreational marijuana for adults over 21 years old—it's your life—do what you want," Stack clarified. "I know some people who take it successfully for specific medical purposes, so please don't write comments in my post about my personal experience. I'm specifically talking about illegal usage by children and young adults under 21, whose adolescent brains are still forming. You may be thinking, 'C'mon, Laura, it's no big deal – it's just pot.' 'Pot's legal, so it must be safe.' Or 'I did pot when I was a kid, too, and look, it didn't hurt me.'
Well, have you recently studied TODAY'S pot, and have you personally seen its effects on your children like I have?"
Stack explained why today's recreational cannabis is so different:
"First, the tetrahydrocannabinol (THC), a crystalline compound that is the main active ingredient of cannabis that gives the 'high,' is extracted out of the cannabis so that it's nearly pure. THC is the principal psychoactive constituent of cannabis. Then a butane torch is used to heat the crystals (similar to beeswax) or oil in a 'rig' (just google it), or a vaping device with a heating element called a dab pen can be used. Forget the 'grass' or 'papers' that were rolled in the 70s and 80s. The pot we grew up with (10% or less THC content) is HUGELY different than today's high-concentrate extracts (often 80% THC content or higher)."
She also explained why young people tend to be affected more by these high THC concentrations, and that the earlier they start the more likely it is that they'll develop a disorder.
"The brain is still developing through a person's 20s, and psychotic disorders typically develop in the late teenage years. During brain formation, heavy cannabis use has been shown to have a negative effect on the formation of neural pathways. It can also lead to heavier drug use. While the vast majority of marijuana smokers never experience CIP, researchers have found that the earlier and heavier someone starts dabbing, the more likely it is that they will develop a disorder at some point (often years later). We must educate our children when they are young (10-12 years old) and use hyper-vigilance in the early teen years, which we found was much easier before the age of 16, when they could drive. We couldn't lock him up or monitor him 24/7. Keep talking and keep trying!!
The harmful combination of a still-forming mind, high-potency THC products, and a high frequency of use = Cannabis-Induced Psychosis. Yes, that's a real diagnosis (or High-THC Abuse – Severe). Repeated CIP incidents can trigger schizophrenia or other mental illness, and even when the cannabis is withdrawn, the psychosis doesn't go away. This is what happened to my beautiful boy. When he died, the toxicology report showed he had ZERO drugs in his system. He wasn't depressed, neglected, drugged, or unloved. He was psychotic, paranoid, and delusional by the time he reached 19, and he refused the anti-psychotic drugs that he now needed, because he thought he wasn't sick (common to schizophrenia)."
It's so easy to think that marijuana use isn't that big of a deal, especially since some states have begun legalizing the drug for recreational use and many people see it as "natural." But the mild, laid-back high many people picture with pot use is not the reality of many of today's marijuana products or methods. Parents need to be aware of the dangers cannabis-derived drugs pose to their children's mental health and educate them as early as possible.
Stack included the following links to articles and studies backing up what she's learned about today's THC products. These are things we all should read and share, as this knowledge and awareness could literally save someone's life.
Potent pot, vulnerable teens trigger concerns in first states to legalize marijuana - The Washington Post
The contribution of cannabis use to variation in the incidence of psychotic disorder - The Lancet Journal
Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood - Journal of the American Medical Association
Cannabis-induced psychosis: A Review – Psychiatric Times
Summary of literature on marijuana and psychosis - Moms Strong
Stack explained that Johnny had "dabbed" since he was 15 or 16. "Do you understand the difference between smoking pot (and some edibles) and dabbing high-THC wax, shatter, or butter?" she asked. "Most of my friends look at me blankly when I say these words and say, 'I've never even heard about this.' If you don't know what cannabis extracts are, and you have children, grandchildren, sisters, brothers, nieces and nephews between the ages of 14 and 24, PLEASE keep reading."
"I am NOT talking about those of you who are supporters of legal recreational marijuana for adults over 21 years old—it's your life—do what you want," Stack clarified. "I know some people who take it successfully for specific medical purposes, so please don't write comments in my post about my personal experience. I'm specifically talking about illegal usage by children and young adults under 21, whose adolescent brains are still forming. You may be thinking, 'C'mon, Laura, it's no big deal – it's just pot.' 'Pot's legal, so it must be safe.' Or 'I did pot when I was a kid, too, and look, it didn't hurt me.'
Well, have you recently studied TODAY'S pot, and have you personally seen its effects on your children like I have?"
Stack explained why today's recreational cannabis is so different:
"First, the tetrahydrocannabinol (THC), a crystalline compound that is the main active ingredient of cannabis that gives the 'high,' is extracted out of the cannabis so that it's nearly pure. THC is the principal psychoactive constituent of cannabis. Then a butane torch is used to heat the crystals (similar to beeswax) or oil in a 'rig' (just google it), or a vaping device with a heating element called a dab pen can be used. Forget the 'grass' or 'papers' that were rolled in the 70s and 80s. The pot we grew up with (10% or less THC content) is HUGELY different than today's high-concentrate extracts (often 80% THC content or higher)."
She also explained why young people tend to be affected more by these high THC concentrations, and that the earlier they start the more likely it is that they'll develop a disorder.
"The brain is still developing through a person's 20s, and psychotic disorders typically develop in the late teenage years. During brain formation, heavy cannabis use has been shown to have a negative effect on the formation of neural pathways. It can also lead to heavier drug use. While the vast majority of marijuana smokers never experience CIP, researchers have found that the earlier and heavier someone starts dabbing, the more likely it is that they will develop a disorder at some point (often years later). We must educate our children when they are young (10-12 years old) and use hyper-vigilance in the early teen years, which we found was much easier before the age of 16, when they could drive. We couldn't lock him up or monitor him 24/7. Keep talking and keep trying!!
The harmful combination of a still-forming mind, high-potency THC products, and a high frequency of use = Cannabis-Induced Psychosis. Yes, that's a real diagnosis (or High-THC Abuse – Severe). Repeated CIP incidents can trigger schizophrenia or other mental illness, and even when the cannabis is withdrawn, the psychosis doesn't go away. This is what happened to my beautiful boy. When he died, the toxicology report showed he had ZERO drugs in his system. He wasn't depressed, neglected, drugged, or unloved. He was psychotic, paranoid, and delusional by the time he reached 19, and he refused the anti-psychotic drugs that he now needed, because he thought he wasn't sick (common to schizophrenia)."
It's so easy to think that marijuana use isn't that big of a deal, especially since some states have begun legalizing the drug for recreational use and many people see it as "natural." But the mild, laid-back high many people picture with pot use is not the reality of many of today's marijuana products or methods. Parents need to be aware of the dangers cannabis-derived drugs pose to their children's mental health and educate them as early as possible.
Stack included the following links to articles and studies backing up what she's learned about today's THC products. These are things we all should read and share, as this knowledge and awareness could literally save someone's life.
Potent pot, vulnerable teens trigger concerns in first states to legalize marijuana - The Washington Post
The contribution of cannabis use to variation in the incidence of psychotic disorder - The Lancet Journal
Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood - Journal of the American Medical Association
Dabs, Wax, Vaping Weed, Edibles and the Real Impact of High Potency THC Products: What Parents Need to Know - Resources to Recover
How Marijuana May Damage Teenage Brains in Study Using Genetically Vulnerable Mice - Johns Hopkins
Significant link between cannabis use and onset of mania symptoms – Science Daily
Cannabis-induced psychosis: A Review – Psychiatric Times
Summary of literature on marijuana and psychosis - Moms Strong
Editor's Note: This article originally appeared on 02.21.20. The opinions expressed in this piece are solely those of the author and the subjects written about or quoted. | Mental Health Treatments |
An anonymous reader quotes a report from Motherboard: Scientists have witnessed brain patterns in dying patients that may correlate to commonly reported "near-death" experiences (NDEs) such as lucid visions, out-of-body sensations, a review of one's own life, and other "dimensions of reality," reports a new study. The results offer the first comprehensive evidence that patient recollections and brain waves point to universal elements of NDEs. During an expansive multi-year study led by Sam Parnia, an intensive care doctor and an associate professor in the department of medicine at NYU Langone Health, researchers observed 567 patients in 25 hospitals around the world as they underwent cardiopulmonary resuscitation (CPR) after suffering cardiac arrest, most of which were fatal.
Electroencephalogram (EEG) brain signals captured from dozens of the patients revealed that episodes of heightened consciousness occurred up to an hour after cardiac arrest. Though most of the patients in the study were sadly not resuscitated by CPR, 53 patients were brought back to life. Of the survivors, 11 patients reported a sense of awareness during CPR and six reported a near-death experience. Parnia and his colleagues suggest that the transition from life to death can trigger a state of disinhibition in the brain that "appears to facilitate lucid understanding of new dimensions of reality -- including people's deeper consciousness -- all memories, thoughts, intentions and actions towards others from a moral and ethical perspective," a finding with profound implications for CPR research, end-of-life care, and consciousness, among other fields, according to a new study published in Resuscitation. [...]
"One of the things that was unique about this project is that this was the first time ever where scientists had put together a method to examine for signs of lucidity and consciousness in people as they're being revived by looking for brain markers, or brain signatures of consciousness, using an EEG device as well as a brain oxygen monitor," Parnia explained. "Most doctors are taught and believe that the brain dies after about five or 10 minutes of oxygen deprivation," Parnia said. "One of the key points that comes out of this study is that that is actually not true. Although the brain flatlines after the heart stops, and that happens within seconds, it doesn't mean that it's permanently damaged and [has] died. It's just hibernating. What we were able to show is that actually, the brain can respond and restore function again, even after an hour later, which opens up a whole window of opportunity for doctors to start new treatments." Indeed, the study reports that "near-normal/physiological EEG activity (delta, theta, alpha, beta rhythms) consistent with consciousness and a possible resumption of a network-level of cognitive and neuronal activity emerged up to 35-60 minutes into CPR. This is the first report of biomarkers of consciousness during CA/CPR."
Electroencephalogram (EEG) brain signals captured from dozens of the patients revealed that episodes of heightened consciousness occurred up to an hour after cardiac arrest. Though most of the patients in the study were sadly not resuscitated by CPR, 53 patients were brought back to life. Of the survivors, 11 patients reported a sense of awareness during CPR and six reported a near-death experience. Parnia and his colleagues suggest that the transition from life to death can trigger a state of disinhibition in the brain that "appears to facilitate lucid understanding of new dimensions of reality -- including people's deeper consciousness -- all memories, thoughts, intentions and actions towards others from a moral and ethical perspective," a finding with profound implications for CPR research, end-of-life care, and consciousness, among other fields, according to a new study published in Resuscitation. [...]
"One of the things that was unique about this project is that this was the first time ever where scientists had put together a method to examine for signs of lucidity and consciousness in people as they're being revived by looking for brain markers, or brain signatures of consciousness, using an EEG device as well as a brain oxygen monitor," Parnia explained. "Most doctors are taught and believe that the brain dies after about five or 10 minutes of oxygen deprivation," Parnia said. "One of the key points that comes out of this study is that that is actually not true. Although the brain flatlines after the heart stops, and that happens within seconds, it doesn't mean that it's permanently damaged and [has] died. It's just hibernating. What we were able to show is that actually, the brain can respond and restore function again, even after an hour later, which opens up a whole window of opportunity for doctors to start new treatments." Indeed, the study reports that "near-normal/physiological EEG activity (delta, theta, alpha, beta rhythms) consistent with consciousness and a possible resumption of a network-level of cognitive and neuronal activity emerged up to 35-60 minutes into CPR. This is the first report of biomarkers of consciousness during CA/CPR." | Medical Innovations |
Please note: This is not a public comment – only the Guardian can see your message. Our writers will monitor these messages and respond to some in this live blog, but unfortunately they will not be able to respond to every message.
Thu 30 Nov 2023 07.59 ESTFirst published on Thu 30 Nov 2023 03.58 EST
Dominic Cummings has tweeted again about Hancock’s evidence. He claims Hancock is wrong about asymptomatic transmission. (See 11.45am.) For once, he is not accusing Hancock of lying; he just claims Hancock is “confused”.
Hancock talking rubbish on asymptomatic
1/ it’s in the whatsapp group 11/3 Hancock claiming tests don’t work on asymptomatic & Vallance telling him ‘wrong’ tests DO work - Hancock kept repeating this false idea (badly confusing the PM on the issue & he repeated the misinformation to Cabinet, cf. minutes)
2/ me saying 19/3 we shd do a *large scale random national survey* precisely cos it was crucial to figure out *the asymptomatic rate*, which wd help the whole world not just the UK - Vallance agreed with this idea & we did it with ONS
3/ NERVTAG in JANUARY. If he’d read the report (his job) he’d have known then
Hancock, Trolley, & Sedwill statements to inquiry show they STILL do not understand their own misconceptions on this subject in Q1-Q2 2020 (I think here Hancock was genuinely confused / rubbish, not lying)
Keith asks why ministers were told there was a 10% chance of the reasonable worst-case scenario happening when they were also told there was a 50% chance of Covid escaping China.
Hancock says that 10% chance was a consequence of two things – the 50% chance of Covid getting out of China, and how it would then develop. He says when Sars spread, the reasonable worst-case scenario did not materialise.
Q: Why was the reasonable worst-case scenario still be debated in early March long after it became clear the virus was coming, and measures needed to be taken to stop it?
Hancock says that is not how he remembers it.
The government decided to take the reasonable worst-case scenario as the planning assumption, he says.
Hancock says Cummings created 'culture of fear' in No 10 which undermined effectiveness of Covid response
Q: Do you think Cummings had too much influence on decision making in No 10?
Yes, says Hancock.
He says in February Cobra was meeting to deal with Covid.
But Cummings decided to circumvent these meeting by arranging for the key decisions to be taken at a different meeting taking place in his office, he says. He says some of the right people were at those meetings, but not all of them.
Q: Do you think Cummings’ role had a significant impact on the smooth running of the government machine?
“Yes, of course,” says Hancock.
Q: How was this allowed to continue?
Hancock says this was “deeply, deeply frustrating”.
There was a structural problem – Cummings trying to take control of the meetings.
But there was also a cultural problem, he says. He suggests Cummings created a culture of fear. He says Cummings effectively got Sajid Javid sacked as chancellor in February.
Keith tries to close down this point, saying it is not relevant.
Hancock insists this is relevant. He explains:
It inculcated a culture of fear, whereas what we needed was a culture where everybody was brought to the table and given their heads to do their level best in a once-in-a-generation crisis. The way to lead in a crisis like this is to give people the confidence to do what they think needs to happen. And it caused the opposite of that.
UPDATE:Hancock said:
As the Cobra system was running in February, the prime minister’s chief adviser decided that he didn’t like the Cobra system – that’s on the record – and he decided instead to take all of the major daily decisions into his office and he invited a subset of the people who needed to be there to these meetings.
He didn’t invite any ministers. He didn’t regard ministers as a valuable contribution to any decision-making as far as I could see in the crisis or, indeed, any other time.
The reason these meetings are important is because there is a proper government emergency response system and it was actively circumvented and in one of these early meetings the chief adviser said decisions don’t need to go to the prime minister.
Now that is inappropriate in a democracy. I saw it simply as essentially a power-grab but it definitely got in the way of organising the response for the period it was in operation.
Dominic Cummings, who was Boris Johnson’s chief adviser for most of 2020, and who has been one of Hancock’s strongest critics, claims Hancock if lying to the inquiry about calling for a lockdown on Friday 13 2020. (See 11am.) He has put this on X.
Hancock flat out lying to Inquiry claiming he privately pushed for lockdown on 13th with PM - but admits there’s no evidence for it - and again on 14th in mtngs - when evidence from ALL others & paper trail is that he was still pushing Plan A herd immunity 13-15th - and his Perm Sec was still pushing Plan A on 18/3 to Cabinet Secretary (email uncovered by media) - the reason I physically stopped him coming to the second mtng on 14/3 was cos he was arguing AGAINST a change of plan & bullshitting everybody about herd immunity & ‘best prepared in the world’ (see evidence from multiple witnesses)
Keith shows an exchange of messages between Sir Patrick Vallance, the chief scientific adviser, and Prof Sir Chris Whitty, the chief medical adviser, in July 2020. In it, Vallance says he does not know why Boris Johnson and Hancock were claiming they were not told about asymptomatic transmission.
Hancock says he and Johnson were not complaining about not being told about the possibility of asymptomatic transmission. They were complaining about the scientists not treating it as the norm. He says the messages in this exchange show the scientists were not certain.
Hancock says his 'single biggest regret' is not insisting on policy being based on assumption of asymptomatic transmission
Keith says he wants to talk about asymptomatic transmission.
He says Hancock says in his witness statement that his biggest regret was not pushing for asymptomatic transmission as being the baseline assumption.
He asks Hancock to confirm that he is saying he wishes he had been told about asymptomatic transmission earlier, when it really mattered.
Hancock confirms that.
Keith shows a document from 27 January 2020 says the chief medical officer, Chris Whitty, said at the time that he could not be sure asymptomatic transmission was not happening.
He shows another minute from the following day quoting Whitty as saying there was credible evidence of asymptomatic transmission in Germany.
He shows minutes from a Sage (Scientific Advisory Group for Emergencies) meeting in early February discussing asymptomatic transmission as a factor.
And he shows another minute from a Sage meeting later in February. NF is Neil Ferguson and JE is John Edmunds; they are both epidemiologists.
Hancock accepts this evidence. He says his “single biggest regret” is that he did not push harder on this issue.
He says the scientists worked on the assumption that the transmission mechanism was the same as it was for Sars. He says he now thinks he should have over-ruled the scientists, and said policy should be based on the assumption that Covid was transmitted asymptomatically.
UPDATE: PA Media reports:
Hancock said there was a “fog of uncertainty” about asymptomatic transmission of Covid-19 that he found “deeply frustrating”.
He said: “I was in the pro-let’s worry about asymptomatic transmission camp. The frustration was that, understandably from their point of view, and here I’m putting myself in their shoes, the PHE scientists said we have not got concrete evidence.”
Asked whether the government should have been aware of the possibility of asymptomatic transmission, he said he had “a significant amount of anecdotal evidence”, but “the scientific advice required, or formally advised, policy should be based on the assumption of no asymptomatic transmission” …
When asked what measures could have been introduced if the advice had been clearer, Hancock said: “It made a difference in terms of how infection prevention and control was done within health and care settings. That is very clear.” | Epidemics & Outbreaks |
Britain has a sick economy. That’s not a metaphor for the flatlining of growth over the past year, but a statement of fact. Never before have so many people been out of the labour force due to long-term sickness or disability. Never before has there been such a loss of human potential.
Better health is desirable in itself. Ill-health makes people miserable, so it shouldn’t really matter whether or not there were economic benefits from reducing the number of people who might want to work if they fell well enough to do so. Gross domestic product is not everything.
But in this instance, fewer people inactive because of health issues would be good both for personal wellbeing and for the economy. It is a win-win as opposed to the current lose-lose.
Here’s how things currently stand. The number of people who say they are not looking for work because of long-term ill health rose by 86,000 in the first three months of 2023 to 2.55m and is now 438,000 higher than it was before the start of the pandemic three years ago.
Clearly, Covid-19 represented a serious blow to the nation’s health and put pressures on an already severely stretched NHS. Of that 438,000 increase, some will be suffering from long Covid, while others found the stress of lockdown followed by the cost of living crisis affecting their mental health.
There are two things that would help instantly: an end to the strikes that have been affecting the NHS for months, and extra investment to start clearing the patient backlog. The government’s long-running battle with nurses and junior doctors has been a spectacular own goal.
At the start of 2023 Rishi Sunak made five pledges. One was to have shorter NHS waiting lists, currently running at more than 7 million for England alone, by the end of the year, while another was to get the economy growing.
The two are linked. A quarter of the 2.55 million people inactive due to ill health say they want a job; better and speedier treatment would help them find one, fill some of the million job vacancies in the economy and boost growth.
To make a real difference will require more than the cosmetic measures contained in Jeremy Hunt’s “back to work” budget. As the Chartered Institute of Personnel and Development has rightly noted, radical reform of statutory sick pay is needed to expand coverage to those on the lowest incomes and increase its generosity so that it is closer to the level of someone earning the “national living wage”.
One thing is certain: toughening up the eligibility criteria for long-term sickness benefits will do nothing other than make the lives of some of the most vulnerable people even harder. The deep-seated nature of Britain’s ill-health problem means a punitive approach won’t work.
It would be wrong to assume that the UK went into the crisis a healthy nation. Rather, the Covid-19 shock aggravated worrying pre-pandemic trends. A recent report from the left-leaning Institute for Public Policy Research thinktank said the death rate from all causes fell between 1990 and 2011, but then started to rise. The prevalence of cancer, diabetes, depression and hypertension all increased in the 2010s. In 1960, the UK ranked 7th for life expectancy among the rich nation members of the Organisation for Economic Co-operation and Development. By 2020 it had dropped to 23rd.
According to the IPPR study, poor physical and mental health is costing individuals close to £2,000 a year in lost earnings and reducing the size of the economy by £43bn. Illness is, unsurprisingly, unevenly distributed geographically and by class, gender and ethnicity.
Times have been hard for the past 15 years. The 1990s and the early 2000s saw a long economic upswing in which real incomes grew and – under the Labour governments – spending on the NHS grew faster than at any time since it was created in 1948. Since 2007, there have been two deep recessions that have left wages – in inflation-adjusted terms – lower than they were 15 years ago.
Jobs have been reasonably easy to come by during this period, but they have often been low-paid, insecure and non-unionised. More than 50% of those living below the official poverty line are in a working household, and the constant struggle to make ends meet has taken its toll, both physically and mentally.
At the same time, spending on the NHS has become far less generous, with nugatory increases in funding since 2010. The need to make savings did not just mean that there was a shortage of capacity when Covid struck, it also meant underinvestment in prevention and mental health.
This is a bad place to be, and rather than setting itself the modest target of reducing waiting lists by the end of the year, the IPPR says the government should show more ambition and commit to a 30-year mission to turn the UK into the healthiest country on the planet.
That’s a worthy aim, but achieving it won’t be easy. It will require – among other things – better paid and more secure jobs; a greater role for unions in the negotiation of working conditions; a willingness to embrace new ideas such as hybrid working and shorter working weeks; and a recognition that the NHS needs to become a genuine National Health Service rather than a national illness service dealing with problems that could have been prevented.
Above all, it will require a recognition that inactivity as a result of ill-health is a symptom of a deeper malaise: the unhealthy state of modern British capitalism.
Larry Elliott is the Guardian’s economics editor | Health Policy |
The anti-aging fanatic who spends $2 million per year on a controversial regimen to fight back the ravages of time said he would drink alcohol for breakfast every morning.
Bryan Johnson — the 45-year-old tech guru whose desire to restore his organs to that of an 18-year-old includes tracking his nighttime erections — would start each day with three ounces of wine, he said during an interview on “The Diary of a CEO” podcast last week.
Johnson, who also used his teenage son as a “blood boy” for transfusions in his bid to find the Fountain of Youth, said he cut out the morning drinking because he couldn’t spare the calories.
“I got rid of it because it was too expensive from a calorie perspective,” Johnson told podcast host Steven Bartlett.
He added that he couldn’t fit the 71 calories into his “calorie budget” for the day, instead waking up and starting his morning with a cold-pressed juice he calls the “green giant” and 60 pills.
“Every calorie has to fight for its life,” Johnson said. “There’s not a single calorie in my entire life protocol that exists for any reason other than serving an objective in the body.”
In total, Johnson takes 111 supplements a day in his bid to eventually have all of his major organs — including his brain, liver, kidneys, teeth, skin, hair, penis and rectum — functioning as they were in his late teens.
The routine also involves Johnson — — who made his fortune in his 30s when he sold his payment processing company Braintree Payment Solutions to EBay for $800 million — having his last meal at 11 a.m.
Johnson said his daily caloric intake is currently 2,250 — up from the 1,977 calories he previously said.
After his morning drink, he works out for one hour, then sits down to a “super veggie” vegan meal of broccoli, cauliflower, ginger, hemp seeds, dark chocolate and one tablespoon of his allotted three daily tablespoons of extra virgin olive oil.
Johnson pointed out that chocolate is good for you, but that doesn’t mean people should be led to eat a Snickers bar.
Instead, “the precise way to think about it is you want dark chocolate, un-Dutch, tested for heavy metals and has a high polyphenol count,” he said.
“If you don’t do all five layers to qualify the value of the chocolate, you have an inferior chocolate and nutritional value for your body.”
An hour after his chocolate-infused morning meal, he indulges in dessert, which he refers to as “nutty pudding:” a mix of macadamia nuts, walnuts, flax seed, pomegranate juice and berries.
And one hour after that, he has his third and final meal of the day.
Johnson said he eats around 70 pounds of vegetables per month.
He claims the strict regimen — part of his anti-aging Project Blueprint — has given him an “atypical relationship with time.”
Before becoming a health nut, the tech mogul recalled having a “not terribly healthy” childhood where he was entrenched in “the United States’ cultural environment in the 1980s.”
“As a kid, my mother did the best she could under the circumstances. We were pretty poor. She ground wheat, she made bread for us. We also ate sugar cereal. We put sugar on our sugar cereal. We were in the sun constantly with no sunscreen so we had excessive sun exposure. We ate processed foods,” he explained.
It wasn’t until after 20 years of entrepreneurship, depression, a divorce and trying to leave Mormonism that Johnson decided to embark on this health journey.
In one of his latest efforts to reverse his biological age, he used his teenage son as his personal “blood boy,” swapping plasma with his then-17-year-old son Talmage in May.
Johnson had enlisted Talmage, now 18, for a tri-generational blood-swapping treatment that also included his 70-year-old father Richard.
During the plasma swap, Johnson, his son and his dad had one liter of blood drained. Talmage’s plasma was fed into Johnson’s veins and Jonson’s plasma was fed into Richard’s veins.
However, Johnson said he stopped the “blood boy” experiment after seeing no benefit from the treatment.
“Does not in my case stack benefit on top of my existing interventions,” he shared via Twitter last month.
“Alternative methods of plasma exchange or young plasma fractions hold promise,” he added. “My father’s results are still pending.” | Longevity |
An outbreak of meningococcal disease in Virginia has sickened dozens of people and killed at least five, local health officials reported this week. Though severe cases are typically rare, the state has seen a noticeable increase over the past year. The bacterial infection is vaccine-preventable, and most cases during this outbreak have been unvaccinated.
Meningococcal disease is caused by Neisseria meningitidis (a relative of the bacteria that cause gonorrhea). About one in every ten people in the U.S. are thought to carry the bacteria without feeling sick at any one time, usually in the back of their throat. But sometimes, the bacteria can invade other parts of the body and cause life-threatening illness. It can reach the lining of the brain and spinal cord and cause meningitis, for instance, or seep into the bloodstream, which can trigger a systematic overreaction of the immune system, known as sepsis. There are six broad groups of these bacteria that can sicken humans, with three groups (B, C, and Y) being the most commonly seen in the U.S.
On Wednesday, the Virginia Department of Health reported that the state has seen an unusual increase in meningococcal disease caused by group Y bacteria as of late. There have been 27 cases across eastern, central, and southwest Virginia documented since June 2022—about three times the number more than expected. Of these cases, five people have died from complications of the infection.
Most cases have been reported in eastern Virginia, and testing has found that the cases are being caused by highly genetically related strains of the bacteria. But officials have not identified a common risk factor for its spread as of yet. Generally, these bacteria are transmitted via a person’s saliva and spit, such as through kissing or sharing personal items like lipstick. Meningococcal bacteria are not as contagious as other respiratory infections like the flu or covid-19, though, and it tends to require close, prolonged contact for transmission to happen.
There are two broad types of vaccines available for meningococcal disease in the U.S. One childhood vaccine is recommended for all people starting at age 11 and helps prevent cases caused by four groups of the bacteria, including C and Y. The second vaccine targets only group B bacteria and is recommended for teens who might be at greater risk of severe illness, such as those with weaker immune systems.
Though these vaccines aren’t 100% effective at preventing infection, they have led to a continued decline in meningococcal disease in the U.S. since their introduction, especially among teens. Notably, all but one case in the Virginia outbreak so far has been unvaccinated.
Officials say that the risk of meningococcal disease remains low for the general public. But they are warning people during this outbreak to practice good hand hygiene, avoid sharing items like vapes or toothbrushes, and get properly vaccinated if they’re not up to date. | Epidemics & Outbreaks |
“Eat your fruit and vegetables!” These foods are packed with essential nutrients, including vitamins, the health benefits of which have been drummed into us since childhood.
We understand that vitamins play a crucial role in preventing disease and maintaining our overall health. But to what extent do they shape our physical characteristics and how have they contributed to our evolution as a species?
Mark Lucock, associate professor at the University of Newcastle, Australia is pushing for a new paradigm of thinking in this area and is revolutionizing the way we might think about vitamins beyond just health and well being.
“[Vitamins] contribute to shaping and maintaining the human phenome, the fingerprint of an individual’s unique biology defined by complex environmental and genetic factors over lifecycle and evolutionary timescales,” Lucock explained in an email.
Spanning a lengthy career, Lucock says the concept of “vitomics and adaptive vitome”, a term he coined for this concept has evolved over several years, dating back to when he was studying folic acid and vitamin D.
He defines it as follows: “Vitamin related actions that adapt an organism’s metabolism/biology to a specific environmental condition(s) within, across and beyond the lifecycle.”
This is different to the traditional and perhaps more one-dimensional view of vitamins, which focuses on their overall health benefits and ability to prevent deficiencies, such as rickets or scurvy.
According to Lucock, this more traditional view has little appreciation for the long-term evolutionary role vitamins play in adapting our biology to environmental conditions over time and their importance in our prenatal development.
Acknowledging these extended functions aids our understanding of evolution and highlights that vitamins are even more important than already known.
Vital for life
From embryo development to childhood, adulthood and old age, vitamins are central to metabolic function and vital for cellular processes that support life. They not only influence small molecules within cells but help direct the organization of these cells and their programming to perform specific functions during embryo development.
For example, in a complex interplay, environmental conditions as well as nutrients and vitamins, such as folic acid, influence the DNA in our genes, turning them on or off. These early controls can impact our health in later life and even predispose us to risk of disease.
However, balance is key because you can have too much of a good thing with excessive levels of certain vitamins, like vitamin A, being toxic and can lead to birth defects.
Turning genes on and off is an example of the short-term effects of vitamins for individual people, but it is their long-term effects on human evolution that Lucock proposes in this new way of thinking about them. A prime example is the proposed evolutionary role of vitamin D and folate in skin pigmentation.
Both vitamin D and folate are sensitive to sunlight, but in opposite ways. Sunlight helps produce vitamin D in the skin whereas ultraviolet (UV) rays break down folate. Because both these vitamins are needed for reproduction, biological mechanisms have evolved over time to protect them and ensure survival of our species.
Evolutionary belief is that our ancestors originated in hot equatorial regions of Africa with strong sun and UV rays, so pigmentation in the skin increased to protect folate, leading to a darker skin. However, when our ancestors moved north where there was less sun, less pigmentation was needed to protect folate. Simultaneous changes in culture, especially the development of farming, may have also influenced this change.
“As hunter gatherers, our early diet was rich in vitamin D (particularly from fish and meat), but after the development of farming practices, grains became a significant dietary component, leading to a deficit in vitamin D ,” explained Lucock. “Given the importance of vitamin D in maintaining reproductive efficiency, natural selection will have favored a loss in skin melanin to allow for improved vitamin D photosynthesis in our skin.”
These examples illustrate the contribution of vitamins beyond just health, and begin to paint a bigger picture of their importance to humans as a species.
Zooming out
Recent advances in laboratory techniques have allowed the measurement of thousands of cellular small molecules related to DNA, proteins, and metabolism. To understand these vast and complex interactions within biological systems, scientists are adopting a “systems biology” approach that looks at the bigger picture by analyzing these interconnected molecules to understand how they fit together and how whole systems work.
With individual roles in cell function, embryo development, and evolution, Lucock argues it is time to put the pieces together, and adopt an integrated approach when researching the role of vitamins in human biology.
“Society will benefit from such a paradigm, which examines the larger picture (a tapestry of all the smaller pieces),” explained Lucock. “Previous generations tended to be reductionists, looking at taking these pieces apart. I think it will be easier for the average person to embrace the bigger picture than consider the minutiae when looking how living systems interact within and across the lifecycle.”
We are still learning about the role of vitamins in these areas and this new concept may facilitate new learning.
“New discoveries involving vitamins in molecular, developmental and evolutionary biology requires a more integrated perspective that embraces a broader, more attuned role for vitamins in life processes,” explains Lucock. It is hoped that adopting this integrated approach will facilitate new scientific discoveries, kick starting a new era for vitamins.
Reference: Lucock, M, D, Vitomics: A novel paradigm for examining the role of vitamins in human biology, Bioassays (2023). DOI: 10.1002/bies.202300127
Feature image credit: Unsplash | Nutrition Research |
Rishi Sunak is “highly unlikely” to meet his promise to cut NHS waiting lists, health leaders have warned, as a “sobering” analysis suggests the backlog will rise to 8 million and won’t begin to fall until next summer.
The prime minister vowed in January that “NHS waiting lists will fall” as he outlined five pledges upon which he staked his premiership. The backlog was 7.2 million at the time. It is now 7.75 million, the highest since records began in 2007.
But a grim report published on Friday by the Health Foundation, an independent thinktank, will pile further pressure on Sunak over the NHS. The 15-page analysis predicts that the waiting list for hospital treatment in England will continue to rise for at least 10 months and ultimately top 8 million, regardless of whether or not strikes continue.
The thinktank modelled four different scenarios and concluded that, based on current trends, NHS waiting list figures could peak by August 2024 if there was no more strike action by healthcare workers, before starting to come down. If strikes were to continue, the list could increase a further 180,000, it said.
Matthew Taylor, the chief executive of the NHS Confederation, said: “This analysis all but confirms that the prime minister’s pledge to reduce the size of the waiting list is increasingly unlikely to be met.”
He added: “As the Health Foundation report rightly says, the root cause of the delays to treatment that patients are now experiencing is a decade of underinvestment in the NHS.”
Taylor said there was a possibility the backlog could grow even more than the analysis predicts.
“The worst-case scenario outlined in the report doesn’t take into account the possibility of a difficult winter, including a heavy flu season or a Covid outbreak, or a continuing deterioration of NHS trust finances as they seek to plug the costs of ongoing industrial action. If these risks do materialise then we are facing an even worse scenario.”
Tim Mitchell, the president of the Royal College of Surgeons of England, said: “The Health Foundation’s sobering analysis highlights that the prime minister’s pledge to cut NHS waiting lists is highly unlikely to be achieved. Waiting lists have ballooned over the past decade due to underinvestment and workforce shortages.”
Mitchell said “transformative solutions”, such as further investment in nationwide standalone surgical hubs, were urgently needed to tackle waiting lists in a meaningful and sustainable way.
“Crucially, we must also improve staff morale and retention,” he added. “The government’s commitment to grow the healthcare workforce is welcome. However, recruiting new staff is only half of the solution. Providing a supportive, well-resourced working environment is vital to reducing burnout.
“Otherwise, the NHS risks being caught in a revolving door as we continuously lose the very staff we are trying to hire. By supporting staff and providing the resources they need to do their jobs, we can begin to reduce waiting times.”
In recent months, as the NHS backlog has continued to spiral, Sunak has sought to blame ongoing industrial action in the health service for the failure to cut waiting lists.
But the Health Foundation analysis shows that industrial action by consultants and junior doctors has so far lengthened the waiting list by about 210,000, just 3% of the overall size of the list.
The shadow health secretary, Wes Streeting, said the report “blows out of the water” attempts by the government to blame doctors for the crisis in the NHS.
The Liberal Democrat health and social care spokesperson, Daisy Cooper, said: “This research shows yet another one of Rishi Sunak’s pledges is set to be left on the scrap heap of Conservative broken promises.
“This government has left our NHS on life support, while people across the country are left waiting in pain for months for the treatment they need.”
NHS England said there had been important progress in bringing down the longest waits, with two-year waits virtually eliminated and waits of more than 65 weeks more than halved.
The government has been approached for comment. | Health Policy |
Former health secretary Matt Hancock tried to bypass the education secretary to have schools closed in December 2020, the Daily Telegraph has reported.
In leaked WhatsApp messages, Mr Hancock said Sir Gavin Williamson was battling "tooth and nail" to keep schools in England open, a move he disagreed with.
Other messages show disparaging remarks about teachers' unions and belittling comments towards Sir Gavin.
It is the latest revelation to come from the leaked text messages.
The Telegraph was passed more than 100,000 messages, sent between ministers and officials during the pandemic, by journalist Isabel Oakeshott.
A vocal critic of lockdowns, Ms Oakeshott obtained them while helping Mr Hancock write his book, Pandemic Diaries. The journalist has said she broke a non-disclosure agreement to release the messages because they are "in the public interest".
The BBC has not seen or independently verified the WhatsApp messages nor the context in which they were sent.
A spokesperson for Mr Hancock said the leaks offer "partial accounts, obviously spun with an agenda".
One exchange on 28 December 2020 appears to show Mr Hancock messaging an aide during a video meeting with then-Prime Minister Boris Johnson to discuss rising Covid cases.
At that point, the plan was for all primary schools to return as normal in January, and for the opening of secondary schools to be delayed by two weeks to allow time for mass testing to be set up.
Mr Hancock, who wanted to keep school closed, described Sir Gavin as battling "tooth and nail" to keep schools open and "going absolutely gangbusters" over the issue.
"He's freaking out. You can tell he isn't being wholly rational... just by his body language," Mr Hancock's aide, Emma Dean, wrote.
"I'm having to turn the volume down," Mr Hancock responded.
Later, having apparently failed to persuade the prime minister that schools should stay shut, Mr Hancock wrote: "The next U-turn is born."
He then adds: "I want to find a way, Gavin having won the day, of actually preventing a policy car crash when the kids spread the disease in January. And for that we must now fight a rear-guard action."
Mr Hancock then contacted Dan Rosenfield, Mr Johnson's chief of staff, to discuss how to "avoid the car crash we have just set up for January".
In an exchange on 1 January, as Covid cases continued to rise, Mr Hancock described Sir Gavin as having had to eat "a lot of humble pie".
On 3 January, the prime minister repeatedly insisted that "schools are safe" on BBC One's Andrew Marr Show.
But the next day, hours after pupils returned to the classrooms, he announced the closure of all schools and colleges, as they "may act as vectors for transmission".
Writing for the Telegraph, Sir Gavin said he felt the closure "wasn't done for the right reasons" and he considered resigning in protest over the decision. He remained as education secretary until September that year, when Mr Johnson reshuffled the cabinet.
Unions 'just hate work'
Messages between Mr Hancock and Sir Gavin in May 2020 also show them discussing a shortage of personal protective equipment (PPE) for schools.
Sir Gavin said he wanted to make sure the PPE was provided so that schools "can't use [the shortfall] as a reason not to open" and that some would want to use it as "an excuse to avoid having to teach".
That October, Sir Gavin announced that A-level exams would be delayed by several weeks, a shorter period than some teaching unions had called for.
"Cracking announcement today," wrote Mr Hancock to Sir Gavin. "What a bunch of absolute arses the teaching unions are."
Sir Gavin replied: "I know they really really do just hate work."
Mr Hancock responded with some emojis of a person laughing and another of a dart hitting a bullseye.
In a statement, the Association of School and College Leaders (ASCL) said the "sneering exchange" showed "an appalling lack of respect for teachers".
"We constantly had to sense-check and disentangle the reams of confused guidance they issued, and were often wrong-footed by bizarre policy decisions which were then followed by an inevitable U-turn."
Writing on Twitter following the publication of the texts, Sir Gavin said he wanted to "clarify that these messages were about some unions and not teachers".
"I have the utmost respect for teachers who work tirelessly to support students," he wrote. "During the pandemic, teachers went above and beyond during very challenging times."
Pupils 'sent home with false positives'
Other leaked messages purportedly showed that children who tested positive for Covid-19, but may not have actually had the disease, were sent home anyway because officials did not want to "unpick" a policy that had already been written.
When schools returned after the third lockdown in March 2021, government policy said that a child who tested positive with a lateral flow test should isolate for 10 days, even if they later tested negative with a PCR, a more reliable test.
Mr Hancock asked advisers to look into the issue but was told that the policy had been "written and distributed and schools prepared" and that it would be "difficult to unpick now".
Only three weeks later, on 30 March, the policy was indeed "unpicked", and schools were told that a positive lateral flow test should be confirmed by a PCR.
A spokesperson for Mr Hancock said: "These are partial accounts, obviously spun with an agenda. They show Matt was focussed throughout on saving lives. The right place for a full assessment is the Inquiry".
Face mask row
The leaks also appear to show that an August 2020 change in government policy requiring secondary pupils in England to wear face masks was introduced mainly to avoid a row with the Scottish government.
England's chief medical officer, Sir Chris Whitty, had reportedly been ambivalent about the need for the measure. Following its introduction in Scotland, Mr Johnson posted in a WhatsApp group asking whether UK government would need to change its stance.
Downing Street's director of communications, Lee Cain, warned that "nervous parents would freak out" if Scotland's example was not followed, while Sir Chris said there were no strong reasons for or against the policy, and that the issue was "not worth an argument".
A change in the government's policy was announced that night. | Epidemics & Outbreaks |
Dr. Alison Todd describes herself as an “inventor at heart,” but she’s not the sort of inventor who tinkers with gears in a workshop. Instead, she invents new tools in medical diagnostics, developing better ways to identify gene sequences and how they impact disease. Rather than screwdrivers and hammers, her instruments are the building blocks of life itself: human DNA.“We develop tests that help guide clinicians toward the best therapies that have the best outcomes,” she explains. “I have a huge job, but the bit I’m passionate about is the inventing.”As an inventor on 20 patent families that include more than 160 granted patents and another 87 pending, she’s more than just a little good at what she does. These patents include technologies that detect and quantify genetic sequences, and which have a wide range of applications, including diagnosing diseases. She’s not just an inventor and patent holder, either. Todd lives and works in New South Wales, Australia, and received the Prime Minister’s Prize for Innovation in 2022. She was also invested as a Member of the Order of Australia this year, and was elected as a Fellow of the Australian Academy of Technology and Engineering in 2019.How did she get into this field in the first place? It all started when Dr. Todd was an undergraduate studying science. She says she pursued science not because of some driving ambition, but because it came easy to her. The ambition part would come soon enough, though; she discovered molecular biology during an internship, and right away, she could see the potential.“I was immediately convinced that understanding the genome would revolutionize medical practice both for diagnostic and therapeutic applications,” Dr. Todd says. “From then on, I was totally hooked.”Photograph: Cybele MalinowskiAfter 17 years as a researcher for big pharmaceutical companies, Dr. Todd took the leap into pursuing her own endeavors in 2009, founding SpeeDx with a former student, Elisa Mokany. They started with four people and a goal: to revolutionize diagnostic medicine. Today, SpeeDx has more than 100 employees across Australia, the US, and the UK, and the company develops and produces a range of human diagnostic tests for infectious diseases that are sold in 17 countries.“Thus far, over 6 million people with infections and over 4 million patients with cancer have benefited from a test powered by one of our inventions,” Dr. Todd says. Doctors who treat patients every day use her company’s tests to ensure that the treatments they administer are tailored as closely as possible to each patient’s needs. Since diseases like cancer have underlying genetic mutations that can vary between patients, the treatment that helps one patient recover might be ineffective in another patient with the same type of cancer.“That mutation will determine whether a treatment will or won’t work,” Dr. Todd says. “As we develop our tests, we work very closely with clinicians. Those clinicians are the thought leaders in the field, and they are the ones pushing for better ways to treat patients.”For other illnesses like bacterial infections, the old-fashioned “scattershot” method of throwing antibiotics at the problem has proven to be not just ineffective, but also actively harmful; overuse of antibiotics has led to the growth of antibiotic-resistant “superbugs” that are increasingly difficult to combat. Ensuring that a patient receives exactly the treatment they need is a key component to minimizing the use of the wrong medications and maximizing the patients’ positive outcomes, and that’s what really drives Dr. Todd.“It’s treating the individual but it’s helping the population—you are not driving the emergence of new resistant bacteria,” she says. “Antimicrobial resistance is a massive problem. You can tackle it at the policy level but you can also tackle it by treating the individual.”Of course, her journey through genetics research has had its share of challenges, but Dr. Todd has stepped over every speed bump thrown in her path. Nothing yet has put her off her course to solve the puzzles of modern diagnostics.“At the risk of sounding arrogant, I would say one of my greatest and ongoing challenges stems from being ahead of my time,” Dr. Todd explains. “My vision for medicine is, on occasion, years ahead of clinical practice. As such, I need to dig deep to find the patience and perseverance to see things through.”While Dr. Todd is always looking ahead at what’s coming next for diagnostic medicine, she’s also looking at the next generation of scientists and the changes that need to happen in the industry (and the world itself) in order for everyone to thrive. She’s a strong advocate for LGBTQ+ equality and lives her life, as she puts it, “unapologetically visible.” She encourages her peers to be mindful of biases and stereotypes, advocates for more flexible workplace environments to accommodate parents and carers, and mentors PhD students through the Australian Academy of Technology and Engineering and through her role as an adjunct professor at the University of New South Wales.“I mentor future leaders one at a time so that these individuals may themselves become instruments of further change,” Dr. Todd says. She points to her own SpeeDx, a company founded by two women, as an example of the diversity that’s possible in the modern scientific community.“Overall, we are fortunate to have a vibrant, multicultural workforce which includes 29 nationalities [and] 68 percent of whom are women, almost exactly mirroring the percentage of Australian graduates with life science degrees,” she notes. “Despite the glacial pace of change, I still have hope.”She might be a rock star in the diagnostic world, but Dr. Todd is quick to heap praise on the staff and researchers working alongside her.“I’ve got the most incredibly gorgeous bunch of clever people that I love working with,” she says. “I do not invent in isolation, but rather with a team of incredibly bright researchers, all of whom spark off each other and constantly come up with novel technical solutions.”Does she think about slowing down or stepping back from the work that’s been driving her for so long? Dr. Todd doesn’t see that happening anytime soon.“I can’t imagine stopping altogether,” Dr. Todd says. “My intellectual passion is for inventing technology, but my purpose is to help the patient. That’s the ultimate goal.” | Medical Innovations |
Scientists use harmless viruses to ferry and insert the new genetic material because of their natural ability to get inside cells. But the potential for these viruses to accidentally trigger another cancer has long been considered a theoretical risk. In its notice, the FDA said the use of these viruses may have played a role in patients developing secondary cancers.The downside of using viruses is that they tend to drop off their genetic cargo at a random place in a person’s genome. Depending on where this new genetic material integrates, it could potentially activate a nearby cancer gene. “The concern would be that somehow the new genetic material that you put into patients’ T cells can induce cancer in that cell, perhaps by where it gets inserted in the DNA,” Porter says.Because of this risk, the FDA currently requires that patients who receive CAR-T cell therapies be monitored for 15 years after treatment. In its notice on Tuesday, the agency suggested that “patients and clinical trial participants receiving treatment with these products should be monitored life-long for new malignancies.”Maksim Mamonkin, an associate professor of pathology and immunology at Baylor College of Medicine who is involved in several clinical trials of CAR-T cell therapies, says he is not aware of cases in which engineered T cells became cancerous in the dozens of patients treated there. But he says no therapy is risk-free. “It doesn’t mean it isn’t possible,” he says. “It cannot be ruled out that, just by chance, the CAR gene ends up in the wrong location in the genome.”Another explanation is that previous cancer treatments, including chemotherapy and radiation, played a role in the new T cell cancers patients developed. These treatments kill cancer cells, but they also damage DNA in healthy cells. In doing so, they can cause changes in cells that give rise to cancer later on.“Very often, cancer is more than just one mutation, more than one insult,” Porter says. “So you may damage the DNA with prior chemotherapy or radiation, making that cell more prone. Should it have another event, then it’s well on the way already to becoming a cancer cell.”A spokesperson for Novartis, which makes Kymriah, said that 10,000 patients have been treated with the therapy since its approval in 2017. The company has not seen any evidence to date that would change its confidence in the therapy’s risk-benefit profile. “As part of our continuous safety monitoring, Novartis has not identified a causal relationship between Kymriah and secondary malignancies,” a spokesperson told WIRED via email.A representative for Bristol Myers Squibb, which manufactures two approved CAR-T cell therapies, Abecma and Breyanzi, wrote that the company is aware of the FDA’s investigation. More than 4,700 patients have received the therapies, either in research trials or as commercial products. “To date, BMS has not observed any CAR-positive T-cell malignancy cases and therefore, we have not found a causal relationship between our products and secondary malignancies,” the spokesperson told WIRED by email.Johnson & Johnson, which makes another FDA-approved therapy, Carvykti, said through a spokesperson that the company is committed to the health and safety of patients. “We have shared our data with the FDA and are working with the agency as they assess this newly identified class-effect safety signal,” a spokesperson told WIRED in an email. More than 2,000 patients have been treated with Carvykti, they wrote.In yesterday’s statement, the FDA wrote that “the benefits of these products continue to outweigh their potential risks.”Porter agrees. “Clearly, this is concerning and we need more information,” he says. “But it’s likely to be a rare phenomenon.” | Disease Research |
Adults under-50 in England have just over a week left to take up the NHS offer of a Covid booster jab.
It is the last opportunity for healthy 16-49-year-olds to get a top-up dose - if they have not yet had three jabs.
The vaccine can help protect against severe illness, even if you have caught Covid before.
Appointments are available at thousands of different sites, including GP practices and high street pharmacies, up to and including Sunday 12 February.
Anyone aged 16 or over - or an at-risk child aged 12 to 15 - who has had both primary jabs, can have a booster.
So far, 15,000 people have booked in for next week and there are still 391,000 appointments available, says NHS England.
Amid the spread of the more contagious Omicron variant in December 2021, health officials announced a booster jab for those who had already had both of their Covid vaccinations. An already widespread vaccination programme was ramped up either side of Christmas that year to get as many people jabbed as possible.
That offer of a third jab for anyone remained available throughout last year. For the past few months, a further autumn booster has been available for over-50s and some other people with health issues.
- 53.8m people have had a first dose
- 50.8m have had a second dose
- 40.4m have had a booster or third dose
The latest publicity campaign is designed to attract any of the 10 million people who have so far only had two vaccinations.
The government has said it expects another autumn vaccination campaign later this year for older adults, as well as a potential spring campaign for the most vulnerable.
People with a severely weakened immune system were offered an additional third primary dose before being offered a booster this winter.
The NHS Covid vaccination programme will continue to run a smaller operation after 12 February, allowing those yet to come forward for first, second, or third doses if severely immunosuppressed, to book appointments.
Experts will also be keeping a close eye on new variants of Covid, in case more people need vaccinating in the future.
NHS Director of Vaccinations and Screening, Steve Russell, said: "There is just one week left of the autumn booster campaign and so if you are eligible for a booster but have yet to take up your latest dose, please do so before the end of next week.
"Whether you have had previous doses or a bout of Covid, we know that a booster is the best way to maintain protection against serious illness from Covid for yourself and your loved ones, so please do make the most of the offer while it is available and give yourself both protection and peace of mind for the year ahead."
How do I book my Covid vaccine?
- In England: You can book all doses online, by calling 119, or you can visit a walk-in clinic (some don't offer jabs to under-12s)
- In Scotland: Over-16s can register for their first dose and book second or booster doses online, or by calling 0800 030 8013
- In Wales: Over-16s will be invited for their booster. If you haven't been invited - or you haven't had your first two doses - you can contact your health board. You can change or cancel existing appointments online
- In Northern Ireland: All doses can be booked online or by calling 0300 200 7813
Which vaccine will people get?
The NHS is using Moderna's "bivalent" vaccine, which covers both the original Covid virus and the Omicron variant.
It also approved a second bivalent vaccine from Pfizer.
Health officials advise people to take whichever booster they are offered, as all vaccines provide protection against becoming severely ill from Covid.
First and second vaccine doses are either AstraZeneca or (for under-40s) Pfizer or Moderna. | Vaccine Development |
A deficiency of taurine -- a nutrient produced in the body and found in many foods -- is a driver of aging in animals, according to a new study led by Columbia researchers and involving dozens of aging researchers around the world.
The same study also found that taurine supplements can slow down the aging process in worms, mice, and monkeys and can even extend the healthy lifespans of middle-aged mice by up to 12%.
The study was published June 8 in Science.
"For the last 25 years, scientists have been trying to find factors that not only let us live longer, but also increase healthspan, the time we remain healthy in our old age," says the study's leader, Vijay Yadav, PhD, assistant professor of genetics & development at Columbia University Vagelos College of Physicians and Surgeons.
"This study suggests that taurine could be an elixir of life within us that helps us live longer and healthier lives."
Anti-aging molecules within us
Over the past two decades, efforts to identify interventions that improve health in old age have intensified as people are living longer and scientists have learned that the aging process can be manipulated.
Many studies have found that various molecules carried through the bloodstream are associated with aging. Less certain is whether these molecules actively direct the aging process or are just passengers going along for the ride. If a molecule is a driver of aging, then restoring its youthful levels would delay aging and increase healthspan, the years we spend in good health.
Taurine first came into Yadav's view during his previous research into osteoporosis that uncovered taurine's role in building bone. Around the same time, other researchers were finding that taurine levels correlated with immune function, obesity, and nervous system functions.
"We realized that if taurine is regulating all these processes that decline with age, maybe taurine levels in the bloodstream affect overall health and lifespan," Yadav says.
Taurine declines with age, supplementation increases lifespan in mice
First, Yadav's team looked at levels of taurine in the bloodstream of mice, monkeys, and people and found that the taurine abundance decreases substantially with age. In people, taurine levels in 60-year-old individuals were only about one-third of those found in 5-year-olds.
"That's when we started to ask if taurine deficiency is a driver of the aging process, and we set up a large experiment with mice," Yadav says.
The researchers started with close to 250 14-month-old female and male mice (about 45 years old in people terms). Every day, the researcher fed half of them a bolus of taurine or a control solution. At the end of the experiment, Yadav and his team found that taurine increased average lifespan by 12% in female mice and 10% in males. For the mice, that meant three to four extra months, equivalent to about seven or eight human years.
Taurine supplements in middle age improves health in old age
To learn how taurine impacted health, Yadav brought in other aging researchers who investigated the effect of taurine supplementation on the health and lifespan in several species.
These experts measured various health parameters in mice and found that at age 2 (60 in human years), animals supplemented with taurine for one year were healthier in almost every way than their untreated counterparts.
The researchers found that taurine suppressed age-associated weight gain in female mice (even in "menopausal" mice), increased energy expenditure, increased bone mass, improved muscle endurance and strength, reduced depression-like and anxious behaviors, reduced insulin resistance, and promoted a younger-looking immune system, among other benefits.
"Not only did we find that the animals lived longer, we also found that they're living healthier lives," Yadav says.
At a cellular level, taurine improved many functions that usually decline with age: The supplement decreased the number of "zombie cells" (old cells that should die but instead linger and release harmful substances), increased survival after telomerase deficiency, increased the number of stem cells present in some tissues (which can help tissues heal after injury), improved the performance of mitochondria, reduced DNA damage, and improved the cells' ability to sense nutrients.
Similar health effects of taurine supplements were seen in middle-aged rhesus monkeys, which were given daily taurine supplements for six months. Taurine prevented weight gain, reduced fasting blood glucose and markers of liver damage, increased bone density in the spine and legs, and improved the health of their immune systems.
Randomized clinical trial needed
The researchers do not know yet if taurine supplements will improve health or increase longevity in humans, but two experiments they conducted suggest taurine has potential.
In the first, Yadav and his team looked at the relationship between taurine levels and approximately 50 health parameters in 12,000 European adults aged 60 and over. Overall, people with higher taurine levels were healthier, with fewer cases of type 2 diabetes, lower obesity levels, reduced hypertension, and lower levels of inflammation. "These are associations, which do not establish causation," Yadav says, "but the results are consistent with the possibility that taurine deficiency contributes to human aging."
The second study tested if taurine levels would respond to an intervention known to improve health: exercise. The researchers measured taurine levels before and after a variety of male athletes and sedentary individuals finished a strenuous cycling workout and found a significant increase in taurine among all groups of athletes (sprinters, endurance runners, and natural bodybuilders) and sedentary individuals.
"No matter the individual, all had increased taurine levels after exercise, which suggests that some of the health benefits of exercise may come from an increase in taurine," Yadav says.
Only a randomized clinical trial in people will determine if taurine truly has health benefits, Yadav adds. Taurine trials are currently underway for obesity, but none are designed to measure a wide range of health parameters.
Other potential anti-aging drugs -- including metformin, rapamycin, and NAD analogs -- are being considered for testing in clinical trials.
"I think taurine should also be considered," Yadav says. "And it has some advantages: Taurine is naturally produced in our bodies, it can be obtained naturally in the diet, it has no known toxic effects (although it's rarely used in concentrations used ), and it can be boosted by exercise.
"Taurine abundance goes down with age, so restoring taurine to a youthful level in old age may be a promising anti-aging strategy."
Story Source:
Journal Reference:
Cite This Page: | Longevity |
People often talk about how old their pet pooch is in dog years — but what about cat lovers?
Unlike the well-known 7:1 year ratio for calculating the age of your dog, very little is said about how to estimate a feline's lifespan.
Some say that the same rule applies to cats, but much like with canine companions, the science doesn't support this.
The reason for this, experts say, is because a cat ages at a different rate depending on what stage of life it is at.
Early on it ages much quicker when compared to humans, but this slows down as it gets older.
For example, when a cat is a month old, research suggests its true age is actually closer to six months.
But fast forward just 60 days and this jumps to the equivalent of a 4 year old human.
This rapid ageing continues month-by-month to 5.5 years at four months, 8.5 years at five months and 11.5 years at six months, before slowing down so much so that when a cat reaches 12 months, its true age is only 16 years old.
Do the math and that means cats age 11.5 years in the first six months of their lives and just 4.5 years for the following six months.
The first two years are very similar — equating to the equivalent of a 16-year-old human at 12 months and a 21-year-old at two years.
However, it then suggests that after this, each additional human year is four 'cat years'.
For example, at three its true age would be 25, at four it would be 29 and at five 33.
'A one-year-old cat is physiologically similar to a 16-year-old human, and a two-year-old cat is like a person of 21,' said the Cornell University College of Veterinary Medicine.
'For every year thereafter, each cat year is worth about four human years.
'Using this formula, a 10-year-old cat is similar age-wise to a 53-year-old person, a 12-year-old cat to a 61-year-old person, and a 15-year-old cat to a person of 73.'
The first method differs slightly because it does not just increase by increments of four.
Instead, it suggests a three-year-old cat is actually 31, a four-year-old is 35 and at five it is the equivalent of 38-and-a-half in human years.
The average age a domestic cat lives to is about 14, but the oldest on record – named Creme Puff – reached an incredible 38 years.
The Texas cat was born in August 1967 and died in August 2005, according to Guinness World Records.
The fact that the two competing calculators put the start of a cat's middle age at about six (41 years old and 40 years old, respectively) is therefore in keeping with its expected lifespan.
This has increased dramatically over the past few decades, with the average cat living to just seven years in the early 1980s, and just over nine years in 1995.
A cat's age is generally determined by examining the condition of its teeth.
In kittens, this means measuring the extent of the growth, while in older cats vets are looking at wear and tear.
Complex charts are then deployed to convert this information into a cat's true age.
There are other factors to consider, too, however.
Firstly, it's important to monitor a cat's physical traits rather than emotional ones because many exhibit kitten-like behaviour throughout their adult years.
But one key thing to look out for is how your pet's fur changes: young ones have fine, soft hair, while older felines tend to have a thicker, coarser fur with patches of grey in it.
Older cats may also be bonier, have extra skin hanging or protruding shoulder blades and cloudier eyes.
Of course, it's never easy to say for sure, but if you are looking to gauge the rough age of your cat then the calculator and table above are a good place to start — and a much more accurate way than the 7:1 rule! | Longevity |
Some NHS patients could be prescribed the Wegovy weight-loss drug after limited stock arrived in the UK.
The injection will be offered by some specialist NHS weight-loss management services, as well as some private clinics.
As doses become available, it could help tens of thousands of patients in England, the NHS said.
There has been a global shortage of the jabs, which blunt appetite. The cost to the health service is unclear.
What is Wegovy and does it work?
Research suggests the treatment can help people shed more than 10% of their body weight, by making users feel they are already full so they eat less.
Experts warn the jabs - widely used in the US and endorsed by many celebrities - are not a quick fix nor a substitute for a healthy diet and exercise.
In trials, users often put weight back on after stopping treatment.
It is not clear how much stock the NHS will be able to access or what it will cost but the health service often negotiates a confidential discount with drug manufacturers. The list price for a pack of four pre-filled pens is £73.25. Users inject themselves once a week.
Some high street pharmacies, as well as private medical providers, have said they plan to sell it to customers too, offering a full prescribing and dispensing service.
The Danish maker of Wegovy, Novo Nordisk, said it would continue to restrict global supplies as it works to ramp up manufacturing.
It said in a statement there would be a controlled and limited launch: "As we expect supply to be constrained for the foreseeable future, a proportion of available supply will be allocated for use only within the NHS.
"We will continue to work with healthcare professionals to help ensure that patients with the highest unmet medical need are prioritised.
"We are closely monitoring demand and are working with regulators and providers to ensure people living with obesity can have access to and remain on the treatment."
NHS guidelines say patients can only access Wegovy, which contains the drug semaglutide, if they are significantly overweight and have weight-related health problems.
Eligible patient can be prescribed it for a maximum of two years via specialist weight-management services, alongside diet and exercise advice.
These services are largely hospital based, meaning only about 35,000 have access, but the government says tens of thousands more people could be eligible if a new scheme to let GPs prescribe it works. | Drug Discoveries |
Our sex lives can be a complex, wonderful part of our identities, but they can also bring anxiety and discomfort.
This is particularly true of female-identifying people who suffer from polycystic ovaries syndrome (PCOS) — like myself — a hormonal condition that affects the functioning of someone's ovaries, amongst other things(opens in a new tab).
PCOS misinformation(opens in a new tab) is rife on social media, making it difficult to know where to turn when looking for accurate information about your symptoms.
If you suffer from PCOS, it can affect many areas of your sex life(opens in a new tab), due to its relationship to female sexual dysfunction (FSD). Experts say(opens in a new tab) that FSD can impact your levels of sexual desire, lubrication, and your ability to orgasm.
So, as people with PCOS contend with other areas of our sexual awakening and self-actualisation, we have added obstacles to encounter.
How are PCOS and sexual dysfunction linked?
"The hormonal imbalances associated with PCOS, including high levels of androgens and disrupted levels of oestrogen and progesterone, can contribute to sexual dysfunction by affecting vaginal lubrication and arousal," Dr. Katerina Shkodzik, a gynaecologist and expert in reproductive endocrinology, explains.
Want more sex and dating stories in your inbox? Sign up for Mashable's new weekly After Dark newsletter.
It's not widely known that female sexual dysfunction is a really common PCOS symptom(opens in a new tab), meaning that many of us feel ashamed of coming up against these physical and mental barriers. And, as sexologist Madalaine Munro puts perfectly, "a lack of information and support can lead to feelings of self-blame and frustration, perpetuating a cycle of disempowerment."
So, a range of sexologists and PCOS experts have weighed in on different ways to boost your sex life, if various symptoms — particularly issues with low desire, lubrication, orgasm and irregular periods — are holding you back.
Vaginal dryness
If a lack of lubrication is causing pain or discomfort, sexologist Rhiannon John recommends prioritising masturbation "to understand what you like and what turns you on," keeping a good-quality lubricant on hand and trying pelvic floor therapy from a physiotherapist, which focuses on treating painful sex and can help manage abdominal pain, pelvic pain and painful periods.
She also advocates trying certain sexual positions that aid lower levels of lubrication: "Whether you're having sex with a penis owner or with a strap on, some helpful positions to try are the spooning position, as the angle of the penis is often shallower and less painful, or you can try being on top, as this way you can control the depth and angle of penetration."
For sexual partners with vulvas, John recommends "tribadism, also known as scissoring or tribbing. This position involves rubbing the vulva against the partner's vulva, thighs, or other body parts, which can increase arousal and lubrication."
Problems climaxing
Lubrication issues may lead to trouble orgasming, or you may experience this independently. Relationship and psychosexual therapist Jodie Slee recommends prioritising kissing and touching, spending "plenty of time on genital stimulation either with hands, mouth, or sex toys."
She also suggests trying edging: "an orgasm control technique where a person gets right up to the point where they're about to orgasm, then stops stimulation, waits, and then starts up again." Slee says this is a great method to try, as it can achieve a higher state of arousal and increase the likelihood of greater amounts of vaginal lubrication.
Seeking help for this form a psychosexual therapist could also be helpful, Slee says, particularly focusing on figuring out your "breaks" and "accelerators," essentially what moves you away from sex, and what moves you towards it. She calls this process "getting to the nitty gritty of the psychology of your sexual desire."
Cultivating your desire
Dr. Jolene Brighten, endocrinologist and author of Beyond the Pill, a comprehensive guide to female hormones, explains that problems with desire — a frequent issue for PCOS sufferers — can be rooted in "spectatoring." This refers to an over-focus on yourself from an outsider's perspective during sex, rather than focusing on yourself and your partner in the moment. It can tie into body confidence issues, thinking about what others may think of your sexual activity, interfering with desire and arousal.
Brighten recommends "mindfulness-based practices and sexual meditation," which are effective ways to increase sexual satisfaction, arousal and desire for people with PCOS. "These practices help to improve sexual functioning as they require people to focus on the body's sensations before and during sex," Brighten says.
Period shame
Many with PCOS encounter irregular periods(opens in a new tab), which can cause anxiety around sexual activity, with a partner in particular. While period sex may not suit everybody, it is worth normalising and exploring, if possible.
"It's essential that you give yourself permission to experience pleasure during your period," John says, recommending trying it in the shower with a partner to wash away any fluids, or purchasing a sex blanket that absorbs blood and other liquids.
It may also work to treat and combat some of the nastiest FSD symptoms experienced with PCOS. "The increased sensitivity during menstruation(opens in a new tab) can lead to heightened arousal and more intense orgasms. Additionally, the natural lubrication that occurs during this time can make penetration more comfortable and enjoyable," Munro explains.
On top of expert advice, though, what is needed on a larger scale when it comes to PCOS and sexual dysfunction is increased awareness, discussion and research into the condition.
"[This] would mean that PCOS would be better understood, treatment would become more effective, and there'd be far greater awareness and less shame and embarrassment around the condition and its symptoms," Relf says. "We still have a long way to go when it comes to talking about how PCOS impacts other areas of our health such as mental and sexual health."
Also, so many issues within the world of sex come from its representation — or lack thereof — in the realm of sex education. According to Cooper, we would all benefit from a better education about exactly what PCOS is, and how it might affect our bodies and sex lives.
"For something that can affect one in five women, it really should be taught in sex education so individuals are more aware of how it may affect them throughout their life," Cooper says.
So, as well as committing to helping our bodies through any sexual dysfunction PCOS might cause us, we must advocate for more conversations, education and research — so that our sex lives aren't held back by shame or silence. | Women’s Health |
London could see tens of thousands of measles cases due to low levels of vaccination, the UK Health Security Agency (UKHSA) has warned.
Mathematical calculations suggest an outbreak could affect between 40,000 and 160,000 people.
Higher levels of immunisation in the rest of the UK means there is a "low risk" of a large epidemic elsewhere.
But the UKHSA said there was an "urgent" need to vaccinate children, teenagers and young adults.
Levels of measles, mumps and rubella (MMR) vaccinations in the UK are at their lowest level in a decade, with around one in ten children not protected by the time they start primary school.
Immunisations also took a significant dip in the early 2000s after claims of a link between the MMR jab and autism. This has been completely discredited and the doctor who pushed the idea, Andrew Wakefield, was struck off the medical register.
But measles is one of the most contagious diseases around, and growing numbers of people are without protection. Scientists at the UKHSA and the London School of Hygiene and Tropical Medicine have run the numbers to reach those predictions of tens of thousands of cases in the capital.
This is a theoretical risk, rather than saying we are already at the start of a huge measles outbreak. There have been 128 cases so far this year, compared with 54 in the whole of 2022.
But the latest risk assessment suggests the R number - if you remember from Covid that's the number of people an infected person gives the virus to - has exceeded, or is close to 1.0, which is the point where a virus can take off.
The assessment also highlights 19 to 25-year-olds - who would have missed out at the peak of the autism scare - as being the most susceptible. There is heightened concern around university students.
The UKHSA also says a large outbreak could put pressure on the NHS, with between 20% and 40% of infected people needing hospital care.
"Due to longstanding sub-optimal vaccine uptake there is now a very real risk of seeing big outbreaks in London," said Dr Vanessa Saliba, a consultant epidemiologist at the UKHSA.
"Nobody wants to see their child or loved ones sick with measles, or put others who are more vulnerable, like babies, at risk. I urge those who have missed their MMR vaccines to catch up now."
Measles vaccination rates have taken a knock around the world, as the Covid pandemic has disrupted normal healthcare.
Outbreaks in South Asia and Africa also increase the risk of the virus being brought into the UK, where it can then take off.
The NHS is launching catch-up programmes, and parents are encouraged to check their children are up-to-date with their vaccines.
Measles usually starts as a cold and then is followed by a rash.
Jane Clegg, Regional Chief Nurse for the NHS in London said: "If you have any questions or concerns, please get in touch with your GP practice or local pharmacist for advice. Now's the time to act to protect yourself and your loved ones from measles."
Follow James on Twitter. | Epidemics & Outbreaks |
A disease spread by fleas is becoming more common and deadlier in Los Angeles, California. In a new report this week, health officials say that recorded cases of flea-borne typhus have steadily risen in LA since 2010, with the highest tally seen last year. Additionally, three people are thought to have died from typhus in 2022, the first such deaths reported in the area in three decades.
Flea-borne typhus is caused by the bacteria Rickettsia typhi. It’s a relative of the bacteria responsible for epidemic typhus, a disease that usually only appears and wreaks havoc during times of great human suffering, particularly wars. In contrast, flea-borne typhus is endemic in many parts of the world, though it tends to cause milder illness than its cousin. Symptoms include fever, headache, and a distinctive rash.
The bacteria’s natural life cycle typically starts with rats and other small mammals. Fleas feed on these hosts, becoming infected themselves. When the fleas reach their next meal, the bacteria is pooped out and can enter a new host through the bite or other open wounds. People can also contract infection by breathing in infected flea dirt or rubbing it into their eyes.
Flea-borne typhus used to be more common in the U.S., but improved sanitation and the availability of antibiotics have led to a substantial decline since the 1940s. By the 1980s, typhus became so rare that it was pulled off the list of nationally notifiable diseases. It does still periodically appear in parts of California, Texas, and Hawaii, however. And more recently, the incidence of typhus in these areas seems to have been climbing back up.
This latest paper was published Friday in the Morbidity and Mortality Weekly Report (MMWR), a journal maintained by the Centers for Disease Control and Prevention. In it, scientists with the CDC, the Los Angeles County Department of Public Health, and the California Department of Public Health have detailed the growing rise of typhus in Los Angeles.
In 2010, there were 31 reported cases of flea-borne typhus in LA County. By 2022, that number had jumped to 171 cases. That same year, three deaths linked to the infection were reported in LA as well, which were the first deaths associated with typhus in the area since 1993.
Flea-borne typhus usually isn’t life-threatening, but it can become fatal in rare circumstances. All three victims had other health conditions that might have increased the risk of severe illness. It’s also theoretically possible that a more virulent strain of typhus is now spreading in LA—a possibility that hasn’t been documented but should be monitored for, the authors say.
As for why typhus has become more common as of late, the authors bring up several theories. The Oriental rat flea (Xenopsylla cheopis) is the usual vector of typhus, but in suburban areas, the bacteria might now be hitching a ride more often with the cat flea (Ctenocephalides felis), which can infest a wide range of animals, including opossums, stray cats, and domestic pets. Rat populations in and around these hotspots might be growing as well, increasing the risk of transmission.
Notably, Texas has also been experiencing a resurgence of the disease lately. The authors say that more research is needed to understand these trends and to find ways to stem the tide of typhus in the U.S.
“Monitoring rodent, opossum, free-roaming cat, and dog flea infestations and the numbers of infected fleas is needed to understand disease ecology and more efficiently direct interventions to prevent disease in humans,” they wrote. | Epidemics & Outbreaks |
Want the health benefits of exercising, but aren't too keen on pounding the pavement or pumping iron every day?
Edith Cowan University (ECU) may be able to clarify how many times per week you need to exercise to make it worth your while.
A new study saw participants perform a single three-second, maximum-effort eccentric bicep contraction — similar to slowly lowering a heavy dumbbell, from a bent arm to a straight arm.
Previous ECU research showed this can significantly improve muscle strength when it's performed daily for five days a week (Monday – Friday), for four weeks.
Participants in the new study were split into two groups, with the first group performing a single three-second contraction two days per week, and the other performing the same exercise on three days per week.
After four weeks, researchers compared the participants' bicep strength.
Those who performed the exercise two-days per week saw no significant changes, however the three-day group saw small but significant increases in concentric strength (2.5 per cent) and eccentric strength (3.9 per cent).
Study lead Professor Ken Nosaka said the results helped to further improve our understanding of how our body responds to exercise — and how people can then put that knowledge to good use.
"Our previous work has shown regular, shorter exercise is more beneficial than a one or two big training sessions in a week," Professor Nosaka said.
"Now, we have a clearer idea of where the tipping point is where you start to see meaningful benefits from such a minimal exercise.
"These new results suggest at least three days a week are required, at least for the single three-second eccentric contraction training."
Three is good… but five is better
While the findings showed three days per week will have an impact, finding the willpower to put in a couple of extra days of exercise per week will produce better results.
The previous study's participants who performed the exercise five days a week saw greater improvements in strength — more than 10% increases — than the three-day group.
However, Professor Nosaka stressed this didn't mean exercising every day would improve results even further.
"Muscle adaptations occur when we are resting, so muscles need rest to improve their strength and their muscle mass," he said.
"It should be noted that the exercise was only three seconds, so the rest between exercises in the study was close to 28,800 times more than the exercise time.
"But muscles do appear to like to be stimulated more frequently, especially for the small volume of muscle strengthening exercise."
Applying it to real life
Professor Nosaka said more research was needed to see if the study's findings apply to other types and volumes of exercise.
"Muscles enjoying frequent stimulation may not necessarily be the case for a greater volume of aerobic exercise to improve cardiovascular function, or muscle strengthening exercise such as working out at a gym," he said.
"However, it may be that exercising once a week for 2 hours is less effective than exercising every day for 20 minutes.
"If it is not possible to have 20 minutes a day for exercise, even five minutes a day makes a difference for fitness and health.
"Of course, more studies are needed to confirm this, but our recent studies show the importance of accumulating small amount of exercise as frequently as possible in a week.
"It is important to note that even a very small amount of exercise can make a difference to our body, if it is performed regularly."
'Weekly minimum frequency of one maximal eccentric contraction to increase muscle strength of the elbow flexors' was published in the European Journal of Applied Physiology. | Aerobics & Cardio |
GSK Secures FDA Approval For New Blood Cancer Treatment
The drug can be used by patients with a cancer of the bone marrow called myelofibrosis who have anemia, regardless of their prior therapy, the company said Friday after reporting it received approval from the Food and Drug Administration. GSK gained the medicine through last year’s $1.9 billion acquisition of US biotech Sierra Oncology.
(Bloomberg) -- The U.S. Food and Drug Administration cleared a new treatment from GlaxoSmithKline Plc for a rare blood cancer, bolstering the UK pharmaceutical company’s push back into oncology.
The drug can be used by patients with a cancer of the bone marrow called myelofibrosis who have anemia, regardless of their prior therapy, the company said Friday after reporting it received approval from the Food and Drug Administration. GSK gained the medicine through last year’s $1.9 billion acquisition of US biotech Sierra Oncology.
The medicine, momelotinib, is likely to garner sales “comfortably” above $1 billion a year, according to Luke Miels, the drugmaker’s chief commercial officer. GSK will price it at a premium to its main rival, Miels said in a telephone interview, because anemia is the prime reason patients stop treatment for the cancer, which disrupts the production of blood cells.
“We’re addressing the anemia issue, which is expensive and obviously a high burden,” Miels said.
Incyte Corp.’s best-seller ruxolitinib, known commercially as Jakafi, is currently one of the main treatments for myelofibrosis, which affects about 25,000 people in the US. It has a list price of about $17,500 a month, Miels said, declining to disclose momelotinib’s future cost.
The approval caps a tumultuous journey for the medicine, which will be sold under the name Ojjaara. Sierra bought the drug from Gilead Sciences in 2018 after it disappointed in a clinical trial that pitted it against ruxolitinib. A subsequent study found the once-a-day oral treatment benefited a subset of patients with anemia, reducing the need for blood transfusions.
Cancer Push
About 40% of patients with myelofibrosis have moderate to severe anemia at diagnosis, and almost all will develop it over the course of the disease, according to GSK. Doctors have limited options for these people, and more than 30% stop treatment due to anemia.
“You’ve got 25,000 patients and just under half of them have anemia, which gets worse when you use the standard of care today,” Miels said. “If it gets worse, their life expectancy is reduced, and we’ve got a drug which is going to be very effective.”
Under Chief Executive Officer Emma Walmsley, GSK has worked to rebuild its oncology pipeline after it sold off its cancer drugs portfolio to Novartis in 2015. GSK spent $5 billion on the oncology developer Tesaro in 2019 before buying Sierra last year.
The latest transaction is a “case study of the type of business development we want to do,” with a deal size of about $2 billion to $3 billion, according to Miels.
When GSK ran the numbers on the Sierra takeover, it used a worst-case scenario in which momelotinib would be prescribed only to patients who had already been treated with ruxolitinib. The FDA’s approval also includes newly diagnosed patients with anemia, meaning the drug has a “significantly larger opportunity than when we did the economics of the deal,” according to Miels.
GSK has also applied for regulatory approval in the UK and Europe.
--With assistance from Madison Muller.
More stories like this are available on bloomberg.com
©2023 Bloomberg L.P. | Drug Discoveries |
Newly obtained genetic data from the Chinese Center for Disease Control and Prevention (China CDC) links the pandemic coronavirus SARS-CoV-2 to animals—specifically raccoon dogs—at the Huanan Seafood Wholesale Market in Wuhan, where the earliest COVID-19 cases centered, a group of independent scientists told the World Health Organization this week.The genetic data came from environmental swabs collected at the market by China CDC in January of 2020. The existence of these swabs was previously known, as was the fact that they were positive for SARS-CoV-2 genetic material. But in late January of this year, scientists at China CDC uploaded—and then later removed—additional genetic data from these swabs to a public genetic database called GISAID, the WHO said. That additional data, which had not been previously disclosed, indicates that the SARS-CoV-2-positive swabs also contained genetic material from humans and animals, particularly large amounts of genetic material that closely matches that of raccoon dogs.
Raccoon dogs—foxlike animals whose faces closely resemble those of raccoons—are known to be susceptible to SARS-CoV-2 infection and were known to be sold at the market.
Such close commingling of genetic material from the virus and a susceptible animal at the epicenter of the outbreak provides additional—though still inconclusive—evidence in support of a natural spillover hypothesis instead of the main competing hypothesis of a laboratory biosafety breach, i.e., a "lab leak." Previous genetic studies had identified two genetic lineages of SARS-CoV-2 in people early in the pandemic, suggesting two separate cross-species jumps into humans.
In a spillover scenario, the virus could have leap-frogged to humans from its reservoir in bats via raccoon dogs, which would be considered an intermediate host. This is how many animal viruses move to humans, particularly coronaviruses related to SARS-CoV-2. After the 2003 SARS outbreak caused by SARS-CoV-1, data suggested that masked palm civets and potentially other wild animals—including a raccoon dog—acted as intermediate hosts at a wild animal market much like the Huanan market. Another coronavirus, MERS-CoV, which causes Middle East respiratory syndrome (MERS), is also known to spread to people via dromedary camels.
Data sleuthing
The newly discovered genetic data from the Huanan market has not yet been made publicly available, and much of what is known is from media reports of the data. The Atlantic was the first to report the existence of the data Thursday.
But the WHO confirmed in a press briefing Friday that it had first learned of the data on Sunday, and on Tuesday, it gathered SAGO, the agency's Scientific Advisory Group for the Origins of Novel Pathogens. At that meeting, international scientists who were able to download the data before it was removed from GISAID presented their preliminary analysis to the advisory group.
The scientists working on the analysis include Michael Worobey, an evolutionary biologist at the University of Arizona; Kristian Andersen, a virologist at the Scripps Research Institute in California; Edward Holmes, a biologist at the University of Sydney; and Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada.
Florence Débarre, a theoretician who specializes in evolutionary biology and works at CNRS, the French national research agency, is credited with the data sleuthing that initially discovered the data on GISAID in early March before it was removed.
According to media reports, the data was taken off of GISAID after the international scientists analyzing the data reached out to China CDC to collaborate.
"The big issue right now is that this data exists and that it is not readily available to the international community. This is first and foremost absolutely critical, not to mention that it should have been made available years earlier," Maria Van Kerkhove, the WHO's technical lead on COVID-19, said Friday.Throughout the investigations into SARS-CoV-2 origins, China has pushed a dubious hypothesis that the virus originated outside its borders entirely, suggesting at one point that it was carried into the Huanan market via imported frozen foods. It has strongly pushed back on suggestions of a possible lab leak and had previously denied the existence of any wild animals in Huanan that could have acted as intermediate hosts.
WHO Director-General Tedros Adhanom Ghebreyesus echoed Van Kerkhove's frustration, emphasizing that the agency has again pushed China for transparency.
"These data could have—and should have—been shared three years ago," Tedros said Friday. "We continue to call on China to be transparent in sharing data and to conduct the necessary investigations and share the results. Understanding how the pandemic began remains both a moral and scientific imperative." | Epidemics & Outbreaks |
GP practices in England will be able to order a host of checks directly to help speed up the diagnosis of a range of heart and respiratory conditions.
Traditionally GPs refer to specialists when conditions like heart failure and lung problems are suspected.
But the ability to direct refer, which was rolled out for cancer last year, is now being extended.
GPs welcomed the move, but questioned whether there was sufficient testing capacity to cope.
Currently a quarter of people are waiting longer than six weeks for a diagnostic test - before the pandemic only 3-4% were.
NHS England said the diagnostic testing capacity was increasing with the rollout of one-stop community testing centres to supplement tests available in hospitals.
And it said the move would also free up the time of hospital doctors to focus on tackling the backlog in treatment.
Alongside heart failure, the increased access to testing is aimed at speeding up diagnosis for conditions such as asthma and chronic obstructive pulmonary disease, which causes breathing problems.
Extremely long waits
Dr Vin Diwakar, medical director for secondary care and transformation at NHS England, said: "We know how important it is to diagnose people with conditions like these early so they can get the treatment they need to manage their condition well and to prevent more serious conditions or illness from developing."
GPs in some areas can already order diagnostic tests for these conditions directly, but NHS England said this marked the start of the national rollout.
Royal College of GPs chair Prof Kamila Hawthorne said: "Any initiative to accelerate the process by which patients can be diagnosed and begin to receive any necessary treatment should be seen as positive."
She said GPs had "long been calling" for better access to diagnostic tests.
But she added: "For this initiative to be successful, it is vital that diagnostic capacity - both in terms of testing and people to conduct and interpret tests - is sufficient."
John Maingay, of the British Heart Foundation, also said access to testing was an issue along with waits when diagnosed.
"Many people are facing extremely long waits for heart care in England," he added. | Medical Innovations |
A research paper published today in Science Translational Medicine presents a significant breakthrough in the area of skin regeneration and wound healing by researchers at the Wake Forest Institute for Regenerative Medicine (WFIRM).
The study, titled "Bioprinted Skin with Multiple Cell Types Promotes Skin Regeneration, Vascularization, and Epidermal Rete Ridge Formation in Full-Thickness Wounds," shows the successful development of bioprinted skin that accelerate wound healing, support healthy extracellular matrix remodeling, and provide optimism for complete wound recovery. Anthony Atala, M.D., director of WFIRM, and Adam Jorgensen, M.D., Ph.D., post-doctorate researcher at WFIRM, co-led the study.
Skin regeneration has long been studied with hopes of providing burn victims, wounded warriors, and those with skin disorders opportunities at complete healing. Available grafts are often temporary, or if permanent, have only some of the elements of normal skin, which often have a scarred appearance. The creation of full thickness skin has not been possible to date. This study involved the bioprinting of all six major primary human cell types present in skin combined with specialized hydrogels as a bioink. Multi-layered full thickness skin was created which contained all three layers present in normal human tissue: epidermis, dermis, and hypodermis. When transplanted in pre-clinical settings, the bioprinted skin formed blood vessels, skin patterns, and normal tissue formation. Additional arms of the study demonstrated improved wound closure, reduced skin contraction, and more collagen production to reduce scarring.
“Comprehensive skin healing is a significant clinical challenge, affecting millions of individuals worldwide, with limited options,” explained Atala, who is the primary author on the paper. “These results show that the creation of full thickness human bioengineered skin is possible, and promotes quicker healing and more naturally appearing outcomes.”
By leveraging existing bioprinting technology to address these limitations, the team at WFIRM has proven that fully functional skin regeneration is possible. The bioengineered skin grafts offer a triple-layer structure for full-thickness wound coverage.
In addition to Atala and Jorgensen, the research team includes Anastasiya Gorkun, Ph.D., Naresh Mahajan, Ph.D., Kelsey Willson, Ph.D., Cara Clouse, D.V.M., Claire G. Jeong, Mathew Varkey, Ph.D., Mingsong Wu, Stephen J. Walker, Ph.D., Joseph A. Molnar, M.D., Ph.D., Sean V. Murphy, Ph.D., Sang Jin Lee, Ph.D., James J Yoo, M.D., Ph.D., and Shay Soker, Ph.D. The full research paper, "Bioprinted Skin with Multiple Cell Types Promotes Skin Regeneration, Vascularization, and Epidermal Rete Ridge Formation in Full-Thickness Wounds," is available for review in the October issue of Science Translational Medicine, a leading peer-reviewed journal that publishes cutting-edge research with the potential to transform clinical practice and improve patient care.
Media Contact: Emily Gregg, [email protected] | Medical Innovations |
July 12, 2023 -- Can a seemingly healthy person develop high blood pressure? The answer is yes: You can develop primary hypertension, or high blood pressure, even if you exercise regularly, eat healthy foods, and donât smoke.Â
Primary hypertension is high blood pressure from an unknown cause -- though it commonly stems from family history and genetics as well as lifestyle choices and other factors. Secondary hypertension is high blood pressure from an illness such as kidney failure, sleep apnea, preeclampsia, or thyroid disease.
Nearly 50% of U.S. adults, or around 119 million people, have stage 1 hypertension (meaning a blood pressure at or above 130/80) or stage 2 hypertension (at or above 140/90), according to the CDC. Having high blood pressure can lead to heart disease -- the leading cause of death in U.S. adults -- but only around 1 in 4 people with high blood pressure have the disease under control.
Martin Cassels, 57, falls into the primary hypertension category. He goes on daily 3-mile walks and has maintained a normal weight for his 6-foot stature through the years. Cassels was surprised when his family doctor diagnosed him with high blood pressure in his 40s at a routine checkup. Cassels needed to shed pounds to normalize his blood pressure levels. He adopted a strict diet and exercise plan, and even dropped a pant size.
Losing weight ended up raising Casselsâ blood pressure levels -- a pretty rare phenomenon, said Oscar Cingolani, MD, associate professor of medicine and director of the Hypertension Program at Johns Hopkins Medicine in Baltimore
âWith weight reduction, itâs good if you are overweight. If you are not overweight or obese, weight loss usually has no effect on high blood pressure, says Cingolani. âI don't know of cases where losing weight increases blood pressure.â
What happened next threw him for a loop. âShe [the doctor] said I needed to lose another 5 pounds,â Cassels said. âIâm sort of a fairly lean person anyway. I thought, âhow? I mean, Iâm killing myself.ââ
One day, Cassels ran into a neighbor who happened to be a doctor and casually shared his hypertension struggles. âThatâs not that bad,â the neighbor said after hearing Casselsâ blood pressure level. âThatâs borderline.âÂ
Cassels visited his local walk-in clinic to get a second opinion. The doctor there said some people just have higher blood pressure levels -- and that treatment can help. Cassels got started on a low dose of blood pressure medication. His blood pressure levels have been stable ever since.Â
If you live a healthy, active lifestyle with no symptoms of illness, here are some ways you can get ahead of a possible hypertension diagnosis, along with tips to keep this âsilent diseaseâ in check.
How Common Is Primary Hypertension in America?
Primary hypertension makes up around 90% of high blood pressure cases in the U.S., Cingolani said. Primary hypertension can happen through inheriting various genes from your parents, Cingolani says. But research on is still ongoing.
âWe have identified certain genes that are present in people with hypertension but not in others,â Cingolani says. âSo, unfortunately, we don't have a way of telling if somebody will or will not develop hypertension. We do know that if you were born to hypertensive parents, you are more likely to be hypertensive as you age.â
Cassels says his mother, who is 83, developed high blood pressure. He suspects that he likely inherited hypertensive genes from her.
Keep in mind: High blood pressure can be inherited through extended family, too, such as aunts, uncles, and grandparents, said Cingolani.Â
In addition to genetic makeup, you can also develop hypertension through obesity, eating too much salt, little physical activity, and social determinants of health -- such as socioeconomic status and lack of health insurance, said Rebecca Opole, MD, an internal medicine specialist at the University of Kansas Health System.Â
What Are the Signs That You Might Have Primary Hypertension?
Hypertension is commonly known as the âsilent killer.â A person can have hypertension and have a heart attack or stroke âwith little warning or clear early signs,â said Shannon Hoos-Thompson, MD, a cardiovascular medicine specialist at the University of Kansas Health System.
For patients who have had primary hypertension for a longer period of time, such as months or years, treatment may not be immediately effective since their bodies are already accustomed to higher blood pressure levels.Â
Thatâs one reason regular checkups with your primary care doctor are so important: You likely would not be able to tell you have high blood pressure without it being checked.Â
Can You Prevent Primary Hypertension?
Regularly checking your blood pressure can help you get ahead of the disease or get treatments early in the diagnosis. Cingolani suggested buying a blood pressure machine for your home instead of waiting for your next doctorâs visit. If you're obese or overweight and eat salty foods regularly, changing what you eat could âprevent or delay hypertension for years,â he said.
An active lifestyle can also make an impact. Shoot for at least 10 minutes of light to medium exercise intensity 3 days a week, though 30 minutes of physical activity is ideal, said Hoos-Thompson. Swapping overly processed foods for nutritious veggies and fruits, along with limiting carbs and fats -- like pasta, bread, and other starches -- can also help you maintain a normal blood pressure.
Getting enough sleep -- at least 6 hours -- is critical, too, Hoos-Thompson said. âPeople with sleep disorders are more prone to high blood pressure and resistant hypertension.â | Disease Research |
Back in 2019, I was diagnosed with ADHD at age 40, a process I described for the Guardian. The diagnosis came as a surprise to me, but not to anyone I knew: sure, I’d never been especially hyperactive (or even, y’know, active), but the chronic lateness, difficulty concentrating, lack of emotional self-regulation and decades-long struggle to locate my keys … these were all classic symptoms.
I was prescribed a medication called Vyvanse, which I’ve been taking daily since. It’s proven immensely helpful, allowing me to settle into a reasonably steady routine of writing and working. The days when I just can’t get anything done have been further and further separated by periods of unprecedented productivity.
In other words, everything has been going pretty damn well on the ADHD front. Or at least, it had until July this year, when I moved to the US.
I lived in New York City for most of the 2010s, returning to my native Australia in late 2017 when the company for which I was working went bust. My American partner joined me in Melbourne. We got married and applied for a green card. Then Covid happened, etc, etc, and it wasn’t until July 2023 that we packed our bags and moved back to New York.
Obviously, I made sure to bring as much Vyvanse as possible with me. “As much as possible” turned out to be two months’ worth, and the first month of our return was occupied exclusively with finding a place to live. Once that was sorted, though, my Vyvanse supply had started to wane, and with a two-week trip out of state on the horizon, I began looking into getting a new prescription.
Anyone who’s blessed enough not to have experienced the US’s, um, idiosyncratic approach to healthcare might think that this process should have been relatively straightforward. After all, I am a responsible adult, I’ve been happily taking the medication in question for five years without issues, I have a letter from my doctor attesting to that fact (along with medical records, etc), and I used my newfound freedom to choose an insurance plan to select one that specifically covered ADHD medications.
If so, let me gently disabuse you of that notion, because getting Vyvanse in the US in 2023 is a nightmare.
There are two reasons for this. The first is that there’s clearly been a reaction to the opioid fiasco of the 2010s, an era in which I walked away from a root canal with a no-questions-asked prescription for 60 Vicodin tablets. Sadly, that reaction hasn’t been anything as sensible as “let’s reform our outdated, pointlessly punitive drug laws and throw the Sacklers in prison until the heat death of the universe.” No, it’s been more along the lines of “let’s impose ever more insane restrictions on ‘controlled substances’ and treat anyone trying to obtain them with suspicion.”
The amount of damage this has done to anyone unfortunate enough to need prescription opiates to manage pain has been well documented, but there’s also been a huge overcorrection in regard to other “controlled substances”. Today, just finding a doctor who will prescribe ADHD medications is something of an ordeal: most general practitioners won’t even consult on ADHD, let alone prescribe medications. You might have more luck with a psychiatrist, except that my insurance plan requires a referral from a general practitioner to see a psychiatrist, which would be fine but for the fact that general practitioners won’t see you about ADHD, so … sigh.
The first general practitioner who agreed to actually speak to me insisted on trying to diagnose me with ADHD – a condition with which I have already been being treated for five years, remember – before she’d “even consider” prescribing anything. Thankfully, several weeks after my search began, I finally found a doctor who agreed to give me a prescription once she saw the letter from my doctor in Australia. She even offered to set me up with an innovative online pharmacy who’d deliver the medication to my door.
Hurrah! Now I just have to fill the script, and – oh dear Lord. Why does that say “$444.16”?
You may remember that my insurance plan specified explicitly that it covers ADHD medications. Well, it turns out that “we cover ADHD medications” actually means “we may in fact cover ADHD medications – but we may also choose not to, especially if we reckon we can put you on something cheaper.” Again, one might think this would be a question for a doctor, an idea to which the insurance industry’s collective response appears to be “lol”.
OK. Fine. It took a couple of days to sort prior authorization, and now all I had to do is get the innovative online pharmacy to schedule a delivery. Wednesday? That’s perfect, because I fly out on Thursday. I’m sure they’ll tell me well in advance if there are any problems. I mean, they wouldn’t do anything as obnoxious as wait until Wednesday night to tell me that they’re out of stock, right? Right?
Oh. And this leads to the second reason why this process has been so awful: there is a severe and ongoing shortage of ADHD medications in the US, one whose effects have extended to other countries around the globe. Given that amphetamines were first synthesized in the 1880s and the cartels seem to be pumping out vast quantities of methamphetamine happily enough, you might wonder why ADHD meds are so hard to find.
The intuitive answer is that because Vyvanse, Adderall and the like are controlled substances, the Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) put quotas on their production. However, while it’s hard to know exactly what’s going on, the answer doesn’t seem to be as simple as “the feds won’t let drug companies manufacture enough supply.”
A letter issued by the FDA in August 2023 noted that “based on DEA’s internal analysis of inventory, manufacturing, and sales data submitted by manufacturers of amphetamine products, manufacturers only sold approximately 70% of their allotted quota for the year, and there were approximately 1 bn more doses that they could have produced but did not make or ship,” and that “data for 2023 so far show a similar trend.”
Anyway, the reasons for the shortage don’t matter when you’re just trying to get your medication. And hoo boy, whether or not the controlled substance laws are behind the shortage, they make the process of trying to fill a script absurdly, needlessly difficult. Can I get an actual physical prescription and then ask around until I find a pharmacy? Nope. “Sorry, sir, this is a controlled substance.” Instead, I have to call the doctor and get them to send the prescription to a specific pharmacy. But how to know whether a given pharmacy has stock? Can I call around and ask? “I’m sorry, sir, we can’t tell you that. It’s a controlled substance.” You can’t … go and look in the supply cabinet? “No, sir, it’s a controlled substance.“
There’s something especially obnoxious about forcing people with an executive function disorder to negotiate a system so Byzantine it’d give Franz Kafka conniptions.
As I write this – and by God, has writing this ever been a trial – I’ve been unmedicated for over a week. I have weird episodes of something that’s not unlike narcolepsy, where out of nowhere, I suddenly get overwhelmingly sleepy. I have intermittent headaches – actual physical ones, in addition to the plentiful metaphorical ones that come from trying to deal with this nightmare. And the mental static to which I referred to in my original piece is back with a vengeance: concentration is slippery and ephemeral, and my attention wanders like a kitten constantly finding new things to play with.
The final irony is that if Vyvanse was any fun, I could probably have it illegally delivered to my door in half an hour, like any other illicitly recreational drug for which the US has an appetite. But the thing is that, as a prodrug, with its amphetamine component tied to an amino acid molecule, Vyvanse only has bioavailability if swallowed. Just like everything else about this hellish process, it is, in fact, no fun at all.
Tom Hawking is a Melbourne-born writer based in New York City whose work examines the intersections of politics and culture | Mental Health Treatments |
Published January 25, 2023 5:27PM Conjoined twins separated at Cook Children's Medical Center The twins, Jamie Lynn and Amie Lynn, were joined from the lower chest to their belly button. FORT WORTH, Texas - A team of doctors successfully performed Cook Children's Medical Center's first-ever conjoined twin separation surgery. "It was a scary journey because we didn't know what was going to happen," said father James Finley. Three months into their pregnancy Finley and Amanda Arciniega learned their twin girls were conjoined. The twins, Jamie Lynn and Amie Lynn, were joined from the lower chest to their belly button and shared a liver. (Courtesy: Cook Children's) "One of the questions they asked when I saw them at three months pregnancy is ‘Do we need to go somewhere else?’ And that to me was a very important question," said Dr. Ben Gbulie, a plastic surgeon at Cook Children's. The hospital's answer to that question: no. The family's emotional journey to separate their babies was detailed in a large scale news conference at the hospital complete with a video. FULL VIDEO: Conjoined twins separated at Cook Children's Medical Center Watch the story of Jamie Lynn and Amie Lynn and the amazing surgery to separate them. (Video courtesy: Cook Children's Medical Center) "On the ride home we were just quiet. We were like thank you, but out of everybody we were like, why us?" said Arciniega through tears. The work to assemble a world-class team began. The complexity of what they faced was all documented, from months of planning to the day and minutes before surgery. "We had to work to find the ideal time timing for when to do this. They were born at 34 weeks, they were a little early ,so we had to grow them and get them a little bit bigger. We got to a point where their positioning was a real challenge," said neonatologist Dr. Chad Barber. In the operating room there were two full medical teams, one for each baby girl. It took five hours in the OR just to prep before the procedure began, it lasted hours and ended successfully. The parents broke down in tears upon hearing the surgery was a success. READ MORE: 'Get certified': Stranger saves 10-day-old baby with CPR at restaurant Bishop T.D. Jakes, pastor of the twins' grandmother, was a spiritual counselor for the family. "I asked everybody from all over the country to pray. We're just so happy to see the good outcome that came out of this. The doctors did such an amazing job. I'm so inspired," said Jakes. "Like a lot of doctors told us the truth, the survival rate after birth. A lot of conjoined twins don’t live that long, and so we’ve learned how to be strong," said Finley. "I want to thank Anita and James for the trust you put in us. I hope you can see there not just another patients to us. We really love your girls," said neonatologist Mary Frances. During Wednesday's announcement one of the surgeons said the girls can now sleep in their own beds, and grow and develop on their own. | Medical Innovations |
Cases of 84 cases of extensively drug-resistant Shigella, an unusually high number for the region. Hundreds of cases in travelers returning to the U.S. and countries across Europe from resorts in Cabo Verde included some with multidrug resistance.are on the rise and pose a "serious public health threat," the Centers for Disease Control and Prevention warned last week. In February of 2022, the United Kingdom reported
The CDC said there are signs the percentage of Shigella bacteria cases that are resistant to a broad swath of antibiotics has begun to climb steeply around the U.S. Antimicrobial resistance happens when germs like bacteria ordevelop mutations and no longer respond to medicines designed to combat them, making it harder to treat those infections or diseases, says the World Health Organization. are a growing concern around the world.
These strains can also spread their resistance genes to other stomach bugs, so typical antibiotics that have been successful in the past no longer work, leading to more disease and deaths from illnesses that were previously curable.
"We are seeing an uptick in infections that are actually resistant to all first-line antibiotics," Dr. Payal Patel, an infectious disease physician, told CBS News. "This is important not just for the public to know but for doctors to know and look out for in case they see a patient with this infection."
What is Shigella bacteria?
Shigella bacteria are gram-negative bacteria, shaped like rods, recognized worldwide as the most common cause of dysentery, a gastrointestinal illness resulting in severe diarrhea. There are four species of Shigella bacteria, says the American Academy of Pediatricians, and one of the four species causes a gastrointestinal infection only in humans.
The bacteria causes an infection called shigellosis, which the CDC says infects about 450,000 people a year in the United States. An estimated 242,000 infections involve antimicrobial-resistant strains.
Shigella bacteria that have developed resistance to all of the standard frontline antibiotics — known as "extensively drug-resistant" or XDR Shigella — firstin the U.S. in 2015 from Americans who likely picked it up abroad. The CDC says 5% of all Shigella test samples collected in 2022 were classified as XDR, up from 1% in 2019.
States have reported 148 cases to the CDC from drug-resistant outbreaks, the agency said on Feb. 28; 39% of those cases have led to hospitalization. No deaths have been reported.
How does Shigella bacteria spread?
Shigella is found in the intestinal tract of humans and can be easily transmitted through contaminated food or water or by touching items with the fecal germs and then touching the mouth. The bacteria is very infectious and it takes only a small trace to infect another person, says the CDC.
Medical experts say that washing your hands carefully and frequently with soap and water, especially after using the bathroom, is the best way to protect yourself from infections. Travelers should also drink bottled or filtered water to reduce the chances of infection.
Asymptomatic carriers can transmit the disease. In addition, sexual transmission has become an important route for the spread of shigellosis, said the World Health Organization.
What are the symptoms of a Shigella infection?
Symptoms of a shigella infection include watery or loose stools. The incubation period is 12-96 hours after exposure. Symptoms usually start one to two days after infection and can last up to seven days.
In some cases, the symptoms can be more serious and include fever, stomach pain and cramps, and mucous-filled or bloody stools. Other reported symptoms include nausea, vomiting, loss of appetite, headache and malaise.
"If you are having bloody diarrhea more than three times a day and not able to keep anything down, that is a good time to start thinking about going to the ER," says Patel.
In some cases, bowel habits (the frequency and consistency of stool) do not return to normal for several months, says the CDC.
Who's at risk of Shigella infection?
Anyone can get sick from Shigella bacteria.
Children are more likely to get shigellosis, as they often get infected when they put their hands carrying small amounts of bacteria into their mouths. Day care centers and schools frequently have outbreaks. Children and teachers should wash their hands frequently to reduce the spread of the disease.
The CDC says data suggests that Shigella strains circulating in children so far are almost all susceptible to antibiotics.
Public health agencies say other groups at high risk for shigellosis include men who have sex with men, international travelers who drink contaminated water, and people with decreased immune systems.
Most of the drug resistant outbreaks have been reported among adults who are international travelers, men who have sex with men (MSM), those living with HIV or experiencing homelessness, the CDC said.
"The highest proportion of XDR cases are among adult men (85%). These trends are also consistent with recent increases in outbreaks of antimicrobial-resistant shigellosis among MSM," the CDC's Dr. Naeemah Logan said in a statement.
Is there a treatment or cure?
Most people will get better from a Shigella infection without going to the hospital or taking antibiotics. The most common recommendation is bed rest and fluids, and patients can recover within 5-7 days.
But sometimes the infection can be serious. Shigella bacteria ranks as one of the leading causes of death linked to diarrheal illness around the world.
"Only use antibiotics if you are prescribed antibiotics from your doctor, and try to be aware about antimicrobial resistance and what we can do as citizens to help make sure we preserve antibiotics for our children," says Patel.
Lab tests can determine if a Shigella infection involves "extensively drug-resistant" bacteria. XDR Shigella have shown resistance to all of the typically recommended frontline antibiotic treatments: azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, and ampicillin.
For patients with drug-resistant infections who need to be treated with antibiotics, doctors must seek out a handful of largely untested or typically unavailable options. At a recent webinar, the CDC floated the drugs fosfomycin and meropenem as potential options which have been used abroad, but acknowledged there was far from enough evidence for "official recommendations" by the agency.
–Reporting contributed by Alexander Tin
for more features. | Epidemics & Outbreaks |
The conviction of four care workers for mistreating patients at a specialist hospital in County Durham has once again underlined the vulnerability of people with learning disabilities and autism in such places. The government describes the abuse as a "terrible set of events that should never have happened". There have been many official promises of better, more appropriate services. Despite that, change remains slow.
The court case was the result of a 2019 undercover Panorama investigation into Whorlton Hall. It showed staff mocking and taunting patients. I remember tears running down my cheeks as I watched the secretly filmed footage. It reminded me of a similar investigation, also by Panorama and nearly a decade earlier, that exposed the abuse of patients at another specialist hospital, Winterbourne View, near Bristol.
That 2011 investigation caused a national outcry. It exposed an outdated system of specialist hospitals, known as assessment and treatment units. Patients were only meant to be there for a few weeks, but many remained for years.
Many experts viewed them as "not fit for purpose" - as the charity Mencap puts it, learning disabilities and autism are not conditions that can be "treated".
The government pledged that care and support for people with learning disabilities and autism would improve.
But the mistreatment of patients at Whorlton Hall shows how little has changed for this group of people. The question is why?
Alex's story
"She loved this day out."
Tony is scrolling through the photos on his phone, pointing to one of his daughters, Alex, posing in a phone box decked in artificial flowers.
It was the perfect place for an "Insta-moment", and 25-year-old Alex, who is severely autistic, was clearly loving everything about the recent trip to a shopping centre with her family.
Alex now lives in her own bungalow, with two support workers on hand to help. The contrast couldn't be greater to the life she was leading four years ago, when she was at Whorlton Hall.
There, the BBC Panorama investigation into the 17-bed unit near Barnard Castle exposed how she and some other patients were taunted and mocked.
"The more I saw it [the undercover footage], the more angry I got," says Tony. "You just don't treat people like that, you know, even if it's a difficult job. You still treat people as human beings."
Alex was sent to Whorlton Hall because there was no suitable community support available for her - from both the NHS and local council - when her behaviour became more challenging.
It meant her family had to make a 350-mile (563km) round trip from their home in the Midlands to see her each week. The distance made it more difficult for them to keep checks on what life was like at Whorlton Hall.
I have heard many stories from the families of people with learning disabilities and autism about this failure in the provision of local services.
The secret BBC filming showed how staff reacted when Alex became increasingly upset.
Her family says the hospital team knew she was frightened of men. But, as Alex got more distressed, two senior care workers, Peter Bennett and Matthew Banner, arrived in response to a request for additional help.
They needed to de-escalate the situation, yet Bennett threatened to send the female staff away. A short time later, the two women were told to go. Alex's screams could be heard at the other end of the corridor.
Bennett boasted to the BBC's undercover reporter about inventing what he called the "man button".
The secret filming showed it in action during another incident. Banner was seen sitting outside Alex's room threatening to call "five more men, six more men", unless she calmed down.
The two men were found guilty of ill-treating patients at Teesside Crown Court on Thursday. Care workers Ryan Fuller and John Sanderson were also handed guilty verdicts - Fuller for mocking patients and Sanderson for repeatedly unplugging a patient's phone. They will all be sentenced in July. Five other care workers were cleared of all charges.
The hospital was privately-owned and publicly-funded. A new company took over its running shortly before the Panorama investigation.
In the wake of the programme, an inspection by the regulator, the Care Quality Commission, concluded that services at Whorlton Hall were inadequate.
NHS England says standards fell well below what it expected and immediately took action to close the unit, "with patients moved to other facilities".
Broken promises
Watching the Whorlton Hall footage, it felt like I was seeing history repeating itself.
Although the abuse was different from that secretly filmed at Winterbourne View, the vulnerability, isolation and distress of the people being targeted was the same.
That 2011 BBC investigation exposed a toxic culture at the specialist hospital, north of Bristol. Staff were shown bullying, taunting and restraining patients in a way that, a court was later told, had inflicted pain and humiliation.
Eleven care workers admitted neglecting and abusing patients. Six of them were given jail sentences. The home was also closed.
And, in response to the public outrage, the then coalition government promised fundamental change. It said the inappropriate placement of people with learning disabilities and autism in such long-stay hospitals would stop by 2014.
That didn't happen. This relatively small group of people with complex needs were meant to be supported in the community instead, but often the help wasn't available.
Since then, there have been at least 26 different official reports - either detailing problems found in a range of institutions, or setting out plans for change.
A decade ago, there were an estimated 3,400 people with learning disabilities and autism in long-stay hospitals in England.
Today, despite the promises, there are still more than 2,000 people living in these assessment and treatment units.
NHS England has set a deadline of March next year to reduce those numbers by 50%. The learning disability charity Mencap estimates it will be another missed target.
Jackie O'Sullivan, the charity's director of communications, advocacy and activism, says the system is broken.
"We shouldn't be in a situation where, 12 years after Winterbourne View, this is still happening. Most of the people who were in Whorlton Hall shouldn't have been there in the first place."
It can cost several hundred thousand pounds a year to support someone with the highest needs. In the community, it is often financially-squeezed councils - rather than the NHS - who pick up the bill.
Mencap believes that while patients are still being sent to specialist hospitals, the money remains "locked up in NHS budgets", which makes it more difficult for local authorities to fund new community support. They describe it as a system of "perverse incentives".
Previously, NHS England and local authorities have said they are working together to transform services. This includes through new integrated care boards (ICBs) which help them set joint priorities for services and spending in an area.
The government has also said it is putting millions of pounds more into adult social care in England and reforming the care system as a whole.
And there are some fundamental problems which need fixing. The key one is staffing.
At Whorlton Hall, staff had a difficult job working long hours caring for people whose behaviour could be challenging, even violent. During the trial, the jury was told about the low pay and lack of training of the care workers. Most were on the minimum wage or just above.
Overall, the care sector is very short-staffed. According to Skills for Care, the organisation which monitors workforce pressures in adult social care, out of 1.79 million posts there are more than 165,000 unfilled in England - nearly 10%.
Living life
Alex's life has been transformed by the move to her bungalow.
The support workers help her live as independent a life as possible, her family is nearby, and they can pop in whenever they want.
She spends her time cooking, gardening and making her own animated films.
Her father Tony says that with support Alex is more settled and she is living, "a normal life like anybody else."
And one look at the photos of Alex on his phone shows the difference this is making to the whole family.
This is the change that was promised for people with learning disabilities and autism after Winterbourne View - support in the community to allow them to live life.
It has been provided for some, like Alex, but too many others are still waiting.
After years of reporting on this area, I am struck by two things. This is a relatively small group of people who have these conditions and a lot of money is already being spent on their care - but not enough is getting to the right places.
It is a problem that should be possible to fix, but the question remains - how long will it be before all people with learning disabilities and autism are supported to live life in a way that they choose? | Health Policy |
The social care minister warned that restrictions on visitors to care homes were “inhumane” – but residents remained isolated for months.
Helen Whately sent a WhatsApp message to Matt Hancock in October 2020 warning him against preventing “husbands seeing wives”, as England moved into a “tiered” lockdown system with tighter restrictions in areas with higher levels of Covid.
The minister continued to express concerns to the health secretary as the country went back into national lockdowns, telling him that the elderly were at risk of “just giving up” because they had been isolated for so long.
Despite the repeated warnings, visits to care homes only returned to something like normality in July 2021.
Ms Whately’s misgivings were shared by campaign groups, who warned that the threat from the virus should be balanced against damage caused by loneliness.
Charities including Age UK and the National Care Forum said in February 2021 that opening care homes up for visits was fundamental to residents’ “human rights”, while Amnesty International warned of residents being neglected without relatives able to monitor their care.
Residents spent months separate from loved ones
Care homes were closed to visitors in March 2020 when Britain was first plunged into lockdown – although it took a week before restrictions were officially written into care home guidance.
While the rules were varied throughout the pandemic, in practice, many care home residents spent months apart from their families, including their spouses.
Even when the rules were relaxed, care home residents spent months limited to seeing the same family members every time, often without being allowed to touch or only through a Perspex screen.
On Oct 12, 2020 – a few days before the Government introduced the new “tiers” system of local lockdowns at the start of the second wave – Ms Whately told Mr Hancock she had concerns about the proposed visiting restrictions.
“I’m hearing there’s pressure to ban care home visiting in tier 2 as well as tier 3. Can you help? I really oppose that,” she wrote.
“Where care homes have covid secure visiting we should be allowing it. To prevent husbands seeing wives because they happen to live in care homes for months and months is inhumane.”
When the rules came into force a few days later, care home residents who lived in tier one – the level with the most relaxed restrictions – were told that they could only have up to two consistent visitors.
Those who lived in tiers with tighter restrictions were banned from having visitors at all, unless there were “exceptional circumstances” like “end of life”.
However, on Nov 5, when England entered its second lockdown, the Government allowed care homes to set their own visiting policies, allowing residents up to two visitors. However, some were more zealous than others and imposed blanket bans
The second wave of the pandemic turned out to be the most lethal in care homes, but by the end of January 2021, nearly all care home residents had been vaccinated and the Government was starting to plan the route out of lockdown.
In a message to Mr Hancock, Ms Whately said: “As I think I’ve flagged, we do need to be ready with policy on visiting, given risks of lives lost through old people just giving up as well as Covid ...and expectation that vaccine = safe to visit.”
But Mr Hancock resisted making any swift changes. “Yes on visiting but only after a few weeks. Meanwhile we need to hit the end-of-month target!” he said.
Restrictions on visiting people in care homes were eased in stages over the following few months. Visits almost returned to normal on July 19, 2021, although some restrictions were reimposed later that year as Covid rates rose again. | Epidemics & Outbreaks |
It's a classic scenario: our New Yearâs resolutions often fade, and fast.
People love to set goals, and setting objectives can lead to meaningful change, whether it's quitting smoking, cutting back on alcohol, or getting fit or more organized. But sticking to goals is often much harder than jotting them down. One study found that about 64% (nearly two-thirds) of people abandon their New Year's resolutions within a month. It's practically part of the tradition.
So what will help make this year different?Â
Appreciate the Aspirations
You crack open a new planner or calendar and imagine what could be.Â
"The New Year serves as a cyclical marker of time during which we reevaluate and take inventory on our lives,â says clinical psychologist Sabrina Romanoff, PsyD, clinical psychologist and professor at New York's Yeshiva University. âThe drive for making resolutions is motivated by this punctuation in time. [It] activates hope and expectations for what we hope to achieve going forward.â
With a new year comes a "sense of renewal," says psychologist Mariana Strongin, PsyD. That makes us think about what we want to improve or change. Â
But while that blank slate feeling can be inspiring, we can also get carried away.Â
Think About How, Not Just What
Imagining change can be exciting. But it's going to need some structure to last.Â
âOften people do not map out or think about what it will take to accomplish a goal or make a resolution and instead rely on the excitement of the new year as the thing that will push them to accomplish their goal,â says Amanda E. White. Sheâs a therapist, speaker, and the author of Not Drinking Tonight.
Then it wears off.Â
Or perhaps your goal was too rigid, or you didn't allow enough time to reach it.
If you set a super-specific goal, such as a  a precise body weight, "it can be challenging to persevere in your efforts toward it if results are not immediate," Romanoff says. " Goals take time, and many folks become discouraged and eventually relent before attaining the goal.â
Look Back, Then Move Forward
If you find yourself making the same resolution each time January rolls around, do some detective work.
âWe often set lofty goals for the future without honestly assessing why weâve struggled in the past,â Britt Frank, a trauma specialist and author of The Science of Stuck. Â âWithout examining where we are resistant to change ... the cycle of resolve, relapse, repeat continues year after year.â
Change is possible. Check on whatâs holding you back. âBreaking behavioral cycles requires a rigorous commitment to honesty at all costs,â Frank says.
Consider the Pace: Quick Win or Long Run?
âDivide your goals between those that can be accomplished either in the long or short term,â Romanoff says. Short-term goals are quick wins. Long-term goals are going to take more time.
Romanoff's advice: If you have a long-term goal, create an action plan which links it to near-term achievable and realistic goals.
Achieve Big Goals Bit by Bit
Youâve probably heard that you should break big goals into smaller ones.Â
But why?
âAs humans we are driven by the feeling of mastery,â Strongin says. "So rather than making a goal of âbecoming fit,â I would make the goal of âworking out three times a week for at least 45 minutes each time.â By breaking down the goal into quantifiable measures, we are more likely to feel good about ourselves and even more likely to continue.â
White agrees. âWe only achieve goals by taking small steps daily or weekly. If we want to eat healthier, we must change our eating choices daily. If we want to run a marathon, we must commit to running a certain number of miles every week.
In general, breaking a goal into the smallest step possible makes it more likely that you will follow through. We tend to get overwhelmed and give up when a goal is too lofty.
Set Positive Goals
Research shows that youâre more likely to accomplish a goal that is specific and based on doing something instead of avoiding something.
For example, if you want to complain less in the new year, you are more likely to accomplish it if you phrase it as, "I will create a gratitude list and write down three things I am grateful for every day." This resolution is about an action you'll take, not something you want to stop doing.
Get Your Goals in Sync
Are your resolutions in conflict? That will make one or the other tougher, or impossible, to keep.
For instance, if you set a goal to save money and another to travel more, those goals could collide.
âMake sure you are not twisting yourself in a pretzel and that your goals have a synergistic effect so that working on one does not lead to the detriment of another,â Romanoff says.
Accept Some Losses
Success can feel great. But it may come with some other emotions, too.
âIt is crucial to understand that achieving âbig goalsâ is going to involve a degree of grief and loss,â Frank says. âWhy? When we get healthier, happier and more successful, our relationships change, pressure increases, and the familiarity and comfort ... is challenged.â
It's often an adjustment. âIf we focus only on the benefits and deny the costs of behavioral change, we are unlikely to stick to our resolutions,â Frank says.
Outsmart Your Obstacles
Do you have a backup plan?
What will you do when the weather is too bad for the walk or run you resolved to do? How about when you're feeling low and are tempted to spend, eat, or drink more than you planned? Or if your new routine starts to feel boring?
âMake sure you consider the things that could get in the way of accomplishing your goal and then build in ways to overcome those obstacles in your goal,â Romanoff says.
Be SMART About It
You may have heard of ââSMARTâ goals: Specific, Measurable, Attainable, Realistic, and Timebound.
They're key to lasting behavior change, says Matt Glowiak, PhD, licensed clinical professional counselor and author of A Year of Finding Your Callings: Daily Practices to Uncover Your Passion and Purpose..
For instance, if your resolution is to quit smoking, Glowiak says a SMART goal could look like this:
- Specific: You identify one specific goal. In this case, itâs âI want to quit smoking.â
- Measurable: You put a number on your goal. Is it to have smoked 0 times this week, or a specific number of cigarettes less than the day or week before? You need a measurable way to track your progress.
- Attainable: Do a reality check. For instance, is quitting smoking cold turkey practical for you or would you do better gradually cutting down until youâve quit?
- Time bound: Decide when you aim to reach each milestone and your final goal. You may also want to celebrate each step along the way, which can help you stay motivated.
With health goals such as quitting smoking, changing your diet, or improving your fitness, your doctor can help you know whatâs realistic and what will help. You donât have to figure it all out on your own.
Use Your Values for Motivation
Your values are like a compass. They constantly inform and guide behavior, Romanoff says. And they can help you remember why you set your resolution in the first place.
For instance, Romanoff recommends avoiding a goal like reaching a certain weight. Instead, consider the value behind it, such as if better health is the value driving you.
âChannel those values as incentive for your goal,â Romanoff says. âThe âwhyâ behind your goal will ground it in purpose and contextualize the resolution in a meaningful way.â | Stress and Wellness |
Key takeaways
- UCLA psychologists used music to manipulate emotions of volunteers and found the dynamics of their emotions molded otherwise neutral experiences into memorable events.
- The tug of war between integrating memories and separating them helps to form distinct memories, allowing people to understand and find meaning in their experiences, and retain information.
- These findings could hold therapeutic promise in helping people with PTSD and depression.
Time flows in a continuous stream — yet our memories are divided into separate episodes, all of which become part of our personal narrative. How emotions shape this memory formation process is a mystery that science has only recently begun to unravel. The latest clue comes from UCLA psychologists, who have discovered that fluctuating emotions elicited by music helps form separate and durable memories.
The study, published in Nature Communications, used music to manipulate the emotions of volunteers performing simple tasks on a computer. The researchers found that the dynamics of people’s emotions molded otherwise neutral experiences into memorable events.
“Changes in emotion evoked by music created boundaries between episodes that made it easier for people to remember what they had seen and when they had seen it,” said lead author Mason McClay, a doctoral student in psychology at UCLA. “We think this finding has great therapeutic promise for helping people with PTSD and depression.”
As time unfolds, people need to group information, since there is too much to remember (and not all of it useful). Two processes appear to be involved in turning experiences into memories over time: The first integrates our memories, compressing and linking them into individualized episodes; the other expands and separates each memory as the experience recedes into the past. There’s a constant tug of war between integrating memories and separating them, and it’s this push and pull that helps to form distinct memories. This flexible process helps a person understand and find meaning in their experiences, as well as retain information.
“It’s like putting items into boxes for long-term storage,” said corresponding author David Clewett, an assistant professor of psychology at UCLA. “When we need to retrieve a piece of information, we open the box that holds it. What this research shows is that emotions seem to be an effective box for doing this sort of organization and for making memories more accessible.”
A similar effect may help explain why Taylor Swift’s “Eras Tour” has been so effective at creating vivid and lasting memories: Her concert contains meaningful chapters that can be opened and closed to relive highly emotional experiences.
McClay and Clewett, along with Matthew Sachs at Columbia University, hired composers to create music specifically designed to elicit joyous, anxious, sad or calm feelings of varied intensity. Study participants listened to the music while imagining a narrative to accompany a series of neutral images on a computer screen, such as a watermelon slice, a wallet or a soccer ball. They also used the computer mouse to track moment-to-moment changes in their feelings on a novel tool developed for tracking emotional reactions to music.
Then, after performing a task meant to distract them, participants were shown pairs of images again in a random order. For each pair, they were asked which image they had seen first, then how far apart in time they felt they had seen the two objects. Pairs of objects that participants had seen immediately before and after a change of emotional state — whether of high, low, or medium intensity —were remembered as having occurred farther apart in time compared to images that did not span an emotional change. Participants also had worse memory for the order of items that spanned emotional changes compared to items they had viewed while in a more stable emotional state. These effects suggest that a change in emotion resulting from listening to music was pushing new memories apart.
“This tells us that intense moments of emotional change and suspense, like the musical phrases in Queen’s ‘Bohemian Rhapsody,’ could be remembered as having lasted longer than less emotive experiences of similar length,” McClay said. “Musicians and composers who weave emotional events together to tell a story may be imbuing our memories with a rich temporal structure and longer sense of time.”
The direction of the change in emotion also mattered. Memory integration was best — that is, memories of sequential items felt closer together in time, and participants were better at recalling their order — when the shift was toward more positive emotions. On the other hand, a shift toward more negative emotions (from calmer to sadder, for example) tended to separate and expand the mental distance between new memories.
Participants were also surveyed the following day to assess their longer-term memory, and showed better memory for items and moments when their emotions changed, especially if they were experiencing intense positive emotions. This suggests that feeling more positive and energized can fuse different elements of an experience together in memory.
Sachs emphasized the utility of music as an intervention technique.
“Most music-based therapies for disorders rely on the fact that listening to music can help patients relax or feel enjoyment, which reduces negative emotional symptoms,” he said. The benefits of music-listening in these cases are therefore secondary and indirect. Here, we are suggesting a possible mechanism by which emotionally dynamic music might be able to directly treat the memory issues that characterize such disorders.”
Clewett said these findings could help people reintegrate the memories that have caused post-traumatic stress disorder.
“If traumatic memories are not stored away properly, their contents will come spilling out when the closet door opens, often without warning. This is why ordinary events, such as fireworks, can trigger flashbacks of traumatic experiences, such as surviving a bombing or gunfire,” he said. “We think we can deploy positive emotions, possibly using music, to help people with PTSD put that original memory in a box and reintegrate it, so that negative emotions don’t spill over into everyday life.”
The research was supported by the National Science Foundation, UCLA and Columbia University. | Mental Health Treatments |
The NHS, it is claimed, is facing an exodus of doctors. It is one of the reasons put forward to support their claims for more pay as strike action continues.
But an analysis of data by the BBC suggests this is not the case - yet.
The proportion of the medical workforce leaving the NHS has hardly changed for a decade, while figures on those seeking a move overseas do not, overall, show a clear upwards trend.
There are, however, some worrying signs - with increasing numbers of junior doctors taking a break in their training, and some evidence that aggressive marketing by authorities in Australia on social media and billboards is turning the heads of more UK medics.
Doctors not leaving NHS in greater numbers
Every year thousands of doctors leave the NHS. Some retire, others move into private practice and some head abroad.
But figures from NHS Digital in England show over the past decade the proportion leaving overall has remained pretty constant at about 14-15%.
Meanwhile, the number of new joiners has increased, leading to a rise in the number of doctors in the NHS.
But what about if we just look at junior doctors? This is the group that receives the lowest rates of pay in the profession and is often said to be the most disenchanted.
They make up almost half the hospital doctors in England and include anyone who has finished medical school but has not yet completed their postgraduate training to become a GP, speciality doctor or consultant.
Firstly, most junior doctors do stay. Of those in 2016 who had completed their first two years of foundation training, only 7% had left the profession five years later, according to the General Medical Council (GMC).
But junior medics are taking a break
However, other data from the regulator does show a big jump in the numbers taking a break from their training.
In 2012, two-thirds moved straight on to the third year of their junior doctor training pathway after completing year two.
But by 2020 that figure had fallen to under a third.
Where these doctors are going is unclear. They could be spending time working as a locum - taking well-paid but ad-hoc freelance shifts to cover gaps in rotas - going travelling or seeking opportunities abroad.
Most seem to come back after a pause of a year or two, but the fact there is a clear upwards trend is causing some concern.
Working abroad remains an option
The best data on how many move abroad each year comes from the GMC database on applications for a Certificate of Good Standing, which doctors use to apply for work abroad.
Before the pandemic, there were consistently more than 6,000 certificates a year sent to other medical authorities around the world.
After a drop during the pandemic the number rose to about 7,000 in 2022.
More recent figures for 2023 so far suggest the number will be higher again - although it is unclear if this reflects a long-term rise, as the trend seen over the last 18 months may just be a natural catch-up following the dip during the pandemic.
The most popular countries are Australia, United Arab Emirates, Canada and Ireland, accounting for two-thirds of the certificates.
But applying for one of these certificates does not mean a doctor has definitely left the UK, the GMC says, rather it shows an intention to work abroad in the future. Data from previous years suggests half of doctors who apply for a certificate remain working in the UK.
Australia an attractive destination
The BBC has also approached the medical authorities directly in Australia and New Zealand about the number of doctors trained in the UK emigrating.
New Zealand has the most up-to-date figures, which show about 500 doctors a year trained in the UK and Ireland left to work there before the pandemic. The data available for the first three-quarters of 2022-23 suggests a similar level.
The figures for Australia only go up to 2021, and show a total of 6,621 UK-trained doctors working in the country that year. There has been a gradual upwards trend over the past five years with the figures more than a quarter higher than they were in 2016.
And the British Medical Association (BMA) is convinced this will get worse.
Dr Robert Laurenson and Dr Vivek Trivedi, who jointly chair the BMA junior doctors' committee, said: "You cannot ignore the evidence that if the government won't pay doctors what they are worth, they are going to continue to leave for countries that will."
But as doctors leave the UK, it is also worth noting medics come in from abroad.
Last year more than 12,000 doctors who were trained abroad joined the register. The number of newly-qualified homegrown doctors who joined was 8,000.
It is a two-way street. | Health Policy |
Hospital bosses failed to investigate allegations against Lucy Letby and tried to silence doctors, the lead consultant at the neonatal unit where she worked has told the BBC.
The hospital also delayed calling the police despite months of warnings that the nurse may have been killing babies.
The unit's lead consultant Dr Stephen Brearey first raised concerns about Letby in October 2015.
No action was taken and she went on to attack five more babies, killing two.
Letby has been found guilty of murdering seven babies and attempting to murder six others in a neonatal unit at the Countess of Chester Hospital, in Cheshire.
The first five murders all happened between June and October 2015 and - despite months of warnings - the final two were in June 2016.
BBC Panorama and BBC News have been investigating how Letby was able to murder and harm so many babies for so long.
Baby serial killer Lucy Letby
We spoke to the lead consultant in the unit - who first raised concerns about Letby - and also examined hospital documents. The investigation reveals a catalogue of failures and raises serious questions about how the hospital responded to the deaths.
Dr Brearey says he demanded Letby be taken off duty in June 2016, after the final two murders. Hospital management initially refused.
The BBC investigation also found:
- The hospital's top manager demanded the doctors write an apology to Letby and told them to stop making allegations against her
- Two consultants were ordered to attend mediation with Letby, even though they suspected she was killing babies
- When she was finally moved, Letby was assigned to the risk and patient safety office, where she had access to sensitive documents from the neonatal unit and was in close proximity to senior managers whose job it was to investigate her
- Deaths were not reported appropriately, which meant the high fatality rate could not be picked up by the wider NHS system, a manager who took over after the deaths has told the BBC
- As well as the seven murder convictions, Letby was on duty for another six baby deaths at the hospital - and the police have widened their investigation
- Two babies also died while Letby was working at Liverpool Women's Hospital
Summer 2015: 'Not nice Lucy'
Before June 2015, there were about two or three baby deaths a year on the neonatal unit at the Countess of Chester Hospital. But in the summer of 2015, something unusual was happening.
In June alone, three babies died within the space of two weeks. The deaths were unexpected, so Dr Stephen Brearey, the lead consultant at the neonatal unit, called a meeting with the unit manager, Eirian Powell, and the hospital's director of nursing Alison Kelly.
"We tried to be as thorough as possible," Dr Brearey says. A staffing analysis revealed Lucy Letby had been on duty for all three deaths. "I think I can remember saying, 'Oh no, it can't be Lucy. Not nice Lucy,'" he says.
The three deaths seemed to have "nothing in common". Nobody, including Dr Brearey, suspected foul play.
But by October 2015, things had changed. Two more babies had died and Letby had been on shift for both of them.
By this point, Dr Brearey had become concerned Letby might be harming babies. He again contacted unit manager Eirian Powell, who didn't seem to share his concerns.
In an email, from October 2015, she described the association between Letby and the unexpected baby deaths as "unfortunate". "Each cause of death was different," she said, and the association with Letby was just a coincidence.
Senior managers didn't appear to be worried. In the same month - October 2015 - Dr Brearey says his concerns about Letby were relayed to director of nursing Alison Kelly. But he heard nothing back.
Dr Brearey's fellow consultants were also worried about Letby. And it wasn't just the unexpected deaths. Other babies were suffering non-fatal collapses, meaning they needed emergency resuscitation or help with breathing, with no apparent clinical explanation. Letby was always on duty.
In February 2016, another consultant, Dr Ravi Jayaram, says he saw Letby standing and watching when a baby - known as Baby K - seemed to have stopped breathing.
Dr Brearey contacted Alison Kelly and the hospital's medical director Ian Harvey to request an urgent meeting. In early March, he also wrote to Eirian Powell: "We still need to talk about Lucy".
Three months went by, and another two babies almost died, before - in May that year - Dr Brearey got the meeting with senior managers he had been asking for. "There could be no doubt about my concerns at that meeting," he says.
But others at the meeting appeared to be in denial. Dr Brearey said Mr Harvey and Ms Kelly listened passively as he explained his concerns about Letby. But she was allowed to continue working.
June 2016: The tipping point
By early June, yet another baby had collapsed. Then, towards the end of the month, two of three premature triplets died unexpectedly within 24 hours of each other. Letby was on shift for both deaths.
After the death of the second triplet, Dr Brearey attended a meeting for traumatised staff.
He says while others seemed to be "crumbling before your eyes almost", Letby brushed off his suggestion that she must be tired or upset. "No, I'm back on shift tomorrow," she told him. "She was quite happy and confident to come into work," he says.
For Dr Brearey and his fellow consultants, the deaths of the two triplets were a tipping point. That evening, Dr Brearey says he called duty executive Karen Rees and demanded Letby be taken off duty. She refused.
Dr Brearey says he challenged her about whether she was making this decision against the wishes of seven consultant paediatricians - and asked if she would take responsibility for anything that might happen to other babies the next day. He says Ms Rees replied "yes".
The following day, another baby - known as Baby Q - almost died, again while Letby was on duty. The nurse still worked another three shifts before she was finally removed from the neonatal unit - more than a year after the first incident.
The suspicious deaths and collapses then stopped.
Letby still wasn't suspended, however.
Instead, she was moved to the hospital's risk and patient safety office. Here she is believed to have had access to sensitive documents relating to the hospital's neonatal unit. She also had access to some of the senior managers whose job it was to investigate her.
On 29 June 2016, one of the consultants sent an email under the subject line: "Should we refer ourselves to external investigation?"
"I believe we need help from outside agencies," he wrote. "And the only agency who can investigate all of us, I believe, is the police."
But hospital managers thought otherwise. "Action is being taken," wrote medical director Ian Harvey in his reply. "All emails cease forthwith."
Two days later, the consultants attended a meeting with senior management. They say the head of corporate affairs and legal services, Stephen Cross, warned that calling the police would be a catastrophe for the hospital and would turn the neonatal unit into a crime scene.
Rather than go to the police, Mr Harvey invited the Royal College of Paediatrics and Child Heath (RCPCH) to review the level of service on the neonatal unit.
In early September 2016, a team from the Royal College visited the hospital and met the paediatric consultants.
The RCPCH completed its report in November 2016. Its recommendations included: "A thorough external independent review of each unexpected neonatal death."
In October 2016, Ian Harvey also contacted Dr Jane Hawdon, a premature baby specialist in London, and asked her to review the case notes of babies who had died on the neonatal unit.
The result was a highly caveated report. According to Dr Hawdon, her report was "intended to inform discussion and learning, and would not necessarily be upheld in a coroner's court or court of law".
It was not the thorough review the consultants had wanted - or the thorough external independent review that the RCPCH had recommended. But even the limited case-note report by Dr Hawdon recommended that four of the baby deaths be forensically investigated.
That did not happen.
Early 2017: Still no police inquiry
In early January 2017, the hospital board met and Mr Harvey presented the findings of the two reviews. Both had recommended further investigation of some of the baby deaths - and yet that message did not reach board members.
Records of the meeting show Mr Harvey saying the reviews concluded the problems with the neonatal unit were down to issues with leadership and timely intervention.
A few weeks later, in late January 2017, the seven consultants on the neonatal unit were summoned to a meeting with senior managers, including Mr Harvey and the hospital's CEO Tony Chambers.
Dr Brearey says the CEO told them he had spent a lot of time with Letby and her father and had apologised to them, saying Letby had done nothing wrong. Mr Chambers denies saying Letby had done nothing wrong. He said he was paraphrasing her father.
According to the doctor's account, the CEO also insisted the consultants apologise to Letby and warned them that a line had been drawn and there would be "consequences" if they crossed it.
Dr Brearey says he felt managers were trying to "engineer some sort of narrative" that would mean they did not have to go to the police. "If you want to call that a cover-up then, that's a cover-up," he says now.
Managers also ordered two of the consultants to attend mediation sessions with Letby, in March 2017. One of the doctors did sit down with the nurse to discuss her grievance, but Dr Brearey did not.
Yet, the consultants didn't back down. Two months after the apology, the hospital asked the police to investigate. It was the consultants who had pushed them into it.
Dr Brearey and his colleagues finally sat down with Cheshire Police a couple of weeks later. "They were astonished," he says.
The next day, Cheshire Police launched a criminal investigation into the suspicious baby deaths at the Countess of Chester Hospital. It was named Operation Hummingbird.
Mr Chambers told the Panorama his comments to consultants had been taken out of context and that prompt action had been taken after he was first told of serious concerns in June 2016 - including reviews of deaths.
Spring 2018: Evidence of a poisoner
Letby had not yet been arrested and was still working at the hospital's risk and patient safety office. But Operation Hummingbird was in full swing and Dr Brearey was helping the police with their investigation.
Late one evening, he was going through some historic medical records when he discovered a blood test from 2015 for one of the babies on his unit. It recorded dangerous levels of insulin in the baby's bloodstream.
The significance of the test result had been missed at the time.
The body produces insulin naturally, but when it does, it also produces a substance called C-Peptide. The problem with the insulin reading that Dr Brearey was looking at was that the C-Peptide measurement was almost zero. It was evidence the insulin had not been produced naturally by the baby's body and had instead been administered.
"It made me feel sick," Dr Brearey recalls. "It was quite clear that this baby had been poisoned by insulin."
A few months later, Letby was finally arrested and suspended by the hospital. But three years had passed since Dr Brearey had first sounded the alarm.
When a new medical director and deputy chief executive, Dr Susan Gilby, began work the month after Letby's arrest, she was shocked at what she found.
She says her predecessor, Mr Harvey, had warned her she would need to pursue action with the General Medical Council, the doctor's regulator, against the neonatal unit's consultants - those who had raised the alarm. Mr Harvey denies this.
However, inside a box of files left in his office, Dr Gilby found evidence the problems lay elsewhere. Marked with the word "neonates", the files revealed how a meeting of the executive team in 2015 had agreed to have the first three deaths examined by an external organisation. That never happened.
The management team had also failed to report the deaths appropriately. It meant the wider NHS system could not spot the high fatality rates. The board of the hospital trust was also unaware of the deaths until July 2016.
Dr Gilby says the trust's refusal to call police appeared to be heavily influenced by how it would look. "Protecting their reputation was a big factor in how people responded to the concerns raised," she says.
Later in 2018, after Tony Chambers resigned, Dr Gilby was appointed chief executive and she stayed in post until 2022. She is now suing the trust for unfair dismissal.
Dr Brearey, says hospital managers had been "secretive" and "judgemental" throughout the period leading up to the nurse's arrest.
"There was no credibility given to our opinions. And from January 2017, it was intimidating, and bullying to a certain extent," he tells BBC News. "It just all struck me as the opposite of a hospital you'd expect to be working in, where there's a safe culture and people feel confident in speaking out."
Letby would ultimately be charged with seven murders and 15 attempted murders between June 2015 and June 2016. She was found guilty of all seven murders and seven attempted murders.
She was found not guilty of two counts of attempted murder. The jury also failed to reach a verdict on a further six counts of attempted murder, including all charges related to Baby K and Baby Q.
In a statement, Tony Chambers, the former CEO, said: "All my thoughts are with the children at the heart of this case and their families and loved ones at this incredibly difficult time. I am truly sorry for what all the families have gone through.
"The crimes that have been committed are appalling and I am deeply saddened by what has come to light. As chief executive, my focus was on the safety of the baby unit and the wellbeing of patients and staff. I was open and inclusive as I responded to information and guidance."
He added: "I will co-operate fully and openly with any post-trial inquiry."
Ian Harvey said in a statement: "At this time, my thoughts are with the babies whose treatment has been the focus of the trial and with their parents and relatives who have been through something unimaginable and I am sorry for all their suffering.
"As medical director, I was determined to keep the baby unit safe and support our staff. I wanted the reviews and investigations carried out, so that we could tell the parents what had happened to their children. I believe there should be an inquiry that looks at all events leading up to this trial and I will help it in whatever way I can."
The Countess of Chester Hospital is now under new management and the neonatal unit no longer looks after such sick babies.
The current medical director at the hospital, Dr Nigel Scawn, said the whole trust was "deeply saddened and appalled" by Letby's crimes.
He said "significant changes" had been made at the hospital since Letby worked there and he wanted to "provide reassurance to every patient who accesses our services that they can have confidence in the care that they will receive".
Since Letby left the hospital's neonatal unit, there has been only one death in seven years.
Editing and production by Joseph Lee
Panorama - Lucy Letby: The Nurse Who Killed - will be on BBC One and BBC iPlayer at 20:00 BST (UK only) on Friday 18 August | Epidemics & Outbreaks |
Some patients in England are waiting up to two-and-a-half years for important diagnostic tests such as ultrasound, MRI and CT scans, according to figures seen by the Guardian.
The longest waits were two-and-a-half years for an MRI scan, almost two years for an ultrasound and a year for a CT scan, responses to freedom of information requests by the Liberal Democrats show.
People with heart problems are among the worst affected. Examples from NHS trusts included a 49-week wait for an echocardiogram and a 475-day wait for an angiography.
Under the NHS constitution, patients should wait less than six weeks for diagnostic tests. The target is for only 1% to wait more than six weeks, but now 25% of all patients do so, according to research from the House of Commons library, commissioned by the Lib Dems.
The figures also show that the waiting list for diagnostic tests has shot up by more than half a million to 1.6m – a rise of 50% since 2019. The diagnostic waiting list includes anyone who has been referred for a check or test. It is different to the 7.7 million people who are waiting for treatment, as this figure measures people who have been referred to a consultant. While this can include patients waiting for a scan or check as part of their consultant-led treatment, the diagnostic test numbers include all patients waiting for a test, not just those being treated by a consultant.
Diagnostic procedures are carried out for a range of purposes including diagnosing cancer, identifying heart disease and establishing the extent of musculoskeletal injuries. More than 2m are carried out each month in the NHS in England.
The government is opening new community diagnostic centres but many patients face waits of several weeks for tests despite this additional investment.
The biggest increase was in the number of patients waiting for MRI scans, where the waiting list has jumped by a third and now stands at 280,000. For CT scans, it has shot up by 40,000 to 180,000.
The Lib Dems’ FoI request to NHS trusts found that the longest time for standard diagnostic scans was at Sandwell and West Birmingham NHS trust, where someone waited 914 days for an MRI scan, 665 days for a non-urgent X-ray, 693 days for an ultrasound and 367 days for a CT scan.
One person at Wye Valley NHS trust waited 49 weeks for an echocardiogram, while for an angiography, the longest reported wait was 475 days at Milton Keynes University hospital foundation trust.
Ed Davey, the leader of the Lib Dems, said: “What this Conservative government has done to the NHS is nothing short of a national scandal. Millions are forced to wait in pain and discomfort, anxiously wondering when they will get a diagnosis, let alone treatment.
“We cannot fix our economy without fixing our NHS. People can’t get back to work when they’re stuck waiting to see a GP, get a diagnosis or start treatment. The longer they wait, the worse their health gets and the greater the stress for themselves and their loved ones.
“Ministers are missing in action in this NHS crisis, and it’s patients who are suffering. We need urgent action to get on top of this mess and end these appalling delays.”
The party is calling for an expansion of community diagnostic centres to help people be seen quicker, as well the right for everyone to see their GP within seven days, which they said could be achieved by increasing the number of appointments and the number of GPs by 8,000.
Rachel Power, chief executive of the Patients Association, said: “Waiting for a diagnosis is miserable and for some it can be painful and frightening … We worry that long waits for diagnostic testing may result in delays to treatment, which then may come too late to be effective.”
According to NHS England figures, the average waiting time for diagnostic tests has fallen from almost nine weeks at the peak of the coronavirus pandemic to just 3.1 weeks in July and that overall, there were a total of 2.2m tests and checks carried out in July.
Miriam Deakin, director of strategy and policy at NHS Providers, said ongoing strikes were compounding the problem, with official figures expected to show more than a million patients had care pushed back because of industrial action.
Jo Newens, chief operating officer at Sandwell and West Birmingham hospitals NHS trust apologised for the long waiting times, but said it was working hard to reduce them. Measures include expanding weekend appointments and a refurbished MRI centre to increase capacity and “help speed up the patient journey for those awaiting diagnostics”, she said.
A spokesperson for Wye Valley NHS trust said: “In the last year, post-pandemic, we have made significant headway in reducing waiting times for echocardiograms for urgent and routine appointments, including expanding the echocardiography team and the introduction of seven-day working to increase clinical slots so patients can be seen more quickly.”
A spokesperson at Milton Keynes University hospital said there could be several reasons why some patients waited longer for treatment, including urgency or clinical need, the choices of that individual patient and clinical timing and complexity of the procedure. They said: “We constantly review all of our waiting lists and – where it is clinically appropriate – we bring patients forward to receive their treatment in the shortest time possible.”
The health minister, Maria Caulfield MP, said: “If the Liberal Democrats really cared about reducing NHS waiting lists, they wouldn’t have voted against our Minimum Service Levels Act, which will reduce strike disruption for patients.
“This Conservative Government is focused on the people’s priorities and taking action to cut waiting times – including announcing an additional £200m to boost NHS resilience and care this winter.
“We have already virtually eliminated two year waits and reduced 18-month waits by 91% from their peak, and will continue to cut waiting times through record investment in the NHS to ensure that patients get the care they need.” | Health Policy |
Amid a flu season that started earlier than expected there's also been a higher number of strep A cases in children this year.The Centers for Disease Control and Prevention issued an advisory warning last month about the increase to make sure clinicians and public health authorities know how to identify and treat the infection.While each disease can turn into a serious case on its own, in rare cases, the two can infect people, particularly children, at once and lead to severe, or even fatal, complications, according to health experts.A 5-year-old boy from Greenville, Michigan, died on New Year's Eve after testing positive for the flu and then developing strep A, according to ABC News Grand Rapids affiliate WZZM.Public health experts said influenza can weaken the immune system, which can then make people -- including children -- susceptible to secondary infections.STOCK PHOTO/Getty Images"Influenza is a respiratory virus, meaning it infects the nasal passages, the passages of the back of your throat, and then the lining of the lungs," Dr. Lori Handy, an attending physician in the division of infectious diseases at Children's Hospital of Philadelphia, told ABC News. "Anytime those areas are particularly irritated, they break down some of your normal immune defenses that would protect against secondary bacterial infections and the bacteria really take advantage of that breakdown and go ahead and enter your body."There are several pathways by which the immune system response can breakdown as a result of flu infection. One Yale University study found flu triggers an increase in levels of serum glucocorticoid, a steroid hormone, which suppresses the immune system.Dr. Sam Dominguez, an infectious disease specialist at Children's Hospital Colorado, said there is also evidence the flu can decrease macrophages, a type of immune system cell that destroys bacteria and other organisms, or that the virus allows bacteria to adhere better to respiratory cells."That allows bacteria to gain entry into the body more easily and so that's an advantage that the bacteria can utilize if you had an influenza infection," he told ABC News.Although it's not incredibly common to see children with this type of co-infection, doctors said they do see cases every year.Dominguez said he and his colleagues in the hospital are "definitely seeing more cases this year than last year."Children's hospitals and health agencies across the U.S. have been observing an increase in cases of invasive group A strep infections among kids.Strep A typically causes about 1,500 to 2,300 deaths in the U.S. every year, according to the CDC.The CDC told ABC News it has seen childhood strep A infections in late 2022 return to levels seen during pre-pandemic years, and that it is monitoring the situation."CDC issued a health advisory on Dec. 22 to notify clinicians and public health authorities about an increase in pediatric invasive group A streptococcal, or iGAS, infections. The advisory highlights the importance of early recognition and appropriate treatment of these diseases," the CDC said in its statement.STOCK PHOTO/Getty Images"It's too soon to say whether iGAS case numbers are rising beyond what we would normally expect from GAS seasonal patterns, pre-pandemic. The overall number of iGAS cases is relatively low and iGAS infections are rare," the statement continued.The experts stressed the importance of making sure parents get their children vaccinated against the flu if they haven't done so already.As of Dec. 24 -- the latest date for which data is available -- 47.5% of all children have received a flu vaccine, according to CDC data."The influenza vaccine is very good at preventing severe disease in terms of saving you from getting hospitalized or dying of influenza and then, second of all, it prevents you from getting the secondary bacterial infections on top of that," Dominguez said.While young children and children with underlying health conditions are at higher risk for severe flu disease or hospitalization, even relatively healthy children can develop complications."While parents may feel like, 'My child generally doesn't get sick, I'm going to skip vaccine this year,' we see generally healthy children get severely ill both from influenza and then complicated bacterial infections after," Handy said. "So, we really need everybody to be vaccinated to keep everybody out of the hospital, and also just reduce transmission within the community. So, it's about both protecting yourself but then protecting all of those people you come in contact with."They also recommended that families follow the same advice offered throughout the course of the pandemic including thoroughly washing your hands, staying home when sick and speaking to your primary care doctor.ABC News' Emma Egan, Nicole Wetsman and Dr. Nicole McLean contributed to this report. | Epidemics & Outbreaks |
The Instagram model who had one of her 38J breast implants pop is having her mental health questioned online ... but she says she's not ill and views plastic surgery as a hobby.
The Canadian model, who goes by Mary Magdalene on social media, tells us she started getting plastic surgeries at 18 and after 12 years and a ton of procedures, she says she started feeling like her plastic transformation was her own way of being an adrenaline junkie.
Mary says she's just like anyone who gets super into extreme sports ... but instead of climbing bigger mountains or jumping from higher heights, she went bigger and bigger with her injections ... from her lips, to her butt and, of course, her boobs.
Instagram / @1800leavemaryalone
As we reported ... Mary says she's going to change to a more "natural" look after one of her 11-pound boob implants popped, leaving her with a uni-boob and a bunch of tattooed skin.
Mary says her out-of-this-world surgeries brought her happiness over the years, but adds her feelings have changed and now she's going to change her appearance. In fact, she says if her implant didn't pop, she would have gone even bigger with her next procedure and doubled her already massive 38J cup size.
The IG model says she's going to do her next breast procedure in Brussels, and she's going under the knife twice for a breast reduction that will set her back nearly $33,000 ... and bring her breast implants down from 5,000 cc to 700cc.
TMZ.com
Mary says she had a spiritual awakening after the incident, with her come-to-Jesus moment aided in part by some mind-altering substances ... and she wants to move away from what she sees as her current "bimbo" look.
And, get this ... Mary tells us she's going to save the excess skin cut off during her breast reduction surgery and save it in a jar ... as a reminder of what she's been through. | Mental Health Treatments |
Policymakers are failing to protect patients at risk of hereditary cancer
Millions of people in the United States have a genetic mutation that increases their cancer risk, yet policy gaps leave many of them struggling to pay for the lifesaving preventive health care they need.
We know that additional cancer screenings and preventative surgeries — such as mastectomies and hysterectomies for those with the greatest risk — can help people avoid hereditary cancer or catch it early, before it has a chance to spread; however, high medical costs can be an ongoing burden that causes many people to skip the interventions recommended by their doctors in accordance with national guidelines.
While the Affordable Care Act (ACA) requires most private health insurers to cover BRCA genetic testing for women at high risk for breast and ovarian cancers, it doesn’t require insurers to cover the extra cancer screenings and preventative surgeries recommended for those who test positive. That leaves many patients with the knowledge that they are at high risk for cancer and little financial assistance to stop it.
As head of public policy at FORCE (Facing Our Risk of Cancer Empowered), I meet people every week who are forced to pay out-of-pocket to safeguard their health. One young woman with a BRCA2 mutation told me she pays thousands of dollars every year for an annual breast MRI that her insurance won’t fully cover. Another woman with a PALB2 mutation, whose doctor told her to start mammograms at age 30, has to meet her annual deductible or incur a significant co-pay because she is not yet 40 years old (the age that the ACA requires most insurers to fully cover mammograms). High-risk people needing colonoscopies before age 45 face the same issue.
As a previvor with a BRCA mutation — which puts me at elevated risk for breast, ovarian and pancreatic cancer — I have personally paid tens of thousands of dollars out-of-pocket for cancer screenings and risk-reducing surgery, despite the National Comprehensive Cancer Network (NCCN) and other medical guidelines classifying them as appropriate preventive care for someone with my genetic mutation.
While the ACA doesn’t require it, in most states, private insurance or Medicaid will at least partially cover additional hereditary cancer screenings and risk-reducing surgeries. One glaring exception is Medicare, which covers little to no preventative services for those with cancer-causing mutations. The Reducing Hereditary Cancer Act, introduced in the U.S. House and Senate earlier this year, would ensure that Medicare patients at risk for hereditary cancer have access to the health care they need, as well as genetic counseling and testing.
Under current law, Medicare only covers genetic testing for beneficiaries already diagnosed with cancer, regardless of family cancer history or a known genetic mutation in the family. Wasserman Schultz, who co-sponsored the bill and has a BRCA2 gene mutation, rightly said it was “nonsensical” for Medicare to deny coverage for relatively inexpensive genetic testing until after a patient has received a potentially terminal cancer diagnosis.
The passage of this bill would not only reduce taxpayer spending by helping more patients prevent or catch cancer early, when it’s easier and less expensive to treat, but it would save the lives of countless Americans. It’s a no-brainer.
As if Medicare and health insurers refusing to fully cover preventive cancer services wasn’t bad enough, some insurers are legally allowed to use customers’ health information to deny or raise rates. While the Genetic Information Nondiscrimination Act (GINA) prohibits discrimination by health insurance plans and employers based on genetic information, the same isn’t true for other forms of insurance. This means people in the hereditary cancer community, many of whom have never had cancer, are frequently denied or charged significantly higher rates for basic safety nets like life, long-term care and disability insurance.
I personally have family members who refuse to undergo genetic testing because they are afraid that they, and possibly their children, could be denied insurance or subjected to massive premiums. Not only is this unfair, but it discourages people from seeking genetic testing that could reveal and empower them with life-saving information.
It’s time to update our health care and genetic privacy laws to ensure that people at high risk of hereditary cancer get the genetic counseling, testing, screening, preventative care and insurance coverage they deserve — at little or no additional cost. Contact your members of Congress today to express your support for the Reducing Hereditary Cancer Act and urge them to champion legislation that will close the gaps in preventive health care for those affected by hereditary cancer.
Together, we can fight unfair insurance practices to ensure everyone receives the services they need, without facing financial burdens or discrimination based on their genetic information.
Lisa Schlager is vice president of public policy at Facing Our Risk of Cancer Empowered (FORCE), based in Tampa, Fla. FORCE is a nonprofit organization that serves the hereditary cancer community through education, support, advocacy and research.
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. | Health Policy |
Ministers have drawn up large benefit changes for people who are unable to work due to health conditions, the BBC has learned.
The changes, affecting hundreds of thousands of people from 2025, would save £4bn from the welfare budget.
The proposals would see many more people forced to find work despite suffering from a range of physical and mental health conditions.
The Department for Work and Pensions said reform would be gradual.
The proposals follow the announcement in March that the government wants to scrap the controversial Work Capability Assessment, which is used to determine if people can receive additional benefits payments due to a health condition.
Eligible claimants currently receive £390 a month on top of their universal credit payment.
If the proposals are enacted, people who, for instance, are in severe pain while awaiting an operation or have some mental health conditions, such as depression and anxiety, may not receive the additional payment but would be expected to look for work.
The BBC understands the changes would initially affect new claimants. Existing recipients of the benefit payment would eventually be brought into the new system, towards the end of the decade, but would be given transitional protection if their benefits were to be cut.
Both Chancellor Jeremy Hunt and Mel Stride, the Secretary of State for Work and Pensions, have spoken in recent months of their desire to get more people off benefits and into work.
Speaking in the Commons in September, Mr Stride said more than 2.5 million people were on benefits and inactive due to a long-term health condition.
The proportion of claimants assessed as too unwell to work had risen from 21% in 2011 to 65% in 2022, according to the secretary of state.
Those who currently receive the additional money are placed in one of two categories of people deemed unfit to work:
- either having "limited capability for work-related activity" if they receive universal credit
- or in the support group if they receive employment and support allowance
Under the new proposals, these categories would be scrapped, the additional benefit would not be paid, and work coaches in Job Centres would determine how much effort a person had to make to find a job.
Those considered not to be trying hard enough could be threatened with having their benefits sanctioned. There would be some exceptions, such as for people being treated for cancer and those with a terminal illness.
The proposals are expected to save around £4bn over four years but officials - some of whom fear the changes are being rushed - are pushing for some of the savings to be re-invested.
They want a package of intensive support for those people who'll have to look for work as they fear many of them simply won't be able to find a job, resulting in financial and psychological distress.
The plans foresee the health element of universal credit being more closely aligned with the main disability benefit, Personal Independence Payment.
In future those who qualify for PIP would receive the health element too.
Figures released by the DWP in July showed that in November 2022, 516,000 people who were in receipt of a sickness benefit did not quality for PIP, 29% of all recipients.
Charities have been urging ministers not to merge the two tests, with the group Z2K calling PIP a "deeply flawed assessment process".
The proposals to give work coaches discretion over how much effort a claimant should make to find work has also been criticised by Z2K as a "lottery for sanctions".
One official told the BBC another problem was that the DWP didn't have enough work coaches to help claimants find work as they were "leaving in droves, we can't recruit enough, quickly enough, and they aren't properly trained before being placed in front of very hard to help customers".
A Department for Work and Pensions spokesperson said the BBC's story was "purely speculation".
"The structural reforms set out in the Health and Disability White Paper, which will improve the experience of the benefits system for disabled people, will be rolled out gradually from 2026 and transitional protection will ensure nobody experiences a financial loss as a result of moving onto the new system," the spokesperson added. | Health Policy |
My London life was so stressful I wasn't ovulating - but now I'm a mother-of-two after moving to Tuscany to renovate an 800-year-old farmhouse
- Sophie, 29, and George, 35, appear on tonight's New Lives In The Wild
- Originally from Somerset, Sophie told Ben Fogle she had depression as a teen
- Read more: I left Hollywood to live alone on a 400-acre farm in Uruguay
A mother-of-two living a self-sufficient life with her partner and their two children in Tuscany revealed how she struggled with depression for years in the UK.
Sophie, 29, and George, 35, welcomed Ben Fogle to the 800-year-old farmhouse they are busy refurbishing in a remote part of Italy for this week's episode of New Lives in the Wild.
Speaking on the Channel 5 show airing at 9pm tonight, Sophie, originally from Somerset, revealed she began to suffer with depressive episodes in her teenage years, and was left unable to ovulate due to stress after making an 'escape' to London.
She moved to Italy in her early 20s, where she met George, who was looking to renovate the farmhouse he had inherited from his father, and they are parents to Kayo, five, and India, three.
Sophie, 29, and George, 35, welcomed Ben Fogle to the 800-year-old farmhouse they are busy refurbishing in a remote part of Italy for this week's episode of New Lives in the Wild, airing tonight at 9pm on Channel 5. They have two children, Kayo, five, and India, three
The family are self-sufficient, but aware that a long road full of hard work is ahead of them if they want to renovate the whole property.
Sophie, who grew up in the West Country, admitted to Ben that she began to struggle with depression from a young age.
'When I was a teenager or even earlier, I don't know what the catalyst was, but I closed down a little bit, and I really struggled with depression and that feeling of belonging,' she explained.
'I didn't have my place, I guess I didn't feel like I really fitted in anywhere.
'I didn't really properly address it until I was 17, 18. Which is when I was really unhappy, and I really needed a change.'
Ben landed the couple a hand during his stay, including feeding their mischievous cow Moona, pictured
George relied on the help of a local man named Franco to harvest the farmhouse's 15 beehives for their honey
Sophie believed that moving to London would make her happy and provide her with an escape.
But she found it hard to keep up with the fast-paced city life.
'Maybe I didn't realise how much stress it was putting on my body as well. When I was at university, I pretty much didn't menstruate, like at all,' she told Ben.
'The doctor basically said, "I can't see anything wrong with you, maybe you just don't ovulate, If you want to have a baby, just come back when you're ready and I'll give you some drugs." Which was really, really gutting, and I felt very let down and disappointed,' she added.
Referencing her children, she joked to Ben that it looks she is is now 'apparently very fertile.'
The father-of-two treated Ben to homemade pizza made with ingredients the family have grown in their own garden
Ben noted that the couple had found contentment and happiness on the farm, instead of being faced with non-stop work
George said he had always been attracted to the the self-sufficient lifestyle, and moved to the farm aged 18
She also revealed how she felt like she had found where she belonged when she arrived at the farm.
She told Ben she fell in love with the place before she fell in love with George.
'When I came here, it was like, "Okay, this is it. This is what I always wanted to do, but didn't know existed. It's given me my sense of belonging,' she said.
Ben reflected on Sophie's confessions later in the episode, saying: 'She was looking for a place where she could be free and by doing so, she was able to open her heart, and lo and behold, there's George.
'She has finally found happiness and contentment here.'
The couple are working to renovate the farmhouse, where they hold camping events to make money
George, who grew up in Norwich, admitted he didn't find what he was learning in school relatable, and dropped out after his GCSEs.
'I was unsatisfied, I'm not an academic person, really. I found it very frustrating,' he said.
He had developed a strong interest in self-sufficiency after reading about it in a book, and was aching to try it for himself.
The father-of-two inherited the farmhouse from his own father, and moved there when he was 18.
'I consciously made the decision to come here with an aim, with a goal, with a purpose,' he told Ben.
'I remember wanting to sit in a dark house with no electricity and feel the house and feel the loneliness. I wanted to push my comfort zone away.'
The farm dates back to 800 years ago, and George inherited it from his father, moving there from the UK aged 18
The father-of-two said he would be fine in his children decide to move to a city and become lawyers
In order to make money, George began to organise camping events around the farmhouse, but soon realised he needed money, and started to take it volunteers to help renovate his dwellings.
That how he met Sophie, who had left the UK to travel the world in order to find a place where she belonged.
Since meeting and becoming parents, the couple have been renovating the farmhouse's main building, where their two children sleep in the master bedroom, and they bunk down in the hallway.
Sophie and George revealed the place looked like a squat when they started living there.
They told the presenter how they furnished their house with a lot of recycled items, and furniture they found 'at the side of the road,' with Sophie noting practicality came first and aesthetics came second.
Sophie said she struggled with depression in the UK and that her body was impacted by the stress of her London life
The couple have a cow, Moona, whose manure they use as compost to expand their kitchen garden
'We lived here for years without any lights,' she told Ben, revealing how the couple would use camping lights hooked to the walls to navigate the house.
The family rely on a wood burner for heat and hot water, and get energy from solar panels, thanks to the sunny weather.
They revealed their kitchen garden also allows them to reduce expenses, meaning they roughly spend 500 euros (£440) on necessities such as gas for cooking and food for their animals, including their cow, Moona.
The couple and their two children welcomed Ben into their lives for the show, revealing the challenge they face every day
While she is passionate about her and George's lifestyle, Sophie admitted to Ben she doesn't believe it's possible to be 100 per cent self-sufficient, because you have to rely on other people for things such as gas, however, she said the couple tried to be as self-sufficient as they possibly could using their own space.
That was in spite of setbacks, including their cow Moona breaking into their garden during filming and helping herself to several crops the family was hoping to feed themselves on.
The foundations of the farmhouse date back to 800 years ago, and the couple are keen to maintain and renovate all the farmhouse's neighbouring buildings.
The couple are perfectly content with their life on the farm, and rely on the help of a local named Franco, who lives an hour away, to keep beehives and sell their honey to make extra cash.
Franco, who visited the farm while Ben was there, shared his thoughts on the couple with New Lives in the Wild, saying: 'When I first saw him, George was a beautiful person, reflective. It's not easy, the call of the city with all the comforts, and services can be tempting, but he decided to live a different adventure.
'Sophie is a very beautiful person, inside and out. I've always thought that, for a woman, having children in this place is really courageous. In my experience, spending time up here is extremely formative, for the children. Also you learn to have a balance,' he told Ben.
'I think that this land found the right people. They took this house when it was falling apart and they managed to maintain it which allowed them to live, it's a success,' he added.
Ben was impressed by the young couple's determination, though it left him wondering how they could juggle their young family with this monumental work.
George and Sophie make sure to include their two children under six in all the activities they undertake around the house, from fixing the roof to minding the garden.
At the time of the visit, George was also working on fixing up a track leading to a neighbouring road so that it would be easier for the couple to access civilisation, especially for taking their children to school.
George and Sophie are aware that Kayo and India will have to get to know the outside world in order to adapt.
'We're not anti-society, if we're to home school and that in however many years, the kids are released into the world, they need to know how to deal with that,' Sophie said.
'If they decide to leave and go to Milan and be a lawyer, that's their choice, of course,' George added.
'We are at the beginning of our journey, there is so much that we don't know and that we can learn and it would be amazing to go deeper into that and learn our skills and do that with other people and the children of course,' Sophie told Ben.
The mother-of-two added that she believed it's not by chance that she and George met.
'It's not chance, what we're doing right now feels like we could do this forever,' she told Ben, while George added the couple felt 'privileged and grateful' to be able to live their life in this way.
Ben Fogle: New Lives in the Wild airs tonight at 9pm on Channel 5. | Stress and Wellness |
Google Launches 3 AI Tools For Faster Health Preauthorizations
Source: @Google on Twitter
Google has unveiled new artificial intelligence (AI) tools to improve healthcare efficiency. The company has announced a suite of products designed to streamline current prior authorization processes.
Preauthorization methods used by insurers have long delayed or stopped patients from receiving necessary tests, medications, or treatments. Google hopes to change that.
Use Case for AI in Prior Authorizations
The prior authorization process requires physicians, facilities, and pharmacies to obtain pre-approval for certain diagnostics, procedures, and drugs. Insurance companies collect essential information through disorganized faxes, electronic portals, or phone conversations with service providers, and then they make coverage decisions based on what is obtained.
It is a laborious and time-intensive process for most payers.
The purpose is to control care quality, safety, and cost. Yet, anyone who has worked in health care understands that, as a result, all parties wind up investing major resources (time, money, etc.) in the process. This leads to frustration for patients, doctors, hospitals, and insurance companies.
Delays caused by the prior auth process often lead to delays in care. According to at least one document, the standard review time frame is up to ten business days, excluding holidays.
At least 30 percent of doctors say that the prior authorization process has led to a serious adverse event for a patient in their care.
Furthermore, the back-and-forth communication and additional paperwork are expensive. The Council for Affordable Quality Healthcare estimated that prior authorization transactions cost the US healthcare system $767 million in 2020.
Preauthorization Inefficiencies in Healthcare
Preauthorization inefficiencies have been such a problem for the healthcare industry that the federal government stepped in. According to a recent press release, the Centers for Medicare and Medicaid Services (CMS) has proposed a rule that would require the following:
-
Urgent requests are to be answered within 72 hours
-
Routine requests are to be handled within seven calendar days
-
Payers must implement electronic systems to streamline the review
The Google Claims Acceleration Suite offers three tools to help health insurance companies speed up the process.
“It’s time to modernize the prior authorization process, leverage current technology to improve access to care, and extract value to better serve the people in our communities,” Amy Waldron, Google’s Cloud Director of Global Health Plans Strategy and Solutions, said in a press release.
Google’s 'Claims Acceleration Suite' - 3 Tools
Google has partnered with two other Google Cloud-based solutions—Myndshft and Pega—already used by doctors and hospitals. “We don’t want to compete with existing systems the health care industry is using,” Waldron told Forbes.
The Claims Acceleration Suite has three components:
-
Prior Authorization Submission, by Myndshft
-
Claims Data Activator, by Google
-
Prior Authorization Review, by Pega
Myndshft checks benefits and helps providers submit prior authorization claims. Pega provides workflow software and helps insurers manage the review process.
Claims Data Activator is Google’s new AI feature. It scrubs electronic submissions to extract data. Then it turns unorganized information into structured data so that the professionals can make better decisions that streamline patient care.
Google’s Claims Acceleration Suite is built on Google Cloud’s current healthcare infrastructure, which includes HIPAA-compliant security and compliance capabilities.
The suite connects with existing systems and workflows but is flexible and can be customized to suit each insurance organization’s needs. For instance, the AI Prior Authorization Assistant can be taught criteria, policies, and procedures for specific insurance carriers. Also, the Claims Decision Support module may be configured to include different data sources and conditions, depending on the payer.
The product line uses AI to reduce administrative burdens and costs while improving patient experience.
So far, there are two notable early adopters of Google’s Claims Acceleration.
Blue Shield of California is using Google’s AI tools to streamline prior authorization claims for its 4.8 million members in the US.
Bupa, an international healthcare management company, is also using Google to improve the experience for its 38 million global customers.
The software is available now. Additional features are slated to launch later this year.
The Future of AI in Healthcare
Google isn’t the only tech company harnessing AI and cloud computing to transform the healthcare industry. Microsoft just launched the Microsoft Cloud for Healthcare, which includes capabilities such as virtual health consultations, remote patient monitoring, and data analytics.
The existing state of the US healthcare system is complex and inefficient in many respects. These factors contribute to high pricing and poor patient outcomes.
Many forward-thinking companies, including Google and Microsoft, have focused on it. These companies aspire to improve the overall patient experience by combining artificial intelligence and cloud computing to speed up operations, improve decision-making, and, ultimately, improve the overall patient experience.
However, some worry about the possible hazards and ethical issues associated with using AI in healthcare. For instance, how can companies ensure the algorithms are fair and do not perpetuate inequities in healthcare access and outcomes?
Despite these hurdles, healthcare will likely remain a top priority for technology companies in the future. As more data is collected and the demand for efficient and effective healthcare services develops, AI and cloud computing are set to play a growing role in improving the quality and accessibility of care globally.
Nurse.org's Popular Articles and Resources
Non-Bedside Nursing Jobs
Looking for a change beyond the bedside? Check out our list of the top non-bedside nursing careers
15 Highest Paying Nursing Jobs in 2023
You know all nursing jobs aren’t created (or paid!) equally, but do you know which nurses are making the most money in 2023?
2023's Best Nursing Schools
We've looked at programs nationwide and determined these are our top schools
Best Shoes for Nurses in 2023
We had nurses wear top-rated shoes to work and give their honest reviews. These are the best nursing shoes as rated by nurses. | Medical Innovations |
Exercise-mimicking drug sheds weight, boosts muscle activity in mice
A brand-new kind of drug, tested in mice, shows promising new results that could lead to the development of a new weight-loss drug that mimics exercise.
The new compound, developed and tested by a University of Florida professor of pharmacy and his colleagues, leads obese mice to lose weight by convincing the body’s muscles that they are exercising more than they really are, boosting the animals’ metabolism.
It also increases endurance, helping mice run nearly 50% further than they could before. All without the mice lifting a paw.
The drug belongs to a class known as “exercise mimetics,” which provide some of the benefits of exercise without increasing physical activity. The new treatment is in the early stages of development but could one day be tested in people to treat diseases like obesity, diabetes, and age-related muscle loss. The research comes as drugs like Ozempic have provided a breakthrough in reducing appetite, helping treat these metabolic diseases.
But the new drug, known as SLU-PP-332, doesn’t affect appetite or food intake. Nor does it cause mice to exercise more. Instead, the drug boosts a natural metabolic pathway that typically responds to exercise. In effect, the drug makes the body act like it is training for a marathon, leading to increased energy expenditure and faster metabolism of fat in the body.
“This compound is basically telling skeletal muscle to make the same changes you see during endurance training,” said Thomas Burris, a professor of pharmacy at UF who led the recent research into the new drug.
“When you treat mice with the drug, you can see that their whole body metabolism turns to using fatty acids, which is very similar to what people use when they are fasting or exercising,” Burris added. “And the animals start losing weight.”
With a team of researchers at Washington University in St. Louis and St. Louis University, Burris published his findings Sept. 22 in the Journal of Pharmacology and Experimental Therapeutics.
The new drug targets a group of proteins in the body known as ERRs, which are responsible for activating some of the most important metabolic pathways in energy-gobbling tissues like muscles, the heart, and the brain. The ERRs are more active when people exercise, but they have proven difficult to activate with drugs.
In another paper published in March, the researchers reported that they had successfully designed SLU-PP-332 to boost activity of the ERRs. They also observed that the compound allowed normal-weight mice to run for 70% longer and 45% further than mice not receiving the drug.
In their latest research, the team tested the drug on obese mice. Treating obese mice twice a day for a month caused them to gain 10 times less fat than untreated mice and lose 12% of their body weight. Yet the mice kept eating the same amount of food and didn’t exercise any more.
“They use more energy just living,” Burris said.
In other work the Burris lab is about to publish, the researchers have seen evidence that the compound can also treat heart failure in mice by strengthening the heart muscle.
So far, the drug hasn’t generated any severe side effects. The next step in developing SLU-PP-332 into a drug candidate will be to refine its structure, ideally making it available as a pill instead of an injection. Then the drug would be tested for side effects in more animal models before making the jump to human trials.
Other exercise mimetics have been tested, but none have made it to market, in part because it takes years to develop a new drug. Targeting obesity, specifically, with a drug has historically been difficult because of how complex obesity is. That was until Ozempic, Wegovy, and Mounjaro, developed to treat diabetes, also caused people to lose weight. This development led to a surge of interest, research, and funding for drugs that could treat these metabolic diseases through different biological pathways.
Burris says the greatest hope for the new drug might be in maintaining muscle mass during weight loss – which often threatens lean muscle mass – or during aging, when the body naturally responds less strongly to exercise. But it will take more research to understand the drug’s full potential.
“This may be able to keep people healthier as they age,” Burris said. | Drug Discoveries |
Hundreds of thousands of Britons are taking antidepressants for chronic pain without enough evidence they work, according to a large study.
Researchers looked at drugs commonly prescribed by the NHS including amitriptyline, duloxetine, fluoxetine (Prozac), citalopram, paroxetine (Seroxat) and sertraline.
They concluded only duloxetine had robust evidence for pain relief.
The National Institute for Health and Care Excellence (Nice) recommends them as an option where the root cause is unknown, including for some cancer pain, and conditions that can cause neuropathic pain, such as stroke.
It said it had reviewed the study in detail but decided an update to guidelines was currently unnecessary.
The research looked at 176 trials and almost 30,000 patients, and included institutions such as University College London, and the universities of Bath, Bristol and Southampton.
It also raised concerns about a lack of long-term data on the drugs' safety.
Lead author Professor Tamar Pincus said the findings raised a "global public health concern", with people prescribed the drugs without "sufficient scientific proof they help, nor an understanding of the long-term impact on health".
"Our review found no reliable evidence for the long-term efficacy of any antidepressant, and no reliable evidence for their safety for chronic pain at any point," she said.
"Though we did find that duloxetine provided short-term pain relief for patients we studied, we remain concerned about its possible long-term harm due to the gaps in current evidence."
Read more from Sky News
UK's first 'three-parent baby' born after IVF procedure
COVID no longer health emergency, says WHO
Professor Pincus said there were around 15 million low-dose amitriptyline prescriptions in England in 2020 to 2021 - and hundreds of thousands likely taking it for pain - but the drug is "probably not very healthy".
"The fact that we don't find evidence whether it works or not is not the same as finding evidence that it doesn't work," she added.
"We don't know - the studies simply are not good enough and, similarly, we don't know whether it harms or not."
The authors are urging people to continue drugs they have been prescribed and to raise any concerns with their GP.
Dr Ryan Patel, from King's College London, explained that antidepressants are prescribed for pain because "the systems that regulate mood and pain overlap considerably".
He said the study showed "when clinical trials are designed poorly under the assumption that everyone's experience of pain is uniform, most antidepressants appear to have limited use for treating chronic pain".
The chair of the Royal College of GPs said doctors aim to treat chronic pain with a mix of psychological, pharmacological and physical treatments - and to prescribe "the lowest dose of medicines, for the shortest time".
Professor Kamila Hawthorne said patients "shouldn't panic" and reiterated they should continue with their medication until they've discussed things with their GP.
Nice said its recommendation for antidepressants as a treatment option came after a thorough look at the benefits and harms.
It said evidence showed they can help with "quality of life, pain, sleep and psychological distress, even in the absence of a diagnosis of depression". | Disease Research |
Samantha Holmgren has made a career out of helping people battle chronic joint pain and fatigue. The registered dietitian from Canada knows firsthand how powerful nutrition and mindfulness can be to help people regain control over their lives when living with a disease â she also lives with psoriasis and psoriatic arthritis (PsA). These are known as psoriatic disease.
Holmgren, 33, has had psoriasis since she was a baby. She was diagnosed with psoriatic arthritis (PsA) at 24.
Â
The condition is an autoimmune disease which causes itchy patches on skin and nail problems. It affects more than 8 million people in the U.S.Â
Itâs harder to tell how many people have PsA worldwide. One study on less than 1,000 people from North America and Europe estimates that about 30% of people with psoriasis have PsA. It can be more common in certain areas of the world, compared to others. About 36% of those in the U.S. with psoriasis have PsA.
PsA isnât common in the general population. But if you have psoriasis, youâre more likely to get PsA, too. The inflammatory disease causes joint pain, swelling, and stiffness. As a result, PsA may limit how much you can move.Â
One of the biggest challenges for Leena Chitnis, 44, of California, who has psoriatic disease, was simply finding out that she had it.Â
âIt took forever to get a diagnosis. ⦠I wish doctors and derms [dermatologists] would have figured it out sooner,â Chitnis says. She had psoriasis since 2013 but wasnât diagnosed until 2017. Research shows that itâs common not to be diagnosed until years after you actually have the disease. This is important because psoriatic disease can get worse over time.
Skin color can play a part in delayed diagnosis or misdiagnosis. There are also disparities in treatment. For instance, White people are more likely to get treated with a biologic agent than Black people.
Another challenge is being overwhelmed by resources and research.Â
âThere are so many strategies to help manage life with these conditions, it's hard to know where to start,â Holmgren says.
âAutoimmune disease is often tied to a genetic hand-me-down from one or both of our parents,â Chitnis says. âBut as we've learned, DNA is not destiny. You can literally turn those bad genes on or off with your lifestyle.â
Living Well With Psoriatic Disease
You may want to try a new strategy to improve your quality of life. Research varies on which lifestyle interventions can help, whether you have PsA, psoriasis, or both. These are a few areas you may want to focus on:
Weight management. The higher your body mass index (BMI), the higher the chance that youâll get psoriatic disease. Some research shows that higher weight may raise your risk for psoriasis, specifically. Losing weight can lower psoriasis severity scores, according to some studies. Other evidence shows it may lower psoriasis on your skin and help you respond better to medicines.
Diet. Some evidence shows that what you eat can help with how severe your psoriasis is. But researchers arenât sure if the weight loss or the diet itself improved symptoms. Many say they want to see more studies on people who are not clinically overweight or obese to determine if people below those weight ranges would benefit from following certain diets.Â
Chitnis says the more raw produce she eats, the better she feels.Â
âOne day of eating raw, and you'll feel the results immediately, but for long-term relief, eating as much raw as possible has to become a way of life,â she says.
Supplements. Scientists have studied fish oil and eicosapentaenoic acid (EPA), vitamin D, and curcuma most often for psoriatic disease. Some of the study sizes are small and had short follow-up periods. The three biggest studies didnât show significant effects from taking vitamin D or fish oil. Others that showed some evidence that theyâre effective for psoriasis include herbals indigo naturalis (qing-dai in Chinese medicine) and curcumin, a compound in turmeric.
Movement. Add exercise to your routine to help with PsA â not moving may make it worse. A review of research shows that when done regularly, exercise can help. It outweighs the risk of inflammation where tendons and ligaments meet bones, or enthesitis. You can modify stretches to make up for any mobility challenges you have.
Smoking and drinking. This can up your chances of getting PsA and make the disease more severe. It may limit how well your medications work, too. Some evidence suggests drinking alcohol worsens psoriasis and makes you more likely to get PsA if you have psoriasis.
Complementary Therapies for PsA and Psoriasis
Complementary treatments, from yoga to mindfulness, may help you find relief, too. A National Psoriasis Foundation survey found that 41% of people use complementary therapies âtheyâre more common in those with severe psoriasis than in those who say theirs isnât severe. Out of a group of people with PsA, one survey found 53% used these treatments in the past year.
Chitnis swears by freezing-cold showers to ease inflammation. She alternates the temperature with hot water to relax her muscles. She also gets regular massages and uses magnesium oil to relax her muscles and help her sleep.
New and Upcoming Psoriatic Disease Treatments
Drug development continues for psoriatic disease. In recent years, biologics have been approved to treat it. Deucravacitinib is a newer oral medication that the FDA approved for psoriasis. The monoclonal antibody bimekizumab could soon be approved in the U.S., too.
In addition to medications, researchers are trying to create a diagnostic test for PsA. They hope people can get diagnosed sooner â and treated, too â because earlier treatment can delay joint damage.Â
Itâs equally important to be aware of secondary issues that you may face. Psoriasis is linked to eye problems, weight gain, gum issues, and a higher risk for Crohnâs disease, just to name a few. If you have PsA, youâre more likely to have type 2 diabetes, obesity, high blood pressure, or high cholesterol.
Where to Turn for Psoriasis and PsA Resources
If you feel like youâve exhausted your resources, these groups may be a good way to find new health care professionals, therapies, and clinical trials, and to connect with others who also have your condition.
The National Psoriasis Foundation is a good place to start. The organization offers patient navigators to connect you with resources, as well as events (including webinars) and a peer support service. The Arthritis Foundation holds local events and support groups around the country, offers details on clinical trials, and has a library of articles on healthy living. It also has a helpline at 800-283-7800.Â
Sign up for newsletters and alerts from trusted sources, says David Chandler, the CEO of the Psoriasis and Psoriatic Arthritis Alliance, which is based in the U.K.
âSuch groups are often involved in early developments of new therapies so they can keep people up to date with whatâs new and offer people information to make informed choices,â he says.
It can be challenging to navigate all of the information and integrate it into your life. Plus, your disease can change as time goes on.
Whatâs led Chitnis well is to stay true to herself. It may not be possible to remove all stressors from your life. Life is filled with good and bad stresses, as well as turbulent events, she says. But, she reminds everyone, âlive your truth.â
Show Sources
Photo Credit: Moment / Getty Images
SOURCES:
Samantha Holmgren, registered dietitian, Canada.
Leena Chitnis, California.
David Chandler, CEO, Psoriasis and Psoriatic Arthritis Alliance
CDC: âPsoriasis.â
National Psoriasis Foundation: âPsoriasis Statistics,â âUnderstanding Psoriatic Disease,â âPsoriasis and Skin of Color,â âLittle Stretches, Big Differences,â âSmoking and Psoriasis,â âFDA Approves Sotyktu for Psoriasis,â âPsoriatic Arthritis Diagnostic Test Grant.â
Journal of the American Academy of Dermatology: âPrevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics,â âUse of complementary and alternative medicine by patients with psoriasis.â
Arthritis Foundation: âHow Common is Psoriatic Arthritis in People with Psoriasis?â
Rheumatic Disease Clinics of North America: âThe Epidemiology Psoriatic Arthritis.â
Johns Hopkins Medicine: âPsoriatic Arthritis,â âTurmeric Benefits.â
The Psoriasis and Psoriatic Arthritis Alliance: âKeeping Active.â
British Journal of General Practice: âMapping opportunities for the earlier diagnosis of psoriasis in primary care settings in the UK: results from two matched case-control studies.â
The Journal of Rheumatology: âDiagnostic Delay in Psoriatic Arthritis: A Population-based Study.â
Mayo Clinic: âPsoriatic arthritis.â
Cleveland Clinic: âHow Psoriasis Affects Black People and People of Color.â
Journal of Investigative Dermatology: âRacial Differences in Perceptions of Psoriasis Therapies: Implications for Racial Disparities in Psoriasis Treatment.â
Rheumatology: âAssociation between psoriatic disease and lifestyle factors and comorbidities: cross-sectional analysis and Mendelian randomization.âÂ
PLOS Medicine: âEvidence of a causal relationship between body mass index and psoriasis: A mendelian randomization study.â
Cureus: âEffects of Weight Loss on Psoriasis: A Review of Clinical Trials.â
American Academy of Dermatology Association: âWhat Should I Eat If I Have Psoriasis?â âCan Psoriasis Affect More Than My Skin?â
Cochrane Database of Systematic Reviews: âLifestyle changes for treating psoriasis.â
Psoriasis: Targets and Therapy: âThe Effect of Lifestyle Changes on Disease Severity and Quality of Life in Patients with Plaque Psoriasis: A Narrative Review.â
Chinese Medicine: âFrom natural dye to herbal medicine: a systematic review of chemical constituents, pharmacological effects and clinical applications of indigo naturalis.â
JAMA Dermatology: âComplementary and Alternative Medicine Therapies for Psoriasis.â
Nature Reviews Rheumatology: âEnthesitis: from pathophysiology to treatment.â
American Journal of Clinical Dermatology: âAlcohol and Psoriasis for the Dermatologist: Know, Screen, Intervene.â
American College of Rheumatology: âModifiable Risk Factors and the Development of Psoriatic Arthritis in People with Psoriasis,â âUse of Complementary and Alternative Medicine (CAM) in a Psoriatic Arthritis Cohort.â
UCB: âUCB Announces FDA Acceptance of BLA Resubmission for Bimekizumab.â
Tiwari, V., et. al. Psoriatic Arthritis, StatPearls Publishing, 2023. | Nutrition Research |
Treatment times for radiotherapy could be reduced for some early breast cancer patients, according to a trial led by University of Cambridge and The Institute of Cancer Research, London.
Treatment times for radiotherapy could be reduced for some early breast cancer patients, according to a trial led by University of Cambridge and The Institute of Cancer Research, London.
This is a careful step towards even shorter courses of radiotherapy that include more complex techniques. By delivering more targeted boost radiotherapy over shorter time periods, women can get on with their lives more quicklyCharlotte Coles
Results from the IMPORT HIGH trial, published in The Lancet, show that giving some breast cancer patients a targeted additional dose of radiotherapy at the same time as treament to the whole breast (known as simultaneous integrated boost or SIB) cuts the time taken to complete treatment by at least one week.
The trial, funded by Cancer Research UK and the National Institute of Health Research and Care Research (NIHR), found that SIB radiotherapy given at the right dose works just as well as existing radiotherapy techniques in reducing the risk of the cancer returning in the treated breast.
The chance of the cancer returning to the treated breast remained very low after 5 years across all treatment groups. Patients given the lower dose of SIB radiotherapy reported similar rates of side-effects, like breast hardening or firmness, as those who received the standard sequential radiotherapy schedule.
Currently, women with a higher than average risk of cancer coming back in their treated breast are given an additional radiotherapy dose to the original site of the tumour after radiotherapy is given to the entire breast. This approach, known as sequential boost, maximises the chances that any remaining cancer cells are removed from the breast.
But it takes longer for women to complete sequential boost radiotherapy, requiring them to attend more hospital appointments. In the UK, many women requiring breast boost radiotherapy are given 4 weeks of radiotherapy – 3 weeks to the whole breast with 1 week boost afterwards. In some countries, women are given 6.5 weeks of radiotherapy – 5 weeks of whole breast radiotherapy with 1-1.5 weeks boost afterwards. SIB radiotherapy cuts this down to just 3 weeks in total.
A boost treatment also increases the chance of having potentially long term side-effects after treatment, including changes in shape, size and texture of the breast that can affect women’s self-esteem and wellbeing.
In total, 2,617 patients at 76 centres took part in the trial. Patients were divided into three groups. The first group received whole breast radiotherapy with a sequential boost over 4.5 weeks in total. The second and third groups each received two different doses of SIB radiotherapy. Patients received whole breast radiotherapy with a simultaneous boost of either lower or higher dose a dose over 3 weeks in total. There was no advantage shown for those who received the higher boost dose it also led to slightly increased rates of side effects.
Professor of Breast Cancer Clinical Oncology at Cambridge University, NIHR Professor and chief investigator for the trial, Professor Charlotte Coles, said: “Some women have to live with permanent breast changes after radiotherapy which may affect their well-being. With SIB, we can deliver high-quality effective radiotherapy whilst minimising toxicity from it.
“This is a careful step towards even shorter courses of radiotherapy that include more complex techniques. By delivering more targeted boost radiotherapy over shorter time periods, women can get on with their lives more quickly."
The NIHR-funded FAST Forward trial, which was also led by the ICR-CTSU and reported results in 2020, showed that whole breast radiotherapy could be given over a week. Researchers are now hoping to run another clinical trial to find out if SIB radiotherapy can be delivered to patients requiring a boost in just one week.
Professor Judith Bliss, Professor of Clinical Trials at The Institute of Cancer Research, London, Director of the Cancer Research UK-funded Clinical Trials and Statistics Unit at the ICR which is managing the IMPORT HIGH trial, said: “For some patients who have a higher risk of seeing their cancer return in the treated breast, delivering an extra, targeted boost of radiotherapy to breast tissue close to the original tumour site is an effective way to lower that risk and help keep cancer from returning to the breast.
"IMPORT HIGH has uncovered how we can streamline our delivery of these radiotherapy boosts - giving them simultaneously with whole breast radiotherapy - without impacting the effectiveness of treatment, or causing patients additional side effects. We hope this trial will change clinical practice - allowing women to benefit from sophisticated radiotherapy delivery with shorter treatment times and fewer hospital visits."
The team hope that SIB radiotherapy could reduce the costs for patients travelling to hospital and cut the time taken to undergo treatment and recovery. It could be quickly adopted by the NHS and health systems worldwide as standard radiotherapy equipment is used, freeing up valuable appointment visits that could be used to treat more cancer patients sooner.
Chief Executive of Cancer Research UK, Michelle Mitchell, said: “At a time when health services across the UK are facing chronic staff shortages in cancer services, we need to look at new ways to get more patients treated as quickly as possible. In addition to training up more staff, more precise forms of radiotherapy can help to reduce the number of people who are waiting too long to begin vital treatment.
“Trials like IMPORT HIGH are leading the way in delivering smarter radiotherapy with existing technology. We hope that treatment centres across the UK and globally will rapidly adopt this approach to beat breast cancer sooner and give patients more precious time with their loved ones.”
Reference
Coles, CE et al. Dose-escalated simultaneous integrated boost radiotherapy in early breast cancer (IMPORT HIGH): a multicentre, phase 3, non-inferiority, open-label, randomised controlled trial. Lancet; 8 June 2023; DOI: 10.1016/S0140-6736(23)00619-0
Adapted from a press release by Cancer Research UK.
Helen Lee (46) from Mepal near Cambridge
In October 2013, Helen Lee first noticed an unusual twinge in her right breast and had a hunch that something wasn’t right. Her GP couldn’t feel anything when she examined Helen but referred her to the Breast Unit at Addenbrooke’s Hospital for a mammogram to reassure her.
But, at the young age of 36, Helen was diagnosed with breast cancer. The mammogram revealed a tumour just over 2cm in size located deep in her breast tissue. She remembered:
“I felt quite relieved because I knew there was something wrong. And my surgeon said it was so deep I wouldn't have felt it. So I was actually really lucky otherwise I would have come in at 51 for screening and it might not have been treatable by then.”
Helen had surgery a few weeks after her diagnosis, followed by a course of chemotherapy. When she was due to begin radiotherapy treatment she was asked if she would like to take part in the IMPORT HIGH trial. Helen was assigned to a group receiving a targeted radiotherapy boost delivered simultaneously during her whole breast radiotherapy treatment, which reduced her treatment from 23 sessions over 4.5 weeks to 15 sessions over 3 weeks.
After undergoing surgery, chemotherapy and radiotherapy treatment, Helen has now been clear of cancer for nearly 10 years. Since her diagnosis and treatment, she has taken part regularly in Cancer Research UK Race for Life, Pretty Muddy and Shine Night Walk events in Cambridge, Bedford and Stamford, fundraising for life-saving research into future treatments for cancer patients.
Reflecting on her cancer journey, Helen said: “One thing that really struck me, at one of the first Cambridge Race for Life events that I did after my diagnosis, was watching the screen on Parker's Piece where they're playing the films where the scientists are talking about what they've been working on.
“I felt so overwhelmed that all of the people there that day were part of saving my life, and that all the people who took part in trials 10 years ago, 15 years ago, 20 years ago, everything they've done meant that I survived my cancer.”
The text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms. | Medical Innovations |
People gather in protest against the death of Mahsa Amini along the streets on September 19, 2022 in Tehran, Iran.Photo: Getty Images (Getty Images)When the Iranian government announced last month it would move to disband its so-called “morality police” following weeks of historic anti-authoritrain protests, dissidents in the country and abroad saw the concession as a potential turning point for women’s rights. Among its compromises, government officials said they would consider loosening the country’s strict obligatory hijab laws, which have been in place since 1979. However, while accounts of police prying people from city streets for refusing to wear head coverings appear to have dwindled, some advocates fear those same dress-code-defying defectors are instead being targeted by facial recognition systems and penalized afterwards.Offen“Many people haven’t been arrested in the streets,” Sarzamineh told Wired. “They were arrested at their homes one or two days later.”University of Oxford researcher Mahsa Alimardani discussed the possibility of facial recognition being used to enforce Iran’s hijab laws in a recent interview with Wired. Alimardani recounted reports of women in Iran who claim to have received mail citations for violating the law without warning or any face-to-face interaction with law enforcement. Those descriptions matched up with first hand accounts from Iranian expat Sarzamineh Shadi, who told the magazine she was aware of multiple women who received citations for flouting hijab rules during protests days after the actual protest occurred. Iran’s theocratic government has been engaged in a brutal crackdown against protesters following the September death of a 22-year-old Kurdish woman named Mahsa Amini who was detained by the country’s morality police for not wearing a hijab while visiting Tehran and died in police custody. The ensuing nationwide protests have reportedly resulted in more than 19,000 arrests and left at least 300 people dead. And while those dissidents have already won major concessions, broadened efforts by protestors calling for real regime change are squaring off with an advanced state surveillance system years in the making.Though it’s difficult to confirm the exact methods used to identify individuals on a case-by-case basis, Iranian officials have said they are using facial recognition to enforce its hijab laws. Last September, The Guardian cited an interview with Mohammad Saleh Hashemi Golpayegani, the Secretary of Iran’s Headquarters for Promoting Virtue and Preventing Vice, where the official said the government intended to use surveillance technology in public spaces.Those detection efforts are made possible in the first place thanks to a seven-year-old government ID system in the country that requires face scans and other biometric identifier. Speaking with Wired, Alimardani said the same database system used to create the country’s national ID cards could simultaneously be used by officials to identify presumed hijab law violators or others considered to have run afoul with the regime.The Iranian government’s surveillance vision extends far beyond facial recognition too. Since at least 2016, officials have attempted, with varying degrees of success, to create its own internal intranet separated from the world-wide-web and rely solely on Iranian server farms. That effort follows in the footsteps of similar isolated internet systems in China and, more recently, Russia. In the meantime, Iranian officials have repeatedly intervened to shut down access to global internet communications platforms, including during the most recent protests. | Women’s Health |
In the Little Mermaid, Ariel sings a whole song about wanting to be part of a world where people get to walk. Merle Liivand, on the other hand, wanted to do the opposite – and now holds the world record for the farthest swim as a mermaid.Liivand swam 26.22 miles wearing a silicone monofin, in just over 11 hours in choppy waters off the coast of Miami on 7 May.Billing herself as an “eco mermaid”, Liivand set out to use her feet – the fourth time she has set a new record for monofin swimming – to raise awareness about the importance of clean oceans, according to Guinness World Records.The record required that Liivand not use her arms: she could only kick with the monofin. Originally from Tallin, Estonia, she told Guinness that she first took up swimming to help her recover from collapsed lungs, the result of auto-immune health problems as a child. She became a competitive ice swimmer and Baltic champion before moving to Florida 11 years ago.She began subjecting herself to long-distance, open-water swims to advocate against marine pollution, which she described as “the plastic pandemic”. She nearly ingested some microplastics during a practice session in open water, which inspired her to do more for the ocean.Long-distance swimming with the monofin was her own idea.“Swimming with the monofin without using my arms is similar to how dolphins and marine animals swim,” Liivand added. “They have a fin and can’t use any arms.”It also mimics the struggle faced by marine animals who become entangled in plastic bags tossed in waters by polluters, she said.Before her recent record-setting swim, Liivand had navigated the Bosphorus, the Golden Gate Straits, the Pacific Ocean and the Baltic Sea. But Miami’s sunny Biscayne Bay presented unique perils, such as the potential for overheating and exhaustion.She trained by waking up at 4am daily for more than a year, and took magnesium and potassium pills to reduce the likelihood of leg cramps. Before the big day, she loaded up on small meals she could easily digest, such as smoothies, baby food and soup.Along the way, she encountered much of the marine life for which she is trying to raise awareness – including a jellyfish that stung her.“I … kept telling myself that it was not the time to cry,” she said.She also collected trash as she swam, handing it up to a friend who followed her in a kayak.“It’s unfair that we have gotten to the point that fish, dolphins and turtles are surrounded by plastic which ends up in their stomachs,” Liivand said. “I feel that we as humans are next.” | Global Health |
Over the weekend, California Governor Gavin Newsom vetoed Senate Bill 58 (SB 58), nixing the state’s attempt to become one of a handful that are loosening restrictions on plant-based hallucinogens. The legislation was an effort to increase access to psychedelic therapy and remove penalties for people seeking these drugs.The bill would have decriminalized the possession of small amounts (4 grams) of certain plant-based psychedelics for adults over the age of 21: mescaline, dimethyltryptamine (DMT), and psilocybin, the hallucinogen found in magic mushrooms. The bill also would have allowed possession of related drug paraphernalia and the home cultivation of psilocybin-containing mushrooms for personal use.State Senator Scott Wiener (D-San Francisco) introduced the bill in late 2022, and believes it would have improved mental healthcare without affecting public safety. “Should we be threatening people with arrest and incarceration for using mushrooms? Of course we should not,” says Weiner. “If you want drugs to be unsafe, the most effective thing you can do is criminalize them and push everyone within the shadows where they're where they're less likely to ask for information and help.”In a letter explaining his decision, Newsom wrote: “Psychedelics have proven to relieve people suffering from certain conditions such as depression, PTSD, traumatic brain injury, and other addictive personality traits. This is an exciting frontier and California will be on the front-end of leading it.” But, he continued, the state would first need “regulated treatment guidelines” that include dosing information, rules to protect patients from being exploited during treatment, and ways to make sure they have no underlying psychoses. “Unfortunately,” he continued, “this bill would decriminalize possession prior to these guidelines going into place, and I cannot sign it.”Psychedelics can lead to serious negative consequences for some users, including psychosis and suicidal ideation, and one of the bill’s most vocal opponents was the Coalition for Psychedelic Safety and Education, a group that includes parents whose children died following psychotic episodes after taking hallucinogens. In news interviews and op-eds, they’d argued that they aren’t opposed to decriminalization, but they want the government to implement first responder training and systems for tracking the health effects of psychedelics first. (WIRED was not able to reach a representative from the group for comment.)Despite the fact that psychedelic decriminalization measures have passed in several local jurisdictions within California, support at the national level remains hotly contested. (Forty-nine percent of American voters support decriminalization, according to the 2023 UC Berkeley Psychedelics Survey.) Newsom, who has positioned himself as one of the Democratic Party’s most visible leaders, had a lot at stake when this bill landed on his desk. “While we firmly believe that Californians should not face incarceration for the use of psychedelic medicines, we understand the challenging position Governor Newsom is in,” says Jeannie Fontana, founder of TREAT California, which is organizing a ballot initiative that aims to devote $5 billion in state government funding for psychedelics research and mental healthcare.Newsom’s choice to veto the bill was “likely the product of his personal political calculus and ambitions,” says Josh Hardman, founder and editor of Psychedelic Alpha, an independent newsletter and resource hub covering drug development, law, and culture. But, he says, “it’s not all negative.” In his letter, Newsom acknowledges the scientific and anecdotal evidence of psychedelics’ potential benefits, and urges further policy discussion. “He hasn’t slammed the door shut,” Hardman believes.A few other states have already eased their rules on plant-based psychedelics. Oregon legalized supervised psilocybin use and decriminalized personal possession of small amounts of drugs in 2020. Two years later, Colorado legalized psilocybin treatment centers and decriminalized plant-based psychedelics for personal use. Within California, cities like Oakland, Santa Cruz, Berkeley, and San Francisco have made personal use and possession of psychedelics the lowest law enforcement priority, to discourage police from arresting people for actions the state considers criminal.Weiner attempted a similar bill, SB 519, in 2021, but it stalled out before the California State Assembly could vote on it. That version included a longer list of substances, which was likely its downfall. Synthetic drugs with ravey reputations, like MDMA and LSD, were nonstarters for the California Police Chiefs Association, which threatened to lobby against any bill that included them. In response, Wiener made the difficult decision to narrow the list.This time around, the bill garnered more bipartisan supporters, largely powered by veterans. Jesse Gould, a former Army ranger and founder of the Heroic Hearts Project, says that many veterans seek out psilocybin and MDMA for treating otherwise-intractable cases of post-traumatic stress disorder. However, because these drugs are illegal in most states, psychedelic-assisted therapy is not licensed there. Often, Gould says, veterans “have to take their mental health into their own hands” to find an underground source. “They’re considered criminals for trying to save their own lives,” he says.Placing veterans front and center “has been a very conscious project,” says Hardman. Veterans garner respect and sympathy across the political spectrum, and their reputation for patriotism lends an aura of credibility. “It’s unexpected,” says Gould. “If this straight-laced person is advocating for magic mushrooms, that’s weird.”Since the passage of the Controlled Substances Act in 1970, funding for psychedelics research has been limited. Federal funding wasn’t available again until 2021, when Johns Hopkins University was awarded a $4 million grant. University-based research groups often work in partnership with organizations like the Heroic Hearts Project or MAPS, the Multidisciplinary Association for Psychedelic Studies.Overall, those studies have shown psilocybin’s promise for treating mental illnesses. Three separate trials conducted by teams affiliated with the Usona Institute, COMPASS Pathfinder, and the University of Zurich all suggested that a single dose can treat major depressive disorder, and that the effects last for weeks (or potentially longer) after the dosing session. Another recent study found that self-administering psychedelics helped people treat obsessive-compulsive disorder symptoms, even without facilitated therapy. And psilocybin, at least in medical settings, has a low abuse potential.Some researchers believe that the use of these substances should be restricted to supervised therapeutic settings. “I think these medicines need to be treated with great respect,” says Fontana. “But respect doesn’t mean abstinence. It means making sure people are educated.” Jennifer Mitchell, a neuroscientist at the University of California, San Francisco, dreams of a public education campaign on psychedelic safety modeled on harm reduction campaigns for the opioid epidemic. She wants people to know that they won’t get in trouble for taking friends to the emergency room, and to understand the potential effects (good and bad) of psychedelics before trying them. “If those posters were all over bus kiosks, and high school classes had even 10 minutes of talking about psychedelics,” Mitchell says, “that would be an easy first step.”Notably, while SB 58 would have allowed the cultivation of your own modest mushroom stash at home, it would not have decriminalized large-scale manufacturing or the commercial sale of hallucinogens. Graham Pechenik, a patent attorney and founder of Calyx Law, a firm focused on the cannabis and psychedelics industries, fields lots of calls from entrepreneurs who hope to launch psilocybin startups, only to let them down. “There’s no legal way of doing this in California,” he says.Hardman says that decriminalization efforts like SB 58 often falter on the supply side, and that had it passed, it would not have been able to “create a psychedelic market in California.” Today, many underground psilocybin businesses sell their products—dried mushroom, capsules, psilocybin-infused chocolates—along existing cannabis delivery lines. “We know people are already breaking the law left and right,” says Ryan Munevar, the campaign director of Decriminalize California, which advocates for the legalization of psilocybin for adult recreational use.All of these drugs remain illegal under federal law, where they are considered Schedule 1 substances, meaning the US Drug Enforcement Agency has deemed them to have “no currently accepted medical use and high abuse potential.” And whenever state laws run up against federal regulations, things get complicated. In 1996, California passed the Compassionate Use Act, allowing the medical use of cannabis. In 2016, California’s Proposition 64 legalized it for adult recreational use. But cannabis remains a Schedule 1 drug, creating roadblocks for government-funded research or loans and agricultural aid for growers, and risking conflicts with federal agencies. This stepwise legalization process appears to be playing out again with plant-based psychedelics, “unfolding in the same pattern,” Pechenik says.As it stands, the DEA can shut down state-run psychedelic treatment centers. On September 21, US Representative Robert Garcia (D-California) introduced the federal VISIONS Act, which aims to protect state-legal psilocybin use from federal law enforcement.Others would like to push decriminalization efforts beyond therapeutics and veteran care. Pechenik believes that responsible adults should be able to access psychedelics “for their own purposes—not necessarily for medical use, but for consciousness expansion.” Decriminalize California is collecting signatures to get the legalization for recreational use of psilocybin on the ballot in 2024. “Is it medical? Is it religious? Did they stumble across it on the playa at Burning Man? Go for it,” says Munevar.Earlier this year, Illinois legislators introduced a bill to legalize psilocybin products, and two initiatives related to psychedelics have been certified for the Massachusetts ballot. Other states like Connecticut, Minnesota, and New York are following suit.Hardman thinks that Wiener will likely resurrect a California bill next year, focusing more tightly on therapeutic use. And last week, Newsom did sign legislation that gives advocates some hope: AB 1021 will automatically bring California law into harmony with federal law if Schedule I drugs like MDMA or psilocybin are reclassified to have fewer restrictions. This would ensure that California healthcare practitioners and pharmacists could legally prescribe and supply these drugs within the state.In the meantime, Pechenik calls the governor’s SB 58 veto “a dreadful shame, and a real setback for California’s leadership. While there is still much to learn about best practices for the therapeutic use of psychedelics, nobody should be criminalized or jailed for using them responsibly.” | Mental Health Treatments |
Biogen (BIIB) reported better-than-expected second-quarter financials Tuesday, as earnings fell more than 20% with its fully approved Alzheimer's drug, Leqembi, not yet profitable. BIIB advanced early Tuesday.X
The Cambridge, Mass.-based multinational biotechnology company announced that second-quarter profits slipped 23% to $4.02 per share while revenue dropped 5% to $2.45 billion. Wall Street expected earnings to fall 28% to $3.77 a share, with sales decreasing 9% to $2.36 billion.
Biogen stock gained 1.5% Tuesday during premarket trade. On Monday, shares edged up a fraction to close at 277 during. On a weekly chart, Biogen stock has formed a flat base with a 319.76 buy point, according to MarketSmith analysis.
Biogen Stock: Q2 Earnings
The company reported revenue from its multiple sclerosis portfolio continuing to decline, falling 15% to $1.21 billion. This includes sales from Tecfidera, Vumerity, Plegridy, Tysabri and Fampyratm.
Biogen also reported a loss of $20.7 million from its Leqembi collaboration during the quarter. For the first half of 2023, Leqembi has resulted in a loss of $39.6 million. Biogen executives told investors it expects Leqembi to stay negative in 2023 as the drug launch ramps up.
Chief Executive Officer Chris Viehbacher told investors during the earnings call that Leqembi's full approval is a "historic moment" and that the launch of the drug is underway in the U.S.
"We're going to be discovering an awful lot and a lot of this is just not that predictable," Viehbacher said.
Biogen also reaffirmed its full-year outlook, with expectations of mid-single digit percentage decline in revenue vs. 2022 and earnings between $15-$16 per share.
Alzheimer's Drug In Focus
The focus on Leqembi comes after the Food and Drug Administration fully approved the treatment on July 6.
The drug already had accelerated approval. But with the traditional approval, the Centers for Medicare and Medicaid Services said it will reimburse patients for the cost of the Alzheimer's treatment. Leqembi costs $26,500 annually without insurance.
But questions remain about how fast Biogen and partner Eisai (ESALF) can ramp up the drug.
Doctors will have to submit patient data before treatment and every six months to a registry database. The approval also includes a black box warning for a heightened risk of brain swelling in patients with a specific genetic abnormality and those on blood thinners. The FDA suggested patients receive genetic testing prior to treatment.
Following FDA final approval of Leqembi, Biogen stock fell to its lowest point since April and has been trading below the 200-day line.
Biogen Stock: First-Quarter Results
Ahead of second-quarter earnings, analysts expected Biogen's full-year earnings to fall 13% to $15.42 a share. That's in line with Biogen's reaffirmed outlook for profit to come in at $15-$16 per share. Wall Street also predicts revenue sliding 6% to $9.6 billion.
On April 25, Biogen beat first-quarter expectations. The company earned $3.40 per share, minus some items, on $2.46 billion in sales. Earnings fell 3% but topped expectations by 12 cents a share. Sales skidded 6%. Still, analysts called for Biogen sales to come in even lower, at $2.34 billion.
Biogen lost $18.9 billion in its Leqembi collaboration with Eisai. Leqembi has been on the market since its accelerated approval in January. Analysts expected a $16 billion loss on Leqembi in the quarter.
Biogen's multiple sclerosis franchise continued to decline, while its bread-and-butter medicines are facing competition from new products and generic knockoffs.
Sales of the company's multiple sclerosis portfolio plummeted 19% across the board to less than $1.13 billion. Revenue from Tysabri missed forecasts at $473 million, but Tecfidera beat with $274 million.
Please follow Kit Norton on Twitter @KitNorton for more coverage. | Drug Discoveries |
State legislators in North Carolina pocketed $530,000 in campaign donations in the first half of 2023 from pro-marijuana and casino industry interests as they mulled various legalization proposals, according to a new report.
The major contributions largely poured in from out of state and also from donors who have faced sanctions over unlawful drug and gambling operations, longtime money and politics expert Bob Hall, ex-director of the left-leaning watchdog Democracy North Carolina, said in a report released this week. More than half of the $530,000 came from people who have never given to any legislators in the Tar Heel State before 2022, the document noted.
"It’s hard to understand why legislative leaders would want to help these shady characters, particularly in the gambling industry, until you see all the money they give politicians," Hall said.
The release of the pot and gambling report comes as both industries have sparked heightened debate in North Carolina over regulations and laws. In June, Gov. Roy Cooper (D-NC) signed a bill into law that legalizes sports betting starting next year. North Carolina's state Senate cleared a bill in early March that would approve medical marijuana sales, but the measure has stalled in the House.
The single largest donor to North Carolina legislators in the first six months of this year was Clint Patterson of Owasso, Oklahoma, who gave $137,900 to 26 lawmakers and four caucus committees, according to the report. He's the CEO of Mockingbird Cannabis, a licensed medical marijuana grower in Mississippi that faced violations of state regulations over its greenhouse operation. Later, regulators ordered the company to destroy $1 million worth of plants over its failure to abide by the rules.
Another donor was Michael Pappas of Orlando Park, Illinois, executive vice president for business development for the Accel Entertainment Group, a gaming company. Pappas steered $6,400 to North Carolina's Senate Appropriations Committee Co-Chairman Brent Jackson in mid-March, the report said, marking his first donation to a Tar Heel State legislator. Accel has faced numerous legal troubles and paid a $1 million fine in 2023 to Illinois to end a case alleging it paid unlawful commissions.
“Suddenly, they’re writing checks for $2,000 or $5,000 to a legislator," Hall said. "It looks like a lobbyist or somebody told them that this is a pay-to-play state — you need to put in the money if you want your bill passed this year or next."
Hall's review also found there are 38 gambling-linked associations and businesses, including 29 not located in North Carolina, that are funneling cash to over 70 lobbyists. Separately, 13 pro-pot firms and organizations have paid 29 lobbyists, the report said.
Meanwhile, President Joe Biden's Department of Health and Human Services sent a recommendation this week to the Drug Enforcement Administration that it should reclassify marijuana as a Schedule III drug, which are substances that have “moderate to low potential for physical and psychological dependence" and include ketamine and certain anabolic steroids.
Marijuana is currently classified as a Schedule I drug, along with heroin, LSD, and peyote. Biden in October of last year pardoned thousands of individuals convicted of federal marijuana possession.
“Following the data and science, HHS has expeditiously responded to President Biden’s directive to HHS Secretary [Xavier Becerra] and provided its scheduling recommendation for marijuana to the DEA on August 29, 2023,” an HHS spokesperson said in a statement. | Health Policy |
A woman who has spent £20,000 to manage her endometriosis has said more should be done to tackle healthcare inequality.
Sophie Richards, 26, has had six surgeries and countless treatments - some of which she has funded privately.
A campaign group has warned women with endometriosis are getting into debt in order to fund their own treatment.
The Welsh government said it was committed to high quality care for people living with the condition.
Endometriosis causes tissue similar to the lining of the womb to grow in other places, such as the ovaries and fallopian tubes.
The condition, which affects 1 in 10 women, can cause serious pain and affect fertility.
Ms Richards, from Carmarthen, said she had only been able to get better because she was "able to access money to fund [the treatments]."
"I would say I've probably spent about £20,000," she said. "Some of that my own money, some my parents' [money]."
Sophie said she received "absolutely amazing care" from clinicians on the NHS, but said accessing them was difficult.
She has paid "at least £15,000" to freeze her eggs in a hospital in London due to concerns the condition has affected her fertility.
"I used my bonus to pay for my first one [round of egg freezing] and my parents paid for the second," she said.
Sophie said she recognised her financial privilege and is calling for a more open conversation about the realities of endometriosis, from a financial and social perspective.
Amy Jenner, from Caerphilly, also has endometriosis.
The condition causes such severe pain that sometimes her 10-year-old daughter has to help care for her.
"Our whole life revolves around this disease," she said.
When her GP told her she would have to wait 18 months to get an NHS scan, Amy decided to be seen privately.
"I did go private to get the scans done, but then I got the fee for the surgery," she said. "It's roughly £10,000 for the treatment. I can't afford it. I've just got to wait."
Stephanie Burgis, 41, is in a similar situation.
In 2019, she and her family took out a loan to help fund a £4,000 private treatment in Cardiff.
The specialist who operated on Stephanie found endometrial tissue on her bladder and bowel and said that her condition was among the most severe they had seen.
"Women in pain don't get taken seriously," said Ms Burgis.
Ms Burgis' condition has since worsened, and she is now on a waiting list to be referred for more NHS treatment.
"I can't afford a second private surgery this time, so I'm back on the waiting list."
'Debilitating pain'
Endometriosis campaigner Beth Hales, from the Fair Treatment for the Women of Wales, said women are being "forced to run up credit card debt" to fund their own treatment or "live indefinitely in chronic, debilitating pain."
The campaign group said waiting times in Wales were "pretty grim", with some of their members being told to expect waits of six to seven years for specialist care.
Mr Anthony Griffiths, one of the few endometriosis specialists in Wales, said waiting times are "frustratingly long".
"Currently our waiting list is in the order of three years," he said.
Mr Griffiths is based in Cardiff and provides treatment for both NHS and private patients.
"The waiting list to see me in the private sector is in the order of weeks," he explained. "As opposed to sadly, in the order of months in the NHS sector."
The Welsh government recently funded a specialist endometriosis nurse in Wales.
Mr Griffiths said it made a "a tremendous difference", playing an "educational role" in raising awareness of the condition. But he said more specialists are needed.
"They are saturated in terms of trying to deal with the amount of disease that's out there," he explained.
The Welsh government said health boards have a responsibility to "deliver high quality gynaecology services, including early diagnosis of endometriosis in accordance with NICE guidelines."Â
A spokesperson added: "We are committed to ensuring equitable, high quality care for conditions which affect women, including endometriosis, and NHS Wales will be publishing a 10-year Women's Health Plan." | Women’s Health |
By Brenda Kong, as told to Shishira Sreenivas
I developed psoriasis and psoriatic arthritis (PsA) at the same time when I was 12 years old. Iâm 41 now. My psoriasis diagnosis was easy, but the PsA diagnosis was not. Because I played sports as a teenager, doctors attributed my aches and pains to that. Unfortunately, I wasn't fully diagnosed until I was 21.
By then, we couldn't turn back time on all the joint mutilation I already had. For example, something that had bothered me since I was 12 was my middle finger joint on my left hand. I said, âHey, this is really bad. It shouldn't be this swollen for this long.â But I kept being told, âYou're playing too much sports,â and âIf you rest it and ice it, It'll be fine."
Itâs not fine. It became my first mutilated joint. Now I literally have full-body arthritis, from my jawline all the way down to my toes.
The Hardest Time
My late teens into my early 20s was the hardest time for me. When I was a college student, 18 years old, I tried out for the school's volleyball team. But because of my pain, I never got to play. The stress I had after starting college was horrible. It all just went from 0 to 60. And the nature of PsA is that it responds to stress.
Most of my joint damage happened when I was between the ages of 18 and 20. At times, I couldnât get out of bed. I couldnât go downstairs without gripping the handrails. I wanted to go clubbing, wear heels, and all of that. I didnât get to do that.
When I was around 21, both my psoriasis and PsA flared up and I was bedridden for 2 months. I had to use a wheelchair or cane to move. I went in and out of the hospital around three times in 3 weeks because we couldnât regulate my body temperature. The inflammation was everywhere. I couldnât even make a fist.
At the time, I very much hated my life. I'd never even heard of a rheumatologist until finally, a dermatologist who was treating my psoriasis urged me to see one.
Find the Right Rheumatologist
I think my biggest regret was not getting to a rheumatologist sooner. I could have taken care of a lot of the joint pain that later on became damage.
In fact, my advice for anyone else going through this would be to see a rheumatologist â not just any doctor â as soon as you can. Also, be consistent about seeing your doctor.Â
I actually went through three rheumatologists before I found one that really clicked. The first one, who diagnosed me, I just didn't like very much. The second one didnât take my insurance. But the third one, I loved. He was my rheumatologist up until I lost my insurance a few years ago and had to switch.
The first thing that rheumatologist prescribed for me was a steroid. It was a very strong steroid.
The first time I took it, I fell asleep on the couch because I was so tired. When I woke up, I sat up on the couch, then put my legs down and stood up. I didnât even register how easy it was. The drugs had reduced my inflammation that much. I didnât take deep breaths and brace myself as I usually did. I thought, âOh my God! What just happened?â Â
But my biggest improvement didnât come until a year and a half later, when my doctor started me on biologics.
Try Different Treatment Options
The first time took a biologic for PsA, I was around 24. I'd just bounce out of bed. I was like, âWhat are we doing?â âWhere are going?â I just wanted to go do something, because I was able to. My friends and I went traveling. We went to Las Vegas six times in 1 year just to do it. My skin was good and my joints were amazing.
This was my first biologic for the arthritis, but my third overall. I'd tried others for my skin only and my joints only. But this worked for both. I went from being covered in psoriasis, barely able to walk, using a wheelchair, and taking 1,800 milligrams of ibuprofen daily to not needing painkillers at all.
I've used a number of biologics since. Funny enough, I'm now using that first biologic I took for my psoriatic arthritis. I got back on it 3 years ago when my arthritis was getting pretty bad again.
Iâve also tried complementary treatments like yoga and meditation in addition to the biologic. Also things like diet â losing weight just gave me a lot less to carry around.
Even on a biologic, you can have a flare-up. And thereâs always a fear that your treatment will stop helping you. That does happen with biologics. After a certain point, it may lose efficacy and you have to figure out a new treatment.
If this biologic ever stops working for me, I would take the steps to try to find another one. I know how bad my body can be and how painful it can be without medication.
Manage Your Stress
Stress is a major contributor to PsA. So mental health is a big thing for me. Now when I have a flare-up, I actually relax a lot more. I know that if I stress out about it, it's going to be worse for me.
I do mental health exercises now. This helps keep me from overthinking, going down rabbit holes, and stressing myself out like I've done before.
When I was in my early 30s, I told myself that I couldnât keep doing that. So I started therapy and made managing stress part of my routine. I started doing calming meditation exercises. I started doing yoga. Even now, when I feel really stiff, I sit and do some light yoga poses until I can function a little bit more.
Itâs impossible to be stress-free. But now I do things to help manage it, and I have a much better mental outlook.
Try Activities That Make You Happy
In my early 20s, I couldnât cook because my hands hurt so much. Now I can. I do hand exercises to keep my hands loose and happy.
I cook massive amounts of food when I need to feel better. I just get in the kitchen, I turn on music, and I don't talk to anyone. No one talks to me. Everyone in my house knows this. I stay in the kitchen and get all my frustrations out, and it always turns out beautifully. I redirect so much of my emotion and stress into cooking.
The psoriatic arthritis life is a roller coaster, for sure. There are going to be many highs and there are going to be many lows, unfortunately. You just have to focus on the highs, and you'll get through the lows.
Show Sources
Photo Credit:Â martin-dm / Getty Images
SOURCE:
Brenda Kong, 41, psoriatic arthritis blogger, Oakland, CA. | Disease Research |
A 'kind and 'gentle' trans woman took a fatal overdose after waiting nearly five years for an appointment at a gender identity clinic, an inquest heard.
The "renaissance woman" artist and activist - Sophie Williams', 28, co-founded hardship fund WeExist - died after an overdose in Belfast, Northern Ireland.
She died only two days after she was told that the years she had spent waiting would not be accounted for by the Gender Identity Clinic (GIC) in London.
Sophie was "devastated" and "raging" by the news that the GIC in Tavistock would not account for the time.
She was previously diagnosed with psychosis and an emotionally unstable personality disorder, MyLondon reports. Assistant Coroner John Taylor concluded that Sophie was not capable of forming the intention to take her own life when she took the overdose.
As she moved from Tottenham to Belfast in July 2020, Sophie was experiencing dissociative episodes in which she had taken overdoses and resorted to self-harm.
Mr Taylor said that Sophie was anxious about the Barnet, Enfield and Haringey Mental Health Trust (BEH) and its failure to provide her with care. Dissociative states like the ones Sophie was experiencing could be caused by stress.
One BEH therapist is reported to have misgendered her and asked her "when she decided to be trans".
Mr Taylor called on the BEH, NHS England, and GICs to improve their care of trans people.
Friend Toby Attrill said he hopes for change so other trans people aren't stuck on "seemingly endless waiting lists to access life-saving care".
Toby said of his friend: "She was kind, gentle and generous and had a deep will to survive. She wanted desperately to engage with any treatment offered to her. Sophie was failed by the institutions which were meant to provide care for her and which were meant to keep her alive."
Sophie Naftalin, a solicitor representing Rupi Bond, said: "Sophie was failed by a mental health system that attributed her very real symptoms of psychosis and dissociation – and risk of self-harm in that context - to personality disorder therefore never meaningfully addressing the ever-present risk to her life.
"The clinical care that Sophie received was also hampered by a lack of understanding by clinicians of the specific challenges that she faced as a trans woman waiting for a first appointment. The Coroner has identified that without change, other lives are at risk." | Mental Health Treatments |
Novel enzyme family could provide insights into bacterial pathogenicity
Gram-negative bacteria cause a variety of infectious diseases in plants and animals alike. Outbreaks of Salmonella and E. coli infections often make headlines due to their severity, and people have to resort to allopathic as well as natural remedies, increasing the burden on the health care system.
While antibiotics offer an effective solution against bacterial infections, the increasing incidence of antibiotic-resistant bacteria have prompted researchers to identify other possible treatments against these infections. With technological advances and modern medicine, researchers are looking into the possibility of disrupting the pathogenicity of the bacteria at a molecular level by interfering with molecular processes at the gene as well as protein level.
Gram-negative bacteria, notorious for their infection capability, produce osmo-regulated periplasmic glucans (OPGs)—long-chain carbohydrates made of multiple glucose units—in the extracellular and/or periplasmic space. Initially, it was believed that OPGs were by-products produced under low solute concentrations, but recent reports confirm that they are crucial for pathogenicity, symbiosis, cell adhesion, and signaling.
However, the enzymes involved in the synthesis, regulation, and degradation of OPGs are not fully known. Genetic analysis revealed that the removal of opgH and/or opgG genes, partially responsible for OPG synthesis, causes bacteria to lose their infection capability, suggesting strong potential links of these genes with bacterial pathogenicity.
Although the structure of OpgG from E. coli (EcOpgG) has been elucidated, the mechanism of action of OpgG and OpgD from E. coli (EcOpgG and EcOpgD, respectively) remains unclear. Understanding the enzymes involved in OPG synthesis and the mechanisms underlying their function could provide us vital insights into the pathogenicity of Gram-negative bacteria, allowing us to develop more effective ways to deal with bacterial infections.
To bridge this gap in knowledge, Mr. Sei Motouchi from Tokyo University of Science, Dr. Kaito Kobayashi from the National Institute of Advanced Industrial Science and Technology (AIST), Associate, Associate Professor Hiroyuki Nakai from Niigata University and Professor Masahiro Nakajima from the Tokyo University of Science conducted structural and functional analyses of EcOpgD and EcOpgG. The study was published in Communications Biology.
Sharing the motivation behind this study, Professor Nakajima says, "Glycans are important biological macromolecules that play a variety of roles in living organisms, including pathogenicity and symbiosis. Their structure is very diverse and complex, and thus there are many types of enzymes that may synthesize and degrade them. However, we humans know only a small fraction of them."
The researchers investigated the functions of OPG-related genes in the model organism E. coli. Functional analyses revealed that E. coli OpgD (EcOpgD) was an endo-β-1,2-glucanase, which specifically broke down β-1,2-glucans. It also had similar kinetic properties as those of general glycoside hydrolases (GH), further confirming its identity as a β-1,2-glucanase.
Structural analysis using crystallography revealed a high degree of similarity between the structures of EcOpgG and EcOpgD. However, the two enzymes had remarkably different activity. Upon further investigation, the researchers found that a few amino acids forming the reaction pathway, termed "Loop A," were critical for enzyme activity and regulated the rate of reaction.
EcOpgG and EcOpgD differed in their catalytic functions, possibly due to the difference in the amino acids in the Loop A region. The LoopA region diversifies among this group of enzymes, which may lead to functional diversity. Nevertheless, the basis of the catalytic center is shared in this group of enzymes. This common point will help scientists develop therapies that could potentially disrupt OPG synthesis and hinder the infection capability of bacteria.
Further, while the two enzymes belonged to the same family of GHs, their structure did not match with any of the existing GH enzymes. Thus, the authors confirmed that they belonged to a novel GH family, namely GH186. This information opens avenues for research into therapies that can target GH186 proteins to stop the progression of bacterial infections.
Professor Masahiro concludes by explaining the long-term applications of the study, "Although it was known that some Gram-negative plant pathogens synthesize OPGs for pathogenicity, most of the key enzymes for their synthesis had not been identified, preventing the development of agrochemicals targeting OPGs."
"We have identified a family of enzymes (GH186) involved in the direct synthesis of OPGs and elucidated their detailed functions, which has presented us with new targets (GH186) to inhibit pathogens and provides a solid foundation for 'structure-based pesticide discovery'".
The findings of this study lay down a strong foundation for further investigation of OPGs and related genes and may usher in a new era of disease management.
More information: Sei Motouchi et al, Identification of enzymatic functions of osmo-regulated periplasmic glucan biosynthesis proteins from Escherichia coli reveals a novel glycoside hydrolase family, Communications Biology (2023). DOI: 10.1038/s42003-023-05336-6
Journal information: Communications Biology
Provided by Tokyo University of Science | Disease Research |
By Keith Hardy - Senior Lecturer, School of Architecture, Design and the Built Environment, Nottingham Trent UniversityCarbon Monoxide is a much-publicised invisible killer. But there’s another little-known gas that kills 27 times more people, causing the deaths of 1,100 people a year in the UK alone. Worse still, it could be seeping into your home. Radon is a radioactive, odourless, colourless gas that is naturally present throughout most of the UK and in several other countries across the globe. It is emitted in varying quantities or concentrations from radioactive elements, for example Uranium, that are naturally present in rocks and soils.Epidemiological studies on the health of miners undertaken by the United States Public Health Service during the 1950s and 1960s established a link between higher concentrations of Radon and incidences of lung cancer.As Radon is emitted from the ground, it quickly dilutes in the atmosphere into relatively harmless concentrations. But in confined and unventilated spaces in buildings, in basements and in underground mines, it’s concentration levels can become dangerously high.The daughters of RadonFollowing more detailed research undertaken in the UK during the 1970s and 1980s, it was recognised that concentrations of Radon in residential dwellings and other buildings could reach concentrations of a sufficiently high level to present a material risk of lung cancer.It was following this research that the UK government introduced a series of policies and regulative measures for the monitoring, recording and reporting of Radon levels, as well as guidance, relating to the mitigation of Radon levels in buildings. In 1991, UK building regulations first introduced a requirement that Radon protection measures, must be incorporated within the design of new buildings in Radon affected areas. This guidance has been revised since.Radon itself does not really cause tissue damage. It is the decay products, sometimes referred to as the progeny or daughters of Radon, that do. Radon gas may be inhaled and exhaled with little damaging effect. But the decay products include Radon - 222 (derived from Uranium - 238) and Radon - 220 (also known as Thoron, and derived from Thorium - 232), and other progeny including Polonium-218, 214 and 210, that can.These isotopes have half lives of between half a second and 138 days. It is the precipitation of isotopes within lung tissue, and their subsequent degradation, that can have a carcinogenic effect. Worse than asbestos?Based on current research, the UK government estimates that 1,100 lung cancer deaths per annum are a direct result of exposure to high concentrations of Radon. This is considerably higher that the reported number of deaths of people with lung cancer associated with asbestos.Concentration levels of Radon are measured in Becquerels per cubic metre (Bq/m3). In the UK, the action level is 200 Bq/m3. This represents the recommended limit for the activity concentration of Radon in UK homes.At that level, the lifetime risk of a non-smoker developing lung cancer is less than 1 in 200, but increases to 1 in 7 for a current smoker. Similarly, the lifetime risk increases significantly to 1 in 100 and 1 in 3 respectively, when indoor levels increase to 800 Bq/m3.Concentration levels of Radon within buildings vary substantially and are influenced by a number of factors. Location is significant. There are areas in the UK where concentration levels are much higher due to the nature of the underlying bedrock, for example; some of the highest recordings to date have been made in buildings situated in Devon and Cornwall.Buildings that have higher levels of natural or mechanical ventilation tend to have proportionally lower concentrations of Radon, for example where ground floors have a ventilated void below them. Those constructed after 1991 that incorporate Radon attenuation measures are also likely to have significantly lower levels of Radon concentrations within them.The Radon AtlasThe Indicative Atlas of Radon in England and Wales (Health Protection Agency, 2007) sets out a series of maps of England and Wales that are colour coded to show Radon Affected Areas, indicating the number of dwellings that have been measured and found to have Radon concentrations at, or above the action level. Most other countries' health and radiation protection agencies publish similar data.The 2002 edition of this publication contains detailed recorded data relating to the measurements of Radon in 400,000 homes, something the 2007 edition does not. In the UK council district of Kerrier in Cornwall, for example, the 2002 data showed that Radon concentration levels were measured in 12,800 homes. The arithmetical average Radon concentration was 248 Bq/m3and the highest recorded concentration was 10,000 Bq/m3, 50 times the action level. Overall, 5,200 homes had concentrations at or above the action level.Conversely, in the UK county of Essex the arithmetical average Radon concentration in all homes measured was 23 Bq/m-3 and no dwellings returned a measurement at or above the action level.The UK is not alone in facing the challenges of the Radon problem. The health protection agency of Canada Health Canada confirms that Radon related lung cancer is responsible for 3,000 deaths per year among its citizens. The United States Environment Protection Agency, meanwhile, reveals high levels of Radon across the country with some states, for example North Dakota, where 100% of households are likely to have indoor levels equivalent to 148 Bq/m3. Conversely, the Australian Government’s Radiation Protection and Nuclear Safety Agency maintains that Australia has some of the lowest levels of Radon in the world, with practically the entire country recording indoor levels below 20Bq/m-3.So what can you do?Public Health England, (PHE), is tasked with providing information on Radon. Other countries offer similar advice, for example the United States Environmental Protection Agency.If you’re worried about Radon, the first thing to do is find out whether your home might be affected. But if it is, there’s no need to panic – there are a wide range of remedial measures, from various forms of ventilation to active Radon sumps, which effectively suck the gas out of your home.The most worrying problem at present is that too few of us understand the risks posed by this invisible gas. Knowledge really is the best protection. | Epidemics & Outbreaks |
Health bosses are warning of major disruption and pressure on the NHS in England, as the hot weather combines with the latest junior doctor strike.
British Medical Association members will walk out for 72 hours from 07:00 on Wednesday.
It is the third strike in the pay dispute and is expected to lead to the cancellation of much routine care.
And with the heat placing extra demands on A&E units, bosses urged people to use services sensibly.
Junior doctors, nearly half the medical workforce, will walk out of both routine and emergency care.
NHS England said the health service would have to prioritise emergency and life-saving care. The hot weather was already causing high demand for urgent services - and people should avoid the sun at the hottest time of day and drink plenty of fluids.
Alongside heat-stroke, hot weather also brings an increase in heart failure and kidney problems as well as high rates of sprains and fractures and respiratory problems.
Consultants are being drafted in to provide cover during the strike but the amount could be lower than during previous junior doctors' strikes, in March and April.
Rory Deighton, of the NHS Confederation, which represents health bosses, said a particular challenge this time was "securing the level of consultant cover" - because of the amount consultants were asking for overtime payments - creating uncertainty over how many appointments would need to be postponed.
The four-day April walkout saw about 196,000 hospital appointments and treatments postponed. And the hospital waiting list, growing since the start of the pandemic, has now hit a record 7.4 million people.
"Each wave of strikes chips away at the NHS's resilience, impacting on staff, internal relationships and their ability to deliver on government pledges to reduce the elective backlog," Mr Deighton said.
'Significant disruption'
NHS England medical director Prof Stephen Powis said the strike would have an "enormous impact".
"The NHS is facing significant disruption this week, with a three-day strike that is set to be exacerbated by the ongoing hot weather," he said.
"Emergency, urgent and critical care will be prioritised this week but some patients will unfortunately have had their appointments postponed - if you haven't been contacted to reschedule, please do continue to attend your planned appointment.
"As ever, use 999 and A&E for life-threatening emergencies - and NHS 111 online for all other health conditions."
While hospitals are expected to bear the brunt of the disruption, community services, including GPs, will be much less affected.
'Staff shortages putting care at risk'
Dr Tom Corkery-Bennett is in his second year as a junior doctors and works in the A&E at Royal Berkshire Hospital.
He works an average of 48 hours a week, but can put in up to 60 and regularly receives messages asking if he can take on extra shifts.
What has happened to pay was a major factor in the staffing shortages, the 26-year-old said, and "grossly unfair".
"The resilience in the system is so low - staffing levels are skeletal," Dr Corkery-Bennett said.
"There is very often situations where doctors call in sick for a nightshift and there's no cover available.
"It means there's a large number of patients without a doctor to cover them and care is really put in jeopardy.
"One doctor will cover the work of two or three doctors if there's no contingency plan in place, which very often happens, and that's unsafe."
Junior doctors want a 35% pay hike to make up for 15 years of below-inflation rises.
In talks last month, the government offered an extra 5%, which Health Secretary Steve Barclay called "fair and reasonable", adding the "extremely disappointing" walkout would put patients at risk.
Shadow health secretary Wes Streeting said he wished the strikes were not going ahead, but added the reason for them was "because they haven't got someone to negotiate".
He told BBC Radio 4's Today Programme that the strikes should be viewed alongside the broader range of issues affecting doctors, such as retention and career progression, but would not be drawn on what salary Labour would offer doctors if in government.
"I really do fear what the state of the economy will be by the time of the next general election - I can't yet be sure what the state of the public finances will be and at the moment I'm fearing the worst."
Prof Powis told the same programme that other discussions held between government and other NHS employees showed it was possible to resolve disputes, but the "key is talking".
BMA junior doctor leader Dr Vivek Trivedi said the offer from government "beggars belief" given inflation had reached double-digits this year.
'Properly valued'
"Junior doctors are in despair at this government's refusal to listen," Dr Trivedi said.
"We have made clear that junior doctors are looking for the full restoration of our pay.
"The NHS can only function with a workforce that is properly valued."
BMA Deputy Chair Emma Runswick told the BBC that doctors' roles had become more important since 2008 and that they were "not willing to accept that further pay cuts is all the government can give us".
This walkout affects services in England only - but junior doctors in Scotland have this week announced they too will be going on strike, after a vote by BMA members.
A strike ballot for consultants in England is also being held. And Royal College of Nursing members are voting on whether to continue their industrial action, after joining the minority of health unions to have rejected the government's offer of 5% plus a one-off payment of at least £1,655.
Have you had your treatment cancelled? You can share with us by emailing [email protected].
Please include a contact number if you are willing to speak to a BBC journalist. You can also get in touch in the following ways: | Epidemics & Outbreaks |
Using nanoparticles administered directly into the cerebrospinal fluid (CSF), a research team has developed a treatment that may overcome significant challenges in treating a particularly deadly brain cancer.
The researchers, led by professors Mark Saltzman, PhD, and Ranjit Bindra, MD, PhD, administered to mice with medulloblastoma a treatment that features specially designed drug-carrying nanoparticles. The study, published in Science Translational Medicine on November showed that mice who received this treatment lived significantly longer than mice in the control group.
Medulloblastoma, a brain cancer that predominantly affects children, often begins with a tumor deep inside the brain. The cancer is prone to spread along two protective membranes known as the leptomeninges throughout the central nervous system, particularly the surface of the brain and the CSF. Leptomeningeal spread is seen in a number of primary brain tumors, as well as in brain metastases from solid tumors in the breast, lung, and other places. Because there are no anatomic barriers in the CSF to prevent further growth, these cancers can spread rapidly.
Targeting tumors in the CSF has proven difficult, in part because the fluid rapidly cycles through the central nervous system about four times a day in humans, typically flushing away anti-tumor drugs before they’ve had a chance to accumulate and have any effect.
“It's like a waterfall system, with a fast, rapid fluid flow,” said Minsoo Khang, lead author of the study and a former graduate student in Saltzman’s lab.
To get around this obstacle, the research team fabricated nanoparticles that adhere to tumors. Designed in Saltzman’s lab, these nanoparticles are made with degradable polymers that slowly release a DNA repair inhibitor, talazoparib, which is FDA-approved and currently used in the clinic for a number of cancers. The drug is one of a relatively new class of cancer drugs known as PARP inhibitors, which block an enzyme that helps repair DNA. Without the ability to repair their DNA, tumor cells are more likely to die.
The nanoparticle treatment is injected intrathecally - that is, it’s delivered directly between the leptomeninges protecting the CSF. Over a period of weeks, the researchers detected the presence of the nanoparticles in the CSF for as long as 21 days after a single dosing.
“We were very excited to have found a medium that has long-term retention in this fluid space, which is otherwise challenging,” Khang said.
Treating brain cancers in general is challenging since few treatments can penetrate the blood-brain barrier, a natural defense system that can block potentially helpful drugs. The research team’s method could offer a solution.
“There’s been very little work on intrathecal delivery of nanoparticles, so we’re very excited because it can allow us to go after leptomeningeal spread of disease from brain metastases,” said Bindra, the Harvey and Kate Cushing Professor of Therapeutic Radiology and professor of pathology. “This has really opened up an entirely new way to treat these patients, although much more work needs to be done.”
Using the nanoparticles to target the tumors allowed the researchers to use the drug talazoparib, which has proven to be effective in a number of solid tumors outside of the brain. Because the drug has limited to no penetration of the central nervous system, however, an orally delivered dose would have limited efficacy against tumors with leptomeningeal spread.
“By encapsulating it in a nanoparticle and directly injecting it into the CSF, we now get very high exposure in just that area,” said Saltzman, Goizueta Foundation Professor of Biomedical Engineering, Chemical & Environmental Engineering & Physiology, and a member of Yale Cancer Center.
Delivering the drug intrathecally also avoids injecting it directly into the brain, a technique referred to as convection-enhanced delivery, a very challenging procedure that can be performed only a few times a year. Intrathecal injections, in contrast, are much less invasive and can be given without a hospital stay.
“This is huge for us, because now we can do multiple nanoparticle treatments over time,” Bindra said.
In addition to the nanoparticle injection, mice were also given an oral dose of a chemotherapy drug known as temozolomide.
“It's a new platform where we can give these oral chemotherapies that get across the blood-brain barrier and a targeted agent just in the central nervous system,” Bindra said. “In essence, this compartmentalization of combination therapy will enhance synergistic tumor cell killing while minimizing systemic toxicity.”
The mice that received the nanoparticle-based treatment lived significantly longer than the mice who received drug therapy that didn’t use nanoparticles, and even longer than the mice that received no treatment. Further, there was much less spreading of the cancer in the mice that received the drug-carrying nanoparticles.
The researchers said the next steps will be to validate the approach in larger animal models, eventually followed by human testing. The team is also planning to test the treatment method on other cancers, particularly those that tend to spread to the brain.
Saltzman noted that the work was an interdisciplinary effort that drew on the expertise of numerous specialists. Other authors of the paper are Ju Hyun Lee, Teresa Lee, Hee-Won Suh, Supum Lee, Alessandra Cavaliere, Amy Rushing, Luiz H. Geraldo, Erika Belitzky, Samantha Rossano, Henk M. de Feyter, Kwangsoo Shin, Anita Huttner, Martine F. Roussel, Jean-Leon Thomas, Richard E. Carson, and Bernadette Marquez-Nostra. | Drug Discoveries |
Air pollution is helping to drive a rise in antibiotic resistance that poses a significant threat to human health worldwide, a global study suggests.
The analysis, using data from more than 100 countries spanning nearly two decades, indicates that increased air pollution is linked with rising antibiotic resistance across every country and continent.
It also suggests the link between the two has strengthened over time, with increases in air pollution levels coinciding with larger rises in antibiotic resistance.
“Our analysis presents strong evidence that increasing levels of air pollution are associated with increased risk of antibiotic resistance,” researchers from China and the UK wrote. “This analysis is the first to show how air pollution affects antibiotic resistance globally.” Their findings are published in the Lancet Planetary Health journal.
Antibiotic resistance is one of the fastest-growing threats to global health. It can affect people of any age in any country and is already killing 1.3 million people a year, according to estimates.
The main drivers are still the misuse and overuse of antibiotics, which are used to treat infections. But the study suggests the problem is being worsened by rising levels of air pollution.
The study did not look at the science of why the two might be linked. Evidence suggests that particulate matter PM2.5 can contain antibiotic-resistant bacteria and resistance genes, which may be transferred between environments and inhaled directly by humans, the authors said.
Air pollution is already the single largest environmental risk to public health. Long-term exposure to air pollution is associated with chronic conditions such as heart disease, asthma and lung cancer, reducing life expectancy.
Short-term exposure to high pollution levels can cause coughing, wheezing and asthma attacks, and is leading to increased hospital and GP attendances worldwide.
Curbing air pollution could help reduce antibiotic resistance, according to the study, the first in-depth global analysis of possible links between the two. It also said that controlling air pollution could greatly reduce deaths and economic costs stemming from antibiotic-resistant infections.
The lead author, Prof Hong Chen of Zhejiang University in China, said: “Antibiotic resistance and air pollution are each in their own right among the greatest threats to global health.
“Until now, we didn’t have a clear picture of the possible links between the two, but this work suggests the benefits of controlling air pollution could be twofold: not only will it reduce the harmful effects of poor air quality, it could also play a major role in combatting the rise and spread of antibiotic-resistant bacteria.”
Although air is recognised as being a direct pathway for disseminating antibiotic resistance, there is limited data on the different pathways that antibiotic resistant genes are carried via air pollution.
Potential pathways include hospitals, farms and sewage-treatment facilities that emit and spread antibiotic-resistant particles through the air and then across wide distances.
Until now, there was limited data on how much influence PM2.5 air pollution – which is made up of particles 30 times smaller than the width of a human hair – has on antibiotic resistance globally.
Sources of PM2.5 include road traffic, industrial processes and domestic coal and wood burning. Data indicates 7.3 billion people globally are directly exposed to unsafe average annual PM2.5 levels.
The authors created an extensive dataset to explore whether PM2.5 was a key factor driving global antibiotic resistance, using data for 116 countries from 2000 to 2018. The data sources included the World Health Organization, European Environment Agency and the World Bank.
The findings indicate antibiotic resistance increases with PM2.5, with every 10% rise in air pollution linked with increases in antibiotic resistance of 1.1%.
The association has strengthened over time, with changes in PM2.5 levels leading to larger increases in antibiotic resistance in more recent years. The analysis indicates antibiotic resistance resulting from air pollution was linked to an estimated 480,000 premature deaths in 2018.
A modelling of possible future scenarios indicates that if there were no changes to current policies on air pollution, by 2050 levels of antibiotic resistance worldwide could increase by 17%. The annual premature death toll linked to antibiotic resistance could rise to about 840,000.
The authors acknowledged limitations to their study. A lack of data in some countries may have affected the overall analysis, they said.
The study was observational, so could not prove cause and effect. Future research should focus on investigating the underlying mechanism of how air pollution affects antibiotic resistance, they said.
A second study published in the journal BMJ Mental Health found that exposure to relatively high levels of air pollution was associated with increased use of community mental health services by people with dementia. The long-term study focused on a large area of London with heavy traffic. | Epidemics & Outbreaks |
Doctors once thought non-small-cell lung cancer (NSCLC) was one disease. Most people got the same treatment -- chemotherapy (chemo) -- especially if their cancer had spread to other parts of the body.Â
Now, doctors know there are many different types of NSCLC, with âmore coming down the pike,â says Nathan Pennell, MD, a medical oncologist specializing in thoracic cancer at the Cleveland Clinicâs Taussig Cancer Institute.
That means treatment plans are no longer once-size-fits-all. Instead, treatments like targeted therapies and immunotherapy are tailored to each personâs tumor.
Targeted Therapies
Some cancer cells have gene changes (also called mutations) that help them grow and spread. The goal of several targeted therapies is to block those changes. The FDA has approved medicines to treat eleven different gene mutations that can drive NSCLC:
- EGFR
- ALK
- BRAF
- ROS1
- RET
- MET
- KRAS
- PIK3CA
- HER2
- NTRK
- MEK1
One drug targets the growth of tumors on blood vessels:
- Ramucirumab (Cyramza)
Epidermal growth factor receptor -- or EGFR -- is the most common. Itâs a protein on the surface of cells that helps them grow and divide. If you have too much EGFR, your cells grow faster than normal. Medicines called EGFR inhibitors stop this growth.  Â
Karen Reckamp, MD, co-directs the lung cancer and thoracic oncology program at City of Hope in Duarte, CA. She says targeted therapy has completely changed the way doctors manage lung cancer. Now, before you start treatment for advanced NSCLC, youâre likely to have genetic testing to see if you have a mutation that might help guide your treatment.
Reckamp says this new way of doing things has changed the game for many people with advanced NSCLC.
âWe donât talk about a cure,â Reckamp says. âBut the tumor shrinks, people feel better, go back to work, and have a better quality of life.â
Targeted therapies also have drawbacks. Some only work for the small number of people who have gene mutations that respond to a certain targeted therapy. About 15% of people with lung cancer have EGFR-positive lung cancer. The numbers are much smaller for other gene changes.
The medicines also have side effects, like:
- Skin rash
- Diarrhea
- Liver damage
- Bone marrow problems
Reckamp says these usually arenât as severe as side effects from chemotherapy.
âFor most people, the side effects are pretty tolerable, and they do pretty well.â
Another problem is that targeted medicines often stop working, eventually.
âCancer cells find ways to survive and overcome the toxic treatments weâre giving them,â Reckamp says. âWhen that happens, you have to try a different treatment.âÂ
Still, she says targeted therapies have greatly improved the odds for people with NSCLC.
âWith chemotherapy alone, [extending life] by 1 year was as good as we could get. Now, with these therapies in addition to chemo, itâs not uncommon for patients to live 2, or even 5 years.â
Immunotherapy
Your immune system normally destroys cancer cells. But tumor cells are sneaky and can find ways to evade your bodyâs best defenses. If you have NSCLC, some cancer cells may churn out a protein called PD-L1. It attaches to another protein, PD-1, on important immune T cells. This is called an immune checkpoint, and it tells your T cells to leave the tumor alone. Â
One way to get around this is with medicines called checkpoint inhibitors. They prevent PD-L1 and PD-1 from getting together. This unleashes your immune system, so itâll be at full power against cancer cells. But healthy cells get caught in the crossfire.
âImmunotherapy can cause inflammation anywhere in your body from head to toe,â Reckamp says. âWhen your immune system never turns off, you can get something resembling an autoimmune disease like rheumatoid arthritis. Or you can have problems with your thyroid, liver, bladder, kidneys, and heart.
âAnd this can happen anytime -- even after youâve stopped treatment. But most symptoms can be well-controlled with high-dose steroids.â
Your doctor wonât suggest immunotherapy unless your tumor tests positive for high levels of PD-L1. The test isnât always correct, though, and some tumors that test positive for PD-L1 may not respond to immunotherapy. Â
Still, Reckamp says immunotherapy is a better choice than chemo for most people who have it, despite the severe side effects and hefty price tag. It may even keep working after you stop taking it.
In the Pipeline
Reckamp says to look for improvements in targeted medicines and smarter drugs that can outwit and outlast cancer cells.
âThere are lots of clinical trials focused on overcoming resistance to targeted medicines and immunotherapy, and combining these with chemotherapy to improve not just the length of a [personâs] life, but also the quality,â she says.
Show Sources
Photo Credit: Robert Kneschke / EyeEm / Getty Images
SOURCES:
Karen Reckamp, MD, co-director, lung cancer and thoracic oncology program, City of Hope, Duarte, CA.
Nathan Pennell, MD, medical oncologist, Cleveland Clinicâs Taussig Cancer Institute.
American Cancer Society: âTargeted Therapy Drugs for Non-Small Cell Lung Cancer.â
Johns Hopkins Medicine: âWhat are Immune Checkpoints, and How Can We Block Them?â
Dana-Farber Cancer Center: âWhat Is a PD-L1 Test?â
Andrews, A. Treating with Checkpoint Inhibitors -- Figure $1 Million Per Patient, American Health & Drug Benefits, 2015. | Disease Research |
Tara Lipinski is gliding through the early months of motherhood.
After all, the Olympic gold medalist and husband Todd Kapostasy are basking in life with their newborn daughter, Georgie, whom they welcomed via surrogate in October. But it's an experience Tara admitted they weren't sure they would ever have.
"We went through a long, five-year journey and it was so difficult as I experienced so much pregnancy loss along the way," she shared on the Nov. 20 episode of The Jennifer Hudson Show. "Going through IVF and trying to get back more embryos to try pregnancy again. It really was like this mystery that never ended."
But after enduring this "long road," Tara is savoring every moment with her baby girl. "She's so precious, I can't believe it," she added. "It's shocking. Every day, I wake up to this surreal feeling that it's actually happened."
In fact, it was that difficult road to parenthood that inspired her and Todd's podcast, Unexpecting.
"I had all of these feelings," she explained. "I didn't know if they were normal or if other people were experiencing it ‘cause you just don't hear these stories as much. You hear about IVF or infertility, but you don't really know what the day-to-day life is—especially when it goes on for half a decade."
Now, with her baby girl, Tara is embracing all the milestones with Georgie to come. As for whether she hopes her little one will follow in her triple-looping skates?
"I feel like that's a lot of pressure! I feel like that's a lot," the 41-year-old noted. "Maybe I'll take her to the rink and then if she wants to skate, then I guess I'll have to skate with her. But hopefully, she finds something of her own that doesn't have to follow in mom's footsteps."
Tara and Todd, who wed in 2017, announced they were expecting their baby girl just a few weeks before confirming her arrival. At the time, the filmmaker recalled their reaction to learning they were finally about to be parents.
"We're on the deck of this house looking at the Pacific Ocean, and the sun is setting and we're like, 'We're pregnant with a kid after the heartbeat scan,'" he reflected on the Oct. 5 episode of Unexpecting. "It felt like this crazy—almost cliché end of a movie—where the sun was finally setting on our horrific fertility journey."
That same month, Tara spoke about her and Todd's decision to choose surrogacy. Calling her surrogate a "match made in heaven," she expressed hope that being vocal about their struggles would help those in similar situations.
"For me, as someone who has experienced pregnancy 4 times, I've felt more connected through this surrogacy pregnancy than any other," she wrote in an Oct. 19 Instagram post. "These positive stories should be spoken about and I hope more of these conversations happen because the amount of messages I've received from women feeling relieved or now optimistic about potential surrogacy has been overwhelming.
Keep reading to see other stars who've also shared their experiences with surrogacy. | Women’s Health |
Shaylee Ragar/Montana Public Radio
toggle caption
Intermountain Residential in Helena, Montana, is one a handful of programs in the U.S. providing long-term behavioral health treatment for kids younger than 10. Administrators recently announced that staffing shortages are forcing them to downsize from 32 beds to 8, and the facility might have to close entirely.
Shaylee Ragar/Montana Public Radio
Intermountain Residential in Helena, Montana, is one a handful of programs in the U.S. providing long-term behavioral health treatment for kids younger than 10. Administrators recently announced that staffing shortages are forcing them to downsize from 32 beds to 8, and the facility might have to close entirely.
Shaylee Ragar/Montana Public Radio
Connie MacDonald works for the State Department at the U.S. consulate in Jeddah, Saudi Arabia. It's a dream job, and she loved living abroad with her two sons.
But earlier this year, MacDonald says, her 8-year-old son started to become aggressive. At first the family thought it was ADHD. Her son was indeed eventually diagnosed with attention-deficit/hyperactivity disorder — as well as disruptive mood dysregulation disorder, which makes it difficult for her son to control his emotions, particularly anger.
"He was hurting me. He was threatening to kill his brother. One of the last straws was they had four people at school holding him down for almost an hour, trying to calm him down," she says.
The American International School of Jeddah told her that her son couldn't come back. His behavior was so severe that MacDonald started to look for residential treatment back in the U.S.
She found Intermountain Residential in Montana. Children in the Intermountain program learn to build healthy relationships through intense behavioral therapy over a long period, often for up to 18 months.
Intermountain Residential is one of the only facilities in the country that serves young children with emotional dysregulation, like her son.
MacDonald remembers crying hysterically when she dropped him off in June, but tears gave way to hope as his violent outbursts decreased over the weeks and months afterward.
"Now when we have our weekly calls, it's very normal. It's like talking to your child again. It's wonderful," she says.
Intermountain is one of about a dozen programs in the country that provide long-term behavioral health treatment for kids under 10, according to the National Association of Therapeutic Schools and Programs. It's one of the only options for kids as young as 4.
Intermountain is tucked away in a quiet neighborhood in Helena, and has been treating children for over 100 years. The children that Intermountain treats have emotional disorders, behavioral issues stemming from mental illness or trauma, and other issues.
They struggle with self-harm, severe depression, or violent outbursts that can involve attacks on other people or animals. Most families that come to Intermountain have tried medication, outpatient therapy, or even short-term residential treatment, all without success.
Long-term treatment programs such as this one are often a last resort for families.
Treatment takes a long time because it can take months before kids with severe mental and behavioral health issues even feel safe enough to open up to Intermountain staff, says Meegan Bryce, who manages the residential program.
Some kids have been traumatized or abused by the adults who they previously lived with, she says. That can leave children deeply scared of interacting with adults, and initially resistant to care and treatment, even after they've started living in a safe environment.
Bryce explains that Intermountain staff first have to gain a child's trust, before they work to figure out the root cause of the child's behavior.
It takes time before they can make an effective long-term treatment plan based on intensive behavioral therapy and building healthy relationships.
Closure notice leaves parents scrambling
Intermountain parents and staff were shocked when the facility announced suddenly at the end of the summer that it would close its doors this fall, blaming staffing shortages.
Some parents threatened to sue. A law firm representing them argued in a September letter to Intermountain's board that it has a contractual responsibility to finish treating children who remain at its residential facility.
Intermountain then reversed course, saying it would downsize in an attempt to keep the program open.
But spokesperson Erin Benedict said there's no guarantee Intermountain can keep its doors open in the long-term. Intermountain plans to decrease its capacity from 32 beds to eight.
Megan Stokes recently worked as executive director of the National Association of Therapeutic Schools and Programs. She thinks staff shortages are not the full story regarding Intermountain's troubles.
"We are seeing a lot of long-term facilities moving to what they call the short-term, intensive outpatient," she says. "You're able to get insurance money easier."
Stokes says she knows of 11 long-term programs for kids 14 and younger that have shifted to offering only shorter stays, of 30 to 90 days.
Short-term programs are cheaper and therefore insurance companies will pay for them more quickly, Stokes explains. Over the course of a year, short-term programs can treat more patients than long-term residential facilities. That can make them more lucrative to operate.
But short-term programs aren't likely to help the types of pediatric patients who are treated at Intermountain. In fact, short-term programs could even cause them harm.
"The problem is if that kid 'bombs out' of that shorter-term stay, or they do well — [but] maybe six months down the road they don't have the tools in their toolkit to continue that, and now you're labeled as treatment-resistant, when that kid wasn't treatment-resistant,'" Stokes says.
Kids labeled treatment-resistant can be turned away from other short-term programs.
Shrinking options for the most vulnerable kids
For now, parents of kids at Intermountain are searching for other treatment options, because of the uncertainty over whether Intermountain will remain open. Some parents told NPR and KFF Health News they've had to sign up for waitlists that can take a year or longer to clear, for the few programs that take kids 10 and younger. That's if they can find facilities that would accept their kids at all.
Stacy Ballard hasn't been able to find a facility willing to treat her 10-year-old adoptive son, who has reactive attachment disorder and is currently at Intermountain. The condition can make it hard for kids to form an attachment with their family. Ballard says her son can be extremely violent.
"He was walking around our house at night thinking about killing all of us, and he said it was almost nightly that he was doing that," Ballard explains.
Facilities that treat children his age generally won't treat kids with a reactive attachment disorder diagnosis, which often is associated with severe emotional and behavioral problems.
Connie MacDonald, the State Dept. employee, also can't find another facility that could be a backup option for her son. He was supposed to complete 14 more months of treatment at Intermountain.
She says she can't gamble on keeping her son at Intermountain, because there's too much uncertainty over whether it will remain open.
So, she's getting ready to leave Jeddah and fly back to the U.S., taking a leave of absence from her job.
"I'll take him to my family's place in South Carolina, until I can find another place for him," she says.
This article comes from NPR's health reporting partnership with MTPR and KFF Health News. | Mental Health Treatments |
A surgeon specialising in amputation who lost both legs to sepsis made it to the shortlist to become an astronaut.
Neil Hopper, consultant vascular surgeon at the Royal Cornwall Hospital Trust, defied advice and expectations by successfully returning to work.
He made the European Space Agency's shortlist for a para-astronaut but was then eliminated from the process.
He said: "I got far enough to start worrying that I might get through."
Mr Hopper, who works at Royal Cornwall Hospital based in Truro, added: "When I saw the advertisement from the European Space Agency for a para-astronaut, I had to put in an application.
"The criteria were quite specific, you had to have a doctorate in engineering or medicine, you had to have a disability below the knee, and you had to speak a second language - hey, Welsh."
Mr Hopper said his wife Rachel thought he was "completely crazy".
He travelled to Hamburg to take part in the selection process which involved medical, personality, psychometric and memory tests.
He said: "I made it reasonably far through the programme but I didn't get selected in the end."
Mr Hopper has told his story, which includes a gruelling recovery and a return to helping patients with a new perspective, for a Welsh BBC documentary.
In the documentary, he explains how he had performed hundreds of amputations during his career when he lost both his legs to sepsis in 2019.
"On the other side"
He added: "I remember imagining the operation - operations which I do all the time, and thinking that power tools were going to be used on me. That was really difficult to process."
In hospital for seven weeks, Mr Hopper said the physical changes were "fairly easy to understand", while the psychological changes and "fitting back into family life" were harder to grasp.
But with prosthetic legs came a glimmer of hope.
He added: "I was starting to think I'd never be able to go back to work, I'd never be able to play football with my son, walk the dog on the beach - that's the kind of mindset I had.
"But once I got legs, things started to change overnight, the future didn't look so bleak."
On reflection, he believes his experience and ability to relate to patients has made him a "better doctor", facilitating improvements to services throughout Devon and Cornwall.
The surgeon had been advised to reconsider his career, but he said: "I was determined to go back to work.
"I wanted to prove that they were completely wrong." | Medical Innovations |
By Dawn Brown, Director of the National Alliance on Mental Illness HelpLine Services, as told to Danny Bonvissuto
My son, Matthew, was rare in that he was diagnosed when he was 8 years old. Most often, schizophrenia manifests in the late teens or early 20s.
At 18, he had a psychotic break and required hospitalization. Eventually he found treatment that was effective, but it took quite a while.
Once we found something that seemed to address his symptoms on several levels, he became treatment-compliant, which means heâs taking his medication on schedule. But medication is a small part of the treatment plan. Heâs also keeping his appointments with his psychiatrist and therapist and doing what he can to maintain his overall health and wellness.
Heâs 38 now. He enjoys his life. He has friends. He has places he goes during the day that keeps him engaged with others. But itâs been a journey.
The most difficult part is when someone first begins to experience symptoms. Itâs rocky. There will be many ups and downs. Over time it does get better. An engaged, informed loved one is often the best indicator of the outcome for a person with schizophrenia.
âThe Perfect Storm'
Very often when people begin to have symptoms, or when they have full-blown psychosis related to schizophrenia, they resist treatment. Itâs the perfect storm. You have young adults coming into their own, theyâre experiencing symptoms, people are throwing around labels, and theyâre resistant to having a serious mental health condition.
For a parent or caregiver, this is a very difficult situation. Theyâre adults at 18 and can make decisions about going to the hospital or taking medication. As a parent, you lose the power to make them do these things.
Listen and Empathize
In terms of getting someone to engage in treatment, we advise family members to listen. Donât just hear, but listen to what their experience is. Their reality is different than most peopleâs reality. I wouldnât say you should agree with what they say if itâs delusional. But you can empathize.
If they think someoneâs out to get them, you can say, âThat sounds very scary. You must be very worried.â
Thatâs their reality. Imagine that it were true. Thatâs what your loved one believes.
Then listen for anything that might motivate them to get treatment. Many people with schizophrenia have trouble sleeping. Treatment will help them with their sleep cycles.
Maybe they want to get back to college. You can say, âI know youâd really love to go back to college, and thatâs what I want for you, too. Letâs see what you can do to get back there.â
Work with them to achieve their goals -- not what you want, but what they want.
Ideally, after youâve listened and empathized, you get them to agree to some therapy. At that point you become what I call a recovery partner, working with your loved one to find solutions and help.
At First, Treatment Is Trial and Error
A lot of people stop treatment because honestly, the medication available for schizophrenia isnât always effective. It can have horrible side effects and people lose hope, so they stop.
One of the side effects is obesity. If you have a young woman whoâs being told she needs to take this medication and she gains 30 pounds in 3 months, she wants to stop. The voices have stopped. But within a week or two the voices are back and the cycle starts all over again.
Itâs common to try different medications at the beginning of treatment. That was true of my son as well. He tried four or five antipsychotics that targeted the more active part of schizophrenia -- the hallucinations. But when he found one that worked, it was almost like a light switch turned on in his brain.
Matthew has obesity and some other unpleasant side effects. But he also has the awareness that he needs the medication and that the side effects arenât as bad as the psychosis itself. Thatâs a very mature place to be.
I offer people hope to keep looking and donât settle. Always work in conjunction with a psychiatrist. And get the person with schizophrenia to sign Health Insurance Portability and Accountability Act (HIPAA) consent so the psychiatrist can work with other mental health professionals. Itâs very likely that, over time, if youâre persistent in seeking treatment options, youâll find something that works.
Explain What The Medications Do
People with schizophrenia should be fully aware and informed about anything they put in their bodies. Part of them being a participant in their treatment is understanding the pros and cons of any type of medication and how you hope it will affect them.
Positive Reinforcement
Once the medication has become effective and the symptoms have receded, you can have a conversation about it. âRemember last month when you were hearing voices and couldnât sleep? Remember how scary and awful that was? Now that the medications are working, itâs a good thing. A really important step.â
Itâs positive reinforcement. Youâre reaching them on an intellectual level about what theyâre doing and what results theyâre seeing. They can think through cause and effect: I like the effect, so Iâm going to keep doing this.
Taper Treatment if Itâs Not Working
Itâs never a good thing to abruptly stop treatment for schizophrenia. If theyâre unhappy with their side effects, or if the medication isnât effective, impress the importance of working with their psychiatrist.
These are powerful medications that change the chemical balance in their brain. You might have to taper down one medication and work another into the regimen so your blood levels are sufficient. You want to avoid extremes, and donât want to be completely knocked out.
Respectfully listen to why they want to stop and look for alternatives. There are a lot of combinations of options out there. It takes patience with the process to find the ones that work. They donât work immediately: It takes a couple of weeks. Talk about what will be least disruptive to their life.
Show Sources
Photo Credit:Â Charles Wollertz / Getty Images
SOURCE:
Dawn Brown, national director, National Alliance on Mental Illness HelpLine Services, Arlington, VA. | Mental Health Treatments |
Good morning. Only 50% of Australia’s eligible aged care residents have had a fourth Covid vaccine dose as deaths climb. Anthony Albanese’s net approval rating is up 40 points since Labor’s victory last month, while inflation is tipped to reach 7%. A dramatic 11th-hour intervention by the European court of human rights has dealt a blow to the UK government’s plan to send asylum seekers to Rwanda.Just over half of Australia’s eligible aged care residents have had a fourth Covid vaccine dose, prompting the federal health minister, Mark Butler, to warn the winter rollout “has been too slow”. Health department data shows about 63,515 aged care residents have had their fourth shot – that’s 51.3% of the eligible population. It comes as the latest health department data shows Covid-related deaths are continuing to climb at a significant rate.The Reserve Bank governor, Philip Lowe, has warned Australians to be prepared for higher interest rates, saying inflation will likely reach 7% by the end of the year and it must be brought under control. Lowe said on Tuesday night he was predicting inflation to rise to 7%. That compares with current inflation of 5.1%. Anthony Albanese is experiencing a post-election boost not seen since Kevin Rudd was elected in 2007, with the prime minister’s net approval rating up 40 points since Labor’s victory last month. The first Guardian Essential poll since the 21 May election shows 59% of voters approve of the job Albanese is doing as prime minister, including 19% who “strongly approve”, compared with just 18% who do not. In the final poll before the election, just 42% of voters approved of Albanese’s performance.The European court of human rights has made a dramatic 11th-hour intervention into the British government’s controversial plans to send asylum seekers to Rwanda that could ground the inaugural flight to the east African nation. Lawyers for one of the asylum seekers due to fly made a successful emergency application to the ECHR after exhausting applications to UK courts. The decision is a blow for Boris Johnson’s flagship policy of sending asylum seekers 4,000 miles to the east African country.AustraliaA colour image from the SkyMapper Southern Sky Survey shows the growing black hole as a bright blue source. Photograph: Christopher A Onken/ANUAstronomers believe they have discovered the fastest-growing black hole of the past 9 billion years. The supermassive black hole consumes the equivalent of one Earth every second and has the mass of 3 billion suns, they estimate. The lead researcher Dr Christopher Onken, of the Australian National University, said the supermassive black hole was “more or less halfway across the universe”.Labor’s election victory was aided by Australia’s rejection of the spectre of three more years of Scott Morrison, according to the man responsible for the party’s winning strategy.Bunnings, Kmart and The Good Guys have been using facial recognition technology in a bid to crack down on theft in-store, research by Choice says.The majority of Australians believe journalists should not express their personal opinions on social media and only 15% of respondents say they follow specific journalists, according to the latest report on digital news.The worldJoe Biden waves as he boards Air Force One at Andrews air force base in Maryland on 14 June. Photograph: Gemunu Amarasinghe/APJoe Biden will visit Israel, the occupied West Bank and Saudi Arabia next month, the White House has announced. The announcement immediately put the administration on the defensive, given the president’s previous stance that the Saudi regime was a “pariah” because of the murder of Jamal Khashoggi and other human rights abuses.People who caught Covid during the first wave of the pandemic get no boost to their immune response if they subsequently catch Omicron, a study of triple vaccinated people reports.Authorities in Beijing have warned that a sharp rise in Covid-19 cases linked to a 24-hour bar was critical and the city of 22 million people was in a “race against time” to get to grips with its most serious outbreak since the pandemic began. The Brazilian ambassador to the UK has apologised to the family of Dom Phillips for incorrectly telling them his body had been found in the Amazon along with that of his missing travelling partner Bruno Pereira.The World Food Programme has said it is suspending food aid to 1.7 million people in South Sudan, as the war in Ukraine sucks funding from the crisis-plagued country and causes the price of staples to soar.The fatal shooting of journalist Shireen Abu Aqleh in May has raised fresh concerns over military inquiries into deaths of Palestinians.Recommended reads‘I found myself dreading the day that my child would ask for something her friends had, that I couldn’t provide.’ Photograph: Maria Teijeiro/Getty Images/OJO ImagesAs the cost of living rises and family budgets tighten, how do you have that awkward conversation with your children? How do you explain to your daughter that you can’t afford an expensive birthday party?Beforeigners is a Nordic noir that pushes beyond the limits of the police procedural and into the unexpected. This stylish TV show, streaming on SBS on Demand, deftly establishes its odd premise in a matter of minutes: as teenagers party by Oslo’s harbour, the water surface is suddenly broken by people who seem to have appeared from nowhere, flailing in the sea and speaking Old Norse. They have no idea where they are or why they are there. They are “beforeigners”, thousands of people from the prehistoric, Viking and Victorian ages who have been inexplicably jolted into the modern world.ListenOn Friday, the Nadesalingam family returned to their home town of Biloela in central Queensland after more than four years in immigration detention. During that time the Tamil family became the face of Australia’s strict asylum seeker policies. Queensland reporter Eden Gillespie documents the family’s return home, and Priya Nadesalingam discusses life after detention.Full StoryHome to BiloelaSorry your browser does not support audio - but you can download here and listen https://audio.guim.co.uk/2020/05/05-61553-gnl.fw.200505.jf.ch7DW.mp300:00:0000:27:26Full Story is Guardian Australia’s daily news podcast. Subscribe for free on Apple Podcasts, Spotify or any other podcasting app.SportAustralia celebrate after defeating Peru in the 2022 Fifa World Cup playoff match in Doha. Photograph: Joe Allison/Getty ImagesThe plan to send on substitute goalkeeper Andrew Redmayne in the event of a penalty shootout in the Socceroos’ World Cup qualifier against Peru had been on the table for weeks, but remained such a secret that not even captain Mat Ryan knew about it.In our weekly lifestyle interview about celebrities and their favourite objects, the TV presenter and former AFL player Tony Armstrong tells us about his childhood as a drum nerd, and his favourite place in the world: the couch.Media roundupParents who send their preschoolers to long daycare will for the first time receive subsidies from the NSW government, with fee relief for four- and five-year-olds being extended to privately run centres, according to the Sydney Morning Herald reports. Genetic research has revealed a direct link between dementia and a lack of vitamin D. The Australian reports on a world-first study from the University of South Australia that investigated the link between vitamin D, neuroimaging features and the risk of dementia and stroke. It found low levels of vitamin D were associated with lower brain volumes and an increased risk of dementia and stroke.And if you’ve read this far …In perfect minute detail: jumping spiders, falling water drops and more – in pictures.Sign upIf you would like to receive the Guardian Australia morning mail to your email inbox every weekday, sign up here.Get in touchIf you have any questions or comments about any of our newsletters please email [email protected] Australian WeekendEvery Saturday at 6am, enjoy early access to the best journalism planned for the weekend in one elegant app, plus a curated selection of the week’s news and analysis from Australia and the world. | Vaccine Development |
In a small village cemetery, 34 tiny iron crosses poke up through the soil.
Many are twisted and a few are missing completely. On some, the nameplates are visible. On others, they are not.
Each cross is a reminder of a patient once cared for by a hospital that looked after people with disabilities in Nayland - a village that sits between Sudbury in Suffolk and Colchester in Essex.
Most of the patients at the long defunct Jane Walker Hospital, says Tom Weston, a former nurse there, were left and forgotten by their families.
"Ninety per cent were not visited, easily," he says. "The staff, the maintenance men, the drivers and the cleaners - they became their family."
He tells of one man who, before being sent to Jane Walker, was a teenage farm worker. He had learning difficulties and once told Mr Weston how he used to be whipped by the foreman.
On one occasion, Mr Weston says, the teenager got hold of the whip and "gave the foreman a good hiding".
"That's how he ended up in care," Mr Weston says. "They were given labels like being aggressive. They weren't."
Mr Weston, now 71 and still working as a nurse, spent nine years at Jane Walker after leaving the Royal Air Force.
Hired in 1977, he fondly remembers it as "a special place at a special point in time".
He tells of group picnics at Thetford Forest, days out at the beach and endless activities at the hospital itself.
With seven wards, the Jane Walker Hospital had between 150 and 200 patient-residents at any one time.
"It was ahead of its time in being person-centred, and everybody who went on from Jane Walker took those values with them," says Mr Weston.
"All those things I learned at Jane Walker - I still use today."
The hospital, originally established by Dr Jane Walker as a tuberculosis sanitorium, closed in 1991.
"It was a sad day for many when the hospital closed," Mr Weston says.
Some patients were sent to a psychiatric hospital on the other side of the county, while others went to live in a new complex at Walker Close in Ipswich.
The BBC has not been able to make contact with any former residents or their families to hear their memories of the institution.
Fazilet Hadi, head of policy at Disability Rights UK, says while Jane Walker Hospital may have been "one of the good places", the wider system of the time saw people with disabilities institutionalised.
"A lot of families just wanted people with disabilities out of the way," she says. "They were very often placed in rural locations."
She says the closure of the Jane Walker Hospital was in line with a general shift during the late 1980s and 1990s from institutional to community care.
"We have made progress," says Ms Hadi, "but there is still some way to go.
"It is still hard for some people to think that having a disability is not in some way a deficit rather than a difference."
Today, the former Jane Walker Hospital grounds are privately owned.
And yet the poor state of the iron crosses, originally funded by The Hospital League of Friends, has triggered an unexpected revival of interest in the hospital and its patients, and a rekindling of friendships among former staff.
"We've all been getting back in touch," says Mr Weston. "Some of the staff back then were just boys and girls and now we're grandparents - and they are still as lovely as they were back then."
John Milbank was one of the first male members of nursing staff when he was hired in 1972 as a nursing assistant. He was still working there when it shut in 1991.
"There was something very special about this place," says Mr Milbank, who met his wife and fellow nurse Vyndia there.
"The patients needed a great deal of care, but one of the things that always struck me was how patients often cared for those who needed more support than they did.
"I found that profound."
Like Mr Milbank, Shirley Mansfield met her husband-to-be, the nursing officer John Mansfield, at the Jane Walker Hospital.
Mrs Mansfield, a nursing assistant, said: "It was lovely, it was a community all of its own and we loved the residents.
"They were wonderful days."
Steven Free, whose wife was a nurse at Jane Walker, often visits Nayland Cemetery to pay respects to his mother, whose grave is in a plot beyond the small iron crosses.
"I noticed the crosses were in a pretty dire state.
"A lot of the names you can't see any more," he says. "I've walked past them many times and just thought, 'How sad is that?'"
He decided to write a poem about the crosses which, with the help of his friend and fellow musician Steve Macbeth, was turned into a song called My Iron Cross.
"I thought we could highlight this by putting this out there and it has got a warm reception," Mr Free says.
Since the song's release, an appeal has been launched towards some form of permanent memorial to the Jane Walker residents, buried in Nayland and in the nearby village of Wiston.
More than £2,000 has already been raised.
Those involved are still debating exactly how those buried there would be best remembered.
While some are keen to see the crosses repaired, others are not so sure.
"I like the fact the crosses are a bit battered and bruised," says Mr Weston, adding their condition reflected the experiences some of the residents had in their lives.
"We need recognition of their names and the fact that they were here and were loved - at the moment they are just anonymous crosses." | Mental Health Treatments |
What would turn bird flu – the kind that's killed millions of birds around the world and a few hundred people – into the next deadly pandemic?
Scientists want to know so they can get ahead of it. That's why, in 2010, two groups of researchers were studying an avian influenza virus that killed about half of the people it infected but does not spread easily among them. They infected ferrets with it to see what it would take to make it more transmissible. Ferrets' lungs and airways are a lot like ours.
"They would infect a ferret, wait a certain amount of time, take the virus that comes out of that ferret and infect the next ferret," said University of Michigan microbiologist Michael Imperiale.
After 10 rounds, the virus had mutated into a much more dangerous form. "They didn't have to transfer it from one ferret to the next," he said. "If they put the ferrets in close proximity, those ferrets could transfer to each other."
That virus has pandemic potential.
The scientists figured out what parts of the virus had mutated to make it spread more easily. That could help experts looking out for the next dangerous virus, they said, and it could help develop drugs and vaccines against it.
On the other hand, the researchers had just created a new, deadly, easy-to-spread disease threat. If it were to get out of the lab somehow, it could start a global pandemic.
Lab leaks are rare but they do happen. SARS escaped from labs in Singapore, Taiwan and China in the early 2000s. A lab accident in Britain led to an outbreak of foot and mouth disease in livestock.
"It just shows that even the best labs in the world are not totally protected from accidents," said Harvard University epidemiologist Marc Lipsitch. "Humans are fallible."
The bird flu experiments set off alarm bells when the researchers went to publish their results in 2011, according to Rutgers University microbiologist Richard Ebright.
"I think everyone hearing the result was surprised, first, that anyone would be so ethically challenged as to conduct such an experiment; and second, surprised that there were no mechanisms of oversight whatsoever that would prevent a researcher from conducting such an experiment," he said.
Not everyone thought the experiments were fundamentally a bad idea. But they did kick off a push for more oversight.
That kind of research is worthwhile under two conditions, according to University of Michigan microbiologist Imperiale.
"Is it addressing a pressing biomedical issue, [for which] we have to have the answer? Is that really the only, or the best way to get it such that other approaches just will not get you to the answer you need? And if the answer to those two questions are yes, then let's figure out a way to do it safely," he said.
U.S. health authorities set up a framework to ask those questions and decide what research should get funding.
However, Ebright said, "that framework was sound on paper but it has not actually occurred in practice."
He said that several research projects that should have gotten extra scrutiny did not, including U.S.-funded research in Wuhan, China on what would make coronaviruses more infectious to people. Ebright contends that research could have been the source of the COVID-19 virus.
Where COVID-19 came from is fiercely debated. But the coronavirus pandemic has drawn more scrutiny of research on germs with pandemic potential.
"It reminds us that this is no laughing matter. It does not have to be a 50 percent lethal virus to cause global societal disruption and a lot of damage and that we need to be really careful," Lipsitch said.
"I think it has spurred some more cautious thought about oversight but the oversight really still is not in place," he added.
A U.S. advisory board has recommended ways to tighten the guidelines. Experts say they are a step in the right direction but loopholes remain. Some say they should be law, not guidelines.
On the other hand, Lipsitch noted, "there's a real risk that Congress will overreact and unduly restrict very valuable and completely safe research in an effort to restrict less valuable and more dangerous research."
Plus, the rules would only apply to U.S.-funded research. Other countries need to do the same, Imperiale said.
"If this is not some sort of international consensus, we're not accomplishing what we really want to accomplish here, which is keeping the world safe," he said. "Because, as we all know, infectious agents don't respect national borders." | Disease Research |
The brains of astronauts hanging out in microgravity environments start to change over time and need at least three years to reset, new research suggests.
A group of researchers studied the brain scans of 30 astronauts after their trips to space and found that the brain ventricles expanded significantly for those who had spent six months or longer on board the International Space Station (ISS). The study, published Thursday in Scientific Reports, suggests that astronauts should spend three years on Earth between their missions to allow their brains to recover.
Ventricles are a network of cavities filled with cerebrospinal fluid that cushion the brain, while also nourishing and protecting it. Without gravity, the fluid starts to shift upwards, pushing the brain higher up against the skull and expanding the ventricles, according to the study.
The more time astronauts spent in space, the bigger the effect on their brains. Out of the 30 astronauts whose brains were studied, eight had gone on two-week missions while 18 had been on six-month-long missions and four were in space for around one year. The brain scans showed no measurable change in the ventricles for astronauts who spent only two weeks in space.
“We found that the more time people spent in space, the larger their ventricles became,” Rachael Seidler, a professor of applied physiology and kinesiology at the University of Florida and author of the new study, said in a statement.
Space can take a serious toll on the body. In 2005, NASA Astronaut John Phillips reported that his vision had changed following a six-month-long mission on board the ISS. Phillips wasn’t the only one; a series of follow-up tests revealed that most astronauts suffered similar changes to their eyesight. Previous research has also shown that long-duration spaceflight may fundamentally alter the amount of cerebrospinal fluid in the brain, with the increased volume of fluid remaining for a full year after astronauts returned from space.
The list doesn’t stop there. As other research shows, long duration spaceflight can result in the loss of bone density and the onset of muscle atrophy, in addition to detrimental effects on the heart, eyes, spine, cells, and overall physical fitness. Returning to brain health, research from 2017 showed that extended stints in space caused gray matter to both increase and decrease in different regions of the brain, which is likely not good; gray matter plays a major role in many essential functions, including muscle control, the processing of emotions, the storage of memories, and the interpretation of sensory perception.
All that said, there still isn’t that much known on the full extent of the effects of spaceflight on the human body given that there are only a few subjects that have actually spent time in space. As NASA and other space agencies begin to set goals of establishing a sustainable human presence on the Moon, and perhaps even Mars, this type of research is now more crucial than ever.
“We don’t yet know for sure what the long-term consequences of this [brain ventricle expansion] is on the health and behavioral health of space travelers,” Seidler said.
The study does show, however, that the expansion of the brain ventricles tapered off after the six-month mark. “We were happy to see that the changes don’t increase exponentially, considering we will eventually have people in space for longer periods,” she added.
The main takeaway for the recent study is that astronauts need some recovery time on Earth before they can venture back out to space again, allowing at least three years for their brain ventricles to return to normal. “Allowing the brain time to recover seems like a good idea,” Seidler said. | Medical Innovations |
Allen G. Breed/AP
toggle caption
Boxes of the drug mifepristone sit on a shelf at the West Alabama Women's Center in Tuscaloosa, Ala., on March 16, 2022.
Allen G. Breed/AP
Boxes of the drug mifepristone sit on a shelf at the West Alabama Women's Center in Tuscaloosa, Ala., on March 16, 2022.
Allen G. Breed/AP
The Biden administration urged the Supreme Court on Friday to reconsider a lower-court ruling that would dramatically limit access to the key abortion pill, mifepristone.
In its petition obtained by NPR, the Justice Department argued that the abortion pill is many women's "best method" to terminate early pregnancies.
"The loss of access to mifepristone would be damaging for women and healthcare providers around the Nation," the Justice Department wrote.
It comes hours after the manufacturer of mifepristone, Danco Laboratories, filed a similar petition asking the court to reverse that decision.
Last month, the 5th Circuit Court of Appeals in New Orleans ruled that mifepristone should not be prescribed past seven weeks of pregnancy or via telemedicine. For the time being, the pill has remained on the market in states where abortion is legal, as well as via telemedicine or mail while the Supreme Court decides whether to hear the case.
If the court agrees to take up the case in the fall, mifepristone will likely remain available under those conditions until the court reaches a decision — probably sometime in 2024, in the midst of a presidential election cycle.
But if the court allows the 5th Circuit's decision to stand, access to the abortion pill could be dramatically reduced nationwide. Such a decision also would represent an unprecedented weakening of the Food and Drug Administration's authority to approve medications.
"To the government's knowledge, the decisions below mark the first time any court has restricted access to an FDA-approved drug based on disagreement with FDA's expert judgment to assure that drug's safe use—much less done so after those conditions had been in effect for years," the Justice Department wrote.
Mifepristone, which is the first of a two-pill regimen, was approved in 2000 by the FDA. Today, it accounts for more than half of all abortions performed in the U.S. It also commonly used to treat miscarriages.
Last year, a coalition of anti-abortion rights groups filed a lawsuit in Texas arguing the FDA improperly approved the abortion pill. In May, a three-judge panel, two of whom were appointed by former President Donald Trump and one who was appointed by former President George W. Bush, heard arguments in the case.
Abortion-rights opponents argue that the federal agency ignored safety risks with the abortion pill and later loosened regulations, like reducing the number of doctor's appointments needed to receive a prescription.
On Friday, the Justice Department argued that those claims were speculative and false, adding that the federal government did not find evidence to suggest that expanding access to mifepristone increased the number of women who suffered from complications after taking the abortion pill.
The dispute over mifepristone would be the first major abortion-related case decided by the Supreme Court since it overturned Roe v. Wade last year. | Women’s Health |
Vitamin B12 Boosts Cell Reprogramming Efficiency
Vitamin B12 plays an important role in tissue regeneration and cellular reprogramming in mice.
Complete the form below to unlock access to ALL audio articles.
What is cellular reprogramming?
Cellular reprogramming, when the identity and function of a cell changes, results in the cell acquiring embryonic stem cell pluripotency. This process requires gene expression patterns changes, orchestrated by a variety of transcription factors. During reprogramming, a cell reaches different “intermediate” states, which could be harnessed for regenerative medicine applications.
Researchers led by Dr. Manuel Serrano at the Institute for Research in Biomedicine (IRB) Barcelona are investigating the molecular mechanisms enabling in vivo cellular reprogramming. In a new study, published in Nature Metabolism, they focused on a particular type of reprogramming that requires the expression of four transcription factors: OCT4, SOX2, KLF4 and MYC, known collectively as “OSKM”.
“Continuous expression of OSKM in mice can recapitulate full reprogramming to pluripotency, a process that culminates with the generation of teratomas,” say the authors. “Interestingly, transient expression of OSKM leads to molecular and physiological features of rejuvenation, including an enhanced capacity for tissue regeneration.”
Microbes affect the efficiency of cellular reprogramming
In vitro cellular reprogramming has “unique” metabolic requirements, the researchers explain. Serrano and colleagues hypothesized that this might also be the case for in vivo reprogramming, and so they chose to explore the role that the gut microbiota might play in this process.
The researchers induced OSKM expression in a mouse model. To test whether the microbiota was important for in vivo reprogramming, they used a cocktail of antibiotics (ABX) – ampicillin, metronidazole, neomycin and vancomycin – to disrupt it. “Strikingly, despite strong transgene induction, reprogramming was significantly reduced in the colon and stomach of ABX-treated mice,” Serrano and team describe. “Consistent with low levels of reprogramming, ABX-treated mice lost significantly less weight than mice with normal levels of reprogramming.” The data suggest that the microbiome is an important factor for successful in vivo tissue reprogramming.
To understand why, the researchers conducted functional analyses of the microbial changes that occurred during this process. Applying metagenomic sequencing to stool samples from both OSKM-expressing mice and control mice, they found “the most profound loss of diversity occurring in reprogrammed mice”.
Microbes that synthesize vitamin B12 were depleted in reprogrammed mice, which adversely affected epigenetic changes that are critical for cellular reprogramming. “Supplementation with vitamin B12 corrected this imbalance, resulting in enhanced gene function fidelity and overall improved reprogramming efficiency,” says Dr. Marta Kovatcheva, a postdoctoral researcher at IRB and the study’s first author.
Validating the role of vitamin B12 in tissue repair
Serrano and colleagues hypothesized that administering vitamin B12 during injury repair could help to promote cell plasticity. They used an animal model of acute ulcerative colitis to explore this, administering both vitamin B12 and OSKM transcription factors in separate experiments. “In this model, successful repair proceeds through natural reprogramming of epithelial cells to a more embryonic-like state,” they describe. “Remarkably, both OSKM and B12 resulted in significantly improved tissue recovery on day 14, as evaluated by blinded histological analysis, colon length and mucosal integrity."
“Our research uncovers a critical role of vitamin B12 in cellular reprogramming and tissue repair. These findings hold promise for regenerative medicine, with the potential to benefit patients through an improved nutrition," says Serrano.
RNA-sequencing data from pediatric ulcerative colitis patient samples revealed similar hallmarks of cellular reprogramming, which suggests a conserved mechanism may exist between animals and humans. “We speculate that similar plasticity-mediated processes are conserved across various adult tissues of limited regenerative capacity, and that vitamin B12 may also improve repair in these diverse settings,” the authors explain.
“Overall, our results advance our current molecular understanding of in vivo and in vitro reprogramming and highlight the possibility to safely administer B12 for the therapeutic enhancement of cellular plasticity for regenerative medicine, organ injury and repair,” they conclude.
Reference: Kovatcheva M, Melendez E, Chondronasiou D, et al. Vitamin B12 is a limiting factor for induced cellular plasticity and tissue repair. Nat Metab. 2023. doi: 10.1038/s42255-023-00916-6
This article is a rework of a press release issued by IRB Barcelona. Material has been edited for length and content. | Medical Innovations |
When most people hear that phrase “humanitarian crisis”, they think “abroad”, “somewhere far away”, and certainly not in Britain. But how else to describe the tens of thousands of bodies avoidably piling up in the nation’s mortuaries? One funeral home worker says that they’ve run out of spaces for the deceased and “are having to keep some encoffined in office rooms”; another hospital porter reports that the mortuary has been near capacity for two weeks. This national issue should be splashed on every front page and leading every bulletin. It isn’t: why?Last year in the UK there were nearly 40,000 excess deaths – that is, deaths above a five-year average. That’s nearly as many as were killed by the Luftwaffe in the blitz. In the last two weeks of 2022, deaths were a fifth higher than the average from 2016 to 2019 (the last pre-pandemic year), and that’s taking into account factors such as a bigger, ageing population. According to the Office for National Statistics, there have been about 170,000 excess deaths in England and Wales since the pandemic began. Most of these can be directly attributed to Covid-19 itself: after all, the virus’s name is scrawled on the death certificates of more than 212,000 UK citizens. Some of those who died may have been vulnerable or infirm, but in other circumstances years away from death. As the pandemic waned, we could have expected excess deaths to shift to below average levels over time. This has not happened.By the beginning of last year, the number of deaths was similar to 2019. As the actuary Stuart McDonald points out, we had been through the worst of a pandemic in which many frail members of society died, and normally mortality falls year on year, so to only equal the death toll of 2019 was already indicative of a worrying trend.Even this data uncovered something disturbing – higher death rates among relatively young adults, and as spring came, more dying than in 2019. And here’s the thing: while the dreadful Covid death toll continues to mount, many of these excess deaths are driven by other factors.Britain is scarred by features that have made it particularly vulnerable, both while the virus raged before mass immunisation, and in the aftermath. Some are the direct consequences of Tory policy, some are more profound: about the way our society is organised. That means today’s excess deaths go way beyond Covid.One, the crisis in our NHS. There were about 2,200 additional deaths in England associated with A&E delays in December alone. Average ambulance response times in England are now the worst on record, and more than half of patients are waiting for more than four hours at A&E for the first time since records began in 2011.Now consider former health secretary Jeremy Hunt’s confession that he was partly to blame for an NHS staffing crisis that left Britain more vulnerable to the pandemic and its after-effects. Consider the impact on retention and recruitment of the Tories’ scrapping of the nurses’ bursary, and the fact that nurses have lost, on average, £5,000 a year in real terms pay since 2010: there are about 50,000 vacancies in England.There is no question that Covid has resulted in high levels of staff absenteeism, and burnt-out health workers who, normally, would have had some respite outside the winter months. A larger, better-resourced workforce would surely have absorbed the impact better.Consider, too, that one of the crises currently afflicting the NHS is that medically fit patients who nonetheless need support cannot be discharged. A major driver of this is a lack of capacity in social care – which, since 2010, has suffered hundreds of millions of pounds’ worth of cuts, despite there being ever greater demand for it from an ageing population.There is also a more structural factor at play. Our society is defined by inequality, and poverty breeds poor health: conditions such as obesity, high blood pressure, respiratory disease, even cancer. So what happens if you throw a pandemic at an under-resourced healthcare system, in a profoundly unequal society ravaged by poor health?What if you add a cost-of-living crisis which – just as an example – leads vulnerable people to fear turning on their heating in cold snaps such as the one we endured in early December? What if you also have a government that has spent years obliterating the public health budget, which is intended to promote healthy lives and prevent illnesses that impose pressures on the NHS?This is the British tragedy: a country left exposed to disaster because of the fatal conjoining of a broken economic system and an ideologically crazed government. This is a humanitarian crisis, and it should be framed as such. But as those bodies pile up in our mortuaries and funeral homes, remember this – it was all avoidable. Owen Jones is a Guardian columnist | Epidemics & Outbreaks |
What is the carbon footprint of a hospital bed?
Researchers from the University of Waterloo completed the first-ever assessment of a Canadian hospital to reveal its total environmental footprint and specific carbon emission hotspots.
Studying a hospital in British Columbia during its 2019 fiscal year, the researchers identified energy and water use and purchasing of medical products as the hospital's primary hotspots, accounting for over half of the yearly footprint, totaling 3,500-5,000 tons of CO2 equivalent. One hospital bed is roughly equivalent to the carbon footprint of five Canadian households.
The study, "Environmental footprinting of hospitals: Organizational life cycle assessment of a Canadian hospital", appears in the Journal of Industrial Ecology.
The new method brings an unprecedented level of comprehensiveness and detail to hospital emissions data that can equip administrative leaders to assess which improvements to focus on to meet their environmental commitments.
"In our work, we often find that the biggest environmental footprints are where you least expect them to be. As the adage goes: out of sight, out of mind," said Alex Cimprich, a postdoctoral fellow in the School of Environment, Enterprise and Development. "The goal is to make hidden environmental footprints more visible so that we can start to manage them."
The researchers calculated the carbon footprint by assessing thousands of unique products purchased by hospitals and using a combination of statistical sampling and calculations of carbon intensity—CO2 equivalent per dollar spent—for the sampled products. The approach is distinct from commonly used environmental assessments that give a rough overall estimate because it employs a bottom-up approach.
"The results suggest that hospital sustainability initiatives need to look further to achieve deeper emissions reductions," said Cimprich. "While transportation of patients and products supplied to hospitals and hospital waste are visible areas of environmental concern, other more hidden areas like the supply-chains of medical products could have much bigger environmental footprints."
Future research could zoom in on the hotspots identified, and the new approach could also be applied to other hospitals and other types of health care facilities, such as primary care or long-term care, or even organizations outside the health care sector.
More information: Alexander Cimprich et al, Environmental footprinting of hospitals: Organizational life cycle assessment of a Canadian hospital, Journal of Industrial Ecology (2023). DOI: 10.1111/jiec.13425
Journal information: Journal of Industrial Ecology
Provided by University of Waterloo | Global Health |
A measles outbreak in central Ohio that sickened 85 children has been declared over, officials at Columbus Public Health announced Sunday. None of the children died, but 36 were hospitalized.
The outbreak of measles infections, which was first reported in early November, spread among children who were not fully vaccinated and was mostly driven by a lack of vaccination in the community. Among the 85 cases, all but five were ages 5 and younger.
Measles cases in central Ohio emerged quickly in November and early December, but the number of new cases being identified appeared to slow during the winter holidays. Local health officials waited until no new cases were reported within 42 days – or two incubation periods of the measles virus – before declaring the outbreak over.
“This milestone fits the CDC’s definition of the end of an outbreak, however we still have test results pending for suspected cases,” Columbus health officials posted to Twitter on Sunday morning.
Health officials fought the outbreak by “sounding the alarm,” including being transparent about the state of the outbreak, informing the public about how easily the measles virus can spread and promoting the importance of getting young children vaccinated against the virus, said Dr. Mysheika Roberts, health commissioner for the city of Columbus, who led the outbreak response.
“In addition, we’ve had family members of individuals who have been infected with measles who have been very vocal and said they made a mistake – they should have gotten their child vaccinated. And I think that has helped as well,” she said.
Experts recommend that children receive the measles, mumps and rubella – known as the MMR – vaccine in two doses: the first between 12 months and 15 months of age and a second between 4 and 6 years old. One dose is about 93% effective at preventing measles if a person comes into contact with the virus. Two doses are about 97% effective.
In the United States, more than 90% of children have been vaccinated against measles, mumps and rubella by age 2, according to the US Centers for Disease Control and Prevention.
Measles was declared eliminated in the United States in 2000, and since then, most cases in the US have emerged in communities with low rates of vaccination against the virus.
Even if a disease is eliminated, outbreaks can still occur if an unvaccinated person travels to or from a country where the disease is still common, becomes infected and brings it back to the United States, introducing the virus into a community. That traveler can transmit measles to anyone who is unvaccinated.
“While we expect importations of measles cases into the United States to continue, the risk for measles for the majority of the population would still remain low,” the CDC says on its website. “That is because most people in the United States are vaccinated against measles.”
How health officials stopped outbreak in its tracks
When the outbreak began, the CDC sent a small team to Columbus to assist with tracking measles cases and pinpointing how the virus was spreading. Once a new case was identified, health officials worked quickly to determine who had been in contact with that person, whether the contacts were vaccinated against measles and, if not, whether they had been infected.
About 90% of unvaccinated people who are exposed to measles will become infected, according to Columbus Public Health, and about 1 in 5 people in the US who get measles will be hospitalized.
“Altogether, we had six CDC people helping us at one point in time on the ground, and that was very effective,” Roberts said. “I think that really helped us slow the progression of this virus in our community.”
She added that the outbreak took Columbus Public Health officials off-guard.
“We’ve had low vaccination rates for MMR in our community for years, but we’ve never had a measles outbreak like we have now. So it did take us by surprise,” Roberts said.
There was not one single community or demographic of people within central Ohio that was at an increased risk of measles infections or had low vaccination rates. Rather, small pockets of communities where families decided not to get their children vaccinated were influenced by “false information that was distributed about the MMR vaccine being associated with autism,” Roberts said, and that’s what drove the outbreak.
‘One of the most contagious viruses that we’ve identified’
Measles can spread through the air when an infected person coughs or sneezes or shares germs by touching objects or surfaces. Even after an infected person leaves a room, measles virus can live for up to two hours in the air.
Symptoms can include fever, cough, runny nose, watery eyes and a rash of red spots. In rare cases, it may lead to pneumonia, encephalitis or death.
Get CNN Health's weekly newsletter
Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.
Making sure children get the recommended MMR vaccinations as part of their routine childhood immunizations can help reduce their risk of measles, said Dr. Tanya Altmann, founder of Calabasas Pediatrics in California and author of “Baby & Toddler Basics,” who is an adjunct clinical professor at Children’s Hospital Los Angeles.
“Measles is one of the most contagious viruses that we’ve identified, and if one person has measles and there’s somebody unvaccinated around them, there’s a 90% chance they’re going to get it,” she said, adding that all of the children infected during the measles outbreak in Ohio were all not fully vaccinated.
“It really just takes one unvaccinated person to travel into a community, and they can have a measles outbreak if there isn’t a high enough vaccination rate in that community,” Altmann said. | Epidemics & Outbreaks |
- All drugmakers of the first 10 medicines selected for Medicare drug price negotiations have agreed to participate in the price talks.
- President Joe Biden's Inflation Reduction Act empowered Medicare to negotiate drug prices for the first time in the program's six-decade history.
- The lengthy negotiation process won't end until August 2024, with reduced prices going into effect in January 2026.
The companies confirmed their participation in separate statements to CNBC. The Centers for Medicare & Medicaid Services did not immediately respond to a request to confirm that all drugmakers agreed to the talks.
President Joe Biden's Inflation Reduction Act, which passed last year, empowered Medicare to negotiate drug prices for the first time in the program's six-decade history. The lengthy negotiation process won't end until August 2024, with reduced prices going into effect in January 2026.
Sunday was the deadline for all 10 pharmaceutical companies to sign an agreement to engage in the negotiations, which aim to make costly medications more affordable for older Americans.
Monday, meanwhile, is the deadline for those companies to submit economic and market information on their drugs, including research and development costs and sales and revenue data.
Here are the 10 drugs and the companies that manufacture them:
- Eliquis, made by Bristol Myers Squibb, is used to prevent blood clotting, to reduce the risk of stroke.
- Jardiance, made by Boehringer Ingelheim, is used to lower blood sugar for people with Type 2 diabetes.
- Xarelto, made by Johnson & Johnson, is used to prevent blood clotting, to reduce the risk of stroke.
- Januvia, made by Merck, is used to lower blood sugar for people with Type 2 diabetes.
- Farxiga, made by AstraZeneca, is used to treat Type 2 diabetes.
- Entresto, made by Novartis, is used to treat certain types of heart failure.
- Enbrel, made by Amgen, is used to treat rheumatoid arthritis.
- Imbruvica, made by AbbVie, is used to treat different types of blood cancers.
- Stelara, made by J&J subsidiary Janssen, is used to treat Crohn's disease.
- Fiasp and NovoLog, made by Novo Nordisk, are insulins.
Many of the drugmakers contend that they had no real choice but to participate in the negotiations, specifically due to the penalties they could face if they choose not to.
If drugmakers decline to engage in the negotiations, they could be forced to pay an excise tax of up to 95% of their medication's U.S. sales or to pull all of their products from the Medicare and Medicaid markets, according to CMS.
"We have no choice other than to sign the 'agreement.' If we did not sign, we'd be required to pay impossibly high penalties unless we withdraw all of our medicines from Medicare and Medicaid. That is not a real choice," a spokesperson for Bristol Myers Squibb told CNBC ahead of the Sunday deadline.
That statement echoes the arguments outlined in at least nine separate lawsuits drugmakers filed against the Biden administration in recent months seeking to declare the negotiations unconstitutional.
The pharmaceutical industry also argues that the process will threaten revenue growth, profits and drug innovation.
However, analysts expect minimal financial losses for companies, at least initially, since most of the drugs selected already face upcoming patent expirations that will likely weigh on revenue.
This fall, CMS will host one meeting with all 10 companies so they can provide context for the data they submitted by Monday.
CMS will also host listening sessions with consumer and patient organizations to obtain information the agency can use to develop its initial price offers for the selected drugs.
CMS will then make an initial price offer to manufacturers in February, and the companies have a month to accept or make a counteroffer.
The negotiations will end in August, with agreed-upon prices published on Sept. 1, 2024. The reduced prices won't go into effect until Jan. 1, 2026.
After the initial round of talks, CMS can negotiate prices for another 15 drugs for 2027 and an additional 15 in 2028. The number rises to 20 negotiated medications a year starting in 2029 and beyond.
CMS will only select Medicare Part D drugs for the medicines covered by the first two years of negotiations. It will add more specialized drugs covered by Medicare Part B, which are typically administered by doctors, in 2028.
The drug price talks are expected to save Medicare an estimated $98.5 billion over a decade, according to the Congressional Budget Office.
The negotiations are also anticipated to save money for people enrolled in Medicare, who take an average of four to five prescription drugs a month and increasingly face out-of-pocket costs that many struggle to afford. | Health Policy |
People whose relatives have a blood condition are often not being screened in Northern Ireland for reasons of cost, a charity has said.
Haemochromatosis - also known as the Celtic Curse - is the most common genetic disorder in Northern Ireland.
Guidance states all close relatives - siblings, parents and children - should be screened if a person is diagnosed.
The Department of Health said screening of people for haemochromatosis would be done if it was required.
That would usually be determined by a series of blood tests to detect high iron levels.
But Haemochromatosis UK says people are struggling to have the genetic blood test carried out.
It typically costs about £200 but the charity has funded 30,000 self-test kits for use by people in Belfast.
The disorder means a person absorbs too much iron and it can start to damage other parts of their body.
'I had to push for it'
Catherine McComb still considers herself one of the lucky ones because she was diagnosed with haemochromatosis before any damage was caused.
She gained her "hard-fought diagnosis" over three years ago.
Since then the 40-year-old has been "in limbo" waiting for an initial consultation to discuss her treatment plan.
Treatment includes regularly giving blood to lower the level of iron in the body.
Catherine described her initial symptoms as feeling "generally under the weather".
She repeatedly contacted her GP before a locum doctor flagged abnormal blood iron levels.
"It was like day and night how much I had changed and I knew it wasn't just that I was getting older," she said.
"I had the self-awareness to push for an understanding."
What is the Celtic Curse?
The gene mutation that causes most cases of hereditary haemochromatosis is believed to have originated in the Celtic population of Europe.
It is most commonly found in people of Irish, Scottish, Welsh or Cornish ancestry.
DNA analysis of the genomes of a Bronze Age farmer on Rathlin Island in County Antrim showed that it was already established by that period.
Earlier still, the remains of a Neolithic woman found at Ballynahatty near Belfast show that she carried a different variant also associated with an increased risk of the disorder.
Read more: DNA sheds light on Irish origins
Three of the Sheridan siblings from Belfast have the condition, with 66-year-old Bill having recently been diagnosed.
"It's interesting because we're all at different stages," he said.
One of his sisters, aged 69, believed she had arthritis and fibromyalgia for 15 years before finally understanding the condition.
"Her doctor told her she quite possibly could have been misdiagnosed," said Bill.
"If people get tested early they could give blood and benefit the rest of society and not be a burden on the health service like my sister has been."
Bill and his siblings were all told they were "red-flag referrals" to see a specialist, later learning that could take two to three years, so they chose to pay for a private consultant.
"I don't know how many people are sitting waiting⦠when it's easily treatable with no cost to society," he said.
'Dad insisted we get tested'
Sean O'Hare, 52 from Forkhill in County Armagh, lost his father Tony to haemochromatosis-induced heart failure in 2018, having been diagnosed two years previously.
"He had signs of fatigue and joint pain but we'd have seen him as being really healthy for his age, active all his life," said Sean.
"He was a keen gardener and golfer who wouldn't have been a person for sitting around.
"My father insisted we get tested - he was a pharmacist himself."
Sean said they now knew of two carriers in the family.
"They don't actually test for haemochromatosis, you have to ask - that has to change," he said.
Since the passing of Sean's father, the family have been raising money to fund genetic testing in Newry this month.
"The big thing is about creating awareness - if it saves somebody's life it'll all be worthwhile."
How can I get tested?
First-degree testing - siblings, parents and children - was recommended by the British Society of Haematology in 2018.
A recent campaign, funded by Haemochromatosis UK, has meant thousands of households in Belfast have been offered free self-test kits.
The resulting samples are posted to an NHS-accredited laboratory, which provides results within a fortnight.
Similar schemes were piloted in Carrickfergus and Londonderry over the past two years.
Neil McClements from the charity said it has established that one in 10 people have the condition.
"They are all now receiving care, having previously been either unaware of their status or having been turned down for a test by their GP when a close relative was diagnosed," he said.
"UK guidance says first-degree relatives should all be screened if someone is diagnosed - this mostly doesn't happen in Northern Ireland for cost reasons."
"I understand we got it from the Vikings," said my nurse said as she extracted blood from me last week.
I am being tested for haemochromatosis after several family members were diagnosed.
We discovered it was in our family in 2017 - back then I had never heard of the disorder referred to as the "Celtic curse".
For centuries people in Ireland lived with it, unaware they had it - did that do them any harm?
My feeling is that it's better to know because then you can do something about it.
There are now more cases being diagnosed as people like me are asking to be tested.
Those affected in my family have changed their diet.
Some breakfast cereals are avoided, as are other iron-loaded foods and certain alcoholic drinks.
Regular venesections - collecting blood for diagnosis - mean their iron counts are going down.
During family get-togethers discussion often turns to "haemo" and comparing iron counts. I await my result. | Disease Research |
Opioid death rates tripled for Ontario teens, young adults since 2014, research shows
Opioid-related deaths among teens and young adults in Ontario tripled from 2014 to 2021, while drug treatment rates significantly decreased, a new report shows.
Opioid deaths among those aged 15 to 24 surged during the first year of the pandemic to 169 deaths, up from 115 the year before, according to research led by the Ontario Drug Policy Research Network at Unity Health Toronto.
Just 37.1 per cent of teens and young adults who had an opioid use disorder and died from drugs had received any treatment in the last year of the analysis, compared to 48.6 of adults aged 25 to 44, the researchers found.
They found that rates of opioid-related emergency department visits quadrupled in that time.
The Office of the Chief Coroner for Ontario, Public Health Ontario, the Ontario Forensic Pathology Service and non-profit research institute ICES were also involved in the project that analyzed provincial health-care and demographic data from 2014 to 2021 for the 15-to 24-year-old age group.
During that time, 752 young people died, there were 711 hospitalizations and 5,401 emergency department visits.
The researchers also found that use of medications to treat opioid use disorder fell 50 per cent over those seven years and in-person residential treatment fell 73 per cent.
“It's really a stark comparison of the harms that this demographic is experiencing and how they're accessing treatment and whether the health-care services that we're providing to them are really meeting their needs,” said Dr. Tara Gomes, a scientist at Unity Health Toronto who leads the Ontario Drug Policy Research Network.
Fentanyl was found in 94 per cent of those who died from opioids during the pandemic, up 10 percentage points after COVID-19 came to the province.
The researchers also found that only about half of young people who died from opioids had an opioid use disorder, which differs from the overall provincial picture. About two-thirds of all opioid-related deaths occur in those who have that disorder.
This suggests young people have more barriers to accessing treatment, Gomes said. That could be due to physicians being reticent about providing treatment such as methadone or buprenorphine to young people, she said.
Patients may also be reluctant to start a methadone regime, for instance, that requires daily trips to the pharmacy for a process that could last years, Gomes said.
“The other side of it is that we might be seeing increasing harms because teens and young adults are more likely to be using drugs occasionally,” Gomes said.
“Our drug supply is incredibly unpredictable and potent, and so if you're only using drugs once in a while, then when you use them, if you are exposed to a very high dose or a drug that has multiple different substances in it, then you can be at really high risk of an overdose.”
Gomes said young people are going to experiment with drugs, a reality unlikely to change.
“The unregulated supply being as dangerous as it is, I think that we should be concerned because we know that younger people are going to be accessing that supply,” she said.
About one in eight young people who died from opioids were homeless, the report found.
The authors concluded a new approach is needed.
Younger peer support workers could help, Gomes said, as well as looking at treatments such as Sublocade, the injectable form of buprenorphine needed just once a month, as opposed to a daily trip to the pharmacy.
She suggested increasing harm reduction options and education, especially the value of carrying around naloxone, an opioid overdose antidote, and not using drugs alone.
“We found that about two thirds of the deaths that happened in this demographic happened within people's own homes and it was quite rare for people to actually have naloxone administered,” Gomes said.
Ontario's chief coroner called the deaths of teens and young adults from opioids “heartbreaking.”
“Families and friends have lost loved ones far too soon and the impact will be felt for decades,” Dr. Dirk Huyer said in a statement.
“This report underlines the importance of policies that recognize the need for accessible resources, harm reduction services and mental health supports necessary to prevent further opioid-related deaths of teens and young people.”
The authors called for more harm reduction options and addressing systemic problems that could be at the root of opioid use.
“Strategies that address upstream risk factors for substance-related harm are warranted, including ensuring access to stable housing, addressing food insecurity, and removing barriers to mental health treatment,” the authors wrote.
This report by The Canadian Press was first published June 27, 2023.
CTVNews.ca Top Stories
A vessel that had been searching for debris from the ill-fated Titan submersible returned to port in St. John's, N.L., this morning.
Ukrainian authorities arrested Wednesday a man they accused of helping Russia direct a missile strike that killed at least 10 people, including three children, at a popular pizza restaurant in a city in east Ukraine.
Canadian wildfires are continuing to send heavy clouds of smoke south, from Northern Ontario and Quebec, through both provinces and into the United States.
Canadians' hearts may be brimming with pride as Canada Day approaches, but a new poll suggests their minds aren't full of the knowledge needed to pass a citizenship test.
A New Jersey man has been sentenced to more than six years in federal prison after exchanging sexually explicit videos and images with a 13-year-old New York girl and later paying USUS$20,000 in bitcoin to have her killed, eventually calling it off.
Archaeologists have potentially discovered a 'distant ancestor' of pizza in a 2,000-year-old painting from the ancient ruins of Pompeii.
Diabetes Canada is set to receive nearly $1 million from the Public Health Agency of Canada for several initiatives across the country.
On June 27, 1995, authorities believe TV news anchor Jodi Huisentruit was abducted while she was on her way to work in Mason City, Iowa and hasn’t been heard from since.
A life-changing lottery ticket is about to expire if it goes unclaimed by tonight.
-
Fourteen Quebec mayors are calling on the Quebec government to adopt a public, mandatory and universal rent registry.
-
The Quebec City fire department (SPCIQ) launched a campaign on Wednesday to raise awareness of the potential risks posed by lithium-ion batteries.
-
As moving day is a step away, even pet owners with support animals are finding locating a place that will allow them to rent is a tall order.
-
No serious injuries were reported, but fire officials said two people were assessed at the scene, one of whom was taken to hospital.
-
WATCH
An investigation into the theft of multiple high-end vehicles prompted a large police response at a residence in east London, Ont. Tuesday morning.
-
Plumes from northeastern Ontario and Québec have moved into the area, resulting in deteriorated air quality that an be harmful to everyone’s health even at low concentrations.
-
Environment Canada is warning “high levels of air pollution” are developing across a large swath of southern Ontario due to smoke from forest fires.
-
A long list of people were speaking out in the Royal City during a Tuesday night council meeting.
-
Doug ford appeared in Ayr on Tuesday to announce a $1.3 million investment in the trucking industry, hoping to help underrepresented job seekers.
-
The parents of a young man who plunged to his death from a downtown Toronto tower last month are coming forward to warn others about what they view as the dangerous pastime of 'rooftopping,' which they believe played a role in their son’s death.
-
On Monday afternoon, the Downtown Timmins BIA posted safety tips on its social media platform on how to stay safe when you’re downtown.
-
A collision on Highway 11, south of North Bay, has resulted in the death of a 91-year-old driver.
-
The union representing Hydro Ottawa workers began strike action Wednesday morning after workers rejected the utility's latest contract offer.
-
The National Capital Commission unveiled the new public art along the pathway on Tuesday, called, 'When the Rubber Meets the Road' by PEI artist Gerald Beaulieu.
-
Smoke from wildfires burning in Quebec will blow back into the national capital region today, with the air quality expected to deteriorate to 'high risk' today and Thursday.
-
Residents who live along Couture Beach in Lakeshore say they’re lawyering up after the access road leading to their street has fallen into disrepair.
-
The special air quality statement from Environment Canada remains in effect as air quality and visibility due to smoke fluctuates over short distances and varies from hour to hour.
-
CTV Windsor's weekend anchor and reporter Sijia Liu will be bringing her skills and sunny disposition to another newsroom.
-
Provincial police are reporting that a person was hit by a vehicle in the southbound lanes between Dunlop St. West and Essa Road.
-
High levels of air pollution caused by smoke plumes from forest fires over northeastern Ontario and Quebec have moved into the area, resulting in deteriorating air quality.
-
A slight overall reduction in the rate of inflation did not impact grocery prices in Canada, a new report from Statistics Canada shows. Here's which foods are still costing Canadians the most.
-
A New Brunswick man is facing a first-degree murder charge for the shooting death of a 26-year-old man from Dieppe.
-
It may be the last thing on your mind heading into the long weekend, but many Nova Scotians who heat with oil are booking a quick top-up in the next few days, hoping to save some money before the federal carbon tax takes effect July 1.
-
Within six weeks, police say thieves broke into ten of the electrical substations across the province.
-
Calgary is in for some hot weather over the next several days as Environment and Climate Change Canada predicts the city will see highs reaching toward 30 C.
-
Residents of an Alberta town that has banned alcohol sales for the past century have weighed in on a bylaw proposal to change that.
-
Police in Lethbridge, Alta., are asking for the public's help to find a 16-year-old girl who has been missing since Sunday.
-
A Tuesday evening storm brought golf ball-sized hail, a possible tornado and heavy rain to parts of Manitoba.
-
A Manitoba town has declared a local state of emergency as a forest fire burns close to the community.
-
Environment and Climate Change Canada (ECCC) has confirmed three tornadoes touched down in Manitoba last week.
-
Two years since the mercury started rising ahead of an exceptionally fatal heat wave, the provincial government has announced a $10 million program to provide air conditioning to thousands of British Columbians vulnerable to heat-related illness and death.
-
After a woman was refused medical assistance in dying at a Vancouver hospital, advocates say the right of facilities associated with the Catholic Church to deny the proceudre will likely be challenged in court.
-
An anti-gang program in Abbotsford is at risk of falling victim to a lack of funding.
-
The "public commentary" portion of a city council meeting in Leduc, Alta., ended abruptly Monday night when a woman insisted colours of the Progress Pride flag stand for bestiality, necrophilia and paedophilia.
-
Experts say Alberta's model for combating drug poisoning in the province is not working as opioid-related deaths reached an all-time high this April.
-
A local woman is warning others after she was victimized by multiple scammers while using Facebook, and one expert said this new scam can have long-reaching consequences for victims, while perpetrators are unlikely to face any. | Drug Discoveries |
Understanding and Managing Amygdala Hijack
Have you ever felt so suddenly overwhelmed by emotion that you reacted in an irrational or aggressive way? This experience is often referred to as “amygdala hijack”. Amygdala hijack involves a strong emotional reaction from the brain’s amygdala that overrides logical thinking and self-control. However, by understanding what’s happening in these moments, we can better manage “hijacked” emotions and respond constructively rather than impulsively. This guide will provide an in-depth look at the amygdala, amygdala hijack, what triggers it, and science-based techniques to control reactions when emotions get hijacked. By learning these tools, we can strengthen emotional intelligence and foster healthier, happier relationships.
The Role of the Amygdala
Research suggests that awareness of mortality-related stimuli has neural correlates in the right amygdala and left anterior cingulate cortexNeurocognitive hacking, A new capability in cyber conflict? Cambridge University Press: 16 April 2020
The amygdala is an almond-shaped set of neurons located deep in the brain’s temporal lobe. It plays a key role in processing emotions, emotional memories, and reactions to perceived threats. Here’s an overview of the amygdala’s main functions:
- Detecting Threats: The amygdala acts as an early warning system, constantly scanning for potential threats. This includes threats from the environment as well as social threats. When a potential threat is detected, the amygdala triggers the classic “fight, flight or freeze” stress response.
- Generating Emotions: The amygdala assigns emotion to experiences and perceptions. It determines if stimuli provoke fear, anger, pleasure or other feelings based on past emotional memories and learnings.
- Storing Emotional Memories: The amygdala activates when recalling emotional memories and learning emotional associations. Painful past experiences get imprinted deeply within the amygdala.
- Controlling Aggression: The amygdala modulates aggression levels and violent behaviors. High amygdala reactivity is linked to increased aggression.
- Reading Faces for Emotion: A key amygdala function is reading facial expressions and gaze to discern the emotional states of others. This helps us rapidly perceive social threats.
Overall, the amygdala generates rapid, primal emotional reactions to everything we encounter. It acts faster than the thinking frontal cortex.
What is Amygdala Hijack?
Amygdala hijack describes sudden emotional reactions where the amygdala “hijacks” logical thinking parts of the brain like the prefrontal cortex. During hijack, the amygdala becomes hyperstimulated, overriding cognition with uncontrolled emotion.
Here are key characteristics of amygdala hijack:
- Intense Emotion: Hijack causes surging emotions – often anger, rage, fear or distress. The amygdala reacts strongly, but not necessarily proportionately, to the trigger.
- Impaired Thinking: During hijack, the prefrontal cortex goes “offline” unable to focus, think rationally, or self-regulate emotions via logic. intense amygdala activation suppresses cognitive control.
- Reactive Behavior: When hijacked, people act impulsively and aggressively without considering consequences. Screaming, hitting, throwing objects, or verbal attacks may occur in the heat of the moment.
- Physiological Changes: Amygdala hijack triggers rapid heartbeat, muscle tension, flushing, sweating, shaking, and other signs of extreme stress. The hypothalamus activates the endocrine system’s stress response.
- Lasting Minutes: Hijack incidents tend to be transient, lasting a few minutes until the amygdala cools down and logic resumes control. But effects of the outburst can endure.
Though normally brief, amygdala hijack episodes can damage relationships, careers, and self-image due to uncontrolled reactions.
Common Triggers of Amygdala Hijack
Many different situations or stressors can overload the amygdala’s capacity to respond calmly, triggering hijack. Common hijack triggers include:
- Conflict: Unresolved relationship conflicts, arguments with loved ones, work disagreements, fighting, or social tensions often trigger hijacks, provoking angry outbursts.
- Negative Feedback: Criticism or perceived failure, humiliation, or rejection activates the amygdala’s self-preservation fear reactions. Even constructive feedback can hurt and incite hijack.
- Past Trauma: Past emotional trauma is deeply imprinted within the amygdala. Present stimuli vaguely reminiscent of painful experiences may elicit sudden hijack reactions like panic attacks.
- Violated Expectations: When outcomes differ drastically from expectations, like a demotion at work or an abrupt breakup, it can stun the amygdala into disproportionate responses like weeping or destroying property.
- Impulsiveness: Individuals with innate amygdala excitability and poor prefrontal inhibition like those with ADHD or bipolar disorder are especially prone to hijacking. Substance use also lowers inhibitions.
Triggers stack if multiple occur in quick succession, overwhelming the amygdala’s capacity to stay calm. By identifying our personal triggers, we gain insight into hijack patterns.
Managing Amygdala Hijack
While inevitable at times, amygdala hijacking can become problematic if unchecked. Here are science-based techniques to limit hijack frequency and intensity:
- Mindfulness Practice: Meditation strengthens connections between the amygdala and prefrontal cortex to improve emotional control. Over time, it desensitizes the amygdala. Stopping and taking mindful breaths when triggered can calm rising emotions.
- Cognitive Reframing: Intentionally re-interpreting situations from a more rational perspective engages the thinking brain and cools hijack emotions. Reframing criticisms or disappointments in a self-protective way helps prevent emotional escalation.
- Lifestyle Regulation: Managing sleep, diet, exercise, and substance use promotes baseline amygdala and prefrontal health so both function optimally when challenged. Good self-care lessens reactivity.
- Exposure Therapy: Controlled, gradual exposure to past trauma memories and hijack triggers can help desensitize the amygdala through extinction learning. This is often guided by therapists.
- Relaxation Exercises: Soothing activities like progressive muscle relaxation, guided imagery, deep breathing, yoga, or music, activate the parasympathetic nervous system to calm amygdala reactions and anxiety.
With regular practice of these techniques, individuals can re-train automatic patterns to respond thoughtfully rather than emotionally when faced with life’s inevitable stressors and upsets.
Conclusion
Amygdala hijack involves intense emotional reactions from the brain’s threat detection center that override logical thinking, often prompting impulsive behaviors. Common triggers range from interpersonal conflicts to past trauma memories to instances where expectations are profoundly violated. Though hijacking is temporary, repeated episodes can damage relationships and wellbeing. The good news is we can purposefully “un-hijack” the amygdala through mindfulness, cognitive skills, lifestyle regulation, re-processing trauma, and relaxation techniques – allowing logic and wisdom to prevail over knee-jerk reactions. With deeper insight into what drives our emotions, we gain the power to respond thoughtfully to life’s ups and downs.
Further Reading
- “Amygdala Hijack: How It Works, Signs, & How To Cope,” SimplyPsychology.org
- “Reliance on emotion promotes belief in fake news,” National Library of Medicine, National Center for Biotechnology Information, December 2020 | Mental Health Treatments |
Researchers analyze THC in breath of cannabis smokers
Most states in the U.S. allow people to use cannabis for medical or recreational purposes. Yet all states want their roadways to be safe. A breathalyzer that can accurately identify people who recently smoked cannabis might help them keep impaired drivers off the road—if such a device existed.
But developing a breathalyzer for cannabis is far more difficult than for alcohol, which people exhale in large amounts when drinking. In contrast, the intoxicating component of cannabis, called THC, is thought to be carried inside aerosol particles that people exhale. The total volume of aerosols can be very small, making it difficult to accurately measure their THC content. Currently, there is no standard method for doing this.
Now, researchers at the National Institute of Standards and Technology (NIST) and the University of Colorado Boulder have conducted a study in which they collected breath samples from people both before and after they smoked high-THC cannabis, aka marijuana, and used laboratory instruments (not a handheld device) to measure the amount of THC in their breath.
The goal of this study, published in the Journal of Breath Research, was to begin developing a protocol that yields reproducible results—a necessary step toward a reliable, validated field-based method.
The samples collected before people smoked were important because THC can persist in the bodies of people who frequently use cannabis for a month or more, long after the effects of the drug have worn off.
"One key question that we cannot yet answer is whether breath measurements can be used to distinguish between a person who uses cannabis regularly but hasn't done so lately, and someone who consumed an hour ago," said NIST supervisory chemical engineer and study author Tara Lovestead. "Having a reproducible protocol for breath measurements will help us and other researchers answer that question."
The breath samples were collected in a mobile lab—a comfortably appointed white van that would park conveniently outside participants' homes. This mobile pharmacology lab was developed by researchers at University of Colorado Boulder, including Cinnamon Bidwell, an assistant professor of psychology and neuroscience and a co-author of the study.
In addition, all participants purchased and used a consistent kind of high-THC cannabis prepared by a licensed dispensary in Boulder, Colorado. This study design allowed the authors to conduct their research without handling high-THC cannabis or otherwise running afoul of federal laws.
At the appointed time, participants popped into the van, gave their pre-use breath sample and also provided a blood sample. They then went back into their residence, smoked cannabis according to their usual custom and returned immediately to the van to provide a second blood sample. Since THC concentrations in blood spike immediately after consuming the drug, researchers compared the before-and-after blood samples to confirm that the participants had in fact just used it. An hour later, the participants gave their second breath sample.
Participants provided breath samples by blowing into a tube containing an "impaction filter" that captured aerosols from their breath. Later in the lab, the researchers extracted the material caught in the filter and measured the concentration of THC and other cannabis compounds using liquid chromatography with tandem mass spectrometry, a laboratory technique that identifies compounds and measures their amount.
Because this was a protocol development study that involved only 18 participants, the results of the analysis do not carry statistical weight. However, they do highlight the need for further study.
"We expected to see higher THC concentrations in the breath samples collected an hour after people used," Lovestead said. However, THC levels spanned a similar range across pre-use and post-use samples. "In many cases, we would not have been able to tell whether the person smoked within the last hour based on the concentration of THC in their breath."
"A lot more research is needed to show that a cannabis breathalyzer can produce useful results," said NIST materials research engineer and co-author Kavita Jeerage. "A breathalyzer test can have a huge impact on a person's life, so people should have confidence that the results are accurate."
More information: Kavita M Jeerage et al, THC in breath aerosols collected with an impaction filter device before and after legal-market product inhalation—a pilot study, Journal of Breath Research (2023). DOI: 10.1088/1752-7163/acd410
Journal information: Journal of Breath Research
Provided by National Institute of Standards and Technology | Drug Discoveries |
Practicing mindfulness focused on healthy eating can be good for the heart, a new study shows, because it improves self-awareness and helps people stick to a heart-healthy diet.
When people who had elevated blood pressure participated in an eight-week mindfulness-based blood pressure reduction program for the study, they significantly improved their scores on measures of self-awareness and adherence to a heart-healthy diet compared to a control group. The results were published in JAMA Network Open.
"Participants in the program showed significant improvement in adherence to a heart-healthy diet, which is one of the biggest drivers of blood pressure, as well as significant improvements in self-awareness, which appears to influence healthy eating habits," said lead study author Eric B. Loucks, an associate professor of epidemiology, behavioral and social sciences, and director of the Mindfulness Center at Brown University.
Loucks said the study helps explain the mechanism by which a customized mindfulness training program adapted toward improving diet can affect blood pressure.
"Improvements in our self-awareness, of how different foods make us feel, of how our body feels in general, as well as our thoughts, emotions and physical sensations around eating healthy as well as unhealthy food, can influence people's dietary choices," he said.
High blood pressure, a major cause of cardiovascular disease, is the single most important risk factor for early death worldwide, according to a recent report by the World Health Organization, leading to an estimated 10.8 million avoidable deaths every year. The important thing to note about those avoidable deaths, Loucks said, is that there is ample research supporting effective strategies to control and prevent hypertension.
"Almost everyone has the power to control blood pressure through changes in diet and physical activity, adherence to antihypertensive medications, minimizing alcohol intake and monitoring stress reactivity," he said.
A heart-focused mindfulness program
The mindfulness-based blood pressure reduction program used in the study, which Loucks developed in 2014, trains participants in skills such as meditation, yoga, self-awareness, attention control and emotion regulation. What makes the program unique, he said, is that participants learn how to direct those skills toward behaviors known to lower blood pressure.
The MB-BP plan consisted of a group orientation session, eight 2.5-hour weekly groupsessions and one day-long retreat, as well as recommended home practice for 45 minutes, six days a week. The program was led by trained instructors with expertise in cardiovascular disease etiology, treatment and prevention. Classes were held in Providence, R.I., at Brown University and at a health center in a lower-income, urban neighborhood.
The study compared two groups, totaling 201 participants. The 101 people in the test group were a part of the 8-week MB-BP program, which included personalized feedback and education about hypertension risk factors;mindfulness training of participants in relationship to hypertension risk factors (including mindful eating); and behaviorchange support. The "usual care" control group received educational brochures on controlling high blood pressure. Both groups received a home blood-pressure monitoring device with usage training, and options for referral to primary care physicians.
The researchers focused on participant adherence to the DASH (Dietary Approaches to Stop Hypertension) program, a balanced eating plan rich in fruits, vegetables, whole grains and low-fat dairy, intended to create a heart-healthy eating style for life. Despite its effectiveness, adherence to the DASH diet is typically low.
After six months, the mindfulness group showed a 0.34-point improvement in the DASH diet score. Loucks explained that this effect can be interpreted as equivalent for a participant shifting from a vegetable intake approaching recommended levels (2-3 servings) to recommended levels (at least 4 servings), or making similar shifts across another component of the DASH score. The control group showed a -0.04-point change in DASH diet score.
The mindfulness group also showed a 0.71-point improvement in the average interoceptive awareness (which is the process of sensing and interpreting signals from one's own body) score compared to six months prior, which outperformed the control group by a significant 0.54 points.
The authors said the trial results offer evidence that an adapted mindfulness training program for participants with high blood pressure that targets diet and self-awareness significantly improves both.
"The program gives participants the tools to make heart-healthy diet changes that can lower their blood pressure and decrease their risk of cardiovascular disease," Loucks said.
The researchers are studying different "doses" of the program (for example, shorter program lengths, fewer sessions), as well as factors influencing the implementation of the MB-BP plan in a real-world setting -- including eligibility for health insurance coverage, accessibility for different patient groups and flexibility for physicians.
Additional contributors from Brown University included Frances Saadeh, Matthew Scarpaci, Jeffrey Proulx, Roee Gutman and Willoughby Britton. The study was supported by the National Institutes of Health Science of Behavior Change Common Fund Program through an award administered by the National Center for Complementary and Integrative Health (UH2AT009145, UH3AT009145).
Story Source:
Journal Reference:
Cite This Page: | Stress and Wellness |
- Novo Nordisk launched its Wegovy weight loss injection in the U.K. on Monday, advancing the drug's rollout in Europe despite ongoing supply constraints.
- The Danish pharmaceutical giant said that the weekly injection would initially be available "through a controlled and limited launch."
- The drug will be available to certain patients through the U.K. National Health Service, as well as privately.
Novo Nordisk launched its Wegovy weight loss injection in the U.K. on Monday, advancing the drug's rollout in Europe despite ongoing supply constraints.
The Danish pharmaceutical giant said that the weekly injection would be available initially "through a controlled and limited launch," with only certain patients eligible to receive the drug on the country's National Health Service.
To qualify for treatment, patients must be on the NHS's weight management service, have at least one weight-related condition and have a body mass index of 35, according to recommendations outlined by the National Institute for Care and Excellence.
The drug will also be available privately through a "registered healthcare professional," Novo Nordisk said in a statement, without adding further detail.
Novo Nordisk declined to disclose the final price agreed with NHS England for the drug, but said that NICE, the U.K. drug cost-effectiveness watchdog, had described it as a "cost-effective use of NHS resources." It added that the cost in the private market will be "determined by licensed prescribers."
In the U.S., Wegovy has a list price of $1,350 for a monthly dose, while in Europe it retails for around 170 to 300 euros ($190-$330) per month.
Wegovy's U.K. expansion comes just over a month after the drug launched in Germany — its third European market at the time, after Denmark and Norway.
Surging demand for the weight loss drug, as well as a series of clinical studies which point to its wider health benefits, have shot the company's shares to record highs. On Friday, it briefly unseated French luxury goods behemoth LVMH to become Europe's most valuable company.
Supply constraints continue to weigh heavy on the drug's rollout, with CEO Lars Fruergaard Jorgensen telling a Reuters Newsmakers event last month that it could be "some years" before the company can satisfy all consumers.
In the U.K., Novo Nordisk said that "a proportion" of available supply would be allocated specifically for NHS treatment, and that the company would work with healthcare professional to ensure that "patients with the highest unmet medical need" are prioritized.
"We are closely monitoring Wegovy demand and are working with regulators and providers to ensure people living with obesity can have access to and remain on treatment," it added.
The company has also limited provisions in other markets. In May, it cut the U.S. supply of starter doses to ensure continuity for existing patients, while in Germany it advised doctors to "prescribe responsibly," limiting prescriptions to patients with medical needs. | Drug Discoveries |
Health January 6, 2023 / 12:40 PM / CBS News Omicron subvariant rapidly spreading COVID-19 Omicron subvariant rapidly spreads across the U.S. 03:52 The latest COVID variant of concern, XBB.1.5, continues to rise but still makes up a minority of new COVID-19 infections across the country, the Centers for Disease Control and Prevention estimated Friday, after the agency narrowed its projections of the variant's climb.Some 27.6% of new cases nationwide are linked to the variant, the CDC currently projects, with a prediction interval ranging from 14.0 to 46.5%. The BQ.1.1 variant, which emerged in the fall, is still estimated to make up a larger share of cases for now, at 34.4%.XBB.1.5's prevalence remains highest in the Northeast, where the CDC estimates it makes up around more than 70% of cases. In all other regions, the strain is projected to be less than a third of new infections. Health authorities in Europe had said the CDC's initial data on the strain's growth advantage over its Omicron siblings showed it spreading faster than all other major strains seen during the pandemic so far in the U.S., except the original Omicron lineage that drove a record wave of infections last winter. The World Health Organization said this week it has also asked the CDC for a risk assessment of the threat posed by the new variant. CDC officials had cautioned last week that their initial estimate of 40.5% for XBB.1.5 carried a wide margin of error. Since samples of the virus can take weeks to be sequenced, the agency uses a "Nowcast" model to predict the growth of strains."There is a probability interval on that. And it's really important to stress that probability interval. That's from 22.7 to 61 percent. Those intervals tend to be broader when a variant is growing in proportion quickly," Barbara Mahon, head of the CDC's proposed Coronavirus and Other Respiratory Viruses Division, told CBS News last week.So far, federal health officials say there is no evidence that the strain itself is leading to a higher risk of severe disease compared to previous Omicron waves, based on data from where the strain was first dominant.The current supply of updated bivalent booster shots — which target Omicron as well as the original strain — are expected to offer "some" improved protection against XBB.1.5, the Food and Drug Administration's commissioner said this week, and antiviral treatments like Pfizer's Paxlovid pills are expected to remain effective. XBB.1.5's ascent is displacing other Omicron variant cousins BQ.1 and BQ.1.1, which had dominated a wave of infections over the fall. Scientists believe that XBB.1.5's recent growth could be driven by key mutations on top of what was already one of the more immune evasive strains of Omicron to date.Most of the earliest cases from XBB.1.5 recorded in global databases through early November were sequenced around New York and Massachusetts.An increase in hospitalizationsThe ascent of XBB.1.5 comes as COVID-19 hospitalizations have accelerated across the U.S. in recent weeks. The pace of new admissions is now worse than this past summer's peak in several regions. In New England, the CDC estimates that the rate of hospitalizations among the oldest Americans is now approaching peaks seen during the winter of 2020 to 2021, but still lower than this time during the original Omicron winter.Official case figures have not climbed substantially. However, test positivity rates suggest official tallies are steeply undercounting the spread of the virus. In places like nursing homes, where COVID-19 test results are more regularly reported to health authorities, federal data has tracked a steep rise of infections in New England."There's no suggestion at this point that XBB.1.5 is more severe. But I think it is a really good time for people to do the things that we have been saying for quite a while are the best ways to protect themselves," said Barbara Mahon, head of the CDC's proposed Coronavirus and Other Respiratory Viruses Division.Nearly a quarter of Americans are living in counties of "high" COVID-19 Community Levels, where the agency urges masking and other measures to curb the virus, the worst it has been since August last year. Fort Worth, Miami, and New York City rank among the most populous counties now at these levels. Mahon said XBB.1.5's mutations could be part of driving the increase where XBB had failed to gain a foothold. But she added that other factors, like the higher risk posed by respiratory viruses during the winter holiday season, could also be playing a factor.Mahon cited the agency's recommendations to seek out updated COVID booster shots, as well as taking other precautions like improving ventilation, testing before gathering, or masking in high COVID areas."So that advice doesn't change at all. And this time of year is a really good time to be following that advice," said Mahon.Ungrouping XBB.1.5 from XBBThe XBB.1.5 strain is a spinoff of the XBB variant, itself a "recombinant" blend of two prior Omicron strains, which drove a wave of infections overseas earlier this year. Earlier this year, the Biden administration had voiced optimism that XBB was unlikely to dominate infections in the country. South Asian nations like Singapore reported that strain appeared to pose a lower risk of hospitalization relative to earlier Omicron variants. After it was first spotted in the country, XBB had made up a small fraction of U.S. cases for several weeks despite appearing in a growing share of variants from arriving international travelers. Then over the past month, XBB's prevalence began to swell in the CDC's estimates. These figures are released weekly in "Nowcast" projections based on the sequences that authorities have gathered so far. Now, the CDC says that increase was driven largely by XBB.1.5. After ungrouping XBB.1.5, the agency estimates all other XBB infections had up only a small fraction of cases nationwide.Beyond its parent, XBB.1.5 has an additional change called F486P. That mutation appears to offer a "greatly enhanced" ability to bind to cells, which could be helping drive its spread."We've been tracking XBB for weeks as I said, and it was XBB and XBB.1, and they really weren't taking off. They weren't increasing rapidly in proportion," said Mahon.Vaccines, treatments, and testsBefore evolving into XBB.1.5, XBB had already ranked among the strains with the largest immune-evasion relative to earlier major Omicron strains. XBB appeared to be "the most profoundly resistant variant" to antibodies from breakthrough infections of any lineage tested to date.Like BQ.1, XBB was resistant to a roster of monoclonal antibody drugs that doctors had relied on earlier in the pandemic before they were sidelined by new variants.Data from a team of federally-backed researchers earlier this year found the current batch of updated bivalent boosters appear to offer better "neutralizing activity" Omicron variants, including XBB, when testing antibodies in the blood of people who got the updated booster compared to after only the original vaccines. "We expect that the bivalent booster will provide protection against XBB.1.5 as it has against other Omicron subvariants. And if people haven't gotten it yet, this is a great time to do it," Mahon said. However, antibody responses in that study were also worse for XBB compared to the other strains they studied. "The XBB.1.5 variant would look similar to the XBB we tested in our study. The R346T/I mutation within the spike increases the ability of the virus to evade antibodies more efficiently," Emory University's Mehul Suthar told CBS News in an email.For antiviral drugs like Pfizer's Paxlovid, data from another team of scientists in Japan suggest they will retain efficacy against XBB."With what we know so far, XBB.1.5 has not acquired any new mutations in the viral protein targeted by Paxlovid. The susceptibility of XBB.1.5 against Paxlovid should not change given the current data," the University of Wisconsin-Madison's Peter Halfmann, one of that study's authors, told CBS News in an email.And for tests, the Food and Drug Administration warned last month on its website that one home collection kit — DxTerity's saliva test for the virus — had been discovered to have "significantly reduced sensitivity" to variants with XBB's mutations."We will update the page when significant new information becomes available, including when the FDA's analyses identify tests for which performance may be impacted for known SARS-CoV-2 variants," Jim McKinney, a spokesperson for the regulator, said in a statement.This is an updated version of a story first published Dec. 30, 2022. In: Centers for Disease Control and Prevention COVID-19 Omicron Variant Alexander Tin CBS News reporter covering public health and the pandemic. Thanks for reading CBS NEWS. Create your free account or log in for more features. Please enter email address to continue Please enter valid email address to continue | Epidemics & Outbreaks |
Vapes could be made prescription-only by a Labour government to stop children getting hooked on the “gateway drug”, the shadow health secretary has said.
Wes Streeting said that the party was considering the move as he accused “Big Tobacco” and the vaping industry of “crying crocodile tears” about the rise of vaping among children.
During a visit to Australia last week, he said that the vaping industry should be made to go “back to its roots” as a genuine smoking cessation aid, only available to those trying to quit.
Last week, the Australian government announced plans to ban the import of disposable e-cigarettes, under a plan to make all vaping illegal without a prescription.
Mr Streeting told The Telegraph that he was considering the same policy, having met with Mark Butler, the Australian health minister, who represents the country’s Labor Party.
It has been illegal since 2021 for any Australian to purchase vapes containing nicotine without a doctor’s prescription.
The latest restrictions announced by its Labor government attempt to close down a black market in e-cigarettes.
On Wednesday, the British Government will close a consultation on measures to crack down on youth vaping, which could see a ban on flavours and marketing aimed at children.
The number of children vaping has tripled in the last three years, with one in five children aged between 11 and 17 having tried it, according to the latest survey from Action on Smoking and Health.
Mr Streeting said that Labour was considering making e-cigarettes prescription-only, in an attempt to ensure they can only be accessed by adults trying to quit and not become a “gateway” to smoking for children.
He told The Telegraph: “I’m outraged at the extent to which this irresponsible industry has peddled itself as an altruistic smoking cessation service, at the same time as addicting a generation of children’s nicotine.
“I don’t want to hear any more crocodile tears from vaping industry leaders about the number of children who have taken up vaping, all the pearl clutching that’s going on there.”
Mr Streeting said: “I think this has been a deliberate strategy to increase consumer demand and the fact that you’ve got ‘Big Tobacco’ now weighing in behind vaping tells me that what they want is to addict people to nicotine through a new product.”
Last week, British American Tobacco – a manufacturer of cigarettes and vapes – launched a public campaign backing extra regulation of vape sellers, while resisting any significant increase in taxes or a ban on disposable vapes.
Mr Streeting said: “This whole business model is built on addicting people to one of the most addictive substances known to man or woman so we’re going to go hard on marketing selling to children, but I’m also want the vaping industry to go back to its roots as a genuine smoking cessation tool.”
“I’m looking very carefully at what Mark Butler and the Australian Labor government have announced. Their policy is in part driven by the evidence here in Australia that vaping has become a gateway drug to smoking. So I think we need to look carefully at what the UK evidence is on that front.”
Mr Streeting did not commit to any specific measures for a Labour health plan on vaping, saying: “We’ve got to have an evidence-based approach to this and I don’t want to throw the baby out with the bathwater.
“I’ve always said vaping is better than smoking. So as a step-down service, from smoking to stopping smoking, I think vaping has a role to play.”.
Britain’s rates of vaping among teens and young adults are among the highest in Western Europe.
On Tuesday, Andrea Leadsom, the health minister, said that the Government will bring forward its plans to restrict the sale of vapes to children “as soon as possible” in the new year, with the public consultation due to close on Wednesday.
In the Commons, Ms Leadsom said: “We all know it is an offence to sell vapes to children under 18, yet one in five children has tried a vape in 2023 alone. The numbers trying it have tripled in the last three years.
“We know the industry is targeting children quite cynically. It is unacceptable, so our Tobacco and Vapes Bill will restrict the appeal and availability of vapes to children.”
Meanwhile the UK Vaping Industry Association released retail data showing that the average age of those using disposable vapes is 39, with fruit flavours the most popular among those aged 35 to 44, followed by those in treat/dessert categories.
The association said that moves to restrict flavours or ban disposable vapes would “cut off a lifeline” to 4.5 million adults who have used vapes as a quitting aid.
Research by the Organisation for Economic Co-operation and Development shows that 7 per cent of those aged 15 to 24 make regular use of e-cigarettes, compared with 1 per cent of those in Spain.
Among the Government’s other moves to clamp down on tobacco use are its proposals to create a “smoke-free generation”.
This would see the legal age of sale for tobacco products raised each year to prevent younger generations from taking up smoking.
John Dunne, the director general of the UK Vaping Industry Association, said: “The idea of having vapes only available on prescription has in Australia created a huge black market with unregulated and potentially unsafe vapes widely available. As a result, smoking numbers in Australia have stopped falling in line with other Western economies and only 8 per cent of vapers are using prescriptions to get their vapes.
“To say that vapes are a gateway drug to smoking is completely incorrect and the science proves that quite the opposite is the case. Smoking rates in all age categories have fallen in the past decade, and it is widely acknowledged that the fall in smoking has accelerated thanks to the availability of vapes. If vapes were a gateway to smoking, we’d see the numbers rising not falling.
“We do need to deal with youth vaping, but the answer is to properly enforce the law and penalise rogue retailers who sell to children. With 250 people dying from smoking every day in the UK, let’s focus on restricting youth access, not adult access.”
A Department of Health and Social Care spokesperson said: “We have no plans to emulate the prescription-only vaping model being pursued in Australia.
“We are consulting on plans to reduce the availability, appeal and affordability of vapes to children, while ensuring adults who want to quit smoking remain supported.” | Health Policy |
FIRST ON FOX: Conservative advocacy group Building Americas Future is launching a six-figure ad buy across multiple 2024 swing states and congressional districts over the Biden administration's proposed menthol cigarette ban.
According to Building Americas Future's ad campaign, the Food and Drug Administration's (FDA's) actions restricting menthol cigarette sales would jeopardize hundreds of millions of dollars in state revenue nationwide. Overall, a Tax Foundation analysis conducted in 2022 said the restriction would cost the federal government $1.9 billion and state governments a total of $4.7 billion given the high tax rates on cigarettes.
"Sadly, it appears the menthol‐ban train has already left the station," Jeffrey Singer, a senior fellow at the free market Cato Institute, wrote in a report on Oct. 17. "This means more business opportunities for purveyors of black market products — ranging from illicit drugs to cigars and cigarettes. And if history teaches us anything, we can expect to witness many harmful unintended consequences."
"Prohibition fuels an underground market where peaceful, voluntary transactions become crimes. It gives law enforcement another reason to interact with non‐violent people who commit these victimless crimes," Singer added in comments submitted to the FDA months earlier. "With menthol cigarettes more popular among Blacks and Hispanics, expect police to focus their attention on minority communities."
According to the Tax Foundation analysis from last year, swing states Georgia, Michigan, North Carolina and Ohio would see revenues decline by an estimated $123 million, $219 million, $165 million and $227 million, respectively.
The average pack of cigarettes in the U.S. faces $1.91 in state taxes and $1.01 in federal taxes. Additionally, every state continues to receive funds from the Master Settlement Agreement — a 1998 settlement between the states and nation's four largest tobacco companies to resolve dozens of health-related lawsuits and reduce youth smoking — which, the Tax Foundation concluded, translates to about $0.75 per pack in 2022.
In April 2022, the FDA issued product standards to prohibit menthol as a characterizing flavor in cigarettes and prohibit all characterizing flavors other than tobacco in cigars. The agency said the move would reduce disease and death from tobacco product use by reducing youth experimentation and addiction, and increasing the number of smokers that quit.
"The proposed rules would help prevent children from becoming the next generation of smokers and help adult smokers quit," Health and Human Services Secretary Xavier Becerra said at the time. "Additionally, the proposed rules represent an important step to advance health equity by significantly reducing tobacco-related health disparities."
Tobacco smoking remains the lead cause of preventable death nationwide, according to the FDA. In proposing the rules, the FDA cited its congressional authority to adopt tobacco product standards.
Last month, the FDA sent the proposed regulations to the White House Office of Management and Budget for review, a final step in finalizing and eventually implementing the menthol cigarette ban. Brian King, the director of the FDA's Center for Tobacco Products, previously told Fox News Digital that the move means the proposal reached its "final step of review for regulatory documents."
"This administration would make criminals of law-abiding citizens while granting actual felons early release and encouraging illicit drug use," Sen. Tom Cotton, R-Ark., told Fox News Digital on July 14. "No wonder Americans have lost faith in an administration that's less interested in public safety than targeting political enemies."
"My general perspective would be that as adults, people can make their own choices, and what the government's job to do is to ensure that we have a market that is open and that products are available that are regulated to make sure that everyone is safe," Sen. Kyrsten Sinema, I-Ariz., added at the time. "At the federal level, I believe that it's our job to kind of stay out of that and let states take their own action and manage their own choices."
Additionally, groups representing small businesses like the New England Convenience Store & Energy Marketers Association have also criticized the proposal.
However, proponents of the proposed actions said it could lead to reduced tobacco use and ensure positive health outcomes.
"Once finalized, rules to end the sale of menthol cigarettes and flavored cigars rule will be the most significant actions that the FDA’s Center for Tobacco Products has taken in its 14-year history. The American Lung Association is eager for these lifesaving rules to be implemented and urges the White House to finalize these rules before the end of the year," American Lung Association CEO and President Harold Wimmer said last month.
"The science and data are clear. Ending the sale of menthol cigarettes and flavored cigars will save lives," Wimmer continued. "It will also help reduce the unjust disparities in tobacco use caused by the tobacco companies targeting certain communities with menthol cigarettes."
On Tuesday, a group of 311 faith leaders sent a letter to President Biden, saying the FDA finalizing the regulations was a "moral imperative."
The NAACP, 100 Black Men of America Inc., U.S. Conference of Mayors and Campaign for Tobacco-Free Kids have also signaled support for the FDA's proposal.
The FDA did not immediately respond to a request for comment.
Fox News Digital reporter Joe Schoffstall contribute to this report. | Health Policy |
A doctor asked for nurse Lucy Letby to be taken off shift after raising repeated concerns about her presence and the deaths of babies - but was told "no", a court has heard.
The nurse denies murdering seven babies and the attempted murder of 10 others at Countess of Chester Hospital.
Dr Stephen Brearey told Manchester Crown Court he "didn't want nurse Letby to come back to work" until concerns had been "investigated properly".
But management refused, the jury heard.
Dr Brearey, who was head of the hospital's neonatal unit, asked for Ms Letby to be stood down after the deaths of two baby boys, who were part of a set of triplets, in June 2016.
The court has previously heard that the first boy, referred to as Child O, was in good condition and stable up until the afternoon of 23 June when he suffered a "remarkable deterioration" and died.
His brother, Child P, died just over 24 hours later after also being attacked by Ms Letby, it is alleged.
The prosecution claims Ms Letby murdered the boys by injecting air into their bloodstreams.
Dr Brearey told the court that the death of the brothers was "distressing for those involved and deeply so with me".
He said: "All three triplets were born in such good condition, they were following a healthy path to growing and developing and hopefully going home."
Dr Brearey told jurors that Child O's collapse came "out of the blue" and observed that in the hours before his death there had been an "unusual" rash on his chest. He said this was something he had not "seen before or since".
Following Child P's death on 24 June, there was a debrief for the medical team on the neonatal unit.
"Ms Letby was present in that debrief. I asked her how she was feeling and I can remember suggesting to her she needed the weekend off to recover," the doctor said.
"She didn't seem overly upset to me in the debrief and told me at the time she was on shift next day, which was a Saturday."
The doctor said he was "concerned" about Ms Letby going back on shift because he had "already expressed concerns to senior management over the association between nurse Letby and the deaths we'd seen on the unit".
Dr Brearey said he called Karen Rees, the duty executive senior nurse, to report his concerns and explained that he "didn't want nurse Letby to come back to work the following day or until all this was investigated properly".
'Further conversations'
Dr Brearey said Ms Rees "said no" and told him "there was no evidence" for his claims.
He told the court he asked Ms Rees if she was "happy to take responsibly for the decision, in view of the fact myself and consultant colleagues wouldn't be happy with nurse Letby going to work the following day".
Ms Rees responded "yes", the medic said.
Dr Brearey told the court that "further conversations" took place the following week and the decision was taken to remove Ms Letby from frontline nursing duties - placing her in a clerical role instead.
Ben Myers KC, defending, noted that Dr Brearey had first "identified" Ms Letby as someone of interest as early as June 2015 after the death of the first three babies in the case.
Dr Brearey had noted, with colleagues, that Ms Letby was present when those three children died in 2015.
Mr Myers put it to the doctor that he was guilty of "confirmation bias" towards Ms Letby and failed to look at "suboptimal care" given to the children in this case.
"Absolutely not", the doctor replied.
Mr Myers put it to Dr Brearey that if there was a basis for his suspicions he would have gone to the police.
Dr Brearey said he and his colleagues were trying to "escalate appropriately" and needed "executive support" to decide the "correct plan of action going forward".
The doctor added: "It's not something anyone wanted to consider, that a member of staff is harming babies.
"The senior nursing staff on the unit didn't believe this could be true."
He said with every "unusual" episode of baby collapse between June 2015 and June 2016 there was "increasing suspicion" about Ms Letby, which led him to eventually escalate his concerns and request she be taken off shift.
Ms Letby, 33, originally from Hereford, denies a total of 22 charges.
The trial continues. | Epidemics & Outbreaks |
Health providers are struggling to meet the demand of people in significant immediate distress, Northern Ireland's mental health champion has said.
The number of people on mental health waiting lists for more than nine weeks has grown significantly since 2018.
Prof Siobhan O'Neill said "more psychologists, more psychiatrists" were needed.
"They are really, really struggling to cope with the demand and the increase in referrals of people who are in significant distress right now," she said.
"The facilities they have aren't adequate either. So this requires a reform of the whole system."
Growing waiting times
Waiting lists for mental health services in Northern Ireland have increased over the past four years, according to information provided by the Department of Health.
The number of young people waiting more than nine weeks for access to the Child and Adolescent Mental Health Service (CAMHS) more than tripled from 364 in December 2018 to 1,269 in December 2022.
There were 2,394 patients waiting more than nine weeks for access to adult mental health services in December 2022, compared to 1,579 back in December 2018.
Prof O'Neill said: "There are so many examples of people who have benefited from the services that are there but unfortunately the waiting lists are worrying.
"We need to make sure that the people who are on waiting lists get treatment and help as soon as possible - and the right sort of help so that they're not being passed around from pillar to post."
Annie's Story
Mother-of-two Annie said mental health is not taken as seriously as it should be, and watching her children suffer has affected her mental health as well.
Her daughter was admitted to hospital after a breakdown.
"Despite me pleading with them not to release her, they let her out," she said.
Her son and daughter have both spent some time on waiting lists for services after suicide attempts.
She said those waiting lists were "as big a killer - probably bigger - than most diseases".
"By the time you actually wait and get services, the problem is that once they have opened up and told of all this trauma, the next thing they go and there's maybe a new counsellor there," she added.
"They're having to retell and relive and retell and it's horrendous for them.
"It's as much use as an ashtray on a motorbike."
Department of Health (DoH) figures show the were 2,940 people waiting more than 13 weeks for psychological therapies December 2022. In December 2018 it was 1,923.
In a statement the department said its target from April 2022 was that no patient should wait longer than nice weeks to access CAMHS, adult mental health services or dementia services, and 13 weeks to access psychological therapies.
Amid budget cuts, Prof O'Neill said £24m is needed for the second year of the mental health strategy.
The 10-year strategy was initially published by then-Health Minister Robin Swann in 2021.
It set out 35 actions for the long-term reform of services, including early interventions and ensuring people get "the right support at the right time".
But Prof O'Neill said: "At the minute there is no certainty as to whether that funding is going to be made available."
She said there had been a rise in the number of people accessing support privately, but many can not afford it.
"Poverty, deprivation, adversity - all of those things mean that the people who most need mental health services are those that are least able to afford them and pay for them," she said.
"The rates of suicide are double in the most deprived areas when we compare them with the least deprived areas.
"We do need the full strategy over the next 10 years - that's the only thing that's actually going to change things going into the future." | Mental Health Treatments |
The government could face a judicial review after excluding some health workers from a one-off bonus.
The sum was part of a pay deal for more than a million NHS staff in England this year and was partly to recognise their work since the pandemic.
But thousands of outsourced staff, such as community nurses and physiotherapists, will not receive it - a decision described as an "injustice".
The government said it was considering its position.
The workers were told they did not qualify for the payments of between £1,655 and £3,789 because they were not directly employed by the NHS. Instead, they work for not-for-profit organisations, such as social enterprises, which together provide a third of community health services for the NHS.
About 20,000 health staff are thought to work in those services in England, the Department of Health and Social Care said.
Social Enterprise UK, an industry body which represents more than 10,000 of those workers, told the BBC it had started the process of applying for a judicial review, as it believed the arrangement was "completely unfair".
Chief executive Peter Holbrook said social enterprises were a "crucial part of the NHS family", employing thousands of staff and reinvesting profits in communities.
'Slap in the face'
Many of the healthcare workers Mr Holbrook represents were previously employed by the NHS before being transferred to independent providers as part of a move to outsource some services.
Among those is Julie Tollit, a physiotherapist working for a community provider in homes, clinics, hospitals and schools.
"I am employed by Central Surrey Health to work for the NHS - all my patients are NHS and consider me NHS," she said.
Ms Tollit is employed under the same terms and conditions as her NHS counterparts.
She said: "I feel completely demoralised. Our team worked throughout the pandemic, we worked incredibly hard, we were treating patients in the community trying to keep them out of hospital to help prevent more admissions for those hospitals which were overwhelmed. We worked tirelessly. Apparently, my work doesn't count. Frankly it's a slap in the face."
The government announced a 5% pay rise for more than a million NHS staff in England earlier this year. It said it was agreed during negotiations that outsourced staff would not get the additional bonus.
A spokesperson said: "We hugely value the work of all our healthcare staff" and added that the government was "considering its position" relating to non-NHS staff payments.
Some "bank" staff - health staff at other organisations, deemed "non statutory" - including those working in nursing homes and GP services, have also missed out on the lump sums.
Separate pay deals were made for staff working in the NHS in Wales and Scotland. | Health Policy |
The Centers for Disease Control and Prevention is talking to airlines about the possibility of testing for the coronavirus in sewage from planes, the federal agency told NBC News.Since September 2021, the CDC has been testing international travelers for Covid on a volunteer basis via nasal swabs. The program now includes seven major airports. Expanding that surveillance to include wastewater could allow the CDC to collect more data about emerging variants.The U.S. has been monitoring for the coronavirus in wastewater since the CDC launched its National Wastewater Surveillance System in September 2020. But that testing mainly involves wastewater from households or buildings, not samples from airports or planes. "CDC is exploring all options to help slow the introduction of new variants into the United States from other countries. Previous Covid-19 wastewater surveillance has shown to be a valuable tool, and airplane wastewater surveillance could potentially be an option," CDC press officer Scott Pauley told NBC News. Politico first reported that the agency was considering airplane wastewater testing.A study published Thursday in the journal PLOS Global Public Health shows how this approach could be useful: A team of researchers from Bangor University in Wales found that the coronavirus circulated widely in wastewater from airports and planes in the U.K., even while Covid testing was required for unvaccinated passengers. Those results indicate that plane wastewater sampling could pick up on asymptomatic or presymptomatic infections that might get missed by Covid tests, in addition to detecting other viruses or bacteria."The more information you have, the more accurate decisions that you can make," said Kata Farkas, one of the study’s authors and a postdoctoral research officer at Bangor University. "I believe wastewater-based surveillance is a really good tool to support any decision made on public health."A new report from the National Academies of Sciences, Engineering, and Medicine, also published Thursday, came to a similar conclusion. It suggested that wastewater surveillance could provide critical data about existing or emerging pathogens, and it also outlined a vision for how the existing system should expand and function going forward. As of October, more than 1,250 sites were conducting wastewater testing across the U.S. But most counties don’t have the funding, capacity or will to sample their sewage yet. So according to the report, a more robust system should screen for multiple pathogens at once, and add sampling sites in underserved areas and at specific outposts like sports venues, zoos or major airports.Making the most of wastewater surveillanceWastewater testing can provide different information depending on where samples are collected. Those from an airport, dormitory or long-term care facility, for instance, might offer more granular insight than broader, communitywide testing."If you do have a new variant that’s coming and you have a wastewater sample, it’s going to be more concentrated coming out of a smaller sewer shed or an airport," said Sandra McLellan, a professor of freshwater sciences at the University of Wisconsin-Milwaukee, who was not involved in either report. "If you just look in the municipal wastewater, you could miss it."While samples from individual airplanes are unlikely to represent population-level trends, they offer a different advantage, according to Heather Bischel, an associate professor of civil and environmental engineering at the University of California, Davis: Scientists can trace a pathogen to a specific geographic origin."Having that kind of information about our ports of entry would certainly give forewarning to where a new spread could occur," said Bischel, who was not involved in the reports.Farkas said she believes it would be most useful to test sewage from long international flights, since more passengers are likely to use the airplane toilets. But she also said that there could be legal and political barriers when sampling directly from airplanes."Some countries would consider the plane their own territory, and if you want to take anything out of it, you’re basically stealing from another country, to put it bluntly," Farkas said.For their new study, Farkas and her team analyzed wastewater samples from three U.K. airports — Heathrow, Edinburgh and Bristol — over three weeks in March 2022. Thirty-two samples came from plane sewage, while another 150 came from sewers near airport terminals or wastewater treatment plants associated with the Edinburgh airport.All the samples collected from the Heathrow and Bristol airports were positive for the coronavirus, and 85% of the samples from the Edinburgh airport were positive.Spotting the next pandemic threatIn addition to the coronavirus, the CDC has used wastewater data to detect the mpox (formerly called monkeypox), and polio viruses.The National Academies report suggested that a larger nationwide system could also screen for influenza, antibiotic resistant bacteria and enterovirus D68, a common childhood virus that can cause muscle weakness or paralysis in rare cases."Basically, anything that is found in feces or urine would end up in the wastewater," Farkas said.But identifying novel viruses or bacteria from sewage can be difficult if scientists don’t know what signatures to look for."If we were to sequence everything in wastewater, there’s just a lot there, and so our ability to resolve a unique, novel pathogen is somewhat limited," John Scott Meschke, a microbiologist at the University of Washington and a member of the committee that wrote the National Academies report, said in a webinar on Thursday."Very novel pathogens is still one of the blind spots that we have,” he added. | Epidemics & Outbreaks |
Cooling off in lakes, rivers and streams is a hallmark of the summer — but for an unlucky few, it can lead to an infection caused by Nagleria fowleri, a bacteria more commonly known as the brain-eating amoeba.
In the U.S., there have been at least three reported deaths this year from the infection, which occurs when the bacteria enter the nose during submersion in fresh water, usually while swimming.
Nagleria fowleri can cause the deadly primary amebic meningoencephalitis (PAM), which destroys brain tissue, according to the CDC.
Of the 157 people known to be infected in the U.S. between 1962 and 2022, only four individuals survived — meaning the death rate is more than 97%.
In late July, a 17-year-old Georgia girl, Morgan Ebenroth, died after becoming infected with the bacteria while swimming in a lake with friends.
Also in July, the Nevada Division of Public and Behavioral Health (DPBH) reported that a 2-year-old boy died after contracting a brain-eating amoeba infection from a natural hot spring.
And in February, a Florida man died after he was infected when washing his face and rinsing his sinuses with tap water containing Nagleria fowleri.
Fox News Digital spoke with Tammy Lundstrom, chief medical officer and infectious disease specialist for Trinity Health in Michigan, about the risks and the prevention of infection.
"The risk of brain-eating amoeba is very low," she said. "Fewer than 10 people in the U.S. every year get infected — but unfortunately most cases are fatal. There are only a handful of survivors of known cases."
Hotspots of infection
The Southern U.S., with its warmer temperatures, has reported the most cases — 157 in total between 1962 and 2022, Lundstrom said.
Almost half of these occurred in Texas and Florida.
July, August and September are the highest-risk months.
"However, there are a few even rarer cases reported from the northern states," she said.
The amoeba only lives in freshwater, so swimming in the ocean is not a risk, Lundstrom added.
Naegleria fowleri thrives in warm water, growing best at temperatures up to 115°F. This means that July, August and September are the highest-risk months, according to the CDC’s website.
Some experts believe that climate change could make Naegleria fowleri infections more common.
"As air temperatures rise, water temperatures in lakes and ponds also rise and water levels may be lower," the CDC's website states.
"These conditions provide a more favorable environment for the amoeba to grow."
It also says, "Heat waves, when air and water temperatures may be higher than usual, may also allow the amebae to thrive."
Warning signs to know
The initial symptoms of PAM usually begin about five days after exposure to the bacteria — but they can be noticed sooner.
Early signs usually include headache, nausea, fever and/or vomiting, per the CDC.
"Millions of people enjoy swimming every summer, but only a few become infected."
As the infection progresses, people may experience confusion, stiff neck, disorientation, hallucinations, seizures and coma.
"People usually start to feel ill one to 12 days after the water exposure," Lundstrom said. "Early symptoms should prompt a medical evaluation, as they are also signs of bacterial meningitis."
Death can occur anywhere between one and 18 days of infection, with an average of five days.
Prevention of infection
The best way to prevent infection is to avoid putting your head in the water when swimming, Lundstrom told Fox News Digital.
"Infection occurs when water harboring the amoeba goes up a person’s nose, usually during swimming," she said.
"It is not known why some people get infected and others, even swimming companions, do not."
Drinking contaminated water does not cause infection, and it does not spread from one person to another, Lundstrom added.
Although a death was reported this year after a man was exposed to the bacteria while washing his face and clearing his sinuses with tap water, Lundstrom said this is a remote risk.
"The best protection would be to avoid immersing your head when swimming in the summer."
People can also use nose clips or hold the nose shut to prevent infection.
Because the bacteria is found in soil, the CDC also recommends avoiding stirring up the sediment at the bottom of lakes, ponds and rivers.
Treatment of brain-eating amoebas
When a patient has been diagnosed with a brain-eating amoeba, treatment usually includes a variety of anti-fungal medications, including rifampin and azithromycin, Lundstrom said.
Miltefosine, a newer anti-fungal drug, has been shown to kill the bacteria in laboratory tests and was used to treat three of the surviving patients, the CDC states on its website.
"However, the effect of all of these drugs on actual infected people is unknown due to the high fatality rate," Lundstrom noted.
Those who experience sudden headache, fever, stiff neck or vomiting — especially if they have recently been swimming in warm freshwater — should seek immediate medical attention, the CDC recommends.
Despite the infection’s high fatality rate, Lundstrom emphasized the rarity of cases.
"Millions of people enjoy swimming every summer, but only a few become infected," she said.
"The best protection would be to avoid immersing your head when swimming in the summer." | Disease Research |
LaFAYETTE, Ala. — Charity Hodge had mixed feelings when she spotted a Facebook post announcing that her longtime primary care doctor was ready to retire after decades of serving their rural community.
“I was like, ‘Oh my gosh, no!’” Hodge recalled while sitting in an exam room on a July afternoon, waiting to see the physician, Terry Vester. “Well, I’m happy for the retirement part, but that’s my favorite doctor, so I’m crying on the inside.”
Hodge, a 29-year-old customer service representative, has been seeing Vester for nine years. She had come to check in on her diabetes management and to ask for anti-nausea medication in preparation for a cruise.
LaFayette — pronounced “luh-FAY-it” by most residents — and surrounding Chambers County face high rates of disease and chronic illness. Yet Terry Vester and her husband, Al, are the only primary care doctors in the town of 2,700 residents, surrounded by farms and other small communities.
The Vesters are in their late 60s and would like to retire soon. Terry Vester wants to spend more time with her grandson and aging parents. But she can’t imagine abandoning her patients, some of whom she has cared for since they were born.
“There are people here that still need in-town doctors,” said Vester, who sometimes visits patients in their homes. “So we want to stay here to take care of them until someone else is here to take care of them.”
LaFayette, in east-central Alabama near the border with Georgia, is a 30-minute drive to the nearest sizable city, the college town of Auburn. Its lush, wooded neighborhoods include elegant, restored homes with wraparound porches and massive lawns. But the town also has formerly grand houses that have fallen into disrepair, plus mobile homes and public housing.
The town’s median household income is much lower than the state’s and country’s. Black residents — who make up 70% of the population — are much more likely to live in poverty than white residents. They are also more likely to attend the public high school, whose student body is 90% Black and which is scheduled to close and consolidate with a majority-white school in another community.
The Vesters have worked in LaFayette since the early 1980s and saw the local hospital close in 1988. The nearest emergency room is now in another town 20 minutes away along a rolling road. So are the nearest urgent care clinic and pediatrician’s office.
To fill that void, residents turn to the one place in LaFayette where medical professionals are always on the clock: the city fire department, staffed with full-time firefighters and emergency medics.
Fire Chief Jim Doody worked for 13 years as the fire chief at Bagram Airfield in Afghanistan. He arrived in LaFayette in 2020, just as the county was about to be hit by one of the worst covid-19 outbreaks in Alabama.
Doody said most of the station’s ambulance runs are for nonemergency situations. Other calls involve urgent issues that could have been headed off if patients had better access to preventive care.
People from LaFayette regularly walk or drive themselves to the fire station to ask for help, Doody said. The station has a makeshift exam area within its small entryway, containing a bench, defibrillator machine, and cabinet filled with medical supplies.
Firefighter Tanner Hill said people often arrive with concerns about fatigue, blood sugar levels, breathing difficulties, or heart trouble. He recalled helping a man who walked into the station after getting hit by a car.
“He was just like, ‘Hey, I just got run over.’ And I was like, ‘Oh, OK, well, let me check you out.’ And sure enough, he got run over,” Hill said.
Hill determined the man’s leg was broken and sent him by ambulance to the nearest hospital.
This de facto walk-in clinic option isn’t available in most other rural areas, where emergency medical services are often run by volunteers who aren’t posted at a station all day, Doody said. But he’s noticed fewer LaFayette residents relying on the fire department since a new telehealth service arrived in town.
Rickey Whitlow was recently driving in LaFayette when he saw a sign touting the new option.
The 61-year-old was intrigued. He parked his car and walked into a new health center that also houses an OnMed Care Station, a large booth stocked with a video screen and high-tech health monitoring equipment.
Whitlow was scheduled for his monthly diabetes checkup with physician Al Vester in a few weeks. But his feet felt like they were burning, and he needed relief now.
Whitlow stepped into the telehealth kiosk, pressed a button, and saw a nurse practitioner appear on a large vertical video screen positioned at eye level. After consulting with the provider, he left the free appointment with a prescription for a cream to relieve his foot pain.
OnMed patients use an automated blood pressure cuff and other devices to collect their vital signs, and the data is sent to the provider treating them from a distance. Patients can also hold a stethoscope to their chest to transmit the sounds of their heart and lungs. A special camera captures internal temperatures, which can be used to diagnose infections. A hand-held camera lets providers examine problems such as rashes, irritated eyes, and swollen throats. In some states, the stations can dispense medications.
OnMed, a Florida-based company, has another kiosk in rural Texas and hopes to open several dozen more in various states next year. The company wants to keep its services free for patients, with funding from universities, health systems, nonprofits, and insurance companies.
The kiosks can stay open on evenings and weekends and are much cheaper to operate than brick-and-mortar doctor’s offices, said CEO Tom Vanderheyden. They also make telehealth available to rural residents whose home internet connections are too weak for video appointments.
LaFayette’s OnMed kiosk is part of a new health center inside a building that has seen several medical facilities come and go.
The Chambers County Community Health and Wellness Center is operated by Auburn University, whose students and faculty travel there to host vaccination and diagnostic clinics, such as speech and hearing exams. They also offer health education events on topics such as healthy eating and maternal health.
The university plans to bring similar centers and OnMed kiosks to other rural Alabama towns.
Vester, the longtime primary care physician, is excited about the new health care resources in LaFayette. But she said it’s still important to have doctors in town.
“You know everyone, or you have a connection with someone,” Vester said.
Vester’s statement rang true during recent appointments as she asked about her patients’ lives and relatives.
“Deep breath,” Vester instructed as she placed a stethoscope on Hodge’s chest. “Are you still at home with your mother? Is she doing good?”
“Yes, she’s doing very well,” Hodge said.
Earlier that day, Vester treated a patient who had throat pain and difficultly speaking after surviving a choking incident. During the appointment, the patient mentioned an upcoming funeral.
Vester knew about the funeral. It was for a woman she once treated.
“I see her daughters and then their children, and they have children — so that’s four generations right there,” Vester said. “And so, you sort of know the whole story, you know the context.”
Vester plans to reach out to Alabama medical schools to let them know she’s looking for doctors to take over for her and her husband. But she said not everyone wants to live in rural areas like LaFayette.
The doctor hopes some of the Auburn students will want to serve in LaFayette after seeing what it’s like working at the new health center. She said it’s nice to live in a small, quiet town that’s relatively close to larger cities, and to run an independent clinic rather than work for a larger health system.
Vester said the charm of LaFayette and its residents is also a selling point.
“All they have to do is pretty much come here and spend a day and go through what we do, and I think they would enjoy it,” she said. | Global Health |
Blood tests are a common, yet often painful, step in health care. But what if we could skip the needles altogether? Saliva and blood contain many of the same biomarkers, and collecting spit is as simple as drooling into a container. Researchers reporting in ACS Sensors have developed a device that detects glucose and adenosine monophosphate (AMP) biomarkers in saliva with high sensitivity, which could help make at-home health monitoring easier and without a poke.
Blood tests provide critical information about a person's health. But they also rely on uncomfortable procedures, ranging from collecting small blood samples through frequent finger pricks to blood draws from a trained phlebotomist. Saliva has been explored as an alternative way to track important biomarkers, including glucose. However, most methods for analyzing saliva samples for small molecules require laboratory equipment. To make the analyses convenient for at-home testing, a simple, yet accurate, sensing platform is needed. One possibility is the electrochemical aptamer-based (E-AB) biosensor, which produces a measurable, electrochemical change when a specially designed piece of DNA or RNA, known as an aptamer, binds to its desired target. This type of device has previously been used on blood samples, but this time, Philippe Dauphin-Ducharme and colleagues adapted E-AB biosensors for saliva samples. The team wanted to measure the concentration of glucose and AMP -- a small molecule biomarker associated with gum disease -- in real saliva specimens.
The team took previously reported DNA aptamers that bound to either AMP or glucose, then re-engineered them to improve their sensitivity. They created their E-AB biosensors by mounting the aptamers on a gold electrode. Saliva samples were collected from a group of participants and pooled together. The sensors were then immersed in the saliva, with no additional preparation steps or reagents needed. This simplicity makes the test easy enough to be performed by a patient in their home. In experiments, the researchers found that their devices returned a result within 30 seconds, remained stable in undiluted saliva for up to three days and retained sensitivity for up to a week, if washed after each use. Additionally, the glucose sensor shows high selectivity towards its target, and both the AMP and glucose sensors are sensitive enough to detect the biomarkers at much lower concentrations than typically found in saliva. The researchers say that this simple technology is the first of its kind to detect glucose in human saliva, and they hope it can make at-home health monitoring less invasive and easier to complete, especially for people with chronic diseases such as diabetes.
The authors acknowledge funding from Colgate-Palmolive Company and the Alliance Grant program of the Natural Sciences and Engineering Research Council of Canada. Some authors are employees of Colgate-Palmolive's Research and Development Center.
The authors have patents pending on this technology.
Story Source:
Journal Reference:
Cite This Page: | Medical Innovations |
DARIEN, IL – An updated position statement from the American Academy of Sleep Medicine supports the replacement of daylight saving time with permanent standard time.
It is the position of the AASM that the United States should eliminate seasonal time changes in favor of permanent standard time, which aligns best with human circadian biology. According to the statement, evidence supports the distinct benefits of standard time for health and safety, while also underscoring the potential harms that result from seasonal time changes to and from daylight saving time.
“By causing the human body clock to be misaligned with the natural environment, daylight saving time increases risks to our physical health, mental well-being, and public safety,” said lead author Dr. M. Adeel Rishi, who is chair of the AASM Public Safety Committee and a pulmonary, sleep medicine, and critical care specialist at Indiana University Health in Indianapolis. “Permanent standard time is the optimal choice for health and safety.”
The position statement was published as an accepted paper Oct. 31 in the Journal of Clinical Sleep Medicine, the official publication of the AASM.
The original position statement published by the AASM in 2020 stated that current evidence best supports the adoption of year-round standard time. Based on a growing body of evidence, the updated position statement emphasizes that daylight saving time should be replaced by permanent standard time. This position is supported by similar statements adopted by other organizations including the Society for Research on Biological Rhythms, National Sleep Foundation, Sleep Research Society, and American Medical Association.
“Permanent standard time helps synchronize the body clock with the rising and setting of the sun,” said Dr. James A. Rowley, president of the AASM. “This natural synchrony is optimal for healthy sleep, and sleep is essential for health, mood, performance, and safety.”
The position statement was developed by the AASM Public Safety Committee and based on a review of existing literature. It was approved by the AASM board of directors and endorsed by 20 medical, scientific, and advocacy organizations:
- American Academy of Cardiovascular Sleep Medicine
- American Academy of Dental Sleep Medicine
- American Academy of Otolaryngology-Head and Neck Surgery
- American Association of Sleep Technologists
- American College of Chest Physicians (CHEST)
- American College of Lifestyle Medicine
- American Society for Metabolic and Bariatric Surgery
- American Thoracic Society
- Dakota Sleep Society
- Michigan Academy of Sleep Medicine
- Montana Sleep Society
- National PTA
- National Safety Council
- National Sleep Foundation
- Sleep Research Society
- Society for Research on Biological Rhythms
- Society of Anesthesia and Sleep Medicine
- Society of Behavioral Sleep Medicine
- Southern Sleep Society
- World Sleep Society
Most of the U.S. will return to standard time when daylight saving time ends Sunday, Nov. 5. Visit the Sleep Education website to learn more from the AASM about daylight saving time.
###
To request a copy of, “Permanent standard time is the optimal choice for health and safety: an American Academy of Sleep Medicine position statement,” or to arrange an interview with an AASM spokesperson, please contact the AASM at 630-737-9700 or [email protected]. Accepted papers, which are published online prior to their final inclusion in an issue, are not embargoed. The statement will be published in the January 2024 issue of the Journal of Clinical Sleep Medicine.
About the American Academy of Sleep Medicine
Established in 1975, the AASM advances sleep care and enhances sleep health to improve lives. The AASM has a combined membership of 12,000 accredited sleep centers and individuals, including physicians, scientists and other health care professionals who care for patients with sleep disorders. As the leader in the sleep field, the AASM sets standards and promotes excellence in sleep medicine, health care, education and research. | Stress and Wellness |
The nation’s most thinly staffed nursing homes would be required to hire more workers under new rules proposed on Friday by the Biden administration, the greatest change to federal nursing home regulations in three decades.
The proposed standard was prompted by the industry’s troubled performance earlier in the coronavirus pandemic, when 200,000 nursing home residents died. But the proposal falls far short of what both the industry and patient advocates believe is needed to improve care for most of the 1.2 million Americans in nursing homes.
The proposal, by the Centers for Medicare and Medicaid Services, would require all facilities to increase staff up to certain minimum levels, but it included no money for nursing homes to pay for the new hires.
CMS estimated that three-quarters of the nation’s 15,000 homes would need to add staff members. But the increases at many of those facilities would be minor, as the average nursing home already employs nurses and aides at, or very close to, the proposed levels.
“The standards are a lot lower than what a lot of experts, including myself, have called for over the years,” said David Grabowski, a professor of health care policy at Harvard Medical School. “There are some real positives in here, but I wish the administration had gone further.”
The government said it would exempt nursing homes from punishment if they could prove that there was a local worker shortage and that the facilities had made sincere efforts to recruit employees.
“Fundamentally, this standard is wholly inadequate to meet the needs of nursing home residents,” said Richard Mollot, the executive director of the Long Term Care Community Coalition, an advocacy group based in New York.
Executives in the nursing home industry said that without extra money from Medicare or Medicaid — the two federal insurers that pay for most nursing home care — the requirement would be financially unattainable.
“It’s meaningless to mandate staffing levels that cannot be met,” Katie Smith Sloan, the president and chief executive of LeadingAge, an association that includes nonprofit nursing homes, said in a statement. “There are simply no people to hire — especially nurses. The proposed rule requires that nursing homes hire additional staff. But where are they coming from?”
The new staffing standard would require homes to have daily average nurse staffing levels amounting to at least 0.55 hours per resident. That translates to one registered nurse for every 44 residents. But that is below what the average nursing home already provides, which is 0.66 hours per resident, a 1:36 ratio, federal records show.
At least one registered nurse would have to be on duty at all times under the proposed plan — one of the biggest changes for the facilities, as they currently must have nurses for only eight consecutive hours each day.
The proposed rule also calls for 2.45 nurse aide hours per resident per day, meaning a ratio of about one aide for every 10 residents. While the federal government sets no specific staffing requirements for nurse aides, the average home already provides 2.22 nurse aide hours a day, a ratio of about 1:11.
“The federal minimum staffing standards proposed by CMS are robust yet achievable,” the agency said in a statement. “The proposal also makes clear that the numerical staffing levels are a floor — not a ceiling — for safe staffing.”
Registered nurses are at the top of the chain of command at nursing homes, overseeing assessments of residents and handling complex clinical tasks. Nurses delegate more straightforward clinical roles to licensed practical nurses.
Certified nurse assistants, often called nurse aides, are generally the most plentiful in a nursing home and help residents with basic needs like bathing, getting out of bed and eating.
On average, registered nurses make $37 an hour while licensed practical nurses earn $28 an hour, according to CMS. Aides often start at minimum wage or slightly above, earning $17 an hour on average.
“People have more choice,” said Tina Sandri, the chief executive of Forest Hills of DC, a nursing home in Washington, D.C., referring to nursing home staff. “They can go to hospitals and make more and do less than they do here in a nursing home.”
“We’ve lost staff to hospitals that had $20,000 signing bonuses,” she added, “and as a nonprofit, we can’t compete with that.”
Nursing home officials say they cannot afford to pay higher wages because state Medicaid programs reimburse them too little. Patient advocates, however, note that some for-profit homes are providing substantial returns to investors.
Medicare and Medicaid spent $95 billion on nursing home care and retirement community care in 2021, according to CMS. The agency estimated that the new standards would cost homes another $4 billion in three years, when all homes except those in rural areas would need to comply. Rural homes would have five years.
Ellen Quirk, a retired certified nurse assistant in Hayes, Virginia, recalled that sometimes she would care for all of the residents on a single floor in the nursing home, which could be 20 or more people, by herself. It’s challenging for an aide to care for more than five to seven people at a time, she said.
“If it’s more than that, then things aren’t done properly,” Quirk, 63, said. “Things are skipped over, like a bath or changing them every couple of hours or feeding them properly.”
“I’ve seen patients that roll over and fall out of bed,” she added. “Sometimes they get bed sores because beds are saturated in urine for hours and hours.”
The nursing home industry has been pressing federal and state governments to pay for a bevy of enticements to long-term care workers, including educational subsidies for those who have worked in nursing homes, loan forgiveness and career opportunities for certified nursing assistants working toward their nursing degrees.
The administration said it would offer $75 million in scholarships and tuition as part of the new proposal. The administration is accepting comments for the next 60 days before it finalizes the new standard. | Health Policy |
Could a craving for salty chips actually be a sign of addiction?
A new study from the University of Michigan suggests that could be the case.
Researchers reviewed 281 studies from 36 different countries, finding that 14% of adults and 12% of children showed signs of addiction to ultra-processed foods, according to the Yale Food Addiction Scale (YFAS).
That’s close to the addiction levels seen for alcohol and tobacco, noted the study article, which was published in the journal BMJ.
Ultra-processed foods are those that are high in carbohydrates and fats, such as candy, ice cream and potato chips.
The study suggests that some people’s consumption of these foods may meet the criteria for substance use disorder, resulting in the "biopsychological mechanisms of addiction and clinically significant problems."
Part of the reason that ultra-processed foods have addictive properties is that they deliver fats and carbs to the gut much faster than minimally processed foods, the researchers wrote.
These foods also contain flavor and texture additives that could make them more addictive.
"There is converging and consistent support for the validity and clinical relevance of ultra-processed food addiction," said lead researcher Ashley Gearhardt, a professor of psychology at the University of Michigan, in a press release announcing the study.
"By acknowledging that certain types of processed foods have the properties of addictive substances, we may be able to help improve global health."
Tanya Freirich, a registered dietitian nutritionist in Charlotte, North Carolina, who was not involved in the study, called out several warning signs of addictive behaviors surrounding food.
These include thinking about food all the time or obsessively, craving foods when not hungry, craving foods as a coping mechanism, eating even after feeling full, having reduced control over intake, experiencing symptoms of withdrawal, and continuing to eat certain foods despite negative consequences.
"While you can enjoy food thoroughly, being addicted to food starts to veer into an unhealthy territory with detrimental effects for the rest of your life," Freirich told Fox News Digital.
"For example, overeating past the point of comfort or to the point of causing digestive distress, or struggling to concentrate on other topics besides food and meals, can be signs of a food addiction."
Gearhardt noted that 103 countries have passed "sugar-sweetened beverage taxes," and several others have additional taxes for ultra-processed foods.
More than 20 countries have also added nutrition labels to these foods, she wrote.
"It’s essential to understand the addiction to these ultra-processed foods globally, particularly in low- and middle-income countries," Gearhardt said in the release.
"Chronic dieting, food shame, food accessibility and even early childhood feeding experiences can all be tied back to food choices and disordered eating habits."
"It will take courageous action to change these and other economic and structural factors that drive people toward ultra-processed foods."
Freirich noted that many countries have banned the production of foods with certain additives that are shown to be detrimental.
"The USDA and FDA could make similar steps to ensure that foods are safe for consumption," she recommended.
Erin Palinski-Wade, a New Jersey-based dietitian with a focus on diabetes and nutrition, is skeptical that foods can be as addictive as drugs. (She was not involved in the study.)
"Although foods rich in added sugar may stimulate the feel-good chemicals in the brain and become habit-forming, sugar itself is not addictive in the way cocaine or another drug may be," she told Fox News Digital.
"Consuming sugar and then reducing or eliminating it from the diet will not result in withdrawal symptoms or side effects as would happen from a true addiction," she continued.
"Food cravings are complex and tied into not just the nutrition profile of a food, but also the emotions and learned behaviors around eating."
Emotions, stress, overall metabolic health, sleep habits and learned feeding behaviors all shape people’s food choices, behaviors and responses, Palinski-Wade said.
"A food craving or binge-eating is almost always tied to an emotional response," she said. "Chronic dieting, food shame, food accessibility and even early childhood feeding experiences can all be tied back to food choices and disordered eating habits."
Although she believes that no single food is addictive, Palinski-Wade acknowledged that foods that are high in added sugar or added fats tend to be associated with the strongest cravings and desire.
"These foods often trigger the release of feel-good chemicals such as dopamine in the brain, leading to cravings and potentially addictive-like eating behaviors," she said.
"As you consume more and more of these foods, you build up a dopamine tolerance, meaning that you will have to eat even more of this food to experience the same pleasure response," Palinksi-Wade said — which can contribute to the development of cravings and loss of control over eating behavior.
More research is still needed to fully understand the relationship between food and addiction, the experts all agreed.
The University of Michigan study was a review and compilation of many other studies' data, Freirich pointed out.
"Ideally, to see if the type of food made a difference, you could run a controlled study with people consuming one meal plan with ultra-processed foods and another with minimally processed foods and then measure their reactions — thoughts about food, rated enjoyment of food, cravings and dopamine levels," she said.
Those who are struggling with disordered eating, binge-eating or uncontrolled food cravings should work directly with a therapist or registered dietitian experienced in eating disorders, Palinski-Wade recommended.
"They can help you to better understand your behaviors and emotions around food and improve your relationship with food so that cravings and addictive behaviors can decrease," she said.
Additionally, Freirich recommended filling the majority of meals with minimally processed foods, as consuming more of these may result in eating fewer ultra-processed foods.
"Lastly, speak to a dietitian about how to get started on changing your diet for your personal health goals," she said.
Fox News Digital reached out to the University of Michigan researcher for additional comments. | Nutrition Research |
Subsets and Splits