GPs and the Fit for Work scheme
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An editorial by primary care researchers at Plymouth University Peninsula Schools of Medicine and Dentistry, and published today, Monday 29 June 2015 in the British Journal of General Practice, analyses the GP role in the sickness certification process and the new Fit for Work scheme and suggests that GPs are key to supporting individuals to maintain the hope and belief that they can work, “rather than adding to the numbers of individuals off work on long term sickness who may have been able to work.”
The Fit for Work Scheme will be introduced in most regions in England and Wales at the end of this month. Its aim is to provide additional support for those in employment at risk of long term incapacity by using an occupational health-based assessment and a plan for helping individuals return to work.
The GP’s role in the new voluntary scheme is advisory, supporting their patients to consider the benefits of extra support. This complements the recently introduced ‘fit note’ certificate that allows GPs to be clearer about their patients’ capacity to work and extra support that may help them return to work.
Experimental treatment sends deadly leukemia into remission
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An experimental new treatment approach for a rare, deadly leukemia can send the disease into remission even in patients for whom the standard therapy has failed, buying them more time to have the stem cell transplant that could save their lives, a small pilot study has found.
“It was unbelievable, really, seeing a patient who had already failed Campath [the drug typically used to treat the disease] literally going back into remission,” said Thomas P. Loughran Jr., M.D., director of the University of Virginia Cancer Center and one of the leaders of the study. “We were able to get every single patient back into remission.”
The new approach to battling T-cell prolymphocytic leukemia combines immunotherapy - boosting the body’s immune system - with epigenetics, the manipulation of gene activity. It’s a cutting-edge combination that holds great promise not just for treating T-cell prolymphocytic leukemia but, possibly, many other cancers as well. “There’s been a revolution in the last few years seeing success with immunotherapy, and people speculated that perhaps if you combined epigenetic and immunotherapy, that might be even more spectacular,” Loughran said. “This is proof of principle that this might be true.”
Study could reduce unnecessary cancer screening
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A large clinical trial led by researchers at The Ottawa Hospital and the University of Ottawa has found that contrary to expectations, a CT scan of the abdomen and pelvis does not improve cancer detection in people with unexplained blood clots in their legs and lungs. The results, published in the June 22 edition of the New England Journal of Medicine, are expected to improve patient care and reduce screening costs around the world.
More than 500,000 Canadians and Americans are diagnosed with blood clots in the lungs and legs each year (called venous thromboembolism). In some cases, the clots are caused by trauma, surgery prolonged immobility or a known cancer, but in about half of cases, the cause of the blood clots is unknown.
‘Unexplained blood clots have long been thought of as a possible early warning sign of cancer, with previous studies suggesting that up to 10 percent of patients with unexplained clots will be diagnosed with cancer within the year,’ explained Dr. Marc Carrier, lead author of the study and a hematologist and senior scientist at The Ottawa Hospital. ‘Some clinical guidelines recommend a CT scan of the abdomen and pelvis in these patients, in addition to other cancer screening, but there has been very little evidence to know if the added CT scan is helpful. We did this study to find out.’
Study shows global warming is unlikely to reduce winter deaths
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A study by researchers at Columbia University’s Mailman School of Public Health debunks the assumption that global warming will lead to a decline in the number of deaths in winter. Findings by Professor Patrick Kinney, ScD, professor of Environmental Health Sciences and director of the School’s Climate and Health Program, showed that a warming climate trend led to much smaller reductions in cold-related mortality than some experts have anticipated. Among 39 cities in the U.S. and France, there was no evidence that cities having warming temperatures experienced any less winter mortality than did cooler cities.
“Some have claimed that warmer winters due to climate change will lead to big reductions in winter deaths. Our work suggests that this is unlikely to be the case,” said Dr. Kinney, who was a lead author on the recent report from the Intergovernmental Panel on Climate Change and also serves on the New York City Panel on Climate Change.
If cold temperatures were directly responsible for winter mortality rates, then we would expect future warming to lead to substantial reductions in winter mortality, according to Dr. Kinney. On the other hand, “climate warming would have little benefit if seasonal factors other than temperature are mainly responsible for winter excess mortality,” he noted.
Massively parallel gene function assays aim to reduce uncertainty of genetic diagnoses
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Patients seeking certainty in genetic tests often receive a perplexing result. Many learn they carry a ‘variant of unknown significance’ of a disease-linked gene. Such variants might—or equally might not—increase disease risk.
A study published in the June issue of the journal Genetics characterized nearly 2000 variants of the breast cancer-associated gene BRCA1, demonstrating the potential of a new approach for sorting out which variants are harmful and which are harmless.
Because genetic tests increasingly use more comprehensive multi-gene and whole-genome sequencing methods, it’s becoming more common for patients to learn they carry a variant of unknown significance. For example, a 2014 study showed 42 percent of breast cancer patients who received results from a 25-gene hereditary cancer genetic test carried a variant of unknown significance in one of the scanned genes.
Academies make recommendations for improving public health
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In recent decades, enormous successes have been achieved in the field of public health. Three examples of these are the fight against HIV, the reduction in cardiovascular disease, and protection for non-smokers. For Germany to make even better use of the potential of public health, it needs more political support, improved research structures, and stronger international involvement. The German National Academy of Sciences Leopoldina, acatech - the National Academy of Science and Engineering, and the Union of the German Academies of Sciences and Humanities point this out in a joint statement entitled “Public Health in Germany - Structures, Developments and Global Challenges”, published today.
Public health is the science and practice of preventing disease, prolonging life, and improving quality of life across an entire population. The concept covers the general promotion of health via comprehensive, organised measures at all levels of society. Research questions and measures related to public health affect all sectors of the healthcare system, the education and social systems, and parts of the economy. Germany is doing outstanding research on various aspects of public health. However, the structures in research, teaching and practice are not yet optimally developed - especially considering the major international challenges that exist. In their “Public Health in Germany” statement, the academies make recommendations on how the field can be improved in Germany.
(1) The academies’ recommendations for education and further training include: improving collaboration between public health researchers, the public healthcare service, public health practitioners, and the public; coordinating professional education goals at national level; establishing interdisciplinary training schemes; opening up new career paths in public health; and incorporating elements of public health into the curricula of all medical professions. Public health professions should be made more attractive and more respected career options.
UA researchers discover component of cinnamon prevents colorectal cancer in mice
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Research conducted at the University of Arizona College of Pharmacy and the UA Cancer Center indicates that a compound derived from cinnamon is a potent inhibitor of colorectal cancer.
Georg Wondrak, Ph.D., associate professor, and Donna Zhang, Ph.D., professor, both of the UA College of Pharmacy Department of Pharmacology and Toxicology, recently completed a study in which they proved that adding cinnamaldehyde, the compound that gives cinnamon its distinctive flavor and smell, to the diet of mice protected the mice against colorectal cancer. In response to cinnamaldehyde, the animals’ cells had acquired the ability to protect themselves against exposure to a carcinogen through detoxification and repair.
‘This is a significant finding,’ says Zhang, who, along with Wondrak, is a member of the UA Cancer Center. ‘Because colorectal cancer is aggressive and associated with poor prognoses, there is an urgent need to develop more effective strategies against this disease.’
Large doses of antioxidants may be harmful to neuronal stem cells
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Stem cells are especially sensitive to oxygen radicals and antioxidants shows new research from the group of Anu Wartiovaara in the Molecular Neurology Research Program of University of Helsinki. The research led by researcher Riikka Martikainen was published in Cell Reports -journal May 28th 2015.
Mitochondria are cellular power plants that use oxygen to produce energy. As a by-product they produce reactive oxygen. Excessive oxygen radicals may cause damage to cells but they are needed in small quantities as important cellular signaling molecules. One of their main functions is to control function of stem cells. Antioxidants are widely used to block the damage caused by reactive oxygen. To enhance their effect some new antioxidants are targeted to accumulate into mitochondria.
The current research showed that a small increase in oxygen radicals did not directly lead to cellular damage but disrupted intracellular signaling in stem cells and lead to decrease in their stemness properties. Treatment with antioxidants was able to improve the stemness properties in these cells. However, surprisingly, the researchers found that an antioxidant targeted to mitochondria showed dose-dependent toxic effects especially on neural stem cells.
As death rates drop, nonfatal diseases and injuries take a bigger toll on health globally
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People across the world are living longer but spending more time in ill health as rates of nonfatal diseases and injuries - including diabetes and hearing loss - decline more slowly than death rates, according to a new analysis of 301 diseases and injuries in 188 countries.
Using a measurement known as years lived with disability, or YLDs, researchers from around the world quantified the impact of health problems that impair mobility, hearing, or vision, or cause pain in some way but aren’t fatal. In 2013, low back pain and major depressive disorder were among the 10 leading causes of YLDs in every country. Other leading causes globally included neck pain, anxiety disorders, migraine headaches, and diabetes. The leading causes of years lived with disability have remained largely the same during this period, but they are taking an increased toll on health due to population growth and aging.
YLDs per person increased in 139 of 188 countries between 1990 and 2013, meaning that more people are spending more time in poor health. Musculoskeletal disorders, combined with fractures and soft tissue injuries, accounted for one-fifth of YLDs globally in 2013, ranging from 11% in Mali to 30% in South Korea. Mental and substance abuse disorders also caused 20% of YLDs globally, ranging from 15% in Germany to 37% in Qatar.
Drug prevents passage of HBV during pregnancy
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The antiviral drug telbivudine prevents perinatal transmission of hepatitis B virus (HBV), according to a study1 in the June issue of Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association.
“If we are to decrease the global burden of hepatitis B, we need to start by addressing mother-to-infant transmission, which is the primary pathway of HBV infection,” said study author Yuming Wang from Institute for Infectious Diseases, Southwest Hospital, Chongqing, China. “We found that telbivudine not only eliminated vertical transmission of HBV from pregnant women to theirs infants, but that it is also safe and well tolerated by women and infants.”
Researchers performed a prospective study of 450 HBV-positive pregnant women with high viral load, or significant HBV in the blood, during the second or third trimester of pregnancy. Two hundred and seventy nine women received telbivudine (600 mg daily) during weeks 24 through 32 of gestation, and 171 women who were unwilling to take antiviral drugs participated as controls. At six months after birth, none of the infants whose mothers were given telbivudine tested positive for HBV, compared to 14.7 percent of infants in the control group.
