Apollo Health Blog
As Reported On bbc.co.uk
Restricting the number of fast-food outlets around offices and homes could help combat the obesity epidemic, UK researchers say.
Exposure to too many pizza and fried-food outlets can nearly double your chances of obesity, research suggests.
Measures to restrict access, such as not opening takeaway restaurants near schools, may help, scientists report in the BMJ.
Others argue that policymakers should focus on making fast food more healthy.
It is difficult now to imagine a world in which broccoli rivals chips at the takeaway counter, but small steps in this direction are already being taken”
Dr Kathryn NeckermanColumbia University, New York
The evidence comes from a study tracking more than 5,000 adults born in Cambridgeshire between 1950 and 1975.
Epidemiologists at Cambridge University looked at workers’ consumption of takeaway food – including hamburgers, pizza, fried food and chips – at home, work and on their commute.
As far as possible, they allowed for factors known to influence obesity, such as education, income and smoking.
They found that greater access to takeaway food was linked with higher body mass index and higher odds of obesity.
Dr Thomas Burgoine, who led the study, told BBC News: “Those most exposed to takeaway food outlets overall were nearly twice as likely to be obese, compared to those least exposed.”
Several local authorities have introduced restrictions on fast-food outlets, around schools or in places where there are already lots of takeaways.
“Our research suggests that policies to make our neighbourhood more healthy by restricting access to takeaway food might be successful,” said Dr Burgoine.
However, research in the US has produced conflicting results on the link between fast-food exposure and obesity.
Dr Kathryn Neckerman, of Columbia University, New York, said her research on schoolchildren indicated children in neighbourhoods with a lot of fast-food restaurants were slimmer.
“Instead of restricting takeaway food, we should seek to transform it,” she told the BMJ.
“Healthy takeaway food should not only be available, it should be as visible, tasty, and cheap as unhealthy food.”
She added: “It is difficult now to imagine a world in which broccoli rivals chips at the takeaway counter, but small steps in this direction are already being taken.”
In the past decade in the UK, spending on food eaten outside the home has increased by 29%.
According to the study, the average person encounters 32 takeaway restaurants around their home, workplace and travelling between the two.
Tracy Parker, heart health dietician at the British Heart Foundation, which helped fund the study, said: “We already know that people are spending more than ever on takeaways and food eaten away from home, and that these foods are often less healthy than the meals we make ourselves.
“This is a worrying trend given that a quarter of adults in the UK are already obese, putting them at greater risk of heart disease.
“While this study can’t prove someone’s local environment can cause them to become obese, it’s vital we have the tools to make healthy choices when eating takeaways or food in a restaurant.”
As Reported On bbc.co.uk
A hormone released during childbirth and sex could be used as a treatment for the eating disorder anorexia nervosa, scientists suggest.
Small studies by UK and Korean scientists indicated patients were less likely to fixate on food and body image after a dose of oxytocin.
About one in every 150 teenage girls in the UK are affected by the condition.
The eating disorders charity Beat said the finding was a long way from becoming a useable treatment.
Oxytocin is a hormone released naturally during bonding, including sex, childbirth and breastfeeding.
It has already been suggested as a treatment for a range of psychiatric disorders, and has been shown to help lower social anxiety in people with autism.
And one four-week study in Australia found people given doses of oxytocin had reduced weight and shape concerns.
In the first of the most recent studies, published in Psychoneuroendocrinology, 31 patients with anorexia and 33 people who did not have the condition were given either a dose of oxytocin, delivered via nasal spray, or a placebo, or dummy, treatment.
We need much larger trials, on more diverse populations, before we can start to make a difference to how patients are treated.”
Prof Janet TreasureLead researcher
They then looked at a series of images to do with a range high and low calorie foods and people of different body shapes and weight.
People with anorexia have previously been found to focus for longer on images of overweight people and what they perceive as undesirable body shapes.
However after taking oxytocin, patients with anorexia were less likely to focus on such “negative” images of food and fat body parts.
The second study, published in PLOS ONE, involved the same people and looked at their reactions to facial expressions, such as anger, disgust or happiness.
It has been suggested that anorexia can be linked to a heightened perception of threat, and animal research has shown oxytocin treatment lessened the amount of attention paid to threatening facial expressions.
In this study, patients with anorexia were less likely to focus on the “disgust” faces after oxytocin treatment.
They were also less likely to avoid looking at angry faces.
‘Lack of treatments’
Eating disorder expert Prof Janet Treasure, from King’s College London’s Institute of Psychiatry, led both studies.
She said: “This is early stage research with a small number of participants, but it’s hugely exciting to see the potential this treatment could have.
“We need much larger trials, on more diverse populations, before we can start to make a difference to how patients are treated.”
There is much that still needs to be understood about the biological basis for eating disorders.”
Her co-researcher, Prof Youl-Ri Kim, from Inje University in Seoul, South Korea, added: “Our research shows that oxytocin reduces patients’ unconscious tendencies to focus on food, body shape, and negative emotions such as disgust.
“There is currently a lack of effective pharmacological treatments for anorexia.
“Our research adds important evidence to the increasing literature on oxytocin treatments for mental illnesses, and hints at the advent of a novel, ground-breaking treatment option for patients with anorexia.”
Leanne Thorndyke, of the eating disorders charity Beat, said: “Eating disorders are complex, and a number of risk factors need to combine to increase the likelihood that any one individual develops the condition.
“Brain chemistry and hormonal factors are part of the mix, with adrenaline, dopamine and the various appetite regulating hormones such as ghrelin being active areas for researchers as well as this research looking at the hormone oxytocin.
“We know that there is much that still needs to be understood about the biological basis for eating disorders.
“We are hopeful that this research will lead to a new, effective treatments being designed, but it is early days yet.”
AS Reported On bbc.co.uk
A gel that can be used by women after sex to protect against HIV is a step closer, according to researchers.
Drugs applied three hours after infection could protect female monkeys from a type of HIV, US scientists said.
The findings, published in Science Translational Medicine, could lead to new ways to fight HIV, which is continuing to spread globally.
Experts say large clinical trials would be needed to test any new treatment, and condoms remain the best defence.
Vaginal gels containing HIV medicines have had mixed success in human clinical trials.
In the latest research, a US team took a different approach, testing a new HIV treatment in monkeys that has the potential to work after HIV exposure.
They found the gel protected five out of six monkeys from an animal-human laboratory strain of HIV when applied shortly before or three hours after infection.
The Centers for Disease Control and Prevention in Atlanta, Georgia, which led the study, say it is a “proof of concept” in an animal model.
Dr Charles Dobard, of the division of HIV/Aids prevention, told BBC News: “It’s a promising after-sex vaginal gel to prevent HIV infection.
“Studies still need to be done to look at the window [of opportunity] – is it six, eight, 24 hours?”
So far, tests have been carried out in only a small number of monkeys infected with a combination of HIV and a related monkey virus.
Experts say there are several obstacles before any new human treatment can become a reality.
Dr Andrew Freedman, reader and consultant in infectious diseases at Cardiff University School of Medicine, said the gel contained a different class of anti-HIV drug, which attacks the virus at a later stage in infection, potentially allowing it to be used after exposure to infection.
“This is proof of concept that such a topically applied gel, applied post-coitally, might be effective in preventing HIV transmission in humans,” he said.
However, he said caution was needed as the study involved only a few monkeys and it had failed to prevent infection in one of the six.
“Much larger human trials would be required before such a gel could be licensed for routine use,” he added.
Jason Warriner, clinical director at the OTerrence Higgins Trust, said having a gel that could be applied after sex would be “another small step forward, particularly in countries where high HIV rates and cultural barriers to condom use have created the perfect storm”.
But he said no microbicide had yet been found that offered full protection against HIV.
“In the UK, condoms remain our best defence against the virus,” he added.
As Reported On bbc.co.uk
A “brave and courageous” woman who was one of the faces of a controversial pancreatic cancer campaign has died at the age of 24.
Kerry Harvey died on Saturday morning, the charity Pancreatic Cancer Action said.
The “envy” campaign involved patients saying they would rather have breast, cervical or testicular cancer.
It was designed to raise awareness about how poor the chances of survival are with pancreatic cancer.
It has a five-year survival rate of 3%, compared with 85% for breast cancer, 97% for testicular cancer and 67% for cervical cancer.
Ms Harvey, who was diagnosed in April 2013, said she wished she had breast cancer.
Early signs of pancreatic cancer
- weight loss
- stomach pain
- lack of appetite
- back pain
The comment sparked a furore and drew criticism from breast cancer groups.
However, in subsequent interviews she defended that stance.
In a statement, Pancreatic Cancer Action, said: “She was a brave and courageous young woman who touched so many hearts with her determination to raise awareness of pancreatic cancer despite being very ill herself.
“She devoted a significant amount of her own time trying to raise the profile of the disease that she, like many other pancreatic cancer patients, had not heard of before her diagnosis.
“Kerry campaigned with selfless vigour and, despite facing criticism, wanted to help others by encouraging earlier diagnosis and attract more funds for research.
“We will never forget Kerry who will be dearly missed, and remain in the hearts and thoughts of all of us at Pancreatic Cancer Action.”
As Reported On bbc.co.uk
Doctors at Great Ormond Street Hospital in London are aiming to reconstruct people’s faces with stem cells taken from their fat.
The team has grown cartilage in the laboratory and believe it could be used to rebuild ears and noses.
They say the technique, published in the journal Nanomedicine, could revolutionise care.
Experts said there was some way to go, but it had the potential to be “transformative”.
The doctors want to treat conditions like microtia, that results in the ear failing to develop properly and can be missing or malformed.
At the moment, children have cartilage taken from their ribs, which is then delicately sculpted by surgeons to resemble an ear and implanted into the child.
It requires multiple operations, leaves permanent scarring on the chest and the rib cartilage never recovers.
The team envisage an alternative – a tiny sample of fat would be taken from the child and stem cells would be extracted and grown from it.
An ear-shaped “scaffold” would be placed in the stem cell broth so the cells would take on the desired shape and structure. And chemicals would be used to persuade the stem cells to transform into cartilage cells.
This could then be implanted beneath the skin to give the child an ear shape.
The researchers have been able to create the cartilage in the scaffold, but safety testing is needed before they could be used in patients.
One of the researchers, Dr Patrizia Ferretti, told the BBC: “It is really exciting to have the sort of cells that are not tumourogenic, that can go back into the same patient so we don’t have the problem of immunosuppression and can do the job you want them to do.
“It would be the Holy Grail to do this procedure through a single surgery, so decreasing enormously the stress for the children and having a structure that hopefully will be growing as the child grows.”
The technique could help patients like 15-year old Samuel Clompus, who has had the reconstructive ear surgery.
His mother, Sue, said the family welcomed the research.
She told the BBC: “They wouldn’t have needed to take the cartilage.
“He has a scar there now and Sam said it was the most uncomfortable bit.”
The technique could be used to create cartilage for other tissues such as the nose, which can be damaged in adults after cancer surgery.
Doctors say they could also make bone using the same starting material.
“Obviously we are at the beginning of this, the next step will be to perfect just the choice of materials and to develop this further,” said Dr Ferretti.
Commenting on the study, Prof Martin Birchall, a surgeon at University College London, said: “If you had something that was truly regenerative, that would be transformative.”
He was involved in the first operations to give people lab-grown windpipes.
He said the fat-based technique needed more safety testing to reach that stage.
“We used [bone marrow] stem cells as they’ve been used in 10,000s of people for bone marrow transplants, fat stem cells are likely to be fine, but they haven’t got that safety record yet.”
As Reported On bbc.co.uk
Passive smoking causes lasting damage to children’s arteries, prematurely ageing their blood vessels by more than three years, say researchers.
The damage – thickening of blood vessel walls – increases the risk of heart attacks and strokes in later life, they say in the European Heart Journal.
In their study of more than 2,000 children aged three to 18, the harm occurred if both parents smoked.
Experts say there is no “safe” level of exposure to second-hand smoke.
This study goes a step further and shows it [passive smoking] can cause potentially irreversible damage to children’s arteries increasing their risk of heart problems in later life”
Doireann MaddockBritish Heart Foundation
The research, carried out in Finland and Australia, appears to reveal the physical effects of growing up in a smoke-filled home – although it is impossible to rule out other potentially contributory factors entirely.
Ultrasound scans showed how children whose parents both smoked developed changes in the wall of a main artery that runs up the neck to the head.
While the differences in carotid intima-media thickness were modest, they were significant and detectable some 20 years later when children had reached adulthood, say the investigators.
Study author Dr Seana Gall, from the University of Tasmania, said: “Our study shows that exposure to passive smoke in childhood causes a direct and irreversible damage to the structure of the arteries.
“Parents, or even those thinking about becoming parents, should quit smoking. This will not only restore their own health but also protect the health of their children into the future.”
The results took account of other factors that might otherwise explain the association, such as whether the children went on to be smokers themselves, but the findings remained unchanged.
However, if only one parent smoked the effect was not seen – possibly because exposure was not as high.
Dr Gall said: “We can speculate that the smoking behaviour of someone in a house with a single adult smoking is different. For example, the parent that smokes might do so outside away from the family, therefore reducing the level of passive smoking. However, as we don’t have this type of data, this is only a hypothesis.”
Regardless, experts say all children should be protected from second-hand smoke.
- Smoke can stay in the air for up to two and a half hours even with a window open
- It may still be there even if you can’t see it or smell it
- Second-hand smoke contains more than 4,000 chemicals, some of which are known to cause cancer
- Children who breathe in second-hand smoke have an increased risk of asthma and coughs and colds, as well as cot death, meningitis and ear infections
Doireann Maddock, senior cardiac nurse at the British Heart Foundation, said: “The negative health effects of passive smoking are well known, but this study goes a step further and shows it can cause potentially irreversible damage to children’s arteries increasing their risk of heart problems in later life.
“If you’re a smoker, the single most effective way of reducing your child’s exposure to passive smoke is for you to quit.
“If this isn’t possible, having a smoke-free home and car offers the best alternative to help protect your child from the harmful effects of passive smoke.”
Simon Clark, director of the smokers’ group Forest, said: “We must avoid scaremongering because damage to arteries could be caused by a number of factors including poor diet and other forms of air pollution.
“While it’s sensible and considerate not to smoke around children in a small confined space it’s far too easy to point the finger at smokers when the issue is extremely complicated.”
As Reported On bbc.co.uk
US researchers have revealed another baby carrying the HIV virus, which leads to Aids, may have been cured through early treatment.
Antiretroviral drugs were reportedly administered to the baby in California just four hours after birth.
The unidentified nine-month-old child is now said to be HIV negative.
It is the second such case after an HIV-positive Mississippi infant brought into remission following early treatment was reported in 2013.
‘Not without risk’
“This is a call to action for us to mobilize and be able to learn from these cases,” Johns Hopkins University paediatrics specialist Dr Deborah Persaud said at a Boston medical conference.
No trace of the virus can now be found in the infant’s blood or tissues, the doctor revealed.
Dr Persaud said the nine-month-old child is still receiving a three-drug anti-Aids cocktail, while the three-year-old Mississippi child stopped receiving antiretroviral treatments two years ago.
“Really the only way we can prove that we have accomplished remission in these kids is by taking them off treatment and that’s not without risk,” Dr Persaud added.
Both children are reported to have been born to mothers infected with HIV, which weakens the body’s immune system.
The human immunodeficiency virus has infected more than 34 million people worldwide, researchers estimate.
As Reported On bbc.co.uk
Warmer temperatures are causing malaria to spread to higher altitudes, a study suggests.
Researchers have found that people living in the highlands of Africa and South America are at an increased risk of catching the mosquito-borne disease during hotter years.
They believe that temperature rises in the future could result in millions of additional cases in some areas.
The research is published in the journal Science.
Prof Mercedes Pascual, from the University of Michigan in the US, who carried out the research, said: “The impact in terms of increasing the risk of exposure to disease is very large.”
Vulnerable to disease
Areas at higher altitudes have traditionally provided a haven from this devastating disease.
This expansion could in a sense account for a substantial part of the increase of cases we have already observed in these areas”
Professor Mercedes PascualUniversity of Michigan
Both the malaria parasite and the mosquito that carries it struggle to cope with the cooler air.
Prof Pascual said: “The risk of the disease decreases with altitude and this is why historically people have settled in these higher regions.”
But the scientists say the disease is entering new regions that had previously been malaria-free.
To investigate, scientists looked at densely populated areas in the highlands of Colombia and Ethiopia, where there are detailed records of both temperature and malaria cases from the 1990s to 2005.
They found that in warmer years, malaria shifted higher into the mountains, while in cooler years it was limited to lower elevations.
“This expansion could in a sense account for a substantial part of the increase of cases we have already observed in these areas,” said Prof Pascual.
The team believes that rising temperatures could cause a further spread.
In Ethiopia, where nearly half of the population live at an altitude of between 1,600m (5,250ft) and 2,400m, the scientists believe there could be many more cases.
“We have estimated that, based on the distribution of malaria with altitude, a 1C rise in temperature could lead to an additional three million cases in under-15-year-olds per year,” said Prof Pascual.
The team believes that because people living in areas that have never been exposed to malaria are particularly vulnerable to the disease, attempts to stop the spread should be focused on areas at the edge of the spread. The disease is easier to control there than at lower altitudes where it has already established.
According to the latest estimates from the World Health Organization, there were about 207 million cases of malaria in 2012 and an estimated 627,000 deaths. Most deaths occur among children living in Africa.
As Reported On bbc.co.uk
A blood test can accurately predict the onset of Alzheimer’s disease, according to US researchers.
They showed that testing levels of 10 fats in the blood could predict – with 90% accuracy – the risk of the disease coming on in the next three years.
Their findings, published in Nature Medicine, will now be tested in larger clinical trials.
Experts said the results needed to be confirmed, but such a test would be “a real step forward”.
The number of people living with dementia stands at 44 million around the globe and is expected to treble by 2050.
The disease silently attacks the brain for more than a decade before any symptoms emerge. Doctors think drug trials are failing because patients are simply being treated too late to make a difference.
This is why discovering a test that predicts the risk of dementia is a major priority for the field.
Scientists at Georgetown University in Washington DC analysed blood samples from 525 people over the age of 70 as part of a five-year study.
They took 53 of them who developed Alzheimer’s or mild cognitive impairment and compared their blood with 53 who stayed mentally agile.
They found differences in the levels of 10 lipids, or fats, between the two groups.
And when the research team looked in the other blood samples, those 10 markers of Alzheimer’s could predict who was likely to enter mental decline in the following years.
Dementia specialist Dr Iracema Leroi explains the significance of the research
Howard Federoff, professor of neurology at Georgetown University Medical Center, told the BBC: “I think there is a huge need for a test.
“But we must look at larger numbers of people before this could be used in clinical practice.”
The full power of the test has not been investigated either. So far they know a diagnosis of dementia can be predicted three years ahead of time, but the researchers are now investigating whether the test works even earlier.
It is not clear exactly what is causing the change in fats in the blood, but it could be a residue of the early changes in the brain.
As Reported On bbc.co.uk
Sixteen people have died in Manchester in the past four years while infected with a highly resistant superbug, figures show.
Klebsiella pneumoniae carbapenemase (KPC) is causing increasing concern and a rising number of cases.
Some 1,241 patients were affected within the Central Manchester University Hospitals trust area from 2009 to 2013, the figures show.
Despite infection control, the numbers have increased year on year.
The figures, revealed in a Freedom of Information request by the BBC, found 62 patients so far have suffered blood poisoning – with 14 confirmed deaths within 30 days of infection – at Central Manchester University Hospitals NHS Foundation Trust.
Two further deaths have occurred in the current year, the hospital trust confirmed.
KPC, which causes urinary tract infections and pneumonia in sick patients, is resistant to carbapenems, the last major group of antibiotics to work against multidrug-resistant bacteria.
The trust said the chemical, an enzyme, that KPC uses to render antibiotics ineffective had now entered other bacteria, including E. coli and Enterobacter.
“This trust has and continues to make strenuous efforts to control and reduce this infection. We continue to work very closely with Public Health England at both a local and national level to develop solutions for the long-term management of patients,” it said.
The trust stated that all the patients who had died were seriously ill. Some had diabetes, kidney problems or transplant rejection; some were suffering from leukaemia or other forms of cancer.
Central Manchester Hospitals has already had to review guidelines on antibiotics and the treatment of patients who require bowel surgery or cancer treatment that may leave their immunity compromised.
Another Manchester hospital, the Christie, a specialist in cancer care, said nine patients had been colonised by KPC last year. but they had all been transferred to the cancer unit and there had been no cross-infection in the hospital.
A Freedom of Information request has also revealed two cases of KPC at New Cross Hospital in Wolverhampton, with one patient dying in the past two years.
Scientists say more research is needed into treating the KPC superbug
Microbiologist Dr Mike Cooper said that the patient who died was 96 and the form of KPC that had infected her was still susceptible to some drugs.
“There’s a huge element of luck in this. Either Manchester has been extremely unlucky or we have been extremely lucky not to have more cases,” he said.
Ten patients have also been infected at the University Hospital of North Staffordshire. Two had urinary tract infections, but neither patient died of blood poisoning.
Stoke’s microbiologist, Jeorge Orendi, said: “Unlike the situation in certain hospitals in Manchester and London, fortunately in our hospital and catchment area carbapenemase producers have remained rare to date.”
The KPC resistance mechanism first emerged in the US and spread to Israel. In Europe, it has taken hold in Greece and has reached epidemic proportions in Italy.
Gian Maria Rossolini, of the University of Siena, said that the first case was identified in Italy in 2008, but now 4% of all infections in Italy are resistant to carbapenems.
Dr Rossolini said deaths from blood infections were running at more than 40%, but for immune-compromised patients they could be as high as 80%.
Although KPC is still susceptible to an old and quite toxic antibiotic, colistin, in Florence this year more than 50% of KPC cases proved resistant to it.
“Although present in the UK, the problem seems to be still much more limited as compared to Italy and Greece,” he said.
Professor Laura Piddock, of Birmingham University, said: “It’s clear that what has gone on in Italy is our tomorrow. We have got to start preserving what we have got and use it wisely.
“If we are really serious about tackling this problem, we have to start viewing this in the same way as high-income countries viewed the Aids epidemic in the 90s.
“It’s going to take that sort of level of global policymaker decision-making to really tackle this issue properly.”
Research published in the Journal of Antibiotics found that colonisation with KPC is long-lasting, with 39% of patients still carrying KPC in their gut a year after being released from hospital.
In Birmingham, Prof Peter Hawkey is conducting nationwide research to identify the extent of KPC resistance and that of a more widespread, but slightly less virulent superbug, ESBL.
Patients in London, Southampton, Birmingham and Shropshire are being asked to send in faeces samples so the spread of the disease can be mapped.
Prof Hawkey said: “It makes sense whilst we are looking for these ESBL that we are also able to detect how many of these KPC organisms are in the community.
“I can conceive of techniques which may be able to make bacteria to kill these multidrug-resistant bacteria. It’s very much at an advanced research level at the moment, but in order to drive that, we need to know how big the problem is.”
Dr Rossolini said that the use of carbapenem antibiotics to control high levels of ESBL in the Midlands could actually help KPC take hold in the region.