Tag: Health sciences

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Lost Matters

Birthweight advantage
of Black immigrants: lost in
a generation.

Birthweight can be a predictor of a range of health and socioeconomic outcomes, and in the United States Black women are known to have the highest prevalence of low birthweight babies of all racial groups. Evidence also suggests that immigrant women who give birth in the US have babies with higher weights than women born in the US.

Yet new research suggests that this birthweight advantage of immigrants extends beyond a single generation… for some races.

Andrasfay & Goldman (2020) looked at 1971-2015 Florida birth records to assess intergenerational changes in birthweight. They found that Black immigrants typically have larger babies than US-born Black women but that, in contrast to Hispanic immigrants, this ‘healthy immigrant’ effect is lost within a generation.

Whilst the study did not specifically investigate reasons for this difference, the authors suggest that a “lifetime exposure to discrimination and socioeconomic inequality is associated with adverse health outcomes for Black women.”

Original research: Andrasfay & Goldman (2020) Intergenerational change in birthweight: effects of foreign-born status and race/ethnicity, Epidemiology, https://doi.org/10.1097/EDE.0000000000001217

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Aid pride

Got hearing aid shame?
No sense in letting age-pride
steal away your brain.

For many people the idea of needing a hearing aid is embarrassing, a sign of ageing that they don’t want to be reminded of or seen to need. Yet this shame may actually be harmful – a new study by Sarant et al. (2020) suggests that the use of a hearing aid may stave off cognitive decline.

The researchers assessed 99 adults aged between 60 and 84 before and after hearing aid use. After 18 months they found cognitive executive function (the higher level mental abilities used organise information, plan, and initiate and complete tasks) improved across the whole sample, especially in women.

Whilst sample sizes were small, the researchers also found that speech perception in quiet environments improved, as did participants’ self-reported quality of life and listening disability. This is an exciting development and, whilst further and larger studies are needed, it suggests that hearing aids may help to delay cognitive decline.

Further reading: http://dx.doi.org/10.3390/jcm9010254

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The Psychopharmacological Revolution

’50s to ’60s
use of new psychotropics
soars in both genders

by Dr Michael J. Leach.

Psychotropic drugs act on the central nervous system to elicit a range of therapeutic effects, such as improved sleep and anxiety relief.

Barbiturate psychotropics are older medicines with narrow therapeutic indices, meaning that there is little difference between beneficial and harmful doses. Actress Judy Garland is one of many people who has tragically died from a barbiturate overdose.

Non-barbiturate psychotropics such as benzodiazepines, meanwhile, are newer and safer alternatives to barbiturates for the treatment of psychological disorders. An example of a psychotropic that is widely used in modern society is the benzodiazepine diazepam, which was first marketed under the brand name Valium.

Historically, the Psychopharmacological Revolution of the 1950s and 1960s saw the introduction of a wide range of non-barbiturate psychotropics onto a growing global pharmaceutical market. There has been little research into the gender-specific, community-level use of psychotropic drugs over the Psychopharmacological Revolution of the 1950s and 1960s.

In order to shed light on the origins of Australia’s relatively high modern-day consumption of psychotropics, my colleague and I conducted a study to explore gender-specific volumes of psychotropic dispensing at a Melbourne pharmacy during the 1950s and 1960s. This original research has been published in the peer-reviewed journal Pharmaceutical Historian.

In this study, I sourced data on the name of medicine dispensed, dispensing date during 1954 or 1961, and patient gender from a set of old prescription books that were kept at a community pharmacy in the inner Melbourne suburb of Toorak. I cross-referenced the dataset with historical pharmacy reference books to classify each medicine into one of the following mutually exclusive categories: barbiturate psychotropics, non-barbiturate psychotropics, and non-psychotropic medicines. After collecting data and classifying each medicine, I calculated the number of prescriptions dispensed in each year and adjusted for the size of the population residing in the surrounding local government area.

The study results indicated that twice and 1.7 times as many medicines were dispensed to females than to males during 1954 and 1961, respectively. Such gender differences were evident across all three categories of dispensed medicines: barbiturate psychotropics, non-barbiturate psychotropics, and non-psychotropic medicines. There was also a pronounced shift in psychotropic dispensing from the older, more dangerous barbiturates (77% in 1954; 38% in 1961) to newer, safer non-barbiturate psychotropics (23% in 1954; 62% in 1961). The extent of this shift over time to newer, safer psychotropics was similar in both genders.

Original research: Gender differences in psychotropic medicine dispensing at a pharmacy in Melbourne, Australia, 1954 and 1961 by Michael J. Leach and Rebecca Kippen.

Michael Leach (@m_jleach) is an Australian health researcher, biostatistician, and poet with a PhD in Pharmacoepidemiology and a passion for health humanities. Examples of his science poems are online here: https://imagesofhealth.wordpress.com/.

If you enjoyed this sciku, check out Michael’s other sciku ‘Quality of Life at Seven Years Post-Stroke‘ and ‘Drug-Induced Hip Fractures‘, ‘The Core Correlate of Covid-19 Vaccine Acceptance’, ‘The Early Impacts of COVID-19 on Australian General Practice‘, ‘The Burden of Bushfire Smoke‘, and ‘Australian Science Poetry‘ with science communicator Rachel Rayner.

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Supine Risks

Supine position,
dreaming towards tragedy.
The risk of stillbirth.

New research has found that the risks of stillbirth are higher when the mother falls asleep lying on her back. Cronin et al (2019) analysed sleeping position and resulting birth success. Whilst no difference was found between going-to-sleep on the left or right side, the researchers found evidence that the supine going-to-sleep position is a contributing factor for late stillbirth. In fact, they suggest that if every pregnant woman of 28 weeks gestation and beyond settled to sleep on her side the number of late stillbirths could be reduced by 5.8%.

Original research: http://dx.doi.org/10.1016/j.eclinm.2019.03.014

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Drug-Induced Hip Fractures

psychoactive drugs
flood and fog brains soon before
falls and hip fractures

by Dr Michael J. Leach

There is an inherent poetry to pharmacy whereby medicines can help people through intended beneficial effects and harm people through unintended adverse events, including side effects and drug-drug interactions. It is crucial for prescribers to carefully weigh up the risks and benefits of treatment whenever a new medicine is considered for any given patient. As the modern world has an aging population, there have been rises in frailty, multiple morbidities (i.e. multimorbidity), and multiple medicine use. Multiple medicine use can be defined in terms of polypharmacy, which denotes the concurrent use of five or more drugs, and hyper-polypharmacy, which denotes the concurrent use of ten or more drugs. The increasing prevalence of polypharmacy and hyper-polypharmacy means that, in modern society, there is high potential for harmful side effects and drug-drug interactions.

Psychoactive medicines are examples of drugs that have unfavourable side effects and that can interact with one another to cause harm. Psychoactive medicines act on the central nervous system in different ways to elicit therapeutic and adverse effects. The main types of psychoactive medicines are antidepressants, antipsychotics, benzodiazepines, benzodiazepine-related drugs, opioid analgesics, anticholinesterases, antiepileptics, and anti-Parkinson medicines. A common side effect across all these psychoactive medicines is sedation. While treatment with benzodiazepines, benzodiazepine-related drugs, and antipsychotics may be aimed at helping people to relax or sleep at night, the sedative effect can still be harmful when there is unwanted daytime sedation or oversedation. The sedative effects of psychoactive medicines likely explain why these drugs increase the risk of falls and fractures, especially in older, frailer individuals. Furthermore, when any one psychoactive medicine is taken with another psychoactive medicine, there is an increased sedative burden on the patient. This increased sedative burden can place people at an even greater risk of falls and fractures.

Pharmacoepidemiology is the population-level study of medicine use. In original research conducted as part of my PhD in Pharmacoepidemiology, I used a number of study designs and statistical methods to quantify the risk of hip fracture following psychoactive medicine use in older people. I focused on particular types of psychoactive medicines (e.g. antipsychotic drugs and selective serotonin reuptake inhibitor [SSRI] antidepressants) used individually and in combination with one another. The risk of hip fracture was increased for a range of psychoactive medicines, most notably when they were used concurrently. This research is relevant to real world medical practice because the risk factors identified are potentially modifiable. If prescribers better understand the risks associated with psychoactive medicine use, then they can make more informed prescribing decisions and de-prescribe psychoactive medicines where appropriate. Older patients, their carers, and their family members, as well as nursing home staff, would also benefit from better understanding the significant risk posed by the use of psychoactive medicines.

The pharmacoepidemiological studies that make up my PhD thesis have been published in peer-reviewed journals and are available online:

Leach MJ, Pratt NL, Roughead EE. The risk of hip fracture due to mirtazapine exposure when switching antidepressants or using other antidepressants as add-on therapy. Drugs – Real World Outcomes. 2017; 4(4): 247-255. http://dx.doi.org/10.1007/s40801-017-0120-y

Leach MJ, Pratt NL, Roughead EE. The risk of hip fracture in older people using selective serotonin reuptake inhibitors and other psychoactive medicines concurrently: a matched case-control study in Australia. Drugs – Real World Outcomes. 2017; 4(2): 87-96. http://dx.doi.org/10.1007/s40801-017-0107-8

Leach MJ, Pratt NL, Roughead EE. Psychoactive medicine use and the risk of hip fracture in older people: a case-crossover study. Pharmacoepidemiology and Drug Safety. 2015; 24(6): 576-582. https://doi.org/10.1002/pds.3785

Leach MJ, Pratt NL, Roughead EE, Hayward K, Jenkins N. Medicine use among the elderly before and after hip fracture. Australian Journal of Pharmacy. 2014; 95(1125): 72-74. [A secondary publication arranged by the original publisher]. Available here.

Leach MJ, Pratt NL, Roughead EE. Medicine use among older Australians before and after hip fracture. Journal of Pharmacy Practice and Research. 2013; 43(4):265-268. https://doi.org/10.1002/j.2055-2335.2013.tb00271.x

Michael Leach (@m_jleach) is an Australian health researcher, biostatistician, and poet with a PhD in Pharmacoepidemiology and a passion for health humanities. Examples of his science poems are online here: https://imagesofhealth.wordpress.com/.

If you enjoyed this sciku, check out Michael’s other sciku ‘Quality of Life at Seven Years Post-Stroke‘ and ‘The Psychopharmacological Revolution‘, ‘The Core Correlate of Covid-19 Vaccine Acceptance’, ‘The Early Impacts of COVID-19 on Australian General Practice‘, ‘The Burden of Bushfire Smoke‘, and ‘Australian Science Poetry‘ with science communicator Rachel Rayner.

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A body projects by Prof Tania Douglas

A body projects

to a model of others

and finds its own shape

by Tania Douglas

Reyneke et al (2018) review the state of the art in 3D reconstruction of bone from 2D images, based on deformable models. Such reconstructions are useful in a variety of clinical applications such as surgery planning and postoperative evaluation, and implant and prosthesis design.

Original research: https://doi.org/10.1109/RBME.2018.2876450

Prof Tania Douglas is the South African Research Chair in Biomedical Engineering & Innovation at the University of Cape Town, South Africa. You can follow her on Twitter under the handle @tania_douglas

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Hidden benefactor

Your water footprint.

Hidden benefactor of

a healthy diet.

 

Dietary changes can lead to big health benefits, but there are global benefits to a change in diet too. Vanham et al (2018) have found that a healthy diet results in a decrease in the water footprint required to produce the food. Whilst healthy vegetarian or pescetarian diets have the lowest water footprint, even a change to a healthy diet containing meat results in a decrease in water footprint of between 11% and 35%.

Original research: http://dx.doi.org/10.1038/s41893-018-0133-x

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Dynamic toll

Dynamic toll roads.

Prices fluctuate with load,

save time, money, health.

 

Traffic congestion damages health, the environment and the economy. Whilst more roads might seem like the answer, history shows that additional roads don’t reduce traffic jams. Now Cramton et al (2018) suggest that smart toll roads – roads that track usage and charge accordingly – could be the solution.

By increasing prices in real time on roads that are busy, the authors suggest that road users would look to alternative routes and modes of transport or choose to travel at a different time. It would also reduce the financial burden on those individuals that rarely use road travel but still pay taxes to maintain road links.

Original source: http://dx.doi.org/10.1038/d41586-018-05836-0

 

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Affordable care

Affordable care:

Act for the vulnerable.

Will you endure yet?

 

New research reveals the broadly positive impact of the Patient Protection and Affordable Care Act (otherwise known as Obamacare).

McKenna et al (2018) used data from 2011 to 2016 and found that, whilst not perfect, the Affordable Care Act reduced the financial strain of healthcare and increased access and utilisation to healthcare for low- and middle-income adults. In particular, those that benefit most are those making an income of twice the poverty-line designation or below.

Original research: https://doi.org/10.1177/0046958018790164

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Extrapolation

Extrapolation

from laboratory tests.

Not always correct?

 

Experiments within the laboratory are often used to understand biological interactions in a controlled manner. Yet research by Comforth et al (2018) suggests that what we learn from the laboratory may not always represent what happens in reality.

The researchers found that Pseudomonas bacteria (a pathogen that threatens immunocompromised people) behaved differently in humans compared to under laboratory conditions. This was particularly apparent in the levels of gene expression involved in antibiotic resistance, cell to cell communication and metabolism. The implications of this work suggest laboratory studies only take us so far and further understanding bacterial behaviour in humans is just as important.

Original research: https://doi.org/10.1073/pnas.1717525115

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Sleep disruption

Modern screens can cause

sleep disruption if used late.

Weekends may top up?

 

Research suggests that sleep duration is important for health, making maintaining decent sleeping patterns important for a healthy lifestyle. Chinoy et al (2018) have found evidence that the use of electronic tablet devices with light-emitting screens close to bedtime can result in later bedtimes and disrupted circadian rhythms and result in lower alertness in the morning.

Many of us like a lie in at the weekend, as if we are making up for the week gone by. Research by Åkerstedt et al (2018) studying over 40,000 subjects across 13 years suggests that longer weekend sleep may indeed compensate for shorter weekday sleep.

Original research:

Chinoy et al (2018): https://physoc.onlinelibrary.wiley.com/doi/10.14814/phy2.13692

Åkerstedt et al (2018): https://doi.org/10.1111/jsr.12712

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Bright baubles

Bright baubles – the toys

of our childhood. What dangers

lurk behind your joys?

 

Toys have to be versatile – they need to be interesting, fun, tough and safe. Plenty of toys are collector’s items, sold in second-hand stores or passed onto the next generation. Yet some plastic toys may have a hidden danger.

Turner (2018) analysed used plastic toys using x-ray fluorescence spectrometry. Hazardous elements, including lead, barium, bromine, cadmium and selenium, were found to be present in many of the toys. Among the worst offenders were Lego bricks from the 1970s which had high levels of cadmium (particularly the colours red and yellow), reflecting manufacturing processes at the time of production. Happily toy production is a lot safer nowadays.

Original research: http://dx.doi.org/10.1021/acs.est.7b04685

 

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Quality of Life at Seven Years Post-Stroke by Dr Michael J. Leach

Old stroke survivor

a life of low quality

yet high quantity.

A stroke, otherwise known as a cerebrovascular accident, is a serious health problem whereby blood flow to the brain is interrupted by a blocked or ruptured blood vessel. A stroke is life threatening and requires emergency medical attention. If an individual survives a stroke, then he or she may live with one or more long-term effects, such as memory loss, hemiplegia (i.e. paralysis on one side of the body), visual impairment, or speech problems. Such long-term effects can negatively impact on a stroke survivor’s quality of life across multiple domains: independent living, social relationships, illness, physical senses, and psychological wellbeing. While quality of life has been well studied in the short term after stroke, few studies have investigated quality of life among long-term stroke survivors.

In original research conducted as part of my Master of Biostatistics degree, I assessed quality of life at seven years post-stroke among people residing in the north-eastern suburbs of Melbourne. The validated Assessment of Quality of Life (AQoL) instrument was used to measure quality of life. In the AQoL instrument, scores range from -0.04 (worse than death) to 0.00 (death equivalent) to 1.00 (optimal). Among 1321 stroke cases with a mean age of 68 years, 413 (31% of stroke cases) were still alive at seven years post-stroke and 328 (79% of survivors) were assessed in my study. Of the 328 long-term stroke survivors assessed, 76 (23%) had very poor quality of life ranging from -0.038 to 0.100. Furthermore, 6% of patients had quality of life that healthy individuals deem worse than death (i.e. ranging from -0.038 to 0.00). The mean quality of life score at seven years post-stroke was 0.51. This score means that, if faced with the prospect of being an average seven-year stroke survivor, a given person in the general population would rather live in full health for half of his or her expected life span.

This research is important in that it highlights the dire need for interventions to improve quality of life in the long-term after stroke. Potentially modifiable factors associated with better quality of life in the long-term after stroke could be targeted to improve the quality of stroke survivors’ lives. In my original research, the potentially modifiable factors associated with better quality of life included lesser handicap and independence in activities of daily living (e.g. indoor mobility, dressing, and shopping). An example of a promising targeted intervention to improve post-stroke quality of life is cognitive training aimed at improving brain function. As cognitive training has been shown to make people more independent in activities of daily living over a five-year period, it is a promising intervention to improve quality of life in the long-term after stroke.

Original research:

Leach MJ, Gall SL, Dewey HM, Macdonell RAL, Thrift AG. Factors associated with quality of life in 7-year survivors of stroke. Journal of Neurology, Neurosurgery & Psychiatry. 2011; 82(12):1365-1371.  http://dx.doi.org/10.1136/jnnp.2010.234765

Dr Michael J. Leach is an Australian health researcher, biostatistician, and poet with a PhD in Pharmaco-epidemiology and a passion for health humanities. Examples of his science poems are available online: https://imagesofhealth.wordpress.com/.

If you enjoyed this sciku, check out Michael’s other sciku ‘Drug-Induced Hip Fractures‘, ‘The Psychopharmacological Revolution‘, ‘The Core Correlate of Covid-19 Vaccine Acceptance’, ‘The Early Impacts of COVID-19 on Australian General Practice‘, ‘The Burden of Bushfire Smoke‘, and ‘Australian Science Poetry‘ with science communicator Rachel Rayner.

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Transcription by Prof Sridhar Hannenhalli

To express or not

Here now a bit or a lot

That is the question.

 

Every cell in an organism contains an identical copy of the genome, except for rare somatic mutations, that encodes its entire gene complement. Yet, each of the hundreds of individual cell types in an organism utilizes a well-defined subset of the genes – imagine your neurons expressing genes that are normally expressed in skin cells. Thus the cell, starting from the single-celled embryo, must have a mechanism to control when, and how much of, each gene is expressed. This control is exercised, in large part, at the level of transcription – the process of reading the DNA encoding a gene on the genome and copying it into a messenger RNA (mRNA), which is eventually translated into the final protein product (or otherwise processed into a final RNA product).

Besides controlling normal development and defining the identity of individual cells, the response to a change in environment is also managed at the level of transcription.  This was first demonstrated by Jacques Monod and Francois Jacob in their seminal 1961 paper, showing that a group of E. coli genes that encode for proteins required to break down lactose is transcriptionally switched on or off depending on whether the growth medium is rich in lactose or glucose. They went on to win the 1965 Nobel Prize in Physiology or Medicine for their discovery.

Transcriptional control plays a critical role not only in development and environmental response, but also at a longer time scale in mediating evolutionary divergence across species. In their classic 1975 paper, Mary-Claire King and Alan C Wilson, observing very high levels of similarity between several proteins of chimpanzees and humans, concluded that the vast phenotypic differences between the two species could not be explained by such small degree of molecular divergence and are likely to be driven by the changes in the mechanisms controlling the gene transcription.

The role of transcriptional control in dictating natural diversity at multiple natural scales from cells within an organism, individuals within a species, and across species is now well established. This extends even to phenotypic changes associated with all complex diseases, and is underscored by the observation that the vast majority of genotypic signals associated with human diseases reside in non-protein-coding regions of the genome, thus focusing the research efforts in interpreting these signals in the context of transcriptional control.

Original research:

Jacob, F. & Monod, J. (1961) Genetic regulatory mechanisms in the synthesis of proteins. J Mol Biol 3, 318–356.  http://biotheory.phys.cwru.edu/phys320/JacobMonod1961.pdf

King, M. C. & Wilson, A. C. (1975) Evolution at two levels in humans and chimpanzees. Science (80) 188, 107–116. https://doi.org/10.1126/science.1090005

Hindorff, L. A. et al. (2009)Potential etiologic and functional implications of genome-wide association loci for human diseases and traits. PNAS 106, 9362–9367.  https://doi.org/10.1073/pnas.0903103106

Sridhar Hannenhalli is professor of Cell Biology and Molecular Genetics at the UMD, interested in transcriptional regulation and evolution. He is currently visiting IISc, Bangalore, as a Fulbright scholar. You can follow him on twitter @hannenhalli.

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Twisted naval string

Twisted naval string:

Forty turns of jelly and

contrary vessels.

 

Break benefits both before

severing the thread of life.

 

The umbilical cord has traditionally been cut (or at least clamped) 15-20 seconds after birth but increasingly research suggests that a longer delay before cutting is beneficial for both term and pre-term infants.

For term infants a delay of 30-60 seconds can increase haemoglobin levels at birth and iron stores in the first months of life. In preterm infants a delay can improve transitional circulation, result in the better establishment of red blood cell volume and decrease the need for blood transfusions.

A delay before clamping and cutting is therefore recommended by both the World Health Organisation and the American College of Obstetricians and Gynaecologists.

This sciku is actually an example of a tanka – the first two verses of a traditional renga, where haiku originate from. Learn more about haiku, renga and tanka here.

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Gamma sabres by Hannah Hall

Gamma sabres slay

Alzheimer’s amyloid plaques

with disco lighting.

 

Alzheimer’s disease is a neurodegenerative condition that worsens over time leading to problems with short-term memory, mood swings, behavioural issues and ultimately loss of bodily functions and death. But could flashing LED lights be a method of helping to treat the disease?

Exposing laboratory mice to LED strips flickering at 40Hz for an hour reduced beta amyloid plaque levels in the visual cortex by half, reduced Tau protein abnormalities and enhanced gamma oscillations (brain waves) – all of which are characteristics of Alzheimer’s disease. Iaccarino et al, 2016.

Hannah Hall is a Senior Consultant at Pragma Consulting Ltd in London. Though she studied Russian and French at university, she has broad interests and enjoys listening to the RadioLab podcast where she heard about this research.